A YEAR’S WORK 
IN 
ABDOMINAL SURGERY. 
BY 
WILLIAM GARDNER, M.D., 
Professor of Gynaecology, McGill University; Gynaecologist to the 
Montreal General Hospital; One of the Vice-Presidents of the 
British Gynaecological Society. 
Reprinted from the Canada Medical ds Surgical Journal, October, 1887- 
GAZETTE PRINTING COMPANY. 
—MONTREAL: i 
iSSy- A YEAR’S WORK IN ABDOMINAL SURGERY." 
William Gardner, M.D., 
Professor of Gynaecology, McGill University; Gynaecologist to the Montreal General 
Hospital; one of the Vice-Presidents of the British Gynaecological Society. 
Mr. President and Grentlemen—During the last working 
year I have opened the peritoneal cavity 38 times. Of these 
35 were abdominal sections, the others were total vaginal extir- 
pations of the uterus, and I have included them in the list 
because the important element of peritoneal section obtains 
equally in them with the abdominal cases proper. The list I 
submit includes an unusual variety of cases and conditions, and I 
venture to think that its recital may he of some interest and 
furnish material for a useful discussion. Every operation was 
done in a private hospital, with the most scrupulous attention to 
cleanliness of the hands of operator, assistants and nurses ; and 
of instruments, sponges and ligatures, but without the use of 
any antiseptic whatever except to the field of operation—abdomi- 
nal wall or cavity of the vagina,—where a 1-1000 sublimate 
solution was always freely used after thorough scrubbing of the 
part with soap and water. The after-treatment was entirely 
under my own watching and control, a circumstance to which I 
attribute great importance in determining the results obtained. 
The following is a brief classification of the cases with results: 
Recoveries. 
Deaths. 
Ovariotomies.. 16 16 
Hysterectomies 2 2 
Removals of Uterine Appendages 11 10 1 
Abdominal section for opening 
Pelvic Abscess 2 2 
Puerperal Peritonitis 2 2 
Abdominal section for 
Retro-Peritoneal Cyst 1 1 
Exploratory Operations 3 2 1 
Total Vaginal Extirpation of 
Uterus 3 3 
Of the ovariotomies several were of exceptional interest. In 
* Bead in abstract before the annual meeting of the Canadian Medical Association, 
at Hamilton, Sept. Ist, 1887. 4 
two there was twisting of the pedicle, giving rise in both to 
violent pain, and in one of them to severe peritonitis. In the 
latter case, a patient of my friend Dr. Molson, the pedicle was 
twisted three times ; the walls of the cyst, a dermoid, were 
almost black ; adhesions were universal; the second ovary being 
enlarged and cystic, was also removed; the cavity was washed 
out and a drainage-tube employed for five days. The uterus 
was found to be somewhat enlarged, soft and vascular. A sus- 
picion of possible pregnancy flashed across my mind, but the 
idea was not seriously entertained at the time of the operation. 
The patient recovered without a bad symptom. Three months 
afterwards I had an opportunity of examining her, and found 
her undoubtedly pregnant to about five months, gestation per- 
sisting in spite of the rotation of the tumor, with strangulation 
and consequent severe peritonitis, a double ovariotomy with 
washing out and drainage, the glass drainage-tube lying behind 
the uterus and in contact with its posterior wall for five days. 
This is my second ovariotomy during pregnancy; the first also 
recovered without a symptom worthy of note. The patient was 
delivered at full term just six months after the operation. Both 
mother and child are alive and well to-day.* 
The other twisted pedicle case was sent to me by Dr. Yaux 
of Brockville, and was that of an unmarried woman of 25. She 
had for several weeks suffered severe pain, unrelieved by morphia 
in full doses. The twisted pedicle was enormously thickened 
from oedema the result of obstructed circulation, and the cyst wall 
much discolored ; there were papillomatous growths from its 
interior, and hemorrhage into its cavity. Recovery was rapid 
and complete. 
