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REPORT OF A CASE OF PARTIAL OVARIOTOMY, IN WHICH THE PATIENT SURVIVED THE OPERATION FOUR MONTHS.
41 colour is that of pale golden sherry; the odour i sweet; when it has barely any action on litmus paper. -B distinct alkaline reaction upon reddened litmus has not, however, been observed. When poured into a test-tube, a very slight cloud may be seen floating near the bottom; if allowed to stand for an hour or so, a small opaline deposit, easily dispersible, will form. The recent urine is unaffected by heat, or NO5 HO ; but if allowed to stand after their action, a small flocculent precipitate sometimes forms; occasionally, however, Of that portion no precipitate is visible to the naked eye. which is allowed to stand, the supernatant liquid is ilnaffected by heat and NO5 HO; the deposit, however, is dissolved by the latter, indicating the presence of phosphates; and when heat is applied to the mixed fluid, as in the recent urine, a precipitate may or may not be the result. Upon submitting a drop of the recent urine to the field of the microscope, blooddiscs, turgid or collapsed, single and not aggregated, together with epithelial cells and occasional casts of the uriniferous tubes, are seen; no pus-globules have been detected. Such are the usual characteristics of the urine; but the action of concurrent causes, as exposure to cold and the imbibition of diuretic fluids, renders the urine acid for a time, when crystals of uric acid and of the lithates, together with blood-discs, are
recently passed,
seen.
It will be observed that the symptoms, general and local, those of that form of renal disease termed by Payer " Chronic Nephritis," but that there is an important difference in the character of the urine. In treating of this " chronic nephritis," Dr. Christison states (" Lib. of Med.," vol. iv. contains blood or albumen, p. 270) " that the urine very seldom unless other renal diseases concur."" However, of that form of renal disease now under notice, blood-globules have been invariably contained in the urine, but could only be detected with certainty by the microscope. Liability to passive renal hmmorrhage appears to be either constitutional or acquired. Persons constitutionally predisposed are those of lax fibre, fair complexion, with skin soft and supple, easily excited to action, but as readily depressed: persons of a tuberculous tendency, prone to affections of the mucous membranes, as catarrh, bronchitis, diarrhoea, &c., whose arterial system is in that state which may be termed irritable. Such a constitution appears, as it were, acquired by two other classes, who are specially prone to this hæmaturia—viz., those who are in the habit of consuming large quantities of diluent fluids, as haymakers, reapers, engineers, stokers, bleachers, tenters, dressers, and spinners in cotton-mills-persons who, after exciting great cutaneous action by severe manual labour, or by working in a high artificial temperature, check the same by exposure to a much cooler atmosphere after the cessation of their daily employment. The habitual dram-drinker is most prone to the acute form of Bright’s disease, or to that stage which probably supervenes upon this-viz., that in which the urine is of low specific gravity, and contains free albumen. May not the frequent use of spirits, from their direct action upon the kidneys, by over-stimulating the organs," produce this hæmachronic albuminous turias which may ultimately pass on to nephritis" ? It may be observed, that of several cases of "passive renal haemorrhage’’ which have occurred in the practice of the writer, not one could, as far as the patient’s recollection served, be traced to any dropsical affection, are
or remote. The average age of the persons affected was above thirtyfive years; they were chiefly of the male sex, probably on account of the greater exposure of males to the predisposing and exciting causes, which latter appeared, as far as they were traceable, to be exposure to cold, damp air when in a state of perspiration, frequent use of diuretic spirituous liquors-in fact, any circumstances which, depressing the heat of the body, produced congestion of the viscera. The Patlaology of the Disease.-The presence of blood in the urine affords ample proof of the existence of haemorrhage from some part of the genito-urinary passages, the state in which the blood-discs are found, the inadequacy of chemical re-agents to detect them, the occasional c3,sts of uriniferous tubes, and the natural colour of the urine, indicate that the haemorrhage is renal, yet not of an activekind. But the comparativee paucity of the globules discharged would lead to the conclusion that the kidneys are not suffering from any organic lesions, but from an unbalanced state of their circulation. This state of venous engorgement may probably exist for some time without any structural change in the glands themselves, but unless relieved, it is apparent that exudation will ultimately occur, and derange the whole action of these excernant organs. The actual progress of this haematuria into chronic albuminous
