LIGATURE OF THE INNOMINATE.

876 felt much stronger and the wrist pulse was easily was apparently healthy, and was therefore not removed, felt. 1 then brought down the other leg and delivered her. She continued well for some weeks, and then pain comThe child was dead. The placenta came away with a little menced in the right side, making further operation necessary. trouble. I washed out the uterus with permanganate of We are indebted for the notes of the case to Messrs. Blunt potash solution, and at 11.30 A.M., when I left her, she felt and Sansom. A. L-, aged nineteen, was readmitted under the care ot quite comfortable. I repeated the washing out every day for a fortnight, during which time several small portions of Mr. Sydney Jones on Jan. 12th, 1886, after having been some membrane with many clots came away. Her temperature months at a convalescent home, to which she went on her never rose above normal, and she made an uninterrupted discharge from the hospital in June, 1886, having undergone recovery. I saw her on April 12th, and she felt quite well, an operation for hydrosalpinx on the left side. She now and I hope will be able to resume her occupation of a complained of great pain in the right side of the abdomen,. which was persistent, but varied in intensity, increasing in laundress in a short time. On subsequent inquiry, which I had not time to make paroxysms at intervals two or three times a day. It wasat first, I was told that the haemorrhage first came on at the also increased by any muscular efforts, and during the latter end of January, was like ordinary menses, and lasted catamenial periods. Since the previous operation the one day, when with rest it stopped. A week afterwards catamenia had been regular, but scanty and very painful. there was another " show/’ lasting the same period; four She also complained of dragging pains in the lower part of days after this a third came on, which ceased in a few hours ; the back after ordinary exertion. Pain had existed sinc& two days later she passed a large clot. On March 6th there the operation of last year, but had been gradually increasing was a little more haemorrhage, which lasted an hour. The in severity. The abdomen was somewhat distended, having next was on March 9th, when I saw her. I have since learnt a well-marked cicatrix in the middle line, without evidence that the patient has a somewhat curious record of confine- of protrusion. There was considerable tenderness on ments. She has had fourteen children, and three miscarriages pressure in the right iliac fossa, and also in the umbilical at three months each. She has ten children living, their ages region. No tumour could be felt. The general condition of varying from twenty-two to three years, and all healthy- the patient appeared healthy, and the urine was normal. looking. Her tenth was a case of spina bifida, and lived but she did not sleep well on account of the pain. On. nine days. Her thirteenth was also spina bifida, and lived Jan. 30th, there was much pain in the right side, right hip,. fifteen days. The first spina bifida was, I understand, tapped and back. The catamenia ceased the day before; had been twice, but the second was not interfered with. very painful and scanty, lasting four days. She was transferred to the care of Dr. Gervis, under whose treatment she Richmond, Surrey. continued until the end of February. On Feb. 15th the following note was made: "The external LIGATURE OF THE INNOMINATE. look healthy ; there is, however, slight granular parts BY THOMAS HENDERSON, M.B., C.M. erosion of the external os. On passing the sound the uterine axis was found to be slightly retroverted, but of normal I HAVE thought the following brief notice of a somewhat length. No pain on touching the fundus, and no hæmorrare operation of sufficient interest to merit insertion in rhage followed the withdrawal of the sound. On digital examination of the left fornix, no pain was felt by the THE LANCET. The patient, a man of about forty-five years, was suffering patient, but when the finger reached the right fornix thereintense pain from pressure by a very perceptible aneurysm was considerable pain, and a semi-elastic ovoid swelling was of the second part of the right subclavian. Other means felt." No improvement having followed the treatment employed having been tried with no good result, Professor Durante of Rome determined upon ligature of the innominate. up to this time, Mr. Sydney Jones again took her under hisand on March 1st performed the following operation,. Accordingly, on March 25th the operation was performed, care, with strict antiseptic precautions, the vessel being tied in the nature of which was explained to her. Ether having been. two places-viz., immediately below the junction of the given, an incision about three inches in length was made in. subclavian and common carotid, and again slightly lower the old cicatrix in the middle line of the abdomen. The down. The vertebral artery was also tied. The ligature peritoneum was opened with care after the arrest of all used was No. 3 carbolised catgut. The after-progress, up to haemorrhage, a finger introduced, and the peritoneum incised the present date (April 5th) has been most satisfactory. for the whole length of the wound. A large flat sponge Circulation in the right upper limb and side of the head was then introduced to keep the intestines warm, catch any has been completely restored, and the patient’s general blood, and keep the bowels out of the way. The ovary was, health is good, with the exception of obstinate constipa- then brought to the surface, and removed after the applicaof a double silk ligature to its pedicle, this being: tion, which may account for a rise of temperature having tion to the pelvis. The ovary was double the norma returned The external occurred. wound, excepting a small drainage and several cysts were found throughout its body. The size, healed has first intention. aperture, by Fallopian tube was normal. On the left side the parts were Rome. healthy. There was no adhesion of the abdominal contents to the old cicatrix. The wound was closed with alternate silk and catgut sutures. The operation was done under the carbolic spray, and the wound dressed with iodoform, iodoform gauze, and salicylic wool. Morphia was given hypoOF dermically in the evening, and she had a fairly good night. March 2nd.-She complains of great thirst and a good HOSPITAL deal of pain in the abdomen. Temperature at 2 A.M. 100°; BRITISH AND FOREIGN. at 8 A.M. 99°. Pulse 105. On March 5th the wound was re-dressed and two sutures. Nulla autem est alia pro certo noscendi via, nisi quamplurimas et mor- removed. On the 8th all the sutures were removed and! borum et dissectionum historias, tum aliorum tum proprias collectas habere, et inter se comparare.—MORGAGNI De Sed. et Caus. Morb., from along the track which they had made pus exuded on lib. iv. Procemium. pressure. For some time after the operation it was necessary to give her morphia injections, for although she did not ST. THOMAS’S HOSPITAL. appear to suffer much pain, still she was restless and very SUCCESSFUL REMOVAL OF RIGHT OVARY FOR CYSTIC impatient of control, being difficult to manage, as on theDISEASE NINE MONTHS AFTER OPERATION , former occasion. The suppuration which was noted on the FOR HYDROSALPINX. 8th extended to the wound, and it was necessary to open (Under the care of Dr. GERVIS and Mr. SYDNEY JONES.) this up somewhat in order to give freer vent. Much care was, IN August of last year (see THE LANCET, vol. ii., p. 399) taken with the diet; during the first twenty-four hours only we published an account of the operation which this patient ice was allowed, then a drachm of milk every hour for a day,. underwent for the removal of hydrosalpinx on the left side. then this quantity was increased, and so on until it was considered safe to allow solid food. When suppuration She had suffered from pain and symptoms referred to this came on in the wound and the temperature rose (on one disease for four years; these had followed the birth of a occasion, the 8th, it reached 1034°) the previous dressing child, and were so severe as to almost completely incapacitate was changed to boracic acid and warm water, strapping: her for any employment. At the operation the right ovary being applied after the removal of the sutures. When she

patient

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PRACTICE,