In both cases the tumors were small, as is usual in axial rota- 
tion, and they are good examples of the many untoward acci- 
dents to which all ovarian tumors are liable, and furnish strong 
arguments in favor of the plea for early ovariotomy. 
Another of the series was in a hale old lady of 68, whose 
recovery from the conditions incidental to the operation was 
absolutely without any event worthy of note, except slight cys- 
* See Canada Lancet, February, 1887. 5 
titis, but who on the second day developed pleurisy, which soon 
became double, with most alarming symptoms. The pulse rose 
to 180, and was irregular and unequal. She ultimately made 
a perfect recovery. 
In two of the cases the tumors were sarcoma, one being sar- 
comatous degeneration of a dermoid cyst. In both there were 
adhesions to intestine and every other structure within reach. 
In both, washing out and drainage were resorted to. They 
were desperately severe operations, but both recovered. In 
one the curious symptom of polyuria developed in the third 
week, and for several days six to seven pints of urine were 
secreted. There was great thirst and enormous appetite. These 
symptoms had completly disappeared before the patient was dis- 
charged. 
In one case—an enormous tumor—the patient had a success- 
ful pregnancy and uneventful delivery at full term, after the 
tumor had attainedjmnsiderable size, and she had been tapped 
four times, once at the interval of a fortnight before her con- 
finement. 
In nine of the sixteen cases the condition of the second ovary 
was such as in my opinion to demand its removal. Such con- 
ditions were marked enlargement and cystic disease. The 
question of the necessity of removing the second ovary under 
these circumstances has given me some anxiety in young sub- 
jects, as it seems to me it must to every conscientious surgeon. 
So far as I know there is no known method by which to diagnose 
on the operating-table a condition comparatively harmless, and 
which may not prevent successful ovulation and conception 
from one which is the commencement of a disease that must 
ultimately demand operation. It is quite certain that all slightly 
enlarged and cystic ovaries are not commencing ovarian tumors. 
In a woman who has already attained or is nearing the meno- 
pause, the second ovary when in such a condition, or, according 
to some surgeons, even when apparently perfectly healthy, must 
always be removed, knowing as we do its proneness to the 
disease which has required operation for the first. But it is far 
otherwise in the young woman, married or not, from whom by a 
double ovariotomy, it may be, needless, all possibility of realiza- 6 
tion of the much cherished hope of maternity is for ever re- 
moved. I confess that for myself the question is as yet unsolved. 
All recently published experience is quite in accord with my 
own that the double operation does not in the least add to the 
dangers. It may be remembered that Sir Spencer Wells’ sta- 
tistics seemed to indicate an opposite conclusion. 
The operation of removal of the appendages is one, now-a-days, 
of even more interest than ovariotomy, because more recent and 
inasmuch as it involves certain questions not yet quite solved to 
the satisfaction of everybody, f can honestly say that some of 
my cases have given me more satisfaction than anything else in 
my work during this last, as in former years of my work. The 
list comprises examples of almost all the conditions for which 
the operation is ever necessary. Such were pyosalpinx, haemato- 
salpinx, pelvic haematocele, enlarged and cystic ovaries, and 
cirrhotic very small ovaries, with and without adhesions from 
previous pelvic peritonitis. Some have been restored in a few 
weeks from a life of more or less complete invalidism to health, 
activity and usefulness. Others have been slow in recovering 
from the operation, because of secondary inflammation about the 
pedicle. In others still, nothing could have been more favorable 
than the after course quoad the operation, but the morbid con- 
dition of nerve centres which is in some the result of long-con- 
tinued suffering and habits of invalidism continued for several 
months to manifest itself in the persistence of pain in the 
regions whence the diseased appendages were removed, or in 
some distant reflex symptom, most commonly headache. The 
single death of the series was from hemorrhage, and it is the 
only death in the list of which I have any reason to be ashamed, 
as it might have been prevented if I had been called to the 
patient in time. As it was, I reached her bedside nine hours 
after the operation, when she was moribund. The peritoneum 
was found full of blood, but the ligatures held fast. The exact 
source of the blood flow was not found, but it was doubtless 
either a rent of some part of the broad ligaments or one of the 
suture needle punctures. The operation was a perfectly simple 
one for cystic ovaries without any adhesions whatever. Some 
of the operations were the most difficult I have ever had to 7 
encounter, by far more difficult than any but the most difficult 
ovariotomies, and I think that without washing out and the 
drainage-tube some of them had scarcely a chance of recovery. 
It is in such cases, perhaps, more than in any other in the whole 
range of abdominal surgery that the value of experience becomes 
apparent in the separation of adhesions and recognition by touch 
of the educated finger of the parts which must be removed. 
This all important part of the operation must be done solely by 
the sense of touch, and in some of my cases the whole operation 
was done through an inch-and-a-half incision. 
Of the miscellaneous cases, the following one of exploratory 
incision is of exceptional interest: A tumor-like mass of doubt- 
ful nature remained after the symptoms of a severe attack of 
peritonitis in a delicate girl of 30, had subsided. The patient 
continued to vomit and suffer from great pain and difficulty in 
defecation She was much emaciated. On opening the abdomen 
the peritoneum was found studded in numerous places with 
tubercle. This was verified by microscopic examination of a 
portion removed. The mass described was found to consist of 
the small intestine densely matted together in its own coils and 
adherent to everything around. The mass was somewhat sepa- 
rated from its surroundings, returned, and the abdominal open- 
ing closed, with a drainage-tube in the pelvis. She recovered 
easily and rapidly from the operation, and for a time was much 
relieved of her symptoms. For a few weeks she was able to 
dispense with morphia, which she had taken daily up to the 
time of operation, and the bowels acted spontaneously and 
without pain. She survived the operation six weeks, dying of 
exhaustion. This is my second case of tubercular peritonitis 
simulating ovarian tumor. The other case will be found recorded 
in the Canada Medical and Surgical Journal for June 1885. 
In the two puerperal cases the patients were almost in extremis 
and the operations were done as a last resort, but without avail 
in influencing the symptoms. In both the abdominal cavity was 
opened, washed out, and a drainage-tube inserted. The con- 
ditions found were those of intense general peritonitis, with 
copious exudations of lymph and pus, and infiltration of ovaries, 8 
tubes and cellular tissue with inflammatory exudation. In 
neither was there any encysted collection of the products of 
inflammatory action or evidence of disease in or about the appen- 
dages from which the general peritonitis might have started. 
In one of the cases there had been persistent right iliac pain 
during the pregnancy, and the symptoms of the fatal illness 
began by an aggravation of this pain. These facts justified 
Dr. George Ross and myself in opening the peritoneum in the 
hope that some condition within the power of surgery to relieve 
might be found. Puerperal fever was, however, prevailing, and 
the result of the exploration confirmed the idea that these cases 
were of septic character. Both patients died within twelve hours 
of the time of operation, but in neither was death in the least 
hastened by the operation, so far as an opinion could be formed 
from the symptoms present when the operation was undertaken, 
and in one the agonizing pain was at once relieved, an effect 
which morphia had failed to produce. 
The results of exploratory abdominal section for peritonitis, a 
very recent development, have already proved beyond doubt 
that many lives may be saved by an operation which in compe- 
tent hands does not in the least lessen the patient’s chances. 
That peritonitis in the lying-in woman not rarely is of a character 
and has such an origin that we can occasionally thus save a life 
has already been amply demonstrated by the experience of Law- 
son Tait and John W. Taylor of Birmingham, and others. One 
of Mr. Tait’s successful cases I had the good fortune to see and 
assist at during my stay with him last summer. The kind of 
case in which we have the best reasons to anticipate success are 
those of previously existing, perhaps latent disease of ovaries or 
tubes, such as abscess of the ovary or pyosalpingitis, roused to 
activity by the process of parturition, and leading, it may be, 
to general peritonitis. That such conditions not rarely exist was 
shown by Dr. Grigg, of the Queen Charlotte Lying-in Hospital, 
in a paper read before the British Gynecological Society, based 
on the conditions found in certain autopsies. Other conditions in 
which the operation is indicated are encysted collections of the pro- 
ducts of inflammation in the peritoneum or pelvic cellular tissue, I 9 
believe the time has come when it may with perfect justice be 
said that in a suitable case of puerperal, pelvic or peritoneal 
inflammation in which life is threatened, the practitioner is bound 
to do the operation or have it done for him, and so will save the 
valuable life of many a wife and mother. 