proximate
has not been traced, nephritis is which this
of of
checking,
paper if not of
the remedies used in the cases, had the effect
general history, having curing the hæmorrhage. a
The therapeutical indications are three in number. First, to check the haemorrhage by reheving the congestion ; secondly, to restore the general health; thirdly, to guard against relapse, and this is an important point, as there is a great tendency thereto upon the application of any exciting cause. The first indication may be effected by rest, daily use of the warm bath, with friction to the bodily surface, local depletion, abstinence from diuretic drinks, bland farinaceous diet, and the use of astringent remedies. To relieve the gastro-hepatic derangement, a small quantity of blue-pill, with a sedative saline draught, will be found useful at intervals during the exhibition of astringent remedies, the best of which is gallic acid. It has been given in the following form:—Gallic acid, a drachm; dilute hydrochloric acid, two drachms; solution of hydrochlorate of morphia, (E. P.,) one drachm; distilled water, five ounces and a half, as a mixture; a tablespoonful to be taken every fourth hour. The therapeutical effects of gallic acid are well described by Dr. Golding Bird:—" Gallic acid acts as a direct astringent, reaching the renal capillaries, and finding its way into the urine, which becomes strongly charged with To relieve the irritability of the bladder, tive grains it, &c." of soap-and-opium pill should be used every night as a suppository. These medicines should be continued until the hæmorrhage ceases, and the vesical irritability which remains for some time after the cessation of the haemorrhage, is relieved by tincture of cantharides, in doses of from ten to twenty drops, combined with an anodyne. When the urine is free from blooddiscs, the general hygienic rules for restoring tone to the system should be enforced; animal diet, with a few glasses of sherry daily, may be allowed, and quinine with iron prescribed. As preventive measures, the warm bath with friction should be daily persisted in; flannel should be worn next the skin, and all exposure to exciting causes studiously avoided.
Park-road, Chorley, January,
1854.
REPORT OF
A
CASE OF PARTIAL OVARIOTOMY, IN WHICH THE PATIENT SURVIVED THE OPERATION FOUR MONTHS.
CROUCH, F.R.C.S., Bruton, Somerset. MRs. B-, a widow, aged fifty-seven, of sallow complexion BY JOHN
and unhealthy appearance, had conducted for several years the business of a confectioner. She was the mother of three children, and her habits were those of an active and industrious tradeswoman. Very early rising, long continuance in the erect posture, and considerable exertion in her occupation, at the time of the cessation of the menses, were the predisposing causes of her disease. Five years since, she first consulted me respecting a swelling in the left groin. The tumour was the size of a large cocoanut, of a tirm, unyielding character, and was considered to be an enlargement of the left ovary. She underwent a long course of diuretics, iodine, and mercury, and "pressure’’ was applied, without any sensible effect. About two years after the above treatment, this swelling suddenly disappeared, which the patient attributed to drinking acid cider. In the autumn of 1851 she discovered another enlargement, which commenced in the right groin. I was not consulted on this occasion till the abdomen had become as large as that of a woman in the last stage of pregnancy. The circumference of the bowels was nearly forty inches, and fluctuation was perceptible over their whole surface. After taking a short course of alteratives and diuretics, she was tapped on the 13th of June, 1852. Two gallons of a coffee-coloured fluid. which yielded a large proportion of albumen, were drawn off. On examining the bowels after the operation, a hard, immovable substance was found in the right iliac region. Although great temporary benefit was experienced from the tapping, the fluid soon collected again, and at the end of fivee weeks she was so distressed by the accumulation as to earnestly ’, request that something further should be done for her relief. As she had been informed that a patient on whom I had successfully operated in lb49 had suffered from a similar disease, it was necessary to explain that, in the first instance, the tumour was completely extirpated, but with regard to her own case, so favourable a result was not to be expected. After fully explaining its dangers, I obtained her consent to
