A NEW OVARIOTOMY CLAMP.* ALSO APPLICABLE FOR OTHER SURGICAL PURPOSES. By B. F. DAWSON, M.D., New York. Attending Physician to the New York State Woman’s Hospital, Outdoor Department; to the New York Free Dispensary for Sick Children ; Assistant to Prof. Jacobi’s Clinique for Children at College of Physicians and Surgeons, New York. The operation of ovariotomy is rapidly attracting increased attention, and while but a short time since it was performed by -a few surgeons, we now hear of its being undertaken by many young and inexperienced physicians with the boldness of old ovariotomists. Notwithstanding, however, the frequency with which the operation is performed, and the consequent progress made in the procedure itself and the after-treatment of the patient, yet it cannot be denied by any one who studies the subject but that much, very much, remains yet to be learnt, before it can be classed amongst the perfected operations of surgery. Even yet, some of the eminent ovariotomists of Europe * Reprinted from The American Journal of Obstetrics and Diseases of Women and Children, Vol. IV., No. 2, August, 1871. 2 A New Ovaricytomii Clamp. and this country are at variance as to many of the most important points in the operation ; for instance, as to the treatment of the pedicle, whether it is best to ligate and return it or not into the peritoneal cavity; to clamp it, and keep it external to the abdominal wound ; or to dispense with both ligature and clamp, by substituting the ecraseur, the actual cautery, or laceration. The proper treatment of the abdominal incision is also a mooted question, the majority advising immediate and perfect closure, while a few, and not the least distin- guished, advocate the practice of leaving a small open- ing, to allow the exit of septic gases and material, and the advised washing out of the peritoneal cavity.* Although there exists such difference of opinion in regard to the treatment of the pedicle, yet the majority of the distinguished ovariotomists are becoming more in favor of clamping the pedicle than obligating it, and some have given the most conclusive proofs of the former in the statistical results of their cases (Spencer Wells, Thomas, Atlee, etc.), by far a greater number so treated recovering, than where the various forms of sutures are used, and the pedicle returned into the abdomen. The advocates of the latter method, as well as those in favor of the clamp, have been active in endeavors to perfect each detail of the individual methods, and have given us as results varieties in ligatures as regards mate- rial and application, and clamps of different principles and special peculiarities. As it is not my purpose in this paper, however, to * See Prof. E. R. Poaslee’s paper on “ Injections into the Peritoneal Cavity after Ovariotomy,” in The American Journal of Obstetrics and Diseases of Women and Children, Vol. III., No. 2, p. 800. A New Ovariotomy Clamp. 3 discuss the various methods of treating the pedicle, but only the application of the clamp, and especially one possessing new principles, I will pass immediately to the subject. The object of all clamps is to so compress and retain the ovarian pedicle as to perfectly control all haemor- rhage, either temporarily until the ligature is passed, or permanently, without the latter, as the operator may desire. With one exception (Atlee’s clamp), the principle of action of all clamps is the same—compression of the pedicle between two parallel arms of steel, which are brought into co-aptation by two screws, or a hinge and screw combined. Such instruments compress the tissues in but two directions, and thus allow them to spread more or less between the bite of the clamp, and this very spreading of the pedicle is somewhat essential for the proper closing of the clamp. Now, two great objections seem to me to be attached to this spreading of the pedicle: 1st, it must somewhat prevent (perhaps only in a slight degree) perfect liga- tion of the pedicle by any of the various ligatures, for, after ligation, that portion between the ligature and clamp is spread out in a fanlike manner, and therefore offers unequal resistance to ligation ; and, 2d, if the clamp only is used, the pedicle expands transversely to the wound, and thus prevents sufficient approxima- tion at the point where it is situated. The above conclusions have been arrived at after having been present and assisted at some sixteen opera- tions for ovariotomy, performed respectively by Drs. T 4 A New Ovariotomy Clamp. Addis Emmet, T. G. Thomas, E. R. Peaslee, Joseph Kammerer, John Byrne, and Stephen Merritt. To overcome one of these objections, Dr. Washington L. Atlee, of Philadel- phia, has recently in- vented a clamp “ to limit, within certain points, the expansion or spreading of the pedicle when the blades of the clamp are screwed togeth- er.” * By his clamp the pedicle is compressed in four directions, and thus made to occupy a very small space in the abdominal wound. This one has certainly great advantages over other instruments, but, as its mechanism is somewhat compli- cated, there is yet an opening for further improvements. I will therefore call attention to a clamp of entirely new action which I have recently had made, and the mechanism of which is exceedingly simple. * Am. Journal Med. Sciences. April, 1871, page 370. A New Ovariotomy Clamp. 