Aug., 1885.]
NINE CASES OF OVARIOTOMY.
?rijjhmt dfrnrnmrnhprfiaiiis. j
235
in general surgery, will stand the surgeon in good stead here, for whether the spray be used
not, all surgeons insist on the absolute necesfor the cleansing of hands, instruments, sponges, dressings, &c., and in this the surgeon who has the largest experience of Listerism is Civil Surgeon, Benares. In fact, the habit of most likely to succeed best. Ovariotomy is still so rare an operation in mind which, without thinking, will never neglect that I think my experience, which, India, the minutest detail, can only, like every other though it comprises but nine cases, may still habit, be acquired by practice. And it is well be useful to some, who have had no opportunity for the beginner to bear this in mind, for one is of studying it. The extraordinary measures apt to be misled by results obtained by such adopted to prevent the admission of infective men as Keith, unless it is remembered that they, and the jealousy with which visitors are germs, have been disciples of Lister, and have too, excluded from the oviiriotomists' operating acquired, in an emiueut degree, the habit reroom, have done much to enshroud in mystery ferred to. one of the simplest of operations, and to give Want of special instruments need no an exaggerated idea of its difficulty. When one from undertaking the operation.preventfirst My last at home on furlough, I had the greatest six cases were done with only the instruments difficulty in obtaining permission to be present in my pocket-case and two or three pairs of at two or three operations. torsion forceps. Well's trocar is a great conNow, it is very desirable to watch a case venience if at hand, but a pointed tiu tube before undertaking the operation for the first Three or four of would answer equally well. time, if only to learn how much may really be the softest of the quality known as sponges done with perfect impunity, for no one without " " should be procured. It is a mistake some experience will credit the seemingly to Turkey them soaking in carbolic lotion, or to rough handling the peritoneum will stand, when boilkeep them as is constantly recommended, but secured against septic infection, without develop- they should be thoroughly cleansed and dried ing the slightest symptom of inflammation. I in I have the sun before they are put away. was amazed when for the first time I saw the no remarks to offer regarding the operation abdominal cavity kept open for nearly an hour, itself, which is simply described in any of the with its whole anatomy as clearly displayed as text-books, but will merely supplement the at a post-mortem examination, and perfectly pulse and temperature charts which I have preilluminated by reflected light. Sponges were served, a glance at which will give a very fair again and again plunged into every recess idea of the condition of the patient during the where a drop of blood or fluid might have critical period following immediately on the lodged, and every little bleeding-point carefully operation. For cases 1 and II, I must refer secured by catgut ligatures before the wound the reader to the report above quoted. closed. What I had seen left a was finally Case III.?Mt.llajo,a married Hindu womau, profound impression on me, and I went away aged 30 years, was admitted into the Bramley feeling sure that, if that patient recovered, Hospital, Aligarh, ou the 27th June 1884. By the operation would be perfectly safe in my her own statement the tumour was of many hands; and she did recover. On my return to years' standing, and had long been stationary. India, in my very first operation, so firm and Health indifferent, menstruation regular. July general were the adhesions, that I would fain 1st.?With the assistance of Dr. Chard, Medical have given it up; but, encouraged by what I had Officer, E. I, Railway, and Assistant-Surgeon ?witnessed, I did not hesitate to enlarge the Mullraj, the operation was performed under the external incision till the umbilicus came almost spray with all antiseptic precautions, the exterinto its centre, and notwithstanding this fright- nal incision being about three inches long. ful wound, the woman made an excellent The tumour consisted of a single cyst, with a This and my second operation which recovery. long pedicle, and there was only one slender proved fatal on the eighth day owing to the adhesion, which was ligatured with catgut, and slipping of the ligature on the pedicle, have divided. The pedicle was tied with No. 4 silk been reported, along with the year's surgical and catgut as Avell. For the first three days she was very well, and work, in the August-number of The Indian Medical Gazette for 1884. had no difficulty with her water. 4th.?Unable Before describing the remaining operations, to pass water, complains of pain and tenderness and without entering into the question of the in the lower part of the abdomen. After this advantages or disadvantages of the spray in the catheter was regularly employed. On the this operation, I think that all will agree with 5th, 6th and 7th, she had severe fits of ao-ue, me that the antiseptic habit of mind (if I may and 5 grains of quinine were given the use of the be permitted phrase) acquired by 8th?The bowels not having acted, castor oil 31 a thorough practical acquaintance with Listerism NINE CASES OF OVARIOTOMY. By Surgeon A. J. Willcocks, M.D.,
or
sity
daily!
