When an umbilical or a ventral hernia of moderate size is present at the time of the operation, efforts should be made for its radical cure. This is done by cutting out the thinned-out sac by two incisions meeting below and above, and by bringing together the thick edges of the abdominal wall in the final closure of the wound.
In cases of ascites complicating ovariotomy the ascitic fluid should not be wholly removed until the cyst has been cut off and the wound is ready to be closed. By this means any blood oozing from broken adhesions, or any fluid escaping from the cyst into the abdominal cavity, being diluted, is less likely to irritate the peritoneum, the cavity of which can also be more readily cleansed.
When a patient seems in danger of dying on the table from shock or from exhaustion the anæsthetic should be withheld while hypodermic injections of ether and enemata of brandy are given. Warmth should also be applied to the body by bottles of hot water, or, what is better, by rubber bags of the same. Theoretically, atropia administered subcutaneously would be the proper remedy, but I have not yet tested it. In all cases of ovariotomy, especially if prolonged, the woman should not be kept profoundly under the influence of the anæsthetic for any length of time, but should be allowed from time to time to come to at least enough to make her flinch or move about. This caution should especially be observed in very feeble patients and in those with very large cysts.
The Removal of Both Ovaries.
Whenever both ovaries are diseased there can be no question about the extirpation. But when only one has undergone cystic or other degeneration the question of the removal of the sound one may come up. There always is a tendency to the subsequent degeneration of the sound ovary after the diseased one has been removed. More especially is this tendency observed in sterile women and in those with malignant affections of the ovary. Many women, therefore, whose lives should have been imperilled but once, have been compelled to face the dangers of a second operation. In view of these facts, it seems to me wise to remove the sound ovary in all cases of sterility, in every case of malignant degeneration of one ovary, and in all women who have either passed the climacteric or are approaching it, provided its removal is not attended with great additional risk. Double extirpation should also be performed whenever the womb contains a fibroid tumor or whenever it seems desirable to hasten on the climacteric. In these convictions I am further strengthened by the disappointment often expressed to me by my patients that one ovary had been left behind, and by their great fear afterward lest the remaining organ should also become diseased. On the other hand, in women who are in the prime of their menstrual life the sound ovary should be left untouched, unless there exist grave reasons for its removal.
DISEASES OF THE URINARY ORGANS IN WOMEN.
BY ALEXANDER J. C. SKENE, M.D.