Forty cases of ovariotomy / by Thomas Keith.

  • Thomas Keith
Date:
1866
Catalogue details

Licence: Public Domain Mark

Credit: Forty cases of ovariotomy / by Thomas Keith. Source: Wellcome Collection.

    15/22 page 15
    had a severe pelvic peritonitic attack. Restless niglits and rapid loss of flesh followed, and in the end of March I was disappointed to find her again back to me, very anxious, as she was before, to have the tumour removed. The tumour now reached to the ensi- form cartilage, and the uterus was even more fixed than it was before. The general condition was also much less favourable than it had been a year ago. She was paler and more emaciated ; still had some cough ; her voice was husky, and her nights were restless. She was tapped on the 28th of March, with immense relief. The cyst seemed quite loose, and the uterus now felt movable; and having just read in the Medical Times a case of ovariotomy by Mr Wells, in which, before operation, he described the uterus as feeling as if lost in the cyst, whereas it turned out that the pedicle was of good length, I was in hopes that the same might be found to be the case in my patient. Still her general condition was so unfavourable that it was thought better to wait the results of the tapping. The cyst, however, filled with amazing rapidity, and I most unwillingly operated on the 8th of March,—some symptoms of pleuritic irritation, which appeared the first day she was out of bed after the tapping, having subsided. The cyst was already half-filled ; it was tapped and easily drawn out, but it was found to be so closely adherent to the bladder and anterior surface of the uterus that it was deemed un¬ wise, in such a delicate subject, to attempt their entire separation, for this could not have been effected without a careful and tedious dissec¬ tion. The bladder was, however, freed for several inches, and the clamp was placed round the neck of the cyst, which fortunately was thin walled, and it was secured outside. She rallied well; there was copious secretion of urine, and profuse perspiration. Next day, though the pulse had risen to 120, her expression was so good that her cheerful and smiling face made me almost hopeful. But by evening there was a copious secretion of red, somewhat foetid serum. This continued to flow in large quantity, the pulse became more and more feeble, and she died on the fourth day after operation. Case XXX.—Multilocular Ovarian Tumour. Ovariotomy. Recovery. A. R., aged twenty-four, was sent to me on the 4th of May 1865, by Dr Fergus, of Glasgow, as a very favourable case for ovariotomy. Increase of size had been gradual since three years ago, but neither her comfort nor usefulness had been much interfered with till within a few weeks before. Her general health was good, but she was pale and thin about the chest and arms. The tumour was multilocular, i extending under the ribs on either side, and to within two inches of the ensiform cartilage. The girth at the umbilical level was 38-J- i inches, and from ensiform cartilage to pubes 18 inches. The vagina was funnel-shaped, and the uterus was drawn up almost out of the pelvis to the left side, but it was quite movable. There was no evidence either of parietal or pelvic attachment. As the period had just passed off, and as the secretions were healthy,
    digitised image 1
    digitised image 2
    digitised image 3