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By A. J. Howɛ, M. D., Cincinnati, Ohio.
The formidable term placed at the head of this article has lately gained recognition in surgical and gynecological circles. It means about the same as ovariotomy, yet is made to signify the cutting away of disordered (hysterical) and not disorganized (cystic) ovaries.
The diæresis over the second ö indicates that we should pronounce the two vowels in separate syllables. For instance: O-ophorectomy or o-oforectomy.
Our works on gynecology lead us to believe that a skillful practitioner can sit down and spay a woman through the vagina as easily as he may open an abscess. My object in attempting to write at this time is to disabuse the credulous of any such preposterous idea. If the broad ligaments be lax and the ovaries drop deeply into the cul-de-sac of Douglass, it is not difficult to cut through the peritoneo-vaginal septum, and with the forefinger in the wound to seize and drag first one ovary and then the other into view, or within easy reach of excision with scissors. I have done this, and expect to repeat the operation; and I have failed, and may do so as often as I attempt to "reach apples when they hang high." Not long since I reached and excised one ovary, but could not even touch the other, though I pressed heavily the hypogastrium of the patient with my left hand. One ovary had descended, and the other was suspended beneath a tense broad ligament which had not been relaxed by disease.
The above leads me to state that a gynecologist cannot oöphorectomise a woman through the vagina unless her ovaries hang low in the pelvis. Recently I had an excellent female cadaver to test the matter upon. With the point of a bistoury I made an aperture through the peritoneo-vaginal septum, and then with scissors enlarged the opening. The vagina would not admit the hand, therefore I had to utilise the forefinger as an explorer. I could just touch the ovary on one side, yet could not fasten upon it and bring it down. A pair of forceps failed to select an ovary from intestinal folds. Heavy pressure
was put upon the hypogastrium, yet the downward thrust would not push an ovary into the recto-vaginal fossa. This experiment convinced me that the ovaries are easiest reached through an abdominal incision. This may be made in the median line, half way between the umbilicus and pubes, and be four inches or more in length. The aperture admits the hand, which finds and examines either ovary. If it be determined to remove the organs to get rid of epilepsy, menstrual disorders, exalted sexual excitement, and such mental perversions as are supposed to depend on the ovaries, oöphorectomy may be executed. The novice in such operations must bear in mind that the ovaries hang beneath the broad ligaments, and not above them nor in them; and that they are within a plexus of vessels, arteries and veins. To avoid bleeding into the pelvic cavity, a ligature is to be thrown around the membranous structure which suspends the ovary; and then the organ is to be removed with scissors. If the ligature be of animal origin-silk or tendon-it may be left in the abdominal cavity without risk of exciting peritonitis. The safest way is to send an end of the ligature through a puncture in the peritoneo-vaginal septum, so that it may escape by the vagina. The aperture permits of drainage while the ligature is in position, and closes upon its escape. The abdominal wound is to be closed with silver sutures, one being left with long ends, so that it may be untwisted and the incision opened for the introduction of a catheter or drainage-tube.
All traumatic surfaces should be smeared with boro-glyceride scented with thymol, and care be exercised that "animal ferments" be kept from the wounds. So many fatal issues have been charged to the poisonous effects of carbolic acid when employed as an antiseptic, that the prudent surgeon will be cautious about using the agent in abdominal traumatism. Keith and Tait have reported deaths from the deleterious action of carbolic acid. In a recent paper, British Medical Journal, for February 17th, 1883, Mr. Tait says: "The question of Listerism has occupied a part of every paper I have read on abdominal surgery for the last six years, and I hoped that this year I should escape it; for, after trying
it thoroughly, and after having seen it practiced by many others, I have, for now nearly three years, entirely discarded it, as a source of no safety in abdominal surgery, but even of considerable risk. My published experience on this subject has been followed by that of Dr. Bantock, Dr. Keith, and lastly, by that of my colleague, Dr. Savage. Mr. Spencer Wells, in his last work, has confessed that it has entirely disappointed him; and Mr. I. Knowlsley Thornton stands alone in his support of it."
The somewhat inexperienced practitioner is too apt to think that ovarian disease must be that of cystoma or cystic disorganisations of the ovary; but if he ever examine multiple cases of diseases of the uterus and its appendages, he will encounter infæcation of the Fallopian tubes, with cysts and purulent cavities. Gynecological writers have swollen the nomenclature of female diseases till it is useless to consult the olden lexicons for an explanation of the new technical terms. We now encounter hydrosalpinx and pyosalpinx and I do not see why there might not be a complex name for occlusion of the Fallopian tubes.
