A fat abdominal wall or omentum has often been mistaken by the woman, and not infrequently by the physician, for a tumor. These cases are often obscure; indeed, all the difficulties of examination, in case a tumor be present, are very much increased by the enormous deposits of fat that are often present in the abdomens of women.
Careful examination, sometimes with anesthesia, and, if necessary, prolonged watching should be practised. If a fold of the abdominal wall be picked up between the hands, it will often show how much of the abdominal enlargement is due to fat.
TREATMENT OF OVARIAN CYSTS.
Tapping.—At one time the universal method of treating cystic tumors of the ovary was by tapping, or puncture through the abdominal wall. Many women were subjected to this proceeding a very great number of times, and, though not cured, were enabled to drag on a miserable existence until death resulted from exhaustion or from some accident to the cyst. In a few cases the cyst refilled very slowly, relief being experienced for several years before a second tapping became necessary. In still fewer cases the tapping seemed to be curative, the tumor never reappearing after it had been evacuated. Such cases were so unusual that they should have no influence whatever in determining the method of treatment. In the great majority of instances the cyst rapidly refilled. Sometimes the fluid accumulated with such rapidity that evacuation became necessary every few days. Referring again to the old records, we find a case which was tapped 664 times in thirteen years—once in about seven days!
If the cyst were multilocular, tapping furnished but partial relief.
The proceeding itself was attended by serious dangers. Dr. Fock of Berlin in 1856 stated that 25 out of 132 women—or 1 in 5½—died within some hours or a few days after the first tapping. Another operator lost 9 out of 64 cases—or very nearly 1 in 7—within twenty-four hours after the first tapping. The chief mortality occurred in the cases of multilocular tumors. Tapping the unilocular tumors was attended by much less danger.
The sources of danger from tapping were the following: hemorrhage from puncture of a vessel in the cyst-wall; septic or other infection of the peritoneum; and inflammation or suppuration of the cyst.
The majority of the women died in consequence of peritoneal infection.
The danger arose not only from septic infection of the peritoneum, but from papillomatous or other infection from the escape into the peritoneal cavity of some of the cyst-contents. Reference has already been made to the occurrence of the papillomatous infection at the site of puncture in the abdominal wall.
At the present day tapping an ovarian cyst with the hope of cure is never practised.