THE INDIAN MEDICAL GAZETTE.
236
[Aug., Ml
MT mt
IV. CASE TV. Case
KHIRATUN.
Case Case EI.
RAJO. rajo.
12
13
14
1 885.
15
16
17
18
19
20
\X2?_
3.00
Te.mf>tra?(Lnt>
Pcufse, Avas
given,
wound union
and she
passed
two
motions.
The
dressed, and the stitches removed, was After this, perfect throughout. rose every evening for the temperature though some days, there was never any cause for anxiety, and she was convalescent in a fortnight, and left the hospital three weeks from the date of the operation. Case IV.?I did this operation at my old hospital at Bulandshahr, by the kind permiswas
TcrrLpzratwe, PuXsty
13tli.?Wound dressed under spray, sutures it was firmly united throughout.; but It does there was a trace of pus at one point. not appear from the notes that the dressings were again disturbed. The rise of temperature on the 17th was due to ague. She had another attack on the following day, but the temperature was not taken. She was permitted to get up on the 25th, and returned to her home on the 9th October.
removed,
sion and with the assistance of Dr. Armstrong, the Civil Surgeon. Mt. Khiratan, a Mussalman woman, aged 37, married, and has had children, the 29th June. was admitted into hospital on Case Y.?Mt. Jhunnia, Hindu woman, nged She first noticed the tumour shortly after the 30, was admitted into the Bramley Hospital, birth of her last child, now about three years on the 1st December, 1884. She had Aligarh, The cyst was tapped after she had been a child over a old. year old with her, and it was in hospital some days, and a large quantity of not suspected that she was suckling it. The It speedily reaccumulated. fluid drawn of. The cyst was performed on the 3rd. operation September 7th.?After a warm water enema, was of great size but single, and a small part the operation was performed at 9 A.m. The of the tumour was solid. There were no comcyst was adherent nearly over its whole sur- plications, and the operation was exceedingly face; by slow degrees these were broken down simple. with the fingers or tied with fine silk and Case MT Case V. V. Deer. now I and had much mt JHUNNIA. jhunnia. reason to divided, regret that I had forgotten to bring any catgut with DAY OF '12 13 14 15 16 17 18 19 me, for from 12 to 15 silk ligatures were reTEM. PULSE quired for the very vascular adhesions to the xor 120.. intestines. It is iu dealing with these deepseated adhesions, which can scarcely be brought 19M100 ? U?hp J ?L_j into view, that the chief, I may say almost only, difficulty is encountered. No. 4 silk prepared in carbolized wax was used for the pedicle, two ?7i ligatures being applied close to each other. TcrrvptrccUire. this since I lost I have adopted practice my PuLsfy second case by the slipping of the ligature. Much blood and some fluid had escaped into The only medicine she had was castor oil 3ij the abdominal cavity ; this was now very care- on the lltli. .She had 110 pain or other trouble, fully removed till not a particle appeared on nursed her child throughout just as if nothing the soft sponges dipped into every recess ; but had happened, and left the hospital in three though free from any extraneous matter, the weeks from the date of the operation. peritonceum presented a most extensive raw surface in places deeply blood-stained. The Case VI.?Mt. Belesia, Hindu, aged 26. She external wound was closed with five silk sutures, had been suffering for over three years, and was a and dressed in the usual manner. poor ill-fed little woman, whom I found at one of
??SI
Aug., 1885.]
NINE CASES OF OVARIOTOMY.
Admitted into my Brunch Dispensaries. Bramley Hospital on the 9th February 1885.
the On
examination a considerable part of the tumour was found to be solid, and not unlike in appearance and feel to a greatly hypertrophied spleen. Though very weak, she was not considered unfit for the operation. With the assistance of Dr. Chard I did the operation on the lltli. A free incision was made, when it was found that the adhesions were very firm and almost continuous, and had to be tied in all directions. Much blood was not lost, but considerable traction was sometimes necessary to bring the deep parts into view. By slow degrees the tumour was entirely freed, but the external wound had to be again enlarged before it could be removed. Every bleeding point was carefully secured, and the peritonajum perfectly cleansed, but a very extensive raw surface was left. The wound was now closed, but the pulse was extremely weak and fast. She was placed in a warm bed with hot water bottles, and stimulants were freely given, but she never rallied, and died exhausted from the shock next day. No post-mortem examination was made.