42 following operation, which is nearly similar to that first other recovered without a single adverse symptom. No dispractised by Mr. Wilson, of Bristol. It took place on the 13th charge ever took place from the wound, although a large porof August, 1852. Having marked with the tincture of iodine tion of cyst had been removed, and ten arteries secured. Mrs. - one perpendicular and three transverse lines as guides to the B-’s case was a most unpromising one, and the operation operation, I made an incision of twoinches through the skin was only resorted to as a last resource. and cellular tissue about an inch below the navel, and to the No minor operation, however, can supersede that more perright side of the mesial line. The rectus muscle and perito- fect one, by which the total eradication of the disease is innæum were then divided, and the ovarian sac carefully secured sured. Dr. Clay has kindly informed me that he has now perby ligature to the upper angle of the wound. Nine quarts of formed " ovariotomy by the large incision" fifty-eight times, fluid, which had accumulated in eight weeks, were then drawn out of which number only eighteen cases proved fatal-a moroff with the trocar. The cyst was very thick and vascular, tality not exceeding that attendant on hernia, amputation, and adherent to the surrounding structures in every direction. and lithotomy. I extracted a portion three inches in length, and after applying It is satisfactory to find that the leading men of the profesMr. Wilson’s ingenious tourniquet, excised with a large pair sion have not all set their faces against the performance of of scissors a part the size of a crown-piece. Nofewer than ovariotomy. Mr. Fergusson, in the last edition of his excelseventeen small arteries required the application of a fine lent " System of Practical Surgery," says, " Ovariotomy is not ligature silk. In this part of the operation I was very ably only justiJhble, but, in reality, in happily selected cases, an assisted by Mr. T. G. Stockwell and Mr. C. J. Morris. Both admirable proceeding." The late Mr. Aston Key, in the ends of the seventeen ligatures having been cut off, the re- " Guy’s Hospital Reports" for October, 1843, writes as folmaining portion of the cyst was returned into the abdomen, lows :-" If the constitution of the ovarian patient be unafand the outer incision closed with three sutures and adhesive fected by the disease, her nervous system tranquil, and the plaster. The patient was then placed in bed, and forty drops arterial action free from inflammatory tendency, I cannot see of laudanum were administered. any objection to submitting such to the operation." Mr. She passed the first four days after the operation without a Druitt, whose ’’ Manual of Modern Surgery" stands pre-emisingle untoward symptom, having been free from fever, nent as a work of talent and research, makes the following observations in his sixth edition :-" In favour of ovariotomy, it haemorrhage, and peritonitis. On the fifth the wound was dressed, and the external liga- may be argued—1st, that the mortality arising from this is not tures removed. The outer incision had nearly healed, and the greater than that from many other surgical operations ; 2ndly,. bowels acted on this day without the aid of medicine. that no other plan of treatment can effect a radical cure, but I On the seventh, a tympanitic state of the abdomen was first that by this, women relieved of a burden which made life miobserved. This arose from the formation of gas in the ovarian serable, havemarried and borne children ; 3rdly, that if favourable cases only were submitted to the operation, the sac, and was unattended by any symptom of peritonitis. On the fourteenth the cyst became fully distended, and the mortality would be very small, and that increase of experience upper angle of the wound giving way, a large quantity of fostid will lead to the selection and discrimination of favourable cases;. air and matter escaped. 4thly, that if the surgeon, in order to complete his diagnosis. From this time it was necessary to treat the case as one of makes a small incision, to ascertain the existence of adhesions, the
chronic abscess. The sides of the sac were now drawn together with compress and bandage, and nourishment in every form freely given. For the first few days after, the discharge wass ! very considerable and offed-sive, but by the end of August it began to diminish, and the appetite to improve. The cyst was now daily syringed with a pint of warm water, to which was frequently added a drachm of the tincture of iodine, or the same quantity of the sulphate of zinc. By the end of October the matter became more healthy, and the quantity, instead of amounting to ten or twelve ounces, was reduced to three or four, night and morning. She continued slowly to improve, and the cyst had so far contracted that its cavity, which at the operation contained nine quarts, was now only capable of holding a few ounces. A bed-sore, which at first was troublesome, had now completely healed, thus proving the increased vitality of the system. Her death, however, took place suddenly on the 13th of December, sixteen weeks after the operation, and when she was about to partake of a substantial meal. The post-mortem examination proved that matter had escaped from the cyst into the peritoneal cavity, and the solid part of the tumour showed evident traces of cancerous deposit. The left ovary appeared healthv, aud only slightly enlarged. The uterus had a small fibrous tumour imbedded in its substance. The other viscera were not examined. The portion of cyst that was excised at the operation, and which has been preservecl in strong acetic acid, measures more than a quarter of an inch in thickness. Remarks.