IMAGE EVALUATION TEST TARGET (MT-S) & ^^ / 1.0 I.I " Hi ^^ r itt 112.0 L25 iu 1.6 HiotogTtiphic Sciences Corporation 4 \\ ^. <^. 4» 33 WIST MAIN tTIIIT WltlTI»,NY I4!I0 (7l*)l7a-4S0} o^ .5^^^ «? <^ c^. fA CIHM Microfiche Series (Monographs) ICMH Collection de microfiches (monographies) Canadian Institute for Hittoricai Microraproductions / Inititut Canadian da Tnlcroraproductiont hiitoriquas r\r\ Technical and Bibliographic Notes / Notes techniques et bibliographiques The Institute ha« attempted to obtain the best original copy available for filming. 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Lorsque Ie document est trop grand pour Atre reproduit en un S9ul clich*. il est film* 6 partir de I'angle 8up*rieur gauche, de gauche A droite. et de haut en bas, en prenant Ie nombre d'images nAcessaire. Les diagrammes suivants illustrent la m6thode. 6 CASES OF OVARIOTOMY. -*••- HY KENNETH N. PENWTCK, M.A., M.D., Prof. OhsletricH and Dmnaas qf Women and ChUdren', Hoi/al CoUm/a of Phyfticians and Sur(feo7i/>, and Wotnen'» Mediad Colleye, ui ((ffilidtimi with Queen's UnirernUy, Kint/itton ; Afmnher tf Ike Royal Colhuje (f Sitrt/eonn, England; Fnllow of the Ohirttitrical Society, Edin- burgh; and Surgeon t(y the Ki»gnlnn (fenmil llo!iliil. I W.A-'^s^y^ \jtj^ :> ► Vj no Ol^ pHdf^ %^w National Lihi.«v BibliolhO(|u(' n,ili(in,ili "t Can;)(],i du CarMda ^^>^*' W/M 0l,i^\i\\ Canada K CASES OF OVARIOTOMY. I —BY- KENNETH N. FENWTPK^ A nr ,r ^ FENWICK. A.M.. M.D.. M.R.C.S. Eno.. RO.S. Eox... P«OP. OnsTETHlCS AND OYNECOLOGY ROYAr. rnr r . MPnir..r o COLLEGE AND WOMEN's MEDICAL COLLEGE, KINGSTON. .uppo.e «,», „e J ,„.„;,", r* '; , "" ""• """ " ■■ -"""-We lo '»™e.. w,..„ „.„„,,,. a„,r: ;,t 2;:''™ "; °>'-«™ i- »- op.mlio„» wre ,lo„„ i„ tl.e Kin T „ """""''■ *'°" '" ""«» r;:r ^ -.. .... .„„ .,...::: rrr:::;;:::: «l«l"nnnal w,„„„l .„„k p,„„„ ,,, ^J','^ "' "'^"'''^ «"'"" "< «■« 7„'-"-"" ■•" ' •— ■ ' .1... ... 'J! „ :z::,r" '™"°" " In .v.rvc«.„ ,1„. „l„|,„„i,„,l .•,„„„1 „„, ,.|,™„ «ll «,.. ,.a„, „„ p„|i„|„ „, ,. , , _^,^|^ + which was cut short and dropped. A drainage tube was not employed^ in any of the cases, although I would be inclined to use in suitable cases simply a strip of antiseptic gauze, as I saw two years ago used by Dr. Hahn of Berlin, and in Albert's clinic at Vienna. Case 1.— Mrs. B., aged 36, married eleven years; no children; no miscarriages; always regular. About eight years ago first complained of pains in the abdomen, and was then informed by her physician that she had a tumor. About two years ago she moved to Kingston, and upon examination I found a tumor in the right side of the abdomen about the size of a child's head, hard and evidently containing fluid. At that time there were no indications of its fil)roid character, and I had the impression that it was ovarian, but as the symptoms were not urgent an operation was not suggested. She soon after tliis moved to Carleton Place, where the tumor rapidly became larger, and as the pain, distension, and vomiting became very troublesome, she was tapped to give temporary relief. The cyst very rapidly refUled, and four weeks afterwards, the symptoms becoming very distressing, she came to Kingston to have the tumor removed. On admission to th« hospital she was hardly able to retain any food; the abdomen was very fully dis- tended, tense, and marked by veins; she snfffred constant pain in her side; and her face had an expression of 1)0])p1p8s anguish. Tlie next day she was etherized in a room heated to 80°, and an incision four inches long was made, cutting through the structures until the cyst was reached, when a sound was introduced to feel for adhesions, wliicli were slight and easily freed. She was then turned on her right side and the cyst punctured with an ordinary ciirved trocar, when sixteen quarts of a greenish-yellow fluid were removed, the cyst walls being gradually drawn <)ut and a solid niass ns large as two fists, wliich was attached to the upper border of tlie fundus of tlio uterus and the right broad ligament. An endeavor was made tur.t, a„ it, ,,„,,i,.l„ ,va, ticl „,„l ,1 " ■"°'''' " "" "^'^ C.V., „„.,;,.. to,:;: '\: r::^:r"i ^":t'""™'- ..ro„p„, a„„ t„„ ,.eHt„„,.„, ..„.„, ..^.^ZZlt::^, "V ft ran .1 recovery wifh n,. «i .• . *^ *' "'"' ""^'^« pa.n. »M.* , ;,:;,:;,'; :;:;:„: ::-;-- -' -^-^...e Imvo ,p,it„ „„„,■.,„,, """"""■ 1^1"' P"'" »".! .vv,lili, Cahk 4._i\l,„. tt J, w. Alionl llir,,, vmr. I«.fn„, .. " » -v- l«'i.. in I i^l,. .i,„. aa,.r a T « w! ^ ',' "T""""" """ """■•""■■ • ' " «i..i a ,.Z™' : '„:,"'":"'" v»l» of,,, ,„„,„|,., ,„i,,, , ,.,, I"""l>. at .nlor. and I determined to try and remove it. On opening the abdomen the cyst appeared to be divided into two parts by a fibrous partition running obhquely across it. but as it was so firmly adherent to the anterior and lateral wall of the abdomen. I decided not to risk completing the operation, so I closed the wound, and in two weeks she was up and around again. The cyst was afterwards tapped in two places, above and below the site of the partitions, when a large quantity of thick oily amber-colored liquid was got from one cyst, and three quarts of thin greenish fluid from the other. Case 5.-Mrs. E. O.. »t. 46. Three years ago first noticed a tumor m right ihac region. On examination I felt a hard tumor about the size of an infant's head, with some fluctuation. It had every appear- ance of being fibro-cystic, especially as the cavity of the uterus was abnormally deep, and menorrhagia was marked. Dr. McLean of Mich- igan, who examined it with me at this time, also agreed with its being fibro-cystic of the uterus, and advised letting it alone. The subsequent history only shows how impossible it is to be quite sure of the nature of these tumors until the abdomen is opened. Some months after this the tumor becoming very large and troublesome, and fluctuation being everywhere present, I determined to operate. Some slight adhesions to the omentum were found, and after evacuating the cyst the tumor was found to be a fibro-cystic of the ovary with a large hydrosalpinx. The tying of the pedicle was therefore a matter of difficulty. She did fairly well until the third day after the operation, when the pulse began to fail and she gradually sank and died. On post mortem examination the hgaure was found to have slipped and allowed some oozing, which a though very little blood was found, no doubt this, adde.l to the shock ot tlie operation, caused the fatal result. CA8K0._Mrs. C. »t. 55. Never had any childron. Two years be- ore the operation noticed abdominal enlargement On examination I diagnosed an ovarian cyst, and on using a fine aspirator found it to contain colloid matter. She had had an attack of peritonitis a few weeks before, and now as .ho suffered so much discomfort she urgently desired some relief, and preferred to run the risks, which she was told were greatly against success. On coming down to the cyst found recent adhesions in every direction, which broko down easily, and .o.ne •domen the )n running iterior and leting the as up and ces, above thick oily ts of thin d a tumor about the y appear- kerus was of Mich- its being bsequent 16 nature fter this, on being dhesions »e tumor walpinx. Sbo (lid se began nination , which, le shook 3ara be- ation I id it to I a few •'Kently as told found il Sdtne firm adhesions which had to be tied and cut. When tho pedicle had thTrei T'f :r '"' ''''-'' "-''''' ^""^^^-"^ -^^^ -* *o ^ he removal of the cyst, the bo.els were so glued together as to remain then closed, but she only survived the shock about an hour CASK7 Mr,j.c.,«,,32. Never had any children. About two years before noticed abdominal enlargement. The operation, which was done in Picton, was very simple, and was entirely completed in wenty-five minutes; the fluid was clear and watery; there were no ad- hesions; the pedicle, which was small, was tied and droppe