237
iiad nine children, and she has for some years past the change of life. April 20th?The operation w:is commenced under the spray, which,
however, broke down after a few miuutes, and it had to be continued without it. Fortuuately, in this case there was not a single adhesion. The tumour consisted of two cysts, which were both emptied, and the pedicle was tied with two silk ligatures. As there was 110 bleeding except, from the external wound, which continued to ooze a little, very little cleansing of the peritonceum was necessary, nor was it exposed for more than a few minutes, aud the greatest care was exercised in closing the wound. Of all the operations this was by far the simplest, yet a reference to the chart will show that it was followed by the greatest constitutional disturbance, and for want of a better reason I can only attribute it to the absence of the spray. Certain it is that this case gave the greatest anxiety, and, for the present at least, I mean to adhere to the use of the spray in this as in all other operations. From the 25th April, quinine, grs. xx, was given daily in two doses till the temperature fell to normal. The sutures Avere all removed 011 the 5th day, when union was Case VII?Mt. Jinsee, Hindu, aged 40, found to be perfect, and there was not the least admitted into the Prince of Wales' Hospital, trace of pus. Benares, 10th December 1884, when the tumour Besides 3H of castor oil 011 the 29th no other was tapped, and a large quantity of fluid re- medioine was given. The chief point of inmoved which steadily reaccumulated. terest in this case is that, in spite of the severe constitutional disturbance, immediate union of CaseW. MT MT JINSEE. JINSEE. March. CASEW. the wound was in 110 way interfered with: day of it is a remarkable fact about abdominal 19 indeed, 13 17 22 23 24 25 26 27 28 month section that clean wounds heal more kindly TEM 101" 110 and quickly than in almost any other part of A JQ the body. Adhesions constitute the only diffiIOC 100 to met with, and if the case is taken be culty in hand early, in all probability none will be found. It follows then that the operation should be undertaken as soon as the abdomen 96" is moderately distended and before the general health has suffered. And it will be found that there are few, if any, operations in general Tcmpej~
NINE CASES OF OVARIOTOMY.
?rijjhmt dfrnrnmrnhprfiaiiis. j
235
in general surgery, will stand the surgeon in good stead here, for whether the spray be used
not, all surgeons insist on the absolute necesfor the cleansing of hands, instruments, sponges, dressings, &c., and in this the surgeon who has the largest experience of Listerism is Civil Surgeon, Benares. In fact, the habit of most likely to succeed best. Ovariotomy is still so rare an operation in mind which, without thinking, will never neglect that I think my experience, which, India, the minutest detail, can only, like every other though it comprises but nine cases, may still habit, be acquired by practice. And it is well be useful to some, who have had no opportunity for the beginner to bear this in mind, for one is of studying it. The extraordinary measures apt to be misled by results obtained by such adopted to prevent the admission of infective men as Keith, unless it is remembered that they, and the jealousy with which visitors are germs, have been disciples of Lister, and have too, excluded from the oviiriotomists' operating acquired, in an emiueut degree, the habit reroom, have done much to enshroud in mystery ferred to. one of the simplest of operations, and to give Want of special instruments need no an exaggerated idea of its difficulty. When one from undertaking the operation.preventfirst My last at home on furlough, I had the greatest six cases were done with only the instruments difficulty in obtaining permission to be present in my pocket-case and two or three pairs of at two or three operations. torsion forceps. Well's trocar is a great conNow, it is very desirable to watch a case venience if at hand, but a pointed tiu tube before undertaking the operation for the first Three or four of would answer equally well. time, if only to learn how much may really be the softest of the quality known as sponges done with perfect impunity, for no one without " " should be procured. It is a mistake some experience will credit the seemingly to Turkey them soaking