REPORT 
OF TWO CASES OF 
OVARIOTOMY. 
By 8. 8. TODD, M. D., Kansas City, Mo. 
PROFESSOR OF OBSTETRICS, AND DISEASES OF 
WOMEN, IN THE KANSAS CITY COLLEGE 
OF PHYSICIANS AND SURGE GB 
[Reprint hom the St. Louis Mbd. and 3urg. Journal, for AuousTlsWrf- 
VV, P. Kremer, Printer, 816 N. 8th St., St. Louis, Mo. REPORT 
OF TWO CASES OF 
OVARIOTOMY. 
Br S. 8. TODD, M. D., Kansas City, Mo. 
Professor of Obstetrics, and Diseases of Women, in the Kansas City College of 
Physicians and Surgeons. 
Mrs. M. E. B., of Carroll County Mo., was brought to 
me by her husband for treatment, March 17th 1876. 
The patient was 30 years of age, had been married 
thirteen years, and had never been pregnant. The his- 
tory of the case further shows that Mrs. B. had always 
lived a quiet country life; that she had suffered from dys- 
menorrhoea from the first appearance of the catamenia, 
at the age of fifteen, to the present time; but with this 
exception, and an occasional attack of ague with which 
the locality of her home abounded, she had always enjoy- 
ed a pretty fair state of health till about one year and a 
half ago. 
Five years ago she noticed for the first time an ab- 
dominal fullness, which she ascribed to pregnancy. She 
did not remember that this enlargement was greater on 
one side than the other. Gradually the abdominal cav- 
ity became distended, through a period of five years, oc- 2 
casioning however, little pain or inconvenience of any 
sort, except that caused during the past eighteen months 
hy mechanical pressure, and impaired function of the 
viscera involved. Meantime the menses had continued 
to recur with regularity, as to time, quality and quantity, 
save in a few instances where the interval has "been pro- 
longed to five or six weeks. A menstrual period had 
just passed at the time of making her visit. Nothing in 
her history gave evidence of an hereditary tendency to 
the formation of adventitious growths of any kind. She 
had never had any anasarca. No exploratory examina- 
tion had ever been made, nor had she been subjected to 
any surgical treatment, and but little medication of any 
sort directed to the relief of her present condition. 
Mrs. B. was of slender form in health, with a weight of 
about one hundred pounds ; had light hair and a fair 
complexion, but was now sallow, with a dry skin, and 
much emaciated. An inspection of the abdomen showed 
enormous and uniform distension, and a girth at the um- 
bilicus of 38 inches ; dullness everywhere except deep in 
the lumbar regions ; parietes thin, and veins of the ab- 
dominal walls moderately enlarged, with a fluctuation 
remarkably distinct at all points save in the left hypo- 
chondriac and lumbar regions. No aortic impulse was 
perceptible ; crepitus was not to be heard, and the glid- 
ing movement of the tumor upon the walls of the abdo- 
men, felt when the tumor is free, was scarcely, if at all 
discernible. 
Vaginal examination revealed the uterus high, almost 
beyond reach of the linger, deflected to the left, but mo- 
bile, with os and cervix normal. The sound confirmed 
the supposition in regard to the deflection of the uterine 
■axis, and showed a depth of cavity of three inches. No 
sense of fluctuation could be had from the vagina. The 
functions of the urinary organs had never been but 
slightly disturbed, and, with the exception of some little 
trouble from incontinence, were now in healthy exercise. 3 
The urine though not critically examined appeared to 
be normal. The tongue was clean, the appetite fair, no 
thirst; some flatulence, and the bowels regular. Breath- 
ing was being much impeded, and there had been con- 
siderable coughing, but without expectoration. Sleep 
had been but little interfered with, pulse 90 regular and 
soft. 
