Fatal obstruction of the bowels from matting or from constricting bands of organized lymph has been frequently reported. Thus far, I have met with one fatal case, which, however, passed out of my hands after the operation. But occasionally I see cases of obstinate constipation which give me great uneasiness and put me to my wits' ends. In one case, after the failure of other remedies the obstruction was overcome by broken doses of calomel combined with sodium bicarbonate, and by the distension of the lower bowel with very large enemata slowly given. Another desperate case yielded to repeated doses of tincture of belladonna. A third case, complicated by obstinate vomiting, was saved by ten grains of calomel given every two hours until the bowels were moved. Seventy grains were thus administered before the desired effect was attained, yet salivation did not occur.
When symptoms of obstruction once present themselves, they are likely to recur. The contents of the bowel should therefore be kept fluid, and for this purpose I know nothing better than the German compound licorice powder, given in teaspoonful doses at bedtime.
Suppression of urine sometimes follows ovariotomy, and in cases of diseased kidney is an alarming complication for this condition. For this symptom digitalis and the acetate of potassium should be given. Thornton treats it by baring the arms and packing them in towels which are kept wet with ice-water.
Tetanus may destroy the life of a patient while convalescing from the operation of ovariotomy. J. M. Bennett reports such a case.60 The symptoms first showed themselves on the sixteenth day, and the woman died two days later. Chloral in drachm doses, administered by the bowel in the yolk of an egg, is perhaps the only remedy from which any good can be expected.
60 Lancet, Dec. 3, 1881.
Occasionally, a few days after the operation, without any septic symptoms whatever or without any marked rise in the temperature, the parotid glands grow tender, swell up, and run through a course precisely like mumps, ending in resolution. This complication has been met with so frequently by myself and others that it cannot be a mere coincidence, but must be due to a reverse sympathy between the ovaries and these glands. It does not appear to increase the risk of the patient, for recovery took place in all the reported cases, of which three occurred in my own practice.61 Parotid bubo may also take place after ovariotomy, but this sign of blood-poisoning, being a general one, happens as well after other grave surgical operations and during the course of specific fevers. Yet from the sympathetic relation between the parotid glands and the sexual organs it seems to occur more frequently in the septicæmia following ovariotomy.
61 Wm. Goodell, Transactions of American Gynæcological Society, 1885.
Acute mania sometimes follows ovariotomy, especially when both ovaries have been removed. The attack is usually temporary, but it sometimes ends in insanity, and even in death, as in one of my own patients. Keith, Thornton, Tait, and other leading ovariotomists report analogous cases.62
62 The British Medical Journal, March 21, 1885, p. 597.
SURGICAL TREATMENT.—The dressings, being antiseptic, need not, as a rule, be removed until the day following that on which the bowels are moved. Every other stitch may then be removed, and especially all that are loose or are cutting the tissues. The wound is then washed with a 2.5 per cent. solution of carbolic acid, and dressed anew with salicylated cotton. I usually find the first dressing so sweet that I am able to reapply the unsoiled portion of it for a second dressing. A clean binder is now pinned on and the woman's clothing changed. Three or four days later all the stitches should be removed, the wound secured by narrow adhesive strips, and dressed as before. For fear of a weak cicatrix and the formation of a hernia at the site of the wound, the patient should not get out of bed until fully three weeks have elapsed, and should for as many months wear some kind of close-fitting gored binder or abdominal supporter.