—Notwithstanding the fatal termination of the case, the above operation was so far successful that there is every reason to believe the result would have been favourable had the patient’s general health been good, and free from specific disease. Therecan, I think, be little doubt that her life was prolonged by the means employed. It is most desirable that, in addition to the dangerous and formidable operation of complete extirpation, we should possess, in the treatment of ovarian disease, some remedy more efficient than those usually adopted. I allude to diuretics, iodine, pressnre by tight bandaging, issues, setons; subcutaneous sections, and tapping. Dr. Tanner’s proposal of tying the pedicle of the cyst is not included in the above list, because experience is required to test its value. Partial ovariotomy, by quickly and effectually destroying the entirety of the cyst, offers the best substitute for the major operation" in all proper cases, where the total extraction of the tumour cannot be effected. Of three cases treated in this way by Mr. Wilson, one wasrestored to health in three weeks, after the formation of a gmall abscesg near the incision, and an-
and closes it again with suture, if he find this to be the case, great harm is likely to result; in fact, this, which is sometimes raked up as an opprobrium against operators, is a prudent and legitimate measure. Lastly, that it is by far the most merciful plan of treatment, if adopted early, in patients otherwise healthy, with a still growing but non-adherent tumour. In conclusion I would remark, that as Mr. Wilson’s three cases, and one published by Mr. Brown, are the only other instances of "partial ovariotomy" yet on record, it is desirable that the profession should communicate the results of their experience in this important operation. Bruton, December, 1853.
no
IODIDE OF POTASSIUM IN LEAD POISONING. BY J. R.
j
NICHOLSON, M.D. IN the Britist, and Foreiya Medical Review for January appears a translation, by Dr. Budd, of M. Melsens’ paper on the Employment of Iodide of Potassium as a, Remedy for Diseases caused by Lead and Mercury." A supposition had occurred to me, previous to reading that paper, that the effects of these poisonous agents were caused by chemical combination with the tissues of the human body, or by being present in intimate union with those tissues in some analogous manner. The views so ably stated in the abovementioned paper show that there has been given to a similar supposition the form of a definite theory, on the grounds of which M. Melsens has conducted some successful experiments. If the theory be correct,—and it is borne out by the fact that lead and mercury havebeen obtained from the body after "
conclusion is death,-the must be curative
self-evident that the action of the
directed to the conversion of the agent poisonous agent intoa compound having less affinity for those tissues, and therefore readily eliminated from the body.
M. Melsens has shown that iodide of potassium possesses the requisite conditions to become a curative agcnt in these diseases according to this theory, and several examples are given in Dr. Budd’s paper of its effect in mercurial poisoning. The following case shows it is not less efficacious in cases of lead
poisoning. It is not only the successful result, but the comparative rarity of such cases which has determined us to forward
this case for insertion:— P. R--, a house-painter, aged thirty-nve, presented himself to me March 6th, 1853. He was then suffering from of partial paralysis of the left forearm, and occasional fitskeel colic of a very distressing nature. He stated that he
recently passed,
seen.
It will be observed that the symptoms, general and local, those of that form of renal disease termed by Payer " Chronic Nephritis," but that there is an important difference in the character of the urine. In treating of this " chronic nephritis," Dr. Christison states (" Lib. of Med.," vol. iv. contains blood or albumen, p. 270) " that the urine very seldom unless other renal diseases concur."" However, of that form of renal disease now under notice, blood-globules have been invariably contained in the urine, but could only be detected with certainty by the microscope. Liability to passive renal hmmorrhage appears to be either constitutional or acquired. Persons constitutionally predisposed are those of lax fibre, fair complexion, with skin soft and supple, easily excited to action, but as readily depressed: persons of a tuberculous tendency, prone to affections of the mucous membranes, as