An address on the present position of abdominal surgery : delivered before the Medical Society of London, on April 14, 1890 / by W.A. Meredith.

  • Meredith, W.A.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: An address on the present position of abdominal surgery : delivered before the Medical Society of London, on April 14, 1890 / by W.A. Meredith. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    of the stump by uniting the edges of its peritoneal invest- ment by suture, is a very successful procedure in properly selected instances, and its further consideration need no here detain us. Removal of the uterine appendages for the arrest of Jiceniorrhage, due to growth of fibro-myomatous tumours, is an operation of undoubted efficicacy when thoroughly per- formed in suitable cases. Unfortunately, however, as already stated, complete removal of both ovaries and tubes is not always possible, in consequence either of the size or of the mode of development of uterine tumours ; and hence the necessity for resort to more radical measures under such circumstances. The chief objects to be aimed at in the performance of the operation in question are, first, to avoid puncture of any of the frequently much enlarged vessels of the pampiniform plexus; and, secondly, to ensure the complete removal of all ovarian tissue. It is not sufficient, in this latter regard, to aim merely at con- stricting the broad ligament clear of the base of the ovary, but in such close proximity thereto that some portion of ovarian tissue is perforce allowed to remain on the distal side of the ligature, when the ovary and tube are cut away. If the operator be content with this, some return of uterine haemorrhage may almost invariably, I believe, be expected to take place ; possibly becoming in time so free and per- sistent, in the case of a young and full-blooded patient, as to render subsequent resort to hysterectomy advisable. Accepting the theory of the ovarian influence as the factor in menstruation, it seems probable that the recurrence of hsemorrhage under the circumstances referred to can best be accounted for by the fact of a re-establishment of circulation in the distal portion of the pedicle, sufficient to restore and subsequently maintain the ovarian influence. Mr. Lawson Tait's views as to the importance of the tubes in connection with menstruation are well known; and there is the further theory regarding its dependence upon a special centre in relation to a nerve branch, which may or may not be destroyed by the operation. The whole sub- ject, although frequently discussed, has not as yet been definitely settled, and it is to be hoped that further light may be thrown on it in the course of the present debate. With regard to the immediate results of these operations, the mortality, in the hands of skilled operators, is extremely small, as judged by the latest published statistics in this connection.