With little doubt as to the result of the procedure a 
few drachms of the contents of the sac were removed by 
aspiration, and the fluid found to be viscid, dark colored,, 
and highly albuminous. The disease was pronounced to 
be a monocystic tumor of the right ovary, with adhesions, 
a short pedicle probably, and co-existing hypertrophy of 
the spleen. • The patient was rapidly passing into a 
state of cholaemia and spanaemia that boded no good, 
but she was cheerful, tractable, hopeful, and all things 
considered the case appeared to be one favorable for an 
operation. An immediate operation was therefore at 
once decided upon. Her menses were expected to return 
about the 8th proximo. 
After a few days of preparatory treatment, and await- 
ing a favorable change in the weather, the operation was 
performed on April 3d, Drs. Taylor, Schauffler, Lester and 
Porter, assisting. Chloroform was administered, and an 
exploratory incision of an inch and a half having given 
positive assurance of the presence of an ovarian sac, with 
firm parietal attachments, the incision was lengthened to 
seven inches. On now introducing the hand it was found 
that the entire extent of the tumor in front was adherent 
by innumerable small bands, and immovably fixed to the 
front and sides of the abdominal walls. The most of 
these yielded readily to the fingers and without much 
bleeding, but some of them were broken up with difficul- 
ty and bled freely. Having detached the tumor as far as 
the fingers could reach, the sac was partly emptied by 
the removal of about three gallons of dark amber-color- 
ed fluid, of the consistency of thin molasses, after which 4 
the trocar was removed and the opening into the sac tied 
with a stout ligature. 
On attempting to drag the now diminished bulk of the 
tumor through the abdominal wound, it was found to be 
strongly adherent to the left abdominal wall and behind 
by a band of three or four inches in width, and of consid- 
erable thickness, springing from a point of the sac oppo- 
site what was afterwards ascertained to be a mass of 
small cysts contained in the parent-cyst. This was di- 
vided with the scissors and the sac rolled out of its bed. 
The tumor was quite vascular on its sides, and behind, 
and the pedicle very broad and short-too short for 
the clamp. Each half of this ill defined pedicle was tied 
very tightly with astrong silk ligature, one end cut short 
and the remaining end of each brought out at- the lower 
angle of the wound. The sac was now cut away and the 
stump dropped back into its place. Not a drop of the 
contents of the sac had entered the peritoneal cavity. 
The other ovary was examined and found to be healthy ; 
so too of the uterus, the spleen and other abdominal vis- 
cera so far as could be determined. 
No bleeding occured from the pedicle stump, but a 
good deal of oozing continued from ruptured vessels, re- 
quiring the wound to be kept open for half an hour, or 
more. The only bleeding vessel demanding ligation, 
however, was one in the wound of abdominal incision. 
After the lapse of considerable time it being unsafe to con- 
tinue anesthesia longer, the cavity was made as clean 
and dry as possible, and, though oozing of blood still 
continued from many points, the abdominal wound was 
closed, with thirteen silver wire sutures. It was deemed 
imperative,however,that drainage should be provided for, 
and before closing the opening completely a Thomas' 
drainage tube was inserted deeply into the recto-uterine 
cul-de-sac and brought out beside the ligatures in the 
lower part of the wound. Long strips of adhesive plas- 
ter were now applied, a strip of greased muslin covered 5 
the wound longitudinally, and the whole was surmount- 
ed with a compress and tightly fitting bandage. 
The tumor on examination proved to be polycystic. 
The quantity of fluid contained in the main cyst was 
thirty six pints; it also contained within its walls a poly- 
cystic mass weighing three pounds, which, with the 
weight of the sac-two pounds, made the weight of the 
entire tumor about forty-two pounds. The polycystic 
mass spoken of was composed of from fifteen to twenty 
small cysts, varying in size from a pigeon's to a goose's 
egg, filled with a dense colloid substance of extreme 
viscidity. Two or three of the largest of these contained 
within their cavities smaller cysts of the third order. This 
mass was situated on the upper and left lateral aspect of 
the tumor, projecting inwards, and was that which, before 
an opening was made, had been mistaken for an hyper- 
trophy of the spleen. 