The two hysterectomies recovered, both without any bad 
symptom. In both I adopted, as in all my previous hysterec- 
tomies, the extra-peritoneal method of dealing with the pedicle, 
clamping it with Koeberle’s serre-noeud. It is possible, and 
much to be desired, that “ a more excellent way” (as Keith has 
it) may yet be devised, but that it has not yet been attained is 
amply proved by a comparison of the experience of Keith, 
Bantock and Tait by the extra-peritoneal method, with the pub- 
lished results of Schroeder and Martin in Germany by the intra- 
peritoneal method. If ever induced to try the latter method, 
I shall certainly combine it with drainage of the Douglas’ pouch 
through the vagina after Martin’s method. 
In 19 of the 35 abdominal sections the drainage-tube was 
used. It was employed in all cases where adhesions were exten- 
sive and oozing surfaces remained, and when washing out was 
resorted to. In the latter case much sponging to remove the 
water used was thereby saved, as it was sucked out through the 
drainage-tube. Of all improvements in the technique of abdomi- 
nal surgery next to the intra-peritoneal ligature, none has so 
much conduced to success as the use of the drainage-tube. By 
its employment operations may often be much shortened and the 
peritoneum saved much labor in the absorption of effused blood, 
and the patient’s chances of recovery correspondingly increased. 
Experience in the use of the drainage-tube is an important 
factor in the amount of good to be gained by it. In the experi- 
ence of other surgeons I had learnt much as to the kind of case 
in which to use a drainage-tube, but not much as to the length 
of time it must be allowed to remain in the wound. I had never 
seen any definite rules on this point laid down till I read the 
remarks of my friend Dr. Bantock in his paper on “ A Hundred 
Cases of Abdominal Section ” published in the London Lancet a 
few months ago. It is possible to remove the drainage-tube 
much too soon, and I am sure I have seen ill results in my own 10 
practice from this. Since reading Dr. Bantock’s paper I have 
followed his instructions on this point, and with, I believe, signal 
advantage. These are, in the main, to the effect that the drain- 
age-tube ought not to be removed till the whole amount of secre- 
tion that can be removed from it in twenty-four hours does not 
exceed one drachm of amber-colored serum. 
Next to improvements in the technique of abdominal surgery 
the after-treatment of cases is of prime importance as affecting 
the patient’s prospects. When in Europe last year I found that 
Mr. Lawson Tait and Dr. Bantock held very strong opinions on 
certain questions connected with the management of such cases 
after operation. One of the principal points on which they agreed 
is the advantage of the avoidance of opium entirely. During 
the last twelve months I have uniformly followed this example 
with the exception of one or two instances, and a comparison 
with my previous experience has thoroughly convinced me that 
they are right. As a rule, the pain after an abdominal section 
is mainly at the needle punctures of the abdominal wall, and 
almost invariably ceases in twelve hours. A dose of opium or 
morphia will, it is true, relieve the pain, but it dries the secre- 
tions, makes the patient clamorous for drink which it is so im- 
portant that she should avoid for thirty-six hours, it quiets the 
bowels and so favors accumulation of flatus, and distension, 
whereas it is all-important that the peristaltic action of the in- 
testines should be kept up, not only to carry off flatus, but to 
prevent adhesion of coils of intestine to the pedicle, to raw 
surfaces whence adhesions have been separated, or to the inner 
aspect of the abdominal wound, which may lead to obstruction. It 
is more than probable that most of the deaths after abdominal 
section attributed to peritonitis in recent years have been due 
to obstruction. 
In my work during the year I have given no opium, and in- 
variably, immediately on the appearance of distension, pain or 
vomiting, I have given enemas and purgatives with the most 
signal advantage. lam convinced that in my own experience 
I have thus seen lives saved, besides a vast diminution of the 
trouble and difficulty in managing the cases afterwards. 
I append the following table of the ovariotomies included in 
the series:— 11 
Name, &c. 
Ordinary 
Attendant. 
History and Symptoms. 
Local Conditions. 
Operation. 
Recovered 
or Died. 
Subsequent 
History- 
E. T., aged 31, 
unmarried. 
Dr. Bingham, 
Williston, Vt., 
U.S.A. 
Menses began at 14 ; always 
regular. General health 
good. First noticed en- 
largement 3| years before 
operation. 
General abdominal en- 
largement; wave fluc- 
tuation, bulging in 
flanks, flat in front; 
bowel note not distinct 
in flanks; girth 3b in.; 
uterus retroverted, 
prolapsed, and slightly 
mobile. 
Two and a-half inch in- 
cision ; no adhesions; 
parovarian cyst right 
side, limpid fluid, favor- 
able pedicle ; ovary and 
tube spread out oyer 
cyst wall ; operation 
complete in 25 minutes. 
Recovered. 
Perfect health 
M. B., aged 69, 
married. 
Dr. Hill, Ottawa- 
Mother of several children. 
Menopause many years ago. 
General health perfect. No 
symptoms, but tumor first 
noticed li years ago. 
Fluctuation in areas; 
great enlargement ; 
no tenderness; uterus 
pushed forward, lying 
behind pubes. 
Multilocular ovarian cys- 
toma ; few slight anterior 
adhesions; tumor is of 
right side. Severe attack 
of double pleurisy with 
rapid pulse, reaching 180, 
rapidly reduced by digi- 
talis ; rapid recovery. 
Recovered. 
Slight cystitis for a 
few weeks; two 
months after oper- 
ation, a smooth, 
tender swelling in 
' region of pedicle 
slowly disappear’d. 
Otherwise well. 
M. 0., aged 51, 
married. 
Referred by Dr. 
R. P. Howard, 
Montreal. 
Menses began at 17 ; married 
30 years ; one child 25 years 
ago; menses ceased eight 
months ago. Pain in left 
lumbar region and first 
signs of tumor one year ago, 
rapid growth: three months 
before operation measured 
42 inches. Was tapped, 2J 
gallons removed, in Bur- 
lington, Yt. 
Fluctuating _ tumor; 
clear note in flanks; 
no firm areas ; 35i in.; 
uterus retroverted; 
moveable 3f inches by 
sound. 
Unilocular cyst of left 
ovary ; no adhesions ; 
very broad pedicle ; liga- 
tured in sections; a 
small dermoid cyst at- 
tached to base of large 
tumor. 
Recovered. 
Perfectly well. 
OVARIOTOMIES. 12 
Name, &c. 
Ordinary 
Attendant. 
History and Symptoms. 
Local Conditions. 
Operation. 
Recovered 
or Died. 
Subsequent 
History. 
C. M., aged 53, 
unmarried. 
Dr. James Bell, 
Montreal. 
Menses began at 12; ceased 
four years ago. Never preg- 
nant- Is much emaciated 
and sallow ; severe abdomi- 
nal pain, rectal tenesmus 
and pain. Six months ago 
first noticed lump in left 
iliac region. Steady in- 
crease of size, with pain. 
Full doses of morphia for 
six weeks. 
Nodulated, firm tumor 
springing from left 
side, extending from 
pubes to within 2 in. 
of lower ribs ; in parts 
elastic feel; uterus 
moveable: marked in- 
duration in posterior 
cul-de-sac and recto- 
vaginal septum: girth 
of abdomen 34 inches- 
No adhesions: favorable 
pedicle; multilocular 
cyst of left ovary, jelly- 
like contents. In Doug- 
las’ pouch the induration 
felt, evidently malignant 
disease of the rectum. 
