Case of a spontaneous cure of ovarian dropsy, by means of an ulcerative opening of the cyst into the bladder / by John Hughes Bennett, M.D.

  • Bennett, John Hughes, 1812-1875.
Date:
[1849]
Catalogue details

Licence: Public Domain Mark

Credit: Case of a spontaneous cure of ovarian dropsy, by means of an ulcerative opening of the cyst into the bladder / by John Hughes Bennett, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    true nature of the case was rendered manifestj and a large swelling was detected, which was moveable to a certain extent, and presented all the characters of an encysted tumour of the left ovary. When I first examined her in the Infirmary, I found the abdomen swollen to about the size of a woman's during the sixth or seventh month of pregnancy. The tumour extended from the epigastrium to the pubes, but bulged consider- ably towards the left side. Its surface was iiTegular; and two large nodules, each the size of a cocoa-nut, existed about its centre. It was tense and firm to the feel, somewhat elastic, but no fluctuation could be detected. The tumour was firmly fixed, and the seat of constant pain, especially in the left lumbar region, which was increased by pressure, by lying on the right side, or on assuming the erect posture. The urine was of a slight yellow colour, and presented its normal characters. The digestive, respiratory, circulatory, nervous, and integumen- tary organs appeared to be healthy. She had observed the tumour seven months before her delivery ; and it has gone on gradually increasing, and been some- what painful from the first. Eight leeches icere ordered to the most painful 'part of the abdomen. For four days the patient remained in the same condition, the local pain, however, having been relieved by the leeches. On Nov. 12, my attention was directed to the urine, which now presented a copious white deposit, occupying two-fifths of the jar, while the supernatant portion was of a light amber colour, and unusually viscid. The deposit was determined by the microscope to con- sist of pus, mingled with a few compound granular corpuscles. The clear por- tion was strongly coagulable by heat and nitric acid. At first I imagined that the cyst had burst into the vagina, but the patient and nurse assured me that there was no discharge between the intervals of mic- turition, and that all the fluid came from the bladder. The urine presented the same characters during the next three days ; the amount discharged during the twenty-four hours being about three pints. On the 15th, I observed that the tumour had somewhat diminished in size, its hardness and tensity had disappeared, and distinct fluctuation was perceptible in it. A broad flannel roller was ordered to be applied firmly round the abdomen, and compression made by means of pasteboard, previously soaked and modelled to the abdominal surface. From this time, the abdomen rapidly diminished in volume, while the amount of purulent viscous fluid discharged from the bladder varied from three to five pints in the twenty-four hours. The appetite and general health continued good ; and she was ordered nutritious diet, with four ounces of wine daily. On the 23d, the amount of pus contained in the urine was greatly lessened, and the clear portion presented only a slight haziness on the addition of nitric acid. On the 27th the abdomen had regained its natural size, although a dense mass, evidently the collapsed ovarian sac, could readily be distinguished, occu- pying the left iliac and hypocondriac regions. The ui-ine now also was natural in cxuantity, and presented only a shght sediment, consisting, as shown by the microscope, of some crystals of oxalate of lime, and a few pus globules. From this period she may be said to have recovered. She suiFered occasionally from uneasy feelings on the left side, sometimes amounting to pain, which were relieved by the application of four leeches, followed by a small bhster. One of the leech bites ulcerated superficially, but soon healed up. She was dis- missed on the 18th of December, expressing herself as being well in ever^^ re- spect, having been sitting up and running about the ward for the fortnight previous. The indurated mass in the left iliac region was greatly diminished m size, but still very perceptible to the feel, though not to the eye. Remarks.—Tm history of this case can, I think, only lead to one conclusion, namely, that an ovarian encysted tumour was present on the left side; that the individual cysts had, if not altogether, at all events for the most part, broken doAvn to form one large cavity;