Chest complications in abdominal disease : a study in diagnosis : the first Hunterian lecture of the Hunterian Society session 1901-2 / by J. Mitchell Bruce, M.A., L.L.D., M.D., F.R.C.P.

  • Bruce, J. Mitchell (John Mitchell), 1846-1929
Date:
1902
Catalogue details

Licence: In copyright

Credit: Chest complications in abdominal disease : a study in diagnosis : the first Hunterian lecture of the Hunterian Society session 1901-2 / by J. Mitchell Bruce, M.A., L.L.D., M.D., F.R.C.P. Source: Wellcome Collection.

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    ten years, where experienced men like Thomas Keith, Angus Macdonald, and Duncan, among others, have performed coeliotomy for the purpose of removing a suspected fibroid and have found a sequestered foetus instead, and in some of the cases the swelling has been excised and the operation completed, when a subsequent examination of the parts removed has disclosed a foetus. In spite of every care it is occasionally impossible to make an accurate diagnosis, as the following details prove : In 1897 a woman aged 38 came under my care for profuse metrorrhagia. The history and the physical signs indicated very strongly the presence of a submucous fibroid. The patient was anaesthetised and the cervical canal dilated; a large rounded mass could be felt as though a large sessile submucous myoma, embedded in the posterior wall of the uterus, was projecting into the uterine cavity. I consulted with two of my colleagues who were present at the examination as to the advisability of enucleating it. After careful examination it was regarded as a safer measure to perform abdominal hysterectomy. The patient decided to defer so serious a measure, but the bleeding continued to be so profuse during the succeeding three months that she sought relief. At the operation the supposed myoma proved to be a gravid left Fallopian tube containing a “mole” as large as a turkey’s egg. The coelomic ostium of the tube was completely occluded. The operation was followed by arrest of the metrorrhagia. The right ovary and tube were not removed, and menstruation became subsequently normal in rhythm and in quantity. This case is also significant, as it favours the view that blood effused into a Fallopian tube with an occluded coelomic ostium may escape by way of the uterus. If difficulty and doubt arise in uncomplicated cases, how great must be the risks of error when two or more conditions co-exist. Uncomplicated pregnancy is, as a rule, diagnosed with certainty, but when pregnancy occurs