catarrh, bronchitis, diarrhoea, &c., whose arterial system is in that state which may be termed irritable. Such a constitution appears, as it were, acquired by two other classes, who are specially prone to this hæmaturia—viz., those who are in the habit of consuming large quantities of diluent fluids, as haymakers, reapers, engineers, stokers, bleachers, tenters, dressers, and spinners in cotton-mills-persons who, after exciting great cutaneous action by severe manual labour, or by working in a high artificial temperature, check the same by exposure to a much cooler atmosphere after the cessation of their daily employment. The habitual dram-drinker is most prone to the acute form of Bright’s disease, or to that stage which probably supervenes upon this-viz., that in which the urine is of low specific gravity, and contains free albumen. May not the frequent use of spirits, from their direct action upon the kidneys, by over-stimulating the organs," produce this hæmachronic albuminous turias which may ultimately pass on to nephritis" ? It may be observed, that of several cases of "passive renal haemorrhage’’ which have occurred in the practice of the writer, not one could, as far as the patient’s recollection served, be traced to any dropsical affection, are
or remote. The average age of the persons affected was above thirtyfive years; they were chiefly of the male sex, probably on account of the greater exposure of males to the predisposing and exciting causes, which latter appeared, as far as they were traceable, to be exposure to cold, damp air when in a state of perspiration, frequent use of diuretic spirituous liquors-in fact, any circumstances which, depressing the heat of the body, produced congestion of the viscera. The Patlaology of the Disease.-The presence of blood in the urine affords ample proof of the existence of haemorrhage from some part of the genito-urinary passages, the state in which the blood-discs are found, the inadequacy of chemical re-agents to detect them, the occasional c3,sts of uriniferous tubes, and the natural colour of the urine, indicate that the haemorrhage is renal, yet not of an activekind. But the comparativee paucity of the globules discharged would lead to the conclusion that the kidneys are not suffering from any organic lesions, but from an unbalanced state of their circulation. This state of venous engorgement may probably exist for some time without any structural change in the glands themselves, but unless relieved, it is apparent that exudation will ultimately occur, and derange the whole action of these excernant organs. The actual progress of this haematuria into chronic albuminous
proximate
has not been traced, nephritis is which this
of of
checking,
paper if not of
the remedies used in the cases, had the effect
general history, having curing the hæmorrhage. a
The therapeutical indications are three in number. First, to check the haemorrhage by reheving the congestion ; secondly, to restore the general health; thirdly, to guard against relapse, and this is an important point, as there is a great tendency thereto upon the application of any exciting cause. The first indication may be effected by rest, daily use of the warm bath, with friction to the bodily surface, local depletion, abstinence from diuretic drinks, bland farinaceous diet, and the use of astringent remedies. To relieve the gastro-hepatic derangement, a small quantity of blue-pill, with a sedative saline draught, will be found useful at intervals during the exhibition of astringent remedies, the best of which is gallic acid. It has been given in the following form:—Gallic acid, a drachm; dilute hydrochloric acid, two drachms; solution of hydrochlorate of morphia, (E. P.,) one drachm; distilled water, five ounces and a half, as a mixture; a tablespoonful to be taken every fourth hour. The therapeutical effects of gallic acid are well described by Dr. Golding Bird:—" Gallic acid acts as a direct astringent, reaching the renal capillaries, and finding its way into the urine, which becomes strongly charged with To relieve the irritability of the bladder, tive grains it, &c." of soap-and-opium pill should be used every night as a suppository. These medicines should be continued until the hæmorrhage ceases, and the vesical irritability which remains for some time after the cessation of the haemorrhage, is relieved by tincture of cantharides, in doses of from ten to twenty drops, combined with an anodyne. When the urine is free from blooddiscs, the general hygienic rules for restoring tone to the system should be enforced; animal diet, with a few glasses of sherry daily, may be allowed, and quinine with iron prescribed. As preventive measures, the warm bath with friction should be daily persisted in; flannel should be worn next the skin, and all exposure to exciting causes studiously avoided.
Park-road, Chorley, January,
1854.
REPORT OF
A
CASE OF PARTIAL OVARIOTOMY, IN WHICH THE PATIENT SURVIVED THE OPERATION FOUR MONTHS.