The patient rallied well in an hour after the conclusion 
of the operation but suffered much from nausea during 
the night following and for three or four days thereafter, 
-due, no doubt, in part to the anaesthetic, but mainly to 
opium, of which,unfortunately,she had great intolerance, 
but which had been freely used in conjunction with qui- 
nia for the first three days after the operation. The opi- 
um having been suspended, and the patient allowed 
pounded ice, iced champagne, soda-water, etc. at will, the 
nausea ceased and she was able to take food with relish 
on the fourth day. 
On the morning of the second day three or four ounces 
of bloody serum escaped through the drainage tube. 
From this time to the 12th day, at which time the drain- 
age tube was wholly withdrawn, the peritoneal cavity 
was thoroughly washed out twice a day through this 
tube with a weak solution of carbolic acid (one grain to 
the ounce) and common salt, in water at blood heat. 
From being sero-sanguinolent at the first, the discharge 
through the tube soon became purulent, and so continued 6 
in constantly diminishing quantity till tlie ligatures of 
the pedicle had come away, on the 28th day, by which 
time the opening left after removal of the drainage tube 
had nearly closed. 
On the fourth day after the operation the catamenia 
appeared and lasted two days. On the 11th day I re- 
moved four of the sutures and on the 12th day the re- 
mainder, when the abdominal incision was found to be 
firmly united throughout. On the 19th day I had evi- 
dence of perforation of the rectum ; intestinal gases es- 
caped through the opening for drainage, and pus passed 
per rectum and so continued at intervals for three or four 
weeks longer. The patient's appetite and strength con- 
tinued to improve, and on the 51st day she left for her 
home, her complete recovery seeming to be well assured. 
Such however was not the result to follow. She never re- 
covered her normal blood condition, but after a time grew 
more anaemic, the yellow hue of the skin remaining to 
the last. So the alluring hope of my patient's complete 
recovery was one day rudely dispelled by a letter from 
the husband informing me that his wife was dead. Gas- 
tric and hepatic disease, induced by long disturbance of 
function, had accomplished the work, nearly six months 
after the operation. 
The desperate character of this case will be more ap- 
parent when I say that after the fifth, there was no suc- 
ceeding'day up to the close of the sixth week when the 
temperature,-taken in the mouth, fell below 100° or 
the pulse below 110, or when respiration fell short of 
21 inspirations to the the minute. The average temper- 
ature from the 5th to the 42d day, taken at 6 p. m., was 
102 1-6 ° and the average pulse for the same period 122. 
This protracted exaltation of temperature, pulse, and 
respiration was no doubt caused by a circumscribed 
peritonitis, a slight degree of septicaemia, and exhaustion 
from long-continued purulent discharge incident to sep- 
aration of the ligatures of the pedicle. A point worth 7 
noting in this case was the invariable fall of pulse and 
temperature that instantly followed the intra-peritoneal 
injection of antiseptic washes,-a fall in the mercury of 
from one-half to one degree, and of the pulse from five to 
ten beats per minute, within half an hour, being observ- 
ed on several occasions. The power of a combination of 
quinia and salicylic acid to produce similar results was 
scarcely less marked. 
Case II. On June 30th 1876, I was called'to visit the 
wife of C. K. Warren, of Wheeling, Livingston county, 
Mo., who was reported by her physicians to be suffering 
from an ovarian tumor. 
Mrs. Bettie Warren was a native of Kentucky, but 
had spent most of her life in Missouri ; she was the wife 
of a farmer, to whom she had been married twelve years, 
and was now thirty-two years of age. She had never in 
her life menstruated nor conceived; the only recogniz- 
able efforts at menstruation ever noted being on two 
occasions, at long intervals, when after the administra- 
tion of drugs for the purpose of inducing it a very slight 
sanguineous discharge made its appearance for the mo- 
ment, and speedily disappeared. No cause could be 
assigned for the non-establishment of this function, nor 
did its absence seem to influence in any degree her gen- 
eral condition, which, till within a comparatively recent 
period, was that of almost uninterrupted health. 