I recently examined a "uterus and its appendages," in which there was not only ovarian disorganisation, but a degree of tubular distension and distortion that must have established incurable sterility. To diagnosticate such a case of complex morbidity demands skill acquired by varied experiments in abdominal surgery. Salpingian occlusion, the result of acute and chronic inflammations of the uterine appendages, is as common a cause of epileptic and hysterical cataclysms as is a morbid state of ovaries demanding oöphorectomy.
ANTISEPTIC REMEDIES IN OBSTETRIC PRACTICE By T. HODGE JONES, M. D., Lamar, Missouri.
The conclusions which are stated in this paper derived from bedside experience. The employment of antiseptic agents, it is insisted, may be adopted with great advantage in our obstetric practice. The two agents which I name
have not been particularly noticed by medical writers as possessing antiputrescent properties. In thus employing the chloral hydrate and the potassium chlorate, it may be that we are making a new use of remedies comparatively old.
Dr. E. J. Tilt, in his work on Uterine Therapeutics, page 256, remarks: "If the urine be putrid, I have found the employment of chlorate of potash in four to five grains to an ounce of water highly useful. In a case of this nature of very severe character, where life was in jeopardy, I ordered a gargle of chlorate of potash for the severe aphthous mouth. By mistake it was injected into the bladder instead of morphia. Immediately the putridity of the urine ceased and the patient began to improve in general state and in local symptoms. Directly the injection was used the change for the better was most marked."
In October, 1878, I had a puerperal patient, who, after two chills, exhibited pinched expression of face, tenderness over abdomen, shortness of breath, watchful uneasiness and incoherent utterances. The lochia were scanty, of offensive odor, and an acrid ichorous nature. Counsel being called it was agreed that we should inject into the uterus a solution of permanganate of potash in an infusion of tansy. During the preparation it was discovered that we had none of the permanganate, so I substituted the chlorate, and like as in the case cited by Dr. Tilt, the effect was marked and instantaneous. Our patient from reception of the treatment improved till she had made a complete recovery.
Since that time I have witnessed many good results following the administration of chlorate of potash. In my experience with puerperal conditions, when the discharges are putrid and excoriating, no agent has given more decided benefit. When metritis is acute and the discharges are fetid, relief is very speedy and marked after injecting into the uterus, a hot solution of potassium chlorate in pure water, zj to ziv. Or when we can notice bad breath, and if the bedding is disturbed, and a cadaveric smell proceeds from the patient, drachm-doses of the above solution, every one to three hours may be administered with almost certain change of the disagreeable conditions.
In extreme cases of septicemia with high temperature, heat in vagina and os uteri, accompanied by putrescent lochia, we may, in addition to means already given, use cloths wrung out of a saturated solution of the remedy, folded and applied to the vulva; which at once removes any unpleasant odor and corrects the burning pain of the chafed surfaces. A case to point is that of my near neighbor, who had a tedious labor, October, 1880, followed by a profuse hemorrhage, which was checked by hot-water injections. The next day she experienced rigors, faintness and nausea. The discharges became fetid and suppressed; uterus enlarged and tender; respiration quick and short; her countenance expressive of agony; mind bewildered; bodily temperature, 104°; circulation, 110 per minute; and occasionally she vomited a greenish watery fluid containing dark-brown sediment. The os uteri and vagina were sensitive and hot.
The treatment just described was given to this patient and soon all the grave symptoms disappeared, so that in a few weeks she was fairly convalescent. After severe uterine hemorrhage following delivery, retained coagula may become putrescent and annoying; instances of which we see in abortions and hurried labors. Here again injections of a warm solution of the agent under consideration, may be relied upon for the necessary relief. In suppressed lochia with foul breath and general uneasiness of the patient, we administer the remedy internally and apply it topically, as before described, with assurance of a return of the lochial flow and an appreciable improvement in the patient's condition.
In cases of adherent placenta, and of instrumental delivery, the liability to septicemia may thus be averted and many unpleasant coditions removed by use of the treatment suggested. In fact we believe a judicious use of the chlorate of potash may abort metritis, peritonitis, or any of the forms of puerperal fever, by arresting putrefaction and correcting the conditions present favorable to such a disease. No one will suppose it is intended to impress the idea that chlorate of potash is to be given to the exclusion of other agents that may be indicated; but given the proper conditions and we do say it will bring