Extracted from the American Journal of the Medical Sciences for July, 1880. 
A CASE OF OVARIOTOMY IN WHICH PHLEGMASIA 
DOLENS FOLLOWED THE OPERATION. 
BY 
WALTER IF. ATLEE, LT. 3D., 
OF PHILADELPHIA. [Extracted from the American Journal of the Medical Sciences for July, 1880.] 
A CASE OF OVARIOTOMY IN WHICH PHLEGMASIA DOLENS 
FOLLOWED THE OPERATION. 
By WALTER F. ATLEE, M.D., 
OF PHILADELPHIA. 
Mrs. S. S., of Trenton, N. J., thirty-three years of age, medium size, 
rather healthy appearance, eight years married, never pregnant, always 
regularly menstruated, consulted me on account of abdominal enlargement, 
in February, 1880. This enlargement, the patient said, began six years 
before, in the lower part of the belly on the left side, and gradually increased, 
so that her general health was now seriously atfected by interference with 
functions essentially vital, those of digestion, circulation, and respiration. 
She told me she had been under local treatment by electricity for a long 
time, having had over forty sittings. Her pulse was about 120. The 
belly measured forty-twro inches in its greatest circumference ; it seemed 
to project rather more on the left side than on the right. Fluctuation 
could not be felt through the w hole mass, but it could undoubtedly be pro- 
duced over the central portion. 
This history and these particular symptoms, together with those com- 
mon to all ovarian cysts, made me diagnose a multilocular ovarian cyst 
of the left side, and I advised its extirpation at an early day. 
The patient came to this city on the 7tli March to be operated upon, but 
was seized with her monthly sickness one week too soon, for the first time 
in her life. We waited until Wednesday the 17th to perform the opera- 
tion. The sac had some adhesions to the omentum ; one so firm that it 
was cut away, and the cut end was left in the incision when sewed up ; the 
contents were very viscid, and very dark coloured, and there was but one 
sac the ovary diseased was the right one ; the pedicle was very thick so 
that it was difficult to apply the clamp; the Fallopian tube adherent to it 
was so enlarged as to be taken for small intestine by one of the assistants. 
Some of the contents of the sac escaped into the cavity of the abdomen, 
and wrere allowed to remain for reasons not necessary to mention. The 
walls of the sac were very unusually thick, and the inner surface was 
covered with vegetations (papillary growths2) of all sizes up to that of a 
1 A6 said before, I had supposed the sac to be multilocular, because I could not 
cause fluctuation through it. The true reason of its not being caused, however, was 
that the force exerted by the hand in palpating through the thick coverings of the 
cyst, and through the thick fluid, was insufficient to set the fluid contents in motion.— 
See Guttman’s Handbook of Physical Diagnosis, Syd. Society’s Trans., p. 338-9. 
a Dr. Joseph G. Richardson, to whom the growth was sent, says: “Thin sections 
from the nodule you gave me, from the inner surface of the wall of your ovarian 
tumour, show it to be made up of interlaced and convoluted compound papillae cov- 
ered with small columnar epithelial cells. Histologically these growths closely re- 2 
walnut. The patient did perfectly well; the clamp was removed on Sun- 
day ; the bowels were freely moved on Wednesday by injections, the 
patient being allowed to get up on the commode ; on Thursday she sat 
up; on Friday she was allowed to walk a few steps. On Saturday, the 
11 th day of the operation, there was complaint of stiffness and pain in 
the left leg, which was quite swollen, and in the course of the crural vein 
was felt a hard cord. These symptoms diminished so that the patient 
was able to return to Trenton on the fifteenth day. 
Dr. Bodine, her attending physician in Trenton, writes me under date 
of April 29th as follows : “ Mrs. S. is doing very well. The wound in the 
abdomen has entirely healed, and her leg swells only a little during the 
day, the swelling passing off entirely during rest at night. As an ex- 
planation of the attack of phlebitis I would suggest that during the 
winter and spring in this region we have an unusual number of cases of 
various forms of erysipelas, cutaneous, cellular, and in the form of felons, 
and that the relations of erysipelas and phlebitis are very close.” 
