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THE WEEKLY MEDICAL REVIEW.
VOL. XIV. No. 1.
ST. LOUIS, JULY 3, 1886.
IS DISEASE OF THE UTERINE APPENDAGES AS FREQUENT AS IT HAS BEEN REPRESENTED?
This is the title of an interesting and instructive paper by Dr. Henry C. Coe, the accomplished pathologist to the Woman's Hospital, New York. It deserves a careful perusal from all who have any interest in the
subject, and no one can read it, except with pleasure and profit. It is a timely and well directed protest against the unreasoning and unreasonable resort to Tait's operation, and to oophorotomy which has raged with the virulence and indiscrimination of an epi
The doctor also denies, with the voice of authority, the brazen claims set up to precision in the diagnostication of these lesions, that we see [so often paraded in the papers
TERMS: $3.50 A YEAR.
and discussions, claims that have no foundation either in truth or in possibility, and that are conclusively and finally vetoed by the revelations of the dead-house, and by the examination of the organs removed. The author asserts that of all of the extirpated tubes he has examined, and he has examined a large portion of all of those removed in New York, he has found pyo-salpinx in only one case out of five; that in a large proportion of the cases, there was no positive evidence of pathological changes of a serious nature in the ovaries.
The inference to be drawn from his observations, is that a large proportion of the patients operated upon were in no way benefited by the operation, while some of them were made worse.
He does not, of course, undervalue the importance of Tait's operation, nor of the removal of the ovaries, when the necessity exists. His objection is to operations based on insufficient data, and he adduces evidence to show that in many instances these operawith pernicious results. We regret our space tions have been performed needlessly and prevents extensive quotations.
The author says in conclusion, the follow
ing deductions may be regarded as legitimate:
1. Ovarian disease is not as common as it has been represented; the surgeons, and not the pathologists, being responsible far the prevalence of the contrary opinion.
2. Because an ovary is partially diseased, it does not follow either that its functions have been materially impaired, or that its removal is imperative.
3. The expression "cirrhosis" and "cystic degeneration" commonly applied to the ovary are mischievious terms, which are too often
used in justification of unjustifiable opera- cessful labor after the recovery from rupture tions.
SUCCESSFUL LABOR AFTER RECOVERY FROM
RUPTURE OF THE UTERUS.
The remarkable case of rupture of uterus occurring in the practice of Dr. D. W. Bullock, of Whitaker's (North Carolina Med ical Journal, July, 1882, p. 8), will be remembered by most of our readers, but we will hastily recapitulate the prominent fea. tures: A colored multipara, 34 years of age, had rupture of the uterus after being in labor four hours. The head was "button-holed" through the uterus, as Dr. Bullock expressed it, and a loop of intestine was prolapsed through the vagina. There was nothing wanting to show the correctness of the diagnosis. The woman made a good recovery in about seven weeks. We are now able to record the fact that this patient was recently safely delivered of a living child, and made a good recovery.
Cases are on record of the safe delivery after Cesarean section, but after a considerable hunt we found only one case of a suc
of the uterus, viz., that by Dr. D. W. Moore, Milwaukee, Wis., 1881, in Transactions Wisconsin Medical Society, Vol. XV. p. 128. In this case the uterus was ruptured the second time, followed by recovery.
AN UNUSUAL SEQUELA OF OVARIOTOMY. To the Clinical Society of London (March 13), Mr. R. Barwell read a paper on a case. At the latter end of last October he removed the left ovary of an unmarried woman, aged 29. The local results were perfect; but certain sequelæ ensued which had not hitherto been recorded, but, on questioning other surgeons, Mr. Barwell found the event not to be isolated, and notably that Dr. Keith, Mr. Thornton, Mr. Dent, Dr. Bantock and others, had met with a like complication. The patient was of fair complexion, and mobile temperament. She came into Charing Cross Hospital, and it was agreed that ovariotomy should be performed. On October 28th, Mr. Barwell removed the left ovary, first withdrawing twenty-three pints of fluid; the pedicle was tied with silk, and allowed to fall back into the abdomen. The usual mode of suture was employed. During the three subsequent days menstruation recurred, and some hematuria was observed; it then ceased. On the third day the thermometer stood for two hours at 102.4°, but with this exception she never had a temperature worthy of notice. The deep sutures were removed after fortyeight hours. The abdominal wound was healed on November 2d; there was hardly any tenderness in the left groin or elsewhere. The patient, who was naturally very docile and amenable, showed, on November 3rd, a contradictory and aggressive temper; on the 5th (eighth day of operation) this had developed into insanity. On November 7th she had become so violent that she had to be secured, and this could only be effected by giving a little chloroform. A subcutaneous injection. of four minims of solution of morphia only calmed her for three hours. On the 21st, with various phases of comparative violence