A Text-book of Diseases of WomenPenrose, Charles B. (Charles Bingham)
Science
A Text-book of Diseases of Women
Penrose, Charles B. (Charles Bingham)
Women -- Diseases
The diagnosis is usually easily made. Careful palpation and percussion
fail to reveal any pathological mass in the abdomen or any abnormal
area of dulness. In these cases the abdomen is often rendered prominent
by intestinal tympany. If any difficulty is experienced at the
examination, the woman should be etherized. If a satisfactory diagnosis
cannot be made, the case should be watched. Several cases have been
reported, and there are probably many unreported, in which no tumor was
found after the abdomen had been opened.
A fat abdominal wall or omentum has often been mistaken by the woman,
and not infrequently by the physician, for a tumor. These cases are
often obscure; indeed, all the difficulties of examination, in case a
tumor be present, are very much increased by the enormous deposits of
fat that are often present in the abdomens of women.
Careful examination, sometimes with anesthesia, and, if necessary,
prolonged watching should be practised. If a fold of the abdominal wall
be picked up between the hands, it will often show how much of the
abdominal enlargement is due to fat.
TREATMENT OF OVARIAN CYSTS.
=Tapping.=--At one time the universal method of treating cystic tumors
of the ovary was by tapping, or puncture through the abdominal wall.
Many women were subjected to this proceeding a very great number of
times, and, though not cured, were enabled to drag on a miserable
existence until death resulted from exhaustion or from some accident
to the cyst. In a few cases the cyst refilled very slowly, relief
being experienced for several years before a second tapping became
necessary. In still fewer cases the tapping seemed to be curative, the
tumor never reappearing after it had been evacuated. Such cases were
so unusual that they should have no influence whatever in determining
the method of treatment. In the great majority of instances the cyst
rapidly refilled. Sometimes the fluid accumulated with such rapidity
that evacuation became necessary every few days. Referring again to
the old records, we find a case which was tapped 664 times in thirteen
years--once in about seven days!
If the cyst were multilocular, tapping furnished but partial relief.
The proceeding itself was attended by serious dangers. Dr. Fock of
Berlin in 1856 stated that 25 out of 132 women--or 1 in 5½--died within
some hours or a few days after the first tapping. Another operator lost
9 out of 64 cases--or very nearly 1 in 7--within twenty-four hours
after the first tapping. The chief mortality occurred in the cases of
multilocular tumors. Tapping the unilocular tumors was attended by much
less danger.
The sources of danger from tapping were the following: hemorrhage from
puncture of a vessel in the cyst-wall; septic or other infection of the
peritoneum; and inflammation or suppuration of the cyst.
The majority of the women died in consequence of peritoneal infection.
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