5 The principal features of this clamp are: 1st. It com- presses the pedicle in a uniform manner and into as small a compass as may be needed ; 2d. The compressing force is exerted by a single screw; 3d. Its application around a pedicle is quick and exceedingly simple; 4th. With it a ligature can be passed directly around the com- pressed portion of the pedicle, and be made more secure than with other instruments; 5th. Ecrasement could be performed if it were desirable. In the accompanying woodcut, the clamp is seen locked, and in the act of compressing a pedicle, if we imagine the wheel (£) to be turning. By the turning of this wheel the slide (c) is slowly pushed up towards the joint (y its resting on the abdomen. The dotted outlines {(f) in the cut show the arm of the clamp opened ready for application, and needs no particular explanation. Besides the purpose for which this clamp was origin- ally designed, it may advantageously be used in the removal of haemorrhoids, portions of the tongue, penis, scrotum, and extraneous growths. The entire instrument is so light, compact, and small that its case may be carried in the vest-pocket without inconvenience. It is manufactured by G. Tiemann &> Co., 67 Chatham Street, New York. COMMENTS OF THE PRESS ON THE AMERICAN JOURNAL OF OBSTETRICS AND DISEASES OF WOMEN AND CHILDREN. N. Y. Medical Gazette, Jan. 28, 1871. “This is pre-eminently a journal for the family practitioner, whose services are so largely called into requisition by the frequent sickness of women and children. If viewed simply as a current epitome of all things bearing upon the branches of which it treats, it would be of infinite value to every physician engaged in general practice. But beyond this, the important original contributions which have been made to medical science through its columns entitle it to higher estimation. No other American periodical has attiacted a more distinguished array of authors, foreign and domestic ; few journals anywhere have maintained such uniform excellence in the character of their contents.” N. Y. Medical Record, Feb. 15, 1871. “ This quarterly commenced its first issue in May, 1868, under the auspices of the leading obstetricians of this city, and many other equally eminent specialists abroad. The articles con- tained in the different numbers have been singularly good and of a thoroughly practical char- acter, a fact which the profession at large have not been slow to appreciate. The care and discrimination of the working editor, who is also the proprietor, Dr. B. F. Dawson, has been one of the principal means to this end.” Boston Medical and Surgical Journal, Feb. 16, 1871. “ We consider it one of our most valuable exchanges, including, as it does, articles bearing the names of Elliot, Emmet, Barker, Hammond, Skeene, Thomas, Eustace Smith, the Editors themselves, and other distinguished writers on the diseases of women and children. We com- mend the Journal most heartily to those of our patrons who need sound advice on the special subjects to which it is devoted—and who does not ? ” Baltimore Medical Journal, Feb., 1871. “ We have no hesitation in declaring it the best journal devoted to this branch of medical literature. No further evidence of this fact is needed than a glance at the list of contributors, among whom will be found the well-known names of T. Gaillard Thomas and A. Jacobi, of New York ; Storer, of Boston 5 Elliot, Hammond, Nott, Emmet, and Boziman, of New York, and many others, all of whom have contributed articles that would enrich the columns of any journal, and cannot fail to be read with pleasure and profit by all who desire to be infoi med on the subjects of which they severally treat.” Richmond and Louisville Medical Journal, Feb., 1871. “ No journal in this country has achieved more rapidly a deserved and increasing reputa- tion. Its contents are always valuable and interesting, and the very best representatives of these departments of medicine contribute constantly to its pages. The work can be recommended with entire confidence, and all who desire the best and most recent information in connection with the specialties to whose cultivation the Journal is devoted cannot do better than, by sub- scribing, to have its pages always accessible.” Buffalo Medical and Surgical Journal, Feb., 1871. “ The Journal is edited with consummate skill and ability, and receives contributions from many of the most eminent writers and teachers in the profession. The advance of knowledge in this department is so great that practitioners of medicine must give attention to present teach ing, or soon find that their profession is far in advance of them. This journal is a necessity in its department, since in it have appeared, and constantly are appearing, important practical papers, singly of great value, and combined, constituting the progress the art is making from month to month.” Pacific Medical and Surgical Journal, March, 1871. “ The judgment and skill displayed in the choice of material have placed this journal in the foremost rank of medical periodicals, and given it a reputation of which the editors may well be proud.” B. F. DAWSON, M. D , Editor and Proprietor, 8 East 15th Street. N. Y. The Only Journal of its Kind in the English Language. THE AIERICAI JOURNAL OF OBSTETRICS AND DISEASES OF WOMEN AND CHILDREN. EDITED BY B. F. DAWSON, M . D., Attending Physician to the Out-Door department of the New York State Women’s Hospital; to the New York Free Dispensary for Sick Children ; Ass’t to the Clinique for Children in College of Physicians and Surgeons, New York ; District Physician to New York Asylum for Lying-in Women. 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