Charles Verral, Charles Verral
1840 The Lancet  
13 Above the umbilicus, the tumefaction consisted chiefly of flatus; but below the umbilicus, its character was that of solidity, especially at the sides. I passed a catheter, but the bladder was empty. The fluctuation was obscure in every portion of the swelling,and especially at its inferior part. A very remarkable change occurred in the progress of this case a few days after I had been consulted, for on Friday, May 18th, vomiting took place, succeeded by a marked diminution in the sizeof the
more » ... abdomen. The vomiting was at first faecal, and excessively offensive, but it soon assumed a brown colour, and sometimes had a green hue. The vomiting continued with scarcely any intermission until the following Thursday evening, when it sensibly declined, recurring only about once an hour. On the following day it ceased, and the abdomen was then almost flat. It is impossible to compute, with accuracy, the quantity brought up, but it was supposed to have reached eleven or twelve gallons. The quantity which escaped the last three days was measured by Dr. Nelson and myself, and amounted to twenty-eight pints. She may be said to have passed the first few days in one continued act of vomiting. The tumour must have consisted of an ovarian cyst, complicated with a parabysma, the contents of the ,cyst bursting into the intestines, and being mixed with the gastric and intestinal secretions, was discharged by vomiting. She had DO evacuation by the rectum whilst the vomiting continued; and she was supported for many days by means of strong animal broth mixed with the yolk of eggs. I examined this woman on the llth day of Novem. ber. She was then perfectly well in health, I but the solid tumour below the umbilicus was as large as a child's head, and sometimes very painful. I could feel the os uteri very distinctly, and on either side of it I could distinguish the solid ovarium resting on the brim of the pelvis, though mainly on the left side of the abdomen, and extending from the brim of the pelvis to the umbilicus. Eleven months afterwards, during my absence from home, this woman had an illness which terminated fatally, but, unfortunately, there was no examination. Before concluding, I shall say a few words relative to the removal of the enlarged ovary by operation. Of Mr. Lizars' cases I forbear to speak ; but I have already apprised you of the success which has attended the extraction of the sac through the aperture made in the abdominal walls after its evacuation by tapping. To render the operation practicable, the sac must be in its early stage, and unadherent ; and I believe that adhesions rarely, if ever, take place whilst the sac remains small. More numerous cases, however, can alone give permanent value to an operation which, in the only instances (three in number) in which it has , been performed, has been perfectly snccessful. For more extended information on the subject of the present lecture, I beg, Gentlemen, to refer you to an elaborate paper by Dr. Bright, illustrated by a great variety of examples, in the 6th Number of" Guy's Hospital Reports." It is a very instructive paper, and I recommend you to read it with the closest attention. ON
doi:10.1016/s0140-6736(02)84358-6 fatcat:qj5trdrurvhl7hnn6il4tkksqi