Six cases of laparotomy / by John H. Packard.

  • Packard, John H. (John Hooker), 1832-1907.
Date:
[1890]
Catalogue details

Licence: Public Domain Mark

Credit: Six cases of laparotomy / by John H. Packard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    cavity of which was three and a half inches in depth, and encroached upon by the mass. Removal of the ovaries was decided upon, and performed on the 22d, five days after her admission. Both ovaries were cystic, and both tubes enlarged and tortuous. The uterine tumor was found as before described, one portion of it softened and bulging. Owing to the involvement of the broad ligaments, the uterus was too firmly fixed to admit of a hysterectomy. After the ligature, in a Staffordshire knot, had been tied on the left side, the tissues gave way, and there was very free bleeding, which was only controlled with great difficulty by catching the tissues in a large clamp, and including the whole mass in a strong gut ligature. • The abdominal wound was closed and dressed in the usual way. At first only blood came from the drainage-tube, but by the next day there was clear serum. The patient complained very little, but seemed drowsy and apathetic; her pulse ran up to 130, but her temperature did not exceed 100°. On the evening of the second day, as there was some nausea, small quanti- ties of milk and lime-water were given by the mouth, and n^v of tincture of digitalis hypodermically. On the 24th her temperature was 101°; there was not much pain, but fre- quent gulping up of bile-colored liquid. She lay quietly most of the time. A rubber tube was substituted for the glass one. On the 25th the condition was about the same, but the temperature had risen to 102°. The dressings were removed, and it was found that a knuckle of intestine had protruded; it was deeply congested, and adherent to the dressings by a layer of lymph. It was returned, and two new sutures applied. There was a very offensive vaginal discharge, apparently of decomposed blood. On the 26th the temperature was 103°, the pulse almost imperceptible, and the breathing rapid and shallow. At about noon there was stercoraceous vomiting, and death took place at 1.30 p.m. After death the wound was opened, and a good many adhesions, probably of various dates, were found; there was no general peritonitis. In Douglas’s pouch there was a mass of blood resembling that discharged from the vagina, but no opening into that canal could be detected.