CROUCH, F.R.C.S., Bruton, Somerset. MRs. B-, a widow, aged fifty-seven, of sallow complexion BY JOHN
and unhealthy appearance, had conducted for several years the business of a confectioner. She was the mother of three children, and her habits were those of an active and industrious tradeswoman. Very early rising, long continuance in the erect posture, and considerable exertion in her occupation, at the time of the cessation of the menses, were the predisposing causes of her disease. Five years since, she first consulted me respecting a swelling in the left groin. The tumour was the size of a large cocoanut, of a tirm, unyielding character, and was considered to be an enlargement of the left ovary. She underwent a long course of diuretics, iodine, and mercury, and "pressure’’ was applied, without any sensible effect. About two years after the above treatment, this swelling suddenly disappeared, which the patient attributed to drinking acid cider. In the autumn of 1851 she discovered another enlargement, which commenced in the right groin. I was not consulted on this occasion till the abdomen had become as large as that of a woman in the last stage of pregnancy. The circumference of the bowels was nearly forty inches, and fluctuation was perceptible over their whole surface. After taking a short course of alteratives and diuretics, she was tapped on the 13th of June, 1852. Two gallons of a coffee-coloured fluid. which yielded a large proportion of albumen, were drawn off. On examining the bowels after the operation, a hard, immovable substance was found in the right iliac region. Although great temporary benefit was experienced from the tapping, the fluid soon collected again, and at the end of fivee weeks she was so distressed by the accumulation as to earnestly ’, request that something further should be done for her relief. As she had been informed that a patient on whom I had successfully operated in lb49 had suffered from a similar disease, it was necessary to explain that, in the first instance, the tumour was completely extirpated, but with regard to her own case, so favourable a result was not to be expected. After fully explaining its dangers, I obtained her consent to
42 following operation, which is nearly similar to that first other recovered without a single adverse symptom. No dispractised by Mr. Wilson, of Bristol. It took place on the 13th charge ever took place from the wound, although a large porof August, 1852. Having marked with the tincture of iodine tion of cyst had been removed, and ten arteries secured. Mrs. - one perpendicular and three transverse lines as guides to the B-’s case was a most unpromising one, and the operation operation, I made an incision of twoinches through the skin was only resorted to as a last resource. and cellular tissue about an inch below the navel, and to the No minor operation, however, can supersede that more perright side of the mesial line. The rectus muscle and perito- fect one, by which the total eradication of the disease is innæum were then divided, and the ovarian sac carefully secured sured. Dr. Clay has kindly informed me that he has now perby ligature to the upper angle of the wound. Nine quarts of formed " ovariotomy by the large incision" fifty-eight times, fluid, which had accumulated in eight weeks, were then drawn out of which number only eighteen cases proved fatal-a moroff with the trocar. The cyst was very thick and vascular, tality not exceeding that attendant on hernia, amputation, and adherent to the surrounding structures in every direction. and lithotomy. I extracted a portion three inches in length, and after applying It is satisfactory to find that the leading men of the profesMr. Wilson’s ingenious tourniquet, excised with a large pair sion have not all set their faces against the performance of of scissors a part the size of a crown-piece. Nofewer than ovariotomy. Mr. Fergusson, in the last edition of his excelseventeen small arteries required the application of a fine lent " System of Practical Surgery," says, " Ovariotomy is not ligature silk. In this part of the operation I was very ably only justiJhble, but, in reality, in happily selected cases, an assisted by Mr. T. G. Stockwell and Mr. C. J. Morris. Both admirable proceeding." The late Mr. Aston Key, in the ends of the seventeen ligatures having been cut off, the re- " Guy’s Hospital Reports" for October, 1843, writes as folmaining portion of the cyst was returned into the abdomen, lows :-" If the constitution of the ovarian patient be unafand the outer incision closed with three sutures and adhesive fected by the disease, her nervous system tranquil, and the plaster. The patient was then placed in bed, and forty drops arterial action free from inflammatory tendency, I cannot see of laudanum were administered. any objection to submitting such to the operation." Mr. She passed the first four days after the operation without a Druitt, whose ’’ Manual of Modern Surgery" stands pre-emisingle untoward symptom, having been free from fever, nent as a work of talent and research, makes the following observations in his sixth edition :-" In favour of ovariotomy, it haemorrhage, and peritonitis. On the fifth the wound was dressed, and the external liga- may be argued—1st, that the mortality arising from this is not tures removed. The outer incision had nearly healed, and the greater than that from many other surgical operations ; 2ndly,. bowels acted on this day without the aid of medicine. that no other plan of treatment can effect a radical cure, but I On the seventh, a tympanitic state of the abdomen was first that by this, women relieved of a burden which made life miobserved. This arose from the formation of gas in the ovarian serable, havemarried and borne children ; 3rdly, that if favourable cases only were submitted to the operation, the sac, and was unattended by any symptom of peritonitis. On the fourteenth the cyst became fully distended, and the mortality would be very small, and that increase of experience upper angle of the wound giving way, a large quantity of fostid will lead to the selection and discrimination of favourable cases;. air and matter escaped. 4thly, that if the surgeon, in order to complete his diagnosis. From this time it was necessary to treat the case as one of makes a small incision, to ascertain the existence of adhesions, the
chronic abscess. The sides of the sac were now drawn together with compress and bandage, and nourishment in every form freely given. For the first few days after, the discharge wass ! very considerable and offed-sive, but by the end of August it began to diminish, and the appetite to improve. The cyst was now daily syringed with a pint of warm water, to which was frequently added a drachm of the tincture of iodine, or the same quantity of the sulphate of zinc. By the end of October the matter became more healthy, and the quantity, instead of amounting to ten or twelve ounces, was reduced to three or four, night and morning. She continued slowly to improve, and the cyst had so far contracted that its cavity, which at the operation contained nine quarts, was now only capable of holding a few ounces. A bed-sore, which at first was troublesome, had now completely healed, thus proving the increased vitality of the system. Her death, however, took place suddenly on the 13th of December, sixteen weeks after the operation, and when she was about to partake of a substantial meal. The post-mortem examination proved that matter had escaped from the cyst into the peritoneal cavity, and the solid part of the tumour showed evident traces of cancerous deposit. The left ovary appeared healthv, aud only slightly enlarged. The uterus had a small fibrous tumour imbedded in its substance. The other viscera were not examined. The portion of cyst that was excised at the operation, and which has been preservecl in strong acetic acid, measures more than a quarter of an inch in thickness. Remarks.—Notwithstanding the fatal termination of the case, the above operation was so far successful that there is every reason to believe the result would have been favourable had the patient’s general health been good, and free from specific disease. Therecan, I think, be little doubt that her life was prolonged by the means employed. It is most desirable that, in addition to the dangerous and formidable operation of complete extirpation, we should possess, in the treatment of ovarian disease, some remedy more efficient than those usually adopted. I allude to diuretics, iodine, pressnre by tight bandaging, issues, setons; subcutaneous sections, and tapping. Dr. Tanner’s proposal of tying the pedicle of the cyst is not included in the above list, because experience is required to test its value. Partial ovariotomy, by quickly and effectually destroying the entirety of the cyst, offers the best substitute for the major operation" in all proper cases, where the total extraction of the tumour cannot be effected. Of three cases treated in this way by Mr. Wilson, one wasrestored to health in three weeks, after the formation of a gmall abscesg near the incision, and an-
and closes it again with suture, if he find this to be the case, great harm is likely to result; in fact, this, which is sometimes raked up as an opprobrium against operators, is a prudent and legitimate measure. Lastly, that it is by far the most merciful plan of treatment, if adopted early, in patients otherwise healthy, with a still growing but non-adherent tumour. In conclusion I would remark, that as Mr. Wilson’s three cases, and one published by Mr. Brown, are the only other instances of "partial ovariotomy" yet on record, it is desirable that the profession should communicate the results of their experience in this important operation. Bruton, December, 1853.
no
IODIDE OF POTASSIUM IN LEAD POISONING. BY J. R.
j
NICHOLSON, M.D. IN the Britist, and Foreiya Medical Review for January appears a translation, by Dr. Budd, of M. Melsens’ paper on the Employment of Iodide of Potassium as a, Remedy for Diseases caused by Lead and Mercury." A supposition had occurred to me, previous to reading that paper, that the effects of these poisonous agents were caused by chemical combination with the tissues of the human body, or by being present in intimate union with those tissues in some analogous manner. The views so ably stated in the abovementioned paper show that there has been given to a similar supposition the form of a definite theory, on the grounds of which M. Melsens has conducted some successful experiments. If the theory be correct,—and it is borne out by the fact that lead and mercury havebeen obtained from the body after "
conclusion is death,-the must be curative
self-evident that the action of the
directed to the conversion of the agent poisonous agent intoa compound having less affinity for those tissues, and therefore readily eliminated from the body.
M. Melsens has shown that iodide of potassium possesses the requisite conditions to become a curative agcnt in these diseases according to this theory, and several examples are given in Dr. Budd’s paper of its effect in mercurial poisoning. The following case shows it is not less efficacious in cases of lead
poisoning. It is not only the successful result, but the comparative rarity of such cases which has determined us to forward
this case for insertion:— P. R--, a house-painter, aged thirty-nve, presented himself to me March 6th, 1853. He was then suffering from of partial paralysis of the left forearm, and occasional fitskeel colic of a very distressing nature. He stated that he