Case of a spontaneous cure of ovarian dropsy, by means of an ulcerative opening of the cyst into the bladder / by John Hughes Bennett, M.D.

  • John Hughes Bennett
Date:
[1849]
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Licence: Public Domain Mark

Credit: Case of a spontaneous cure of ovarian dropsy, by means of an ulcerative opening of the cyst into the bladder / by John Hughes Bennett, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    that the contents of this cavity had suppurated, and a fistulous open- ing, formed either into the ureter or bladder (most probably the lafter), through which the contained fluid was evacuated, permitting collapse of the sac and cui'e of the disease. The permanency of this cure will depend upon, whether all the secondary cysts had been ruptured and were broken down before the fistulous opening took place. This is a point which it is impossible to ascertain with cer- tainty; but a careful examination of the woman before she left the Infirmary, convinced me that no rounded nodules or cysts could any where be felt. The only instance I am aware of, in which an opportunity pre- sented itself of dissecting an ovarian encysted tumour some time after its spontaneous rupture, was in an individual I saw examined with Dr Simpson, by the late Dr Makellar.—{Monthly Journal, Jan. 1847, p. 558.) In that case the cavity of the cyst was almost obliterated, and its walls were thickened and of cartilaginous hard- ness. A fistulous opening, however, was kept up between the tumour and the abdominal walls, below the umbilicus, where it had burst, and the patient sank jfrom the continued discharge. How far a commmiication with the external atmosphere in this instance, and the presence of chronic peritonitis, may have operated unfavour- ably, I do not know; but the total cessation of all discharge, and absence of these circumstances in the case related, augurs well for her permanent recovery. Whether a fistulous communication between the ovarian sac and urinary passages be favom'able or not, is uncertain ; for I have been unable to discover any recorded case in which this has ever hap- pened. Many instances are to be met with where similar cysts have burst into the peritoneum, the fluid been absorbed, and excreted in large quantities by the kidney as urine. Other cases are to be met with, where the contents of the tumour have burst externally by ulceration through the abdominal walls, or into the vagina, or into the intestines; but in none, so far as I am aware, previous to the one now related, have the contents of the tumour been evacuated directly as a purulent viscous fluid from the bladder, proving a direct communication with that organ. The occasional occurrence of such spontaneous cures, has led to the proposition of producing permanent artificial openings, with a view of imitating a natiu-al cure. Mr Bainbrigge of Liverpool— {Prov. Med. and Surg. Journal, vol. iii. p. 593)—suggests making an incision into the sac, and uniting its edges with the external wound; and Dr Tilt of London—fZawcei, vol. ii. 1848)—has lately proposed making a minute aperture by means of Vienna paste, so as to cause a permanent opening. Such practice can only be use- ful at a particular period in the growth of ovarian tumours—that is, when all the internal cysts have broken down into one; indeed, it is only in these cases that Dr Tilt proposes making the apertui'e. But such cases are exceedingly rare, and the practice recommended
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