in carbolic lotion, or to rough handling the peritoneum will stand, when boilkeep them as is constantly recommended, but secured against septic infection, without develop- they should be thoroughly cleansed and dried ing the slightest symptom of inflammation. I in I have the sun before they are put away. was amazed when for the first time I saw the no remarks to offer regarding the operation abdominal cavity kept open for nearly an hour, itself, which is simply described in any of the with its whole anatomy as clearly displayed as text-books, but will merely supplement the at a post-mortem examination, and perfectly pulse and temperature charts which I have preilluminated by reflected light. Sponges were served, a glance at which will give a very fair again and again plunged into every recess idea of the condition of the patient during the where a drop of blood or fluid might have critical period following immediately on the lodged, and every little bleeding-point carefully operation. For cases 1 and II, I must refer secured by catgut ligatures before the wound the reader to the report above quoted. closed. What I had seen left a was finally Case III.?Mt.llajo,a married Hindu womau, profound impression on me, and I went away aged 30 years, was admitted into the Bramley feeling sure that, if that patient recovered, Hospital, Aligarh, ou the 27th June 1884. By the operation would be perfectly safe in my her own statement the tumour was of many hands; and she did recover. On my return to years' standing, and had long been stationary. India, in my very first operation, so firm and Health indifferent, menstruation regular. July general were the adhesions, that I would fain 1st.?With the assistance of Dr. Chard, Medical have given it up; but, encouraged by what I had Officer, E. I, Railway, and Assistant-Surgeon ?witnessed, I did not hesitate to enlarge the Mullraj, the operation was performed under the external incision till the umbilicus came almost spray with all antiseptic precautions, the exterinto its centre, and notwithstanding this fright- nal incision being about three inches long. ful wound, the woman made an excellent The tumour consisted of a single cyst, with a This and my second operation which recovery. long pedicle, and there was only one slender proved fatal on the eighth day owing to the adhesion, which was ligatured with catgut, and slipping of the ligature on the pedicle, have divided. The pedicle was tied with No. 4 silk been reported, along with the year's surgical and catgut as Avell. For the first three days she was very well, and work, in the August-number of The Indian Medical Gazette for 1884. had no difficulty with her water. 4th.?Unable Before describing the remaining operations, to pass water, complains of pain and tenderness and without entering into the question of the in the lower part of the abdomen. After this advantages or disadvantages of the spray in the catheter was regularly employed. On the this operation, I think that all will agree with 5th, 6th and 7th, she had severe fits of ao-ue, me that the antiseptic habit of mind (if I may and 5 grains of quinine were given the use of the be permitted phrase) acquired by 8th?The bowels not having acted, castor oil 31 a thorough practical acquaintance with Listerism NINE CASES OF OVARIOTOMY. By Surgeon A. J. Willcocks, M.D.,
or
sity
daily!
THE INDIAN MEDICAL GAZETTE.
236
[Aug., Ml
MT mt
IV. CASE TV. Case
KHIRATUN.
Case Case EI.
RAJO. rajo.
12
13
14
1 885.
15
16
17
18
19
20
\X2?_
3.00
Te.mf>tra?(Lnt>
Pcufse, Avas
given,
wound union
and she
passed
two
motions.
The
dressed, and the stitches removed, was After this, perfect throughout. rose every evening for the temperature though some days, there was never any cause for anxiety, and she was convalescent in a fortnight, and left the hospital three weeks from the date of the operation. Case IV.?I did this operation at my old hospital at Bulandshahr, by the kind permiswas
TcrrLpzratwe, PuXsty
13tli.?Wound dressed under spray, sutures it was firmly united throughout.; but It does there was a trace of pus at one point. not appear from the notes that the dressings were again disturbed. The rise of temperature on the 17th was due to ague. She had another attack on the following day, but the temperature was not taken. She was permitted to get up on the 25th, and returned to her home on the 9th October.
