Clinical Memoranda

1878 BMJ (Clinical Research Edition)  
some cysts to relieve the tension, which was a source of great suffering. The patient made a rapid recovery from the operation, but died in six months. Looking at these four cases of malignant disease, one cannot but feel that the deaths, following shortly after the operation and with but little suffering, were better for the patients than the lingering death in the last case, though this one is more satisfactory to the surgeon. In such cases, it is very hard to refuse the patient the last
more » ... e of life, though one knows that neither surgery nor the surgeon will gain anything but discredit from an exploratory operation. The sixth case was one of hydatids of the omentum and pelvic peritoneum, removed during the seventh month of pregnancy, the patient making a good recovery; but, as I am publishing it in full as a separate case, I shall not say more about it here. AGED 41, the lrnother of four children, consulted me in June 1873, on account of profuse menorrhagia, which had been in existence for fourteen months, was becoming rapidly more serious and had reduced her to a condition of marked anremia. On examination, I foand that the uterus was normal in size and pushed over to the left side, but that it was associated with a tumour about the size of a cocoa-nut, which was evidently cystic, and, from its attachment to the uterus, was probably ovarian. I placed her upon a treatment consisting of large doses, fifteen grains, of bromide of potassium, with ergotin, one grain, in order to check the hemorrhage. For this purpose, I also applied astringent and caustic applications to the interior of the uterus, but all to no effect. The menorrhagia continued quite as profuse till September; and then, as it became perfectly evident that something more must be done, I resolved to remove the tumour. This I did on September gth. I made the usual median incision, and, when the tumour was displayed, I found that it was an ovarian cyst on the right side, with no very well defined pedicle, and with a number of very large sinuses in its walls. I tapped it and removed it from the pelvis, drawing it well out, and then I applied a circular clamp as close to the uterus as I could. A small mass of secondary cysts was pulled above the clamp with great difficulty, and the clamp was fastened really round a part of the cyst. The patient did remarkably well after the operation. On the seventh day, the clamp begun to separate, and then it became evident that the part of the cyst-cavity which remained was suppurating, and it discharged large quantities of pus. On the twelfth day, the clamp came off. For about a month after the operation, the cavity discharged freely; but then the opening began to close, and the patient suffered much pain. I therefore passed a double drainage-tube through the cavity and left it there about six weeks. I then removed it, and the whole track closed in a few days, and the patient remains to this day (September I878) permanently well. Ever since the operation, her menstruation has been perfectly regular and normal in quantity, and now she is in robust health. The only explanation of this curious case upon which I can venture is, that the metrorrhagia must have been due to the large venous sinuses which I found in the tumour. One or more of these probably ran through the cornu of the uterus, and thus contributed a supply of blood larger than usual. That the removal of the tumour, leading to the destruction of these sinuses, cured the metrorrhagia strongly supports my hypothesis. E. T., aged 41"single, was sent to me by Dr. Raper in April I873, on account of extreme arneemia, the result of profuse menorrhagia. She presented an appearance a5 if every drop of blood had left her face. She had noticed a lump in the lower part of the abdomen for some months, and during her menstrual periods this lump was the seat of severe pain. When examined, this was found to be a tumour reaching almost up to the umbilicus, free, movable from above, soft but not fluctuating, and attached undoubtedly to the uterus. This organ was high up and somewhat behind the tumour and to the right side.
doi:10.1136/bmj.2.929.596-a fatcat:as5bqwlqibapnjmrbrrizgigfa