A few months after her marriage, or, to be more precise, 
eleven and a half years previous to the date of my visit, 
she noticed for the first time a fullness in the hypogas- 
tric region, but does not remember that the swelling 
when first seen inclined more towards one side than the 
other. 
From that time to the date of my examination the 
swelling constantly and slowly increased, occasioning 
however but little pain or inconvenience of any sort 
and in no way interfering much with her comfort till 
about one year prior to this examination. Since that 8 
time the enlargement has gone on rapidly, and though 
never at any time suffering from any acute attack, or 
febrile symptoms that might be referred to the growing 
tumor, much discomfort has been felt because of her un- 
wieldly bulk and the pressure to which the pelvic, ab- 
dominal, and thoracic viscera were being subjected. 
Further inquiry into the personal history of Mrs. W. 
showed that she had always been a person of active 
habit of body, and cheerful disposition of mind; that she 
had come of a healthy ancestry, leaving no room to sup- 
pose that there existed any constitutional vice, or deriv- 
ed tendency to the formation of adventitious growths. 
Mrs. W. had been tapped about twenty days before 
my visit by Dr. McArthur, of Chillicothe, and Dr. Edger- 
ton, of Wheeling, her regular physician, and about one 
gallon of dark-colored fluid removed, when the flow ceas- 
ed. Tne tapping gave considerable relief to the patient, 
but did not materially diminish the bulk of the tumor, 
causing rather a depression only in the right umbilico- 
hypogastric region , while the swelling at other points re- 
mained much as before the operation. The tumor, which 
had been recognized as ovarian, was hitherto believed 
to be a monocyst, because of its slow growth, the regulari- 
ty of its contour, and distinctness of fluctuation, but it 
was now made manifest to the operators that the tumor 
was a polycyst, and that one cyst only had been emptied 
by the trocar. 
This cyst had nearly re-filled at the time of my visit, 
but her general health continued good, with abundant 
capacity for sufficient bodily exercise. A thorough ex- 
ploration now made, fully confirmed the opinion already 
expressed that the tumor was a polycyst, springing, ap- 
parently, from the right ovary, and that the case was a 
good one for an operation. The patient though some- 
what emaciated was in good physical and mental con- 
dition, and the absence of inflammatory symptoms in the 
history of the case afforded evidence that adhesions, if 9 
any existed, would prove to be no serious obstacle in the 
way of success. The season of the year alone was un- 
suitable, it being mid-summer and very warm. For this 
reason it was deemed advisable to postpone an operation 
till the weather should be more favorable. In the mean- 
time the patient was counseled to continue her usual 
habits of life, availing herself of all the bodily exercise of 
which her surroundings would permit. 
In accordance with this I again visited her October 3d, 
accompanied by my colleague, Dr. Schauffler. Since 
my former visit three months had elapsed, during which 
period she had enjoyed a reasonable degree of comfort 
till towards its close when she had suffered from an oc- 
casional attack of ague, for which she had taken quinine 
and iron. Several days had passed since the last par- 
oxysm however, and I found her quite comfortable and 
cheerful,-desirous of the operation, and hopeful of the 
result. 
The cyst that had been emptied by the tapping was 
now quite refilled, while the entire bulk of the mass had 
considerably increased in volume. Vaginal touch now 
showed the uterus to be less mobile than before-high 
in the pelvis, but other wise normal in position and axis. 
Its cavity on introduction of the sound gave a depth of 
two and a half inches. The tumor could be touched by 
the finger from the anterior vaginal cul de sac., but no 
fluctuation was discernible at this point. 