removed,
sion and with the assistance of Dr. Armstrong, the Civil Surgeon. Mt. Khiratan, a Mussalman woman, aged 37, married, and has had children, the 29th June. was admitted into hospital on Case Y.?Mt. Jhunnia, Hindu woman, nged She first noticed the tumour shortly after the 30, was admitted into the Bramley Hospital, birth of her last child, now about three years on the 1st December, 1884. She had Aligarh, The cyst was tapped after she had been a child over a old. year old with her, and it was in hospital some days, and a large quantity of not suspected that she was suckling it. The It speedily reaccumulated. fluid drawn of. The cyst was performed on the 3rd. operation September 7th.?After a warm water enema, was of great size but single, and a small part the operation was performed at 9 A.m. The of the tumour was solid. There were no comcyst was adherent nearly over its whole sur- plications, and the operation was exceedingly face; by slow degrees these were broken down simple. with the fingers or tied with fine silk and Case MT Case V. V. Deer. now I and had much mt JHUNNIA. jhunnia. reason to divided, regret that I had forgotten to bring any catgut with DAY OF '12 13 14 15 16 17 18 19 me, for from 12 to 15 silk ligatures were reTEM. PULSE quired for the very vascular adhesions to the xor 120.. intestines. It is iu dealing with these deepseated adhesions, which can scarcely be brought 19M100 ? U?hp J ?L_j into view, that the chief, I may say almost only, difficulty is encountered. No. 4 silk prepared in carbolized wax was used for the pedicle, two ?7i ligatures being applied close to each other. TcrrvptrccUire. this since I lost I have adopted practice my PuLsfy second case by the slipping of the ligature. Much blood and some fluid had escaped into The only medicine she had was castor oil 3ij the abdominal cavity ; this was now very care- on the lltli. .She had 110 pain or other trouble, fully removed till not a particle appeared on nursed her child throughout just as if nothing the soft sponges dipped into every recess ; but had happened, and left the hospital in three though free from any extraneous matter, the weeks from the date of the operation. peritonceum presented a most extensive raw surface in places deeply blood-stained. The Case VI.?Mt. Belesia, Hindu, aged 26. She external wound was closed with five silk sutures, had been suffering for over three years, and was a and dressed in the usual manner. poor ill-fed little woman, whom I found at one of
??SI
Aug., 1885.]
NINE CASES OF OVARIOTOMY.
Admitted into my Brunch Dispensaries. Bramley Hospital on the 9th February 1885.
the On
examination a considerable part of the tumour was found to be solid, and not unlike in appearance and feel to a greatly hypertrophied spleen. Though very weak, she was not considered unfit for the operation. With the assistance of Dr. Chard I did the operation on the lltli. A free incision was made, when it was found that the adhesions were very firm and almost continuous, and had to be tied in all directions. Much blood was not lost, but considerable traction was sometimes necessary to bring the deep parts into view. By slow degrees the tumour was entirely freed, but the external wound had to be again enlarged before it could be removed. Every bleeding point was carefully secured, and the peritonajum perfectly cleansed, but a very extensive raw surface was left. The wound was now closed, but the pulse was extremely weak and fast. She was placed in a warm bed with hot water bottles, and stimulants were freely given, but she never rallied, and died exhausted from the shock next day. No post-mortem examination was made.
237
iiad nine children, and she has for some years past the change of life. April 20th?The operation w:is commenced under the spray, which,
however, broke down after a few miuutes, and it had to be continued without it. Fortuuately, in this case there was not a single adhesion. The tumour consisted of two cysts, which were both emptied, and the pedicle was tied with two silk ligatures. As there was 110 bleeding except, from the external wound, which continued to ooze a little, very little cleansing of the peritonceum was necessary, nor was it exposed for more than a few minutes, aud the greatest care was exercised in closing the wound. Of all the operations this was by far the simplest, yet a reference to the chart will show that it was followed by the greatest constitutional disturbance, and for want of a better reason I can only attribute it to the absence of the spray. Certain it is that this case gave the greatest anxiety, and, for the present at least, I mean to adhere to the use of the spray in this as in all other operations. From the 25th April, quinine, grs. xx, was given daily in two doses till the temperature fell to normal. The sutures Avere all removed 011 the 5th day, when union was Case VII?Mt. Jinsee, Hindu, aged 40, found to be perfect, and there was not the least admitted into the Prince of Wales' Hospital, trace of pus. Benares, 10th December 1884, when the tumour Besides 3H of castor oil 011 the 29th no other was tapped, and a large quantity of fluid re- medioine was given. The chief point of inmoved which steadily reaccumulated. terest in this case is that, in spite of the severe constitutional disturbance, immediate union of CaseW. MT MT JINSEE. JINSEE. March. CASEW. the wound was in 110 way interfered with: day of it is a remarkable fact about abdominal 19 indeed, 13 17 22 23 24 25 26 27 28 month section that clean wounds heal more kindly TEM 101" 110 and quickly than in almost any other part of A JQ the body. Adhesions constitute the only diffiIOC 100 to met with, and if the case is taken be culty in hand early, in all probability none will be found. It follows then that the operation should be undertaken as soon as the abdomen 96" is moderately distended and before the general health has suffered. And it will be found that there are few, if any, operations in general Tcmpej~