Recovered. 
Recovery from ope- 
ration rapid and 
perfect; great re- 
lief from pain; no 
morphia needed 
for some weeks. 
Died three months 
after from cancer 
of rectum. 
M. B., aged 29, 
married. 
Dr. 
M. C. MoGannon, 
Brockville, Ont. 
Menses began at 11; always 
regular, profuse. Married 
three years; one child 22 
months ago. First noticed 
tumor in left iliac region 
12 months ago, steadily in- 
creasing ; dysuria last 18 
months. 
Abdomen enlarged, 32i 
inches; uneven fluc- 
tuating areas; uterus 
retroverted, prolapsed 
and moveable. 
Multilocular cystoma of 
left ovary; omental ad- 
hesions, grumous con- 
tents ; favorable pedicle. 
Three ligatures to omen- 
tum ; right ovary size of 
hen’s egg and cystic, also 
removed. 
Recovered. 
Perfect health. 
M. I., aged 39, 
married. 
W. G. 
Menses began at 15. Married 
14 years; five pregnancies, 
last 11 months ago. Menses 
now regular. First noticed 
tumor Sept. 1884, on left 
side. Tapped four times, 
once during last pregnancy 
twojweeks before labor. 
Abdomen very large, 
45| inches, uneven, 
fluctuating over large 
areas; oedema of hypo- 
gastrium; uterus re- 
troverted, prolapsed, 
and moveable. 
Large quantity peritoneal 
fluid; multilocular cys- 
toma left ovary; omen- 
tal adhesions; favorable 
pedicle ; right ovary cys- 
tic and enlarged, also 
removed. 
Recovered. 
Perfect health. 
II. S., aged 30, 
married. 
Dr. Beckstead, 
Lisbon Centre, 
N. Y. 
Menses began at 16; at first 
scanty, of late profuse and 
protracted leucorrhoea; pain 
in hips. Never pregnant- 
In Jan. ’85, diagnosed a pel- 
vic ovarian tumor. No ab- 
dominal enlargement till 
Jan.’S?. Rapid enlargement. 
Elastic, uneven condi- 
tion of abdomen, 35 
in., fluctuates in areas. 
Uterus retroverted ; 
sensitive, moveable 
body felt in Douglas’ 
pouch ; tapped two 
months before opera- 
tion. 
Multilocular cystoma left 
ovary; no adhesions; 
favorable pedicle; right 
ovary size of pullet’s egg 
and cystic, also removed. 
Recovered. 
Perfect health. 
OVARIOTOMIES—{Continued.) J. B., aged 18, 
married. 
Dr. Ball, 
Stanstead, P.Q. 
Menses began at 11; always 
regular. Married two years, 
never pregnant. Noticed 
enlargement four months 
after marriage. A good 
deal of pain during last 
year. Twice tapped during 
last three months. 
Uniform enlargement; 
general fluctuation; 
distinct wave. Uterus 
retroverted, prolapsed. 
Tumor distinct in pel- 
vis ; girth 40J- inches. 
Multilooular cystoma of 
left ovary ; universal an- 
terior parietal adhesions. 
Three ligatures to bleed- 
ing points; drainage- 
tube. 
Recovered. 
Perfect health. 
M. C., aged 25, 
unmarried. 
Dr. Yaux, 
Brockville. 
Menses began at 17; is quite 
regular. Good health till 
two years ago, then began 
to have occasional attacks 
of severe pain in right iliac 
region; this pain almost 
constant last five months; 
three months ago tumor 
first noticed in right iliac 
region; pain at times very 
severe, not relieved by 
morphia; girth 25J inches. 
