Although comparatively simple, this operation should only be undertaken with the proper precautions. The bladder should previously be evacuated in order as much as possible to avoid the danger of puncturing this organ. The patient may be placed on her side, near the edge of the bed; or more conveniently, in some cases where it is possible, sitting on the edge of the bed. The abdomen should be supported by a bandage enough to cover the space between the superior border of the mons Veneris and the inferior margin of the epigastrium; but not too broad, since it might thus impede the respiration. The bandage should be divided at each end, to within a few inches of its centre, into three or four strips, which are to be interlaced as they cross each other behind. As assistant is to be placed on each side of the patient; the one on the left side holding in his hands the extremities of the bandage, which passed from the right side (behind) to the left; the one on the right side holding in his hands the extremities, which passed from the left side (behind) to the right. In this manner firm and uniform pressure may be exerted upon the abdomen, which will at the same time promote the discharge of the fluid and sustain the patient; preventing the feeling of faintness, which would otherwise follow from the sudden deprivation of the accustomed pressure of the tumor on the internal organs.
Preparation having thus been made to protect and sustain the patient, a couple of basins should be at hand to receive the fluid as it flows from the opening; and buckets or even a tub should be placed convenient for emptying the basins. It will be found best to have two basins, one to replace the other as it is being emptied. A third assistant will be useful to attend to these. Should the patient show signs of faintness or dyspnoea, the flow may be checked, by placing the finger upon the canula, until she feels better.
All things being ready, the exact point for introducing the instrument is determined and marked by a slit in the bandage. The instrument is the throat: “holding this firmly in the right hand, with the thumb and index finger resting upon the canula, the surgeon plunges it into the linea alba, about three inches above the pubis, and by a steady forcible pressure, pushed it through the abdominal walls. “When the tumor occupies the side of the abdomen, care must be taken into puncture it external to the course of the epigastric artery, otherwise this vessel might be wounded, and the patient die of hemorrhage. When the tapping is performed in the multilocular variety of dropsy, the puncture should be made in the most prominent and fluctuating part of the tumor. If one eyes does not yield the requisite supply, another is opened, an eye being always had to the situation of the epigastric artery. –Gross.
It is well to introduce the trocar with the handle a little depressed, and the point looking upward; thus the superior integument will from a sort of valvular covering over the wound, and tend to prevent the intrusion of air.
The subsequent treatment requires that the patient remain quiet to prevent peritoneal inflammation; the abdomen being firmly compressed by means of a thickly folded cloth and a broad bandage. Some cases are reported in which this operation has been repeatedly performed; on each occasion drawing off as much of the fluid as would readily flow; sometimes three or four pails full; and this during a course of years. But this constant drain upon the system sooner or later wears it out, and the patient finally perishes of exhaustion.
Apis m. Stinging pains, like bee-stings; sometimes lancinating pains. Absence of thirst. Scanty urine. The dropsical effusion may be trifling and merely local; or the patient may be completely anasarcous and enormously swollen; the skin is usually white and almost transparent. The bowels are often very costive, with large, hard, difficult passages, which Apis also cures.
Arsen. a. The swelling may be small or enormous, and the patient completely anasarcous. The pains are burning, as a characteristic indication. Thirst, for but little water and often. Water is apt to disagree.
China. If the dropsy is developed from the loss of fluids.
Iodium. In strumous habits, of the expectoration or leucorrhoea corrode the linen, both of which phenomena sometimes actually take place.
See also, Dropsy of the Uterus.
CALCULI OF THE OVARIES. See Inflammation of the Ovaries.
CYSTS OF THE OVARIES. See Ovarian Dropsy.
HERNIA OF THE OVARIES. See Prolapsus Uteri.
TUBERCLES OF THE OVARIES. See Inflammation.
