Operations on Ovarian Tumours. I have notes of three cases in which I gave chloroform during the removal of an ovarian cyst. The first of these was in March 1850. Twenty-four pints of liquid were first evacuated from the tumour. It consisted of four cysts united together, two of which contained serous fluid of slightly different colour; the third contained serum tinged with blood, and the fourth and smallest cyst, a purulent fluid. An incision was made, twelve or fourteen inches in length, extending from the pubes to midway between the umbilicus and sternum. Some slender adhesions were removed at one spot. The tumour was attached by a membranous pedicle, with the left iliac fossa, and the fundus of the uterus. Needles were passed through the pedicle, and it was tied in three or four portions, when the tumour was removed. After the tumour was removed, the patient seemed to breathe entirely by the ribs, the diaphragm remaining relaxed, and not contracting, whilst the wound in the abdomen was being closed. Scarcely any blood was lost during the operation. The patient died of peritonitis early on the fourth day.
The next case occurred on August 27th, 1850, and is reported in the Medico-Chirurgical Transactions for 1851. Mr. Duffin was the operator, and the patient made a favourable recovery.
The third operation was performed on the 31st of January, 1854. The patient was a spinster, twenty-eight years of age, and the tumour had not been tapped. It contained about two gallons of clear fluid, and was removed through an opening in the median line above the umbilicus, about seven inches in length. There was no depression when the patient awoke after the operation. She died within three days.
I administered chloroform in two cases where it was intended to remove an ovarian cyst. In one case the cyst was so adherent to the peritoneum that it could not be removed; in the other case, there was no cyst, but some serum in the peritoneal cavity, and a tumour growing from the fundus of the uterus. This tumour was allowed to remain. Several medical men, in addition to the operator, had diagnosed an ovarian tumour in this case. These two patients recovered.
I exhibited chloroform in four operations in which an ovarian cyst was opened, and the cut edges of it sewed to the wound in the abdominal parietes. These four patients, I believe, all died. I am quite certain as regards three of them.
On March 10th, 1852, I administered chloroform in St. Mary’s Hospital to a woman, apparently about thirty-five, who had suffered from an ovarian cyst about eighteen years. Mr. Isaac Baker Brown made an incision, about six inches in length, into the peritoneal cavity, drew out a portion of the cyst, tapped it, and removed several pints of clear serum. He then cut away a piece of the anterior wall of the cyst, about as large as the hand, and allowed the rest of the cyst to remain loose in the abdomen. The wound in the parietes of the abdomen was stitched up. If I remember rightly, the patient died, but I have no note of the result.
Operations for Cancer of the Vagina. I have notes of eighteen cases in which I have given chloroform for operations of this kind by the knife, which would have been extremely painful without the use of an anæsthetic.
I exhibited this agent, in 1848, to a lady, whilst the late Mr. Aston Key applied the actual cautery to malignant excrescence of the os uteri; and I have administered it in several cases in which potassa and other caustics have been applied to the os uteri. In operations on the vagina or perineum, the woman should inhale chloroform whilst lying on her back; and when insensible, should be drawn to the edge of the bed, or the foot of the operating table, and have the knees held back and separated.
Operations for Rupture of the Perineum. I have notes of fourteen operations for this accident. Six of them were performed by Mr. I. B. Brown, five by Mr. Fergusson, and the others by Mr. Paget, Dr. Protheroe Smith, and Mr. Henry Lee. Mr. Fergusson has, in five cases, performed an operation for prolapsus uteri, by paring the edges of the outlet of the vagina, and stitching them together so as to diminish the orifice.
I have given chloroform in several operations for vesicovaginal fistula, some of which were performed by Mr. Spencer Wells; and also for the removal of warts and other growths from the labia pudendi, either by the knife or caustics.