Tumor is tense, elastic, 
insensitive, moveable, 
entirely below umbili- 
cus : uterus anteflexed, 
pressed down in front 
of tumor. ’ 
T 
No adhesions ; cyst wall 
dark colored; pedicle 
twisted very thick and 
oedematous, size of 
adult’s head: contents 
chocolate-colored fluid; 
papillomatous growths 
from interior of cyst, 
which is unilocular, and 
of right ovary; left ovary 
a mass of cysts and of 
size of pullet’s egg, also 
removed; oozing from 
pelvis ; drainage-tube. 
Recovered. 
Perfect health. 
M. D., aged 20, 
married. 
Dr. James Bell, 
Montreal. 
Menses began at 13. One child 
1 year old; suckled ten 
months. Menses returned 
at six months ; regular till 
seven weeks before opera- 
tion. First noticed a lump 
in right iliac region 3£ mos. 
ago; steady growth ; much 
pain, irritation of bladder, 
constipation, pain and diffi- 
culty in defecation; great 
wasting, weakness; pulse 
90-100: in bed for 2 months. 
Irregular, nodular, sen- 
sitive tumor extending 
up right side of abdo- 
men from pelvis to 
hypoohondrium, very 
slightly moveable; in 
places elastic, semi- 
fluctuating ; floor of 
pelvis indurated; os 
uteri pushed forwards 
and to right side ; por- 
tio-vaginalis obliter- 
ated by collar-like in- 
duration around it. 
Desperately severe opera- 
tion ; adhesions to intes- 
tines, omentum and to 
whole of pelvis; lower 
part of tumor a friable 
mass, in which neither 
ovary nor fundus of the 
uterus is distinguishable. 
After enucleation of 
tumor, the operation fin- 
ished by clamping cervix 
uteri and bringing it out 
at lower angle of abdomi- 
nal incision. The tumor, 
a sarcoma with dermoid 
elements. Washing out 
and drainage. 
Recovered. 
Recovery was fairly 
rapid, interrupted 
by septic fever for 
a few days. In 
third week poly- 
uria, 6 to 7 pints 
urine daily; great 
thirst; enormous 
appetite. Returned 
home 6 weeks after 
operation ; general 
and local condi- 
tions excellent; 2 
months later signs 
of recurrence ; a 
month later much 
emaciated, sinking 
fast; recurrence of 
growth, fasoal fis- 
tula at lower end 
of _ abdominal in- 
cision ; is dying. 14 
Name, Ac. 
Ordinary 
Attendant. 
History and Symptoms. 
Local Conditions. 
Operation. 
Recovered 
or Died. 
Subsequent 
History 
Mrs. S., aged 31 
married. 
M. G., aged 38, 
married. 
. 
Dr. Moison, 
Montreal. 
Dr. Moison, 
Montreal. 
Began to menstruate at 19. 
Married eight years ; four 
pregnancies to full term, 
last 14 months ago, suckled 
lumonths; menses returned 
after weaning; four months 
JMjP first noticed a lump in 
left iliac region; three 
weeks ago, after a walk, 
sudden severe pain, vomit- 
ing, fever, retention of 
urine, constipation; full 
doses of morphia up till 
time of operation. 
Married 13 years ; before 
marriage menses irregular, 
last three years profuse, 
especially last six months. 
A thin-walled, fluctu- 
ating cyst size of a 
child’s head, quite 
tender; uterus fixed, 
retroverted, quite ten- 
der. 
Amende, fat, weak 
person ; flowing con- 
tinuously ; pains in 
hips, left leg and thigh. 
The veins of left leg 
and thigh distended, 
varicose; during last 
six months moderate 
enlargement of abdo- 
men ; feels solid thro’ 
the thick rigid pa- 
rietes; uterus fixed. 
Parietal, pelvic and omen- 
tal adhesions ; a dermoid 
cyst of left ovary ; long, 
slender pedicle, twisted 
three times around its 
axis; contents creamy, 
coagulate solid ; cyst wall 
dark-colored, contains 
teeth, hair and bone, 
hair almost black ; right 
ovary enlarged, cystic, 
also removed ; wash out, 
drainage ; uterus some- 
what enlarged, soft, and 
of dark-red color. 