The abdomen was uniformly and symmetrically en- 
larged, as if by a monocyst, and the abdominal walls 
which appeared to be thin, were checkered all over with a 
dark net-work of tortuous and enlarged veins, and could 
not be made to move upon the face of the tumor. There 
was no abdominal tenderness. The tumor was soft and 
elastic, and yielded a distinct aortic impulse on palpa- 
tion. Percussion gave a dull sound everywhere except 
in the lumbar regions, and fluctuation was very distinct 
at all points. The greatest circumference of the body 10 
was at the umbilicus, and gave a measurement of 42 
inches ; ensiform cartilage to the umbilicus 9 1-2 inches, 
and from symphysis pubis to the umbilicus 9 inches. 
Operation.-The following named medical gentlemen 
were present to assist or as spectators; Dr. E. W. 
Schauffler, of Kansas City, Drs. Edgerton and Gish, of 
Wheeling, Dr. A. S. Cloud, of Chillicothe, Dr. Theo. Fiske, 
of Mooresville, and Drs.' Rogers, Thompson and Waters, 
of Meadville. Ether was first given, but failing to get 
complete anaesthesia from this, chloroform was resorted 
to with the most gratifying results. Before commencing 
the operation all parties aiding were required to cleanse 
their hands carefully in a solution containing one drachm 
of common salt and sixteen grains of carbolic acid to the 
pintof warm water. An exploratory incision of an inch 
and a half laid bare the glistening sac and allowed of the 
introduction of the sound and finger, after which the 
wound was extended to six inches. Six or eight ounces 
of ascitic fluid escaped when the peritoneal cavity was 
opened. An examination now showed numerous small 
bands of parietal attachment covering the entire anterior 
face and sides of the tumor which were separated with 
the fingers, one only requiring the use of the scissors. 
Before proceeding further about one-half of the fluid 
contents of the sac was removed, the trocar first entering 
the cyst drained at the former tapping; and successively 
through their partitions two other cysts of large size were 
partially emptied, when the opening made by the trocar 
was closed with a strong ligature. Making traction after 
this, it was soon apparent that the omentum, which over- 
lapped the upper anterior aspect of the tumor, was ad- 
herent for a considerable breadth of space, preventing 
further descent of the remaining mass. In breaking up 
this adhesion the omentum was torn for a distance of two 
or three inches, but the bleeding was trifling and ceased 
after a few minutes, exposure to the air. There were no 
pelvic adhesions, so after detaching the tumor at a few 11 
more remaining poirts on its lateral walls it was easily 
dragged through the abdominal opening. In doing this 
however the ligature that commanded the opening made 
by the trocar, and which had not been drawn quite close 
enough, came off, and some ounces of the fluid escaped 
into the peritoneal cavity. The pedicle, which sprang 
from the folds of the right broad ligament, and which I 
had thought would be found short, was of good length, 
moderate size, and was readily embraced in a Dawson's 
clamp and fastened in the lower extremity of the wound. 
The left ovary was examined and found to be healthy.' 
The mass was now cut away and search made for bleed- 
ing vessels. 
The only vessel tied during the operation was a small 
one in the line of the abdominal wound, compression or 
torsion sufficing for the rest, except that a continuous 
oozing of blood was being kept up from the torn vessels 
at the points where adhesions had been ruptured. For 
this cause the wound was kept open for twenty or thirty 
minutes longer, in an atmosphere of about 70 ° at the 
end of which time the bleeding ceased ; the peritoneal 
cavity was thoroughly cleansed with sponges dipped in 
the solution before mentioned, and afterwards made as 
dry as possible with the softest sponges wrung from the 
same. 
All risk of further bleeding having been as far as pos- 
sible removed, the line of incision was closed by twelve 
silver sutures, the lower two closely and accurately em- 
bracing the pedicle, one on either side, hermetically clos- 
ing the wound from one extremity to the other. A nar- 
row slip of muslin smeared with simple cerate was now 
laid longitudinally over the line of incision, after which 
the body was encircled with strips of adhesive plaster 
and the whole covered with a soