A case of fibrous tumor of the uterus, accompanied with excessive haemorrhage : successfully treated by excision / by B. Fordyce Barker.

  • Barker, Fordyce, 1819-1891.
Date:
1857
Catalogue details

Licence: Public Domain Mark

Credit: A case of fibrous tumor of the uterus, accompanied with excessive haemorrhage : successfully treated by excision / by B. Fordyce Barker. 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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    would permit, I made a careful physical exploration, in order to deter- mine the exact pathological condition which had given rise to these haemorrhages. The os was found very much closed as compared with the state during the haemorrhage. The uterus was greatly hypertrophied, measuring by the sound six inches and three-fourths. The point of the sound was felt through the abdominal walls just at the umbilicus. A catheter was passed into the bladder, while the sound remained in the uterus, and by a careful manipulation, a tumor in the interior of the latter was clearly defined, commencing just above the junction of the cervix. No change of the posterior wall, except enlargement, could be detected, by a careful examination through the rectum. The diagnosis was a submucous fibrous tumor of the anterior wall of the uterus. The haemorrhages were regarded as conclusive evidence of the submucous development of the tumor. It now became an important point to deter- mine whether anything could be done to avert the danger from these recurring hsemon'hages. It was evident that she could not survive another such attack, or anything like it. Each recurrence left her less and less able to resist its effects, while the severity was constantly increas- ing, the tumor inducing a development of the vascular system and mu- cous surface of the interior wall, analogous to that which occurs in pregnancy. The possibility of removing this tumor, the source of the evil, became a matter of serious consideration, and after maturely weigh- ing the whole subject, it seemed to me not only practicable, but as the only resource which offered to prevent an inevitable fatal termination. Dr. Johnston was again called in February 9th, and the whole scheme, with the arguments pro and con, were laid before him. Dr. Johnston was satisfied as to the feasibility of the operation proposed, but he was doubtful as to the capability of the patient to endure the shock of such an operation. By his advice Dr. Mott was also consulted, but the pa- tient, from a delicacy easily understood, declined to submit to a personal examination from others, and he was only able to give an opinion on general grounds. Dr. Smith, in whose opinions she placed great confi- dence, based on a long experience of his medical tact and judgment-, advised the operation, as offering a chance for recovery which she could not otherwise have. The first step in the operation was to eff'ect a com- plete dilation of the cervix uteri, by means of compressed sponges, grad- ually increasing in size. This required twelve days before it was satis- factorily accomplished. The operation was performed on Monday, Feb. 23d, with the efficient aid of Dr. Johnston and two reliable nurses, and Dr. Charles A. Budd,