This complication of the operation for the removal of an ovarian cyst 
I had never before seen or heard of. In the last number (for May) of 
the Medical News and Abstract, is reported, from the British Medical 
Journal of March 13th, a very interesting and very successful case of 
ovariotomy performed during the sixth month of pregnancy without inter- 
ruption to gestation, and in this report we read that the patient did extremely 
well until the fifteenth day after the operation, when she was suddenly 
attacked by phlegmasia dolens of the left leg (and, as in my case, it was 
the right ovary that was removed), accompanied by induration in the 
course of the femoral vessels from the groin to the popliteal space. The 
patient improved gradually, so as to have very good health during the 
last month of pregnancy. Dr. Galabin, of Guy’s Hospital, who was the 
operator in this case, says :— 
“ It is difficult to trace a direct causation for the phlegmasia dolens by which 
my patient was attacked fifteen days after the operation. If there had been 
any access of septic material, notwithstanding the carbolic spray, she would not 
have progressed so favourably for fourteen days after so severe an operation ; 
and if the starting-point were inflammation near the pedicle, set up by the pres- 
ence of the ligatures, it might have been expected that the right leg, and not the 
left, would have been affected.” 
Of course, in my case the presence of ligatures is to be left out of con- 
sideration altogether, in looking for the causes of the inflammation of the 
vein, and I am quite inclined to believe that the trouble did come from 
septic, or more properly, from irritating material, and see no reason what- 
ever to doubt this from the fact that the cases did well for some ten days 
or two weeks. The irritating material was, I believe, the peculiar fluid in 
the sac, which in both cases had the same characters, and some of which, 
as before said in my case, got access to and remained in the abdominal 
semble papillomata and cylindro-cellular epitheliomata, but clinically they are dis- 
tinguished from the latter by absence of any marked tendency to constitutional 
infection.” 3 
cavity. Dr. Galabin says of this fluid that “ it was not pale, but was 
stained by blood pigment to a deep reddish-brown,” and “ that the whole 
interior of the cyst was covered by papillary growth.” The cysts and their 
contents had the same characters in these two cases, and I would attribute 
the extraordinary complication that attended them both, to the influence 
of the fluid that certainly escaped into the cavity of the abdomen in one 
case, and that may have done so in the other. THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES. 
Edited by I. Minis Hays, M. D. Subscription price, (per annum) $5.00. 
Is published Quarterly, on the 1st of January, April, July and October. Each number 
contains about 300 large octavo pages. This Journal has now been issued for over fifty years, 
and during this long period it has maintained its position in the highest rank of Medical 
periodicals, both at home and abroad. 
THE MEDICAL NEWS AND ABSTRACT. Edited by I. Minis 
Hays, M. D. Subscription price in advance, (per annum) $2.50. 
Is issued monthly, commencing with January 1st, 1880, being a consolidation of tbe two 
well-known journals*“The Medical News and Libkaky” and “The Monthly Abstract 
of Medical Science.” 
The “News and Abstract” consists of sixty-four octavo pages, in a neat cover. It contains 
a Clinical Department, in which will be continued the series of Original Clinical Lectures, 
by gentlemen of the highest reputation throughout the United States, together with a choice 
selection of foreign Lectures and Hospital Notes and Gleanings. Then follows the Monthly 
Abstract, systematically arranged and classified, and presenting five or six hundred articles 
yearly j and each number w’ill conclude with a News Department, giving current profes- 
sional intelligence, domestic and foreign, the whole fully indexed at the close of each volume, 
rendering it of permanent value for reference. 
FOR ADVANCE PAYMENT,'® 
Subscribers paying $5.00 in advance will receive both the American Journal of the Medical 
Sciences and the Medical News and Abstract free of postage for one year. 
THE OBSTETRICAL JOURNAL OF GREAT BRITAIN AND IRE- 
LAND. Published monthly, each number containing 64 octavo pages. 
$3.00 per annum in advance. Single copies, 25 cents. 
The subscriber will thus obtain for this trifling sum more than 750 pages per annum, con- 
taining an extent and variety of valuable information which it would be difficult to obtain 
elsewhere. 
Remittances can be made by Rank Draft, P. O. Money Order, or Registered letter at the 
risk of tlie undersigned, 
Henry C. Lea’s Son & Co., Philadelphia, Pa.