Abdominal wall thick, li 
inches fat; rigid omen- 
tum, adherent to lower 
parts of parietes ; a cyst 
on either side, with broad 
attachment, containing 
clear, amber-colored fluid 
with cholestenne crystals- 
Cysts freely opened but 
not removed on account, 
of broad attachment and 
nature of contents; 
ovaries not distinguish- 
able ; washing out, 
drainage • 
j 
Recovered 
I 
1 
1 
!- ' 
Recovered. 
Three and a half 
months later, seen 
and examined; is 
undoubtedly preg- 
nant; 26th Aug., 
1887, daily expect- 
ing confinement at 
full term. 
Recovery was tedi- 
ous, but seemed to 
be complete, when 
(slowly and with 
severe pain) an 
abscess developed 
in right iliac re- 
gion. Opened by 
abdominal section. 
Complete recovery 
OVARIOTOMIES—(Continued.) 15 
M. Y., aged 83, 
married. 
Dr. Geo. Ross, 
Montreal. 
Began to menstruate at 11; 
married 9 years ; five preg- 
nancies, last 20months ago: 
suckled 15 months. Menses 
regular last five months; 
noticed enlargement four 
months ago ; rapid increase 
for one month, then very 
slow; slight abdominal 
pain; losing flesh. 
Uniform, fluctuating 
enlargement, 38J- in.; 
firm areas and trabe- 
culae ; uterus retro- 
verted, fixed. 
Multilocular cystoma of 
left ovary; anterior ad- 
hesions ; adhesion of rec- 
tum to pedicle, pedicle 
broad; ligatured in sec- 
tions ; right ovary en- 
larged and cystic, re- 
moved ; wash out and 
drain. 
Recovered. 
Perfect health. 
N. C., aged 22, 
unmarried. 
Dr. J. Stephenson, 
Iroquois, Ont. 
Menses regular, profuse; be- 
gan at 16 .Noticed enlarge- 
ment 10 months ago ; rapid 
increase ■ General health 
perfect. 
Uneven enlargement 
of abdomen ; fluctua- 
tion in areas; uterus 
retroverted, lies on 
floor of pelvis. 
Multilocular cystoma of 
left ovary; no adhesions, 
favorable pedicle; right 
ovary cystic, enlarged, 
size hen’s egg, removed ; 
bleeding from rent in 
right broad ligament; 
after ligature, oozing; 
drainage-tube. 
Recovered. 
On removal of 
drainage-tube ab- 
scess formed, with 
pain and fever; 
discharged freely 
for a few momhs ; 
silk ligatures came 
away; complete re- 
covery after some 
months. 
A. S., aged 43, 
unmarried. 
Dr.A.D. Blackader, 
Montreal. 
Menses ceased 4 years ago; 
healthy till 3 years ago, 
when began to have pelvic 
pain. Two years ago a small 
pelvic tumor in right iliac 
region, Severe pain last 
few months. Steady in- 
crease of size. 
A rounded, firm, ten- 
der tumor size of a 
child’s head; uterus 
not very moveable, re- 
troverted. 
Desperately severe opera- 
tion ; tumor solid, very 
friable, broke down dur- 
ing removal; adhesions 
toparietes, omentum,in- 
testines and pelvic struc- 
tures proceeding from 
right ovary and involv- 
ing tube ; clamping of 
right corner of uterus; 
wash out and drain ; 
microscopic examination 
showed sarcoma. 
Recovered. 
Recovered from 
operation, but re- 
currence and death 
eleven weeks after 
operation. 
M. A., aged 57, 
married. 
W. G. 
Menses ceased five years ago. 
A few months later, a con- 
stant thin, pinkish dis- 
charge, which has never 
ceased. 
Uterus enlarged and 
retroverted ; cervix 
healthy. 
Uterus extirpated by va- 
gina. After its removal 
a cyst of the size of an 
orange also removed; 
found to be dermoid. 
Recovered. 
Good health.