Licence: Public Domain Mark
Credit: Fourteen cases of ovariotomy / by Thomas Keith. Source: Wellcome Collection.
Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.
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![very feeble. The pulse was small, and generally about 90. Sh had restless nights from dyspnoea, and could scarcely take any foodi She measured 41^ inches at the umbilicus. The upper part of the tumour was fluid, but from the extremely (Edematous condition o the abdominal wall it was impossible to make out the state of the lower portion. The uterus was central, normal, and movable, bu the roof of the vagina came very low down, especially on the le side. The general condition of the patient was so unfavourable that the idea of operation could not then be entertained; but in liopes of giving her some temporary relief, about two gallons of fluid were removed fi-om the u]jper cyst by puncturing it above the umbilicus. A large semi-solid mass was now felt to occupy the lower and left side of the abdomen below the umbilicus. After some days, when the oedema of the wall had somewhat subsided, Dr M'Watt was able to make a more careful examination, and was satisfied that the adhesions were both firm and extensive. Much to our surprise she rallied, and had so far regained strength as to be removed to town in the beginning of January. The tumour had nearly regained its former dimensions, and tlie oedema- tous anterior wall Imng down over the pubis, forming a tumour nearly the size of the head. She got cold on her way into town, and had an attack of in- fluenza, whicli was prevalent at the time. To relieve the bronchial irritation and dyspnoea, she was again tapped, and the oedema of the limbs and abdominal wall having somewhat subsided, the tumour was removed on the 16th of January. Dr M'Watt of Dunse, Professor Stewart of Kingston, Dr Sidey, and Dr Keith were present. Tlie external incision was extended to two inches above the umbilicus. The omentum was lying between the tumour and wall, adherent to both. As the parietal adhesion was very firm, I cut through the omentum till the sm-face of the tumour was reached ; and finding the adhesion of the omentum less firm to the tumour than to the wall, I separated it from the tumour to the left side till the tree edge was reached. It was then freed and turned to the right side, but all its parietal attachments were not separated. Very firm parietal adhesion existed between the serai- solid part of the tumour occupying the left side and iliac region. Posteriorly the tumour was embedded in a mass of small intestine and mesentery. These adhesions were easily separable, except a jiiece of mesentery, about the size of the palm of the hand, which was very firmly attached, and contained large vessels. Lower down its connections were sejiarated along the brim of the pelvis on the left side, and a semi-solid mass was adherent along the side of the rectum and hollow of the sacrum. This last adhesion was firm, and part of the serous covering of the tumour was torn otF and remained. Finally, the mass was turned out after much injury had been inflicted on the peritoneum. The pedicle was short, and when the calliper clamp was secured outside, from the thickened state of the abdominal wall there was a great pull upon the uterus. Part](https://iiif.wellcomecollection.org/image/b21477413_0012.jp2/full/800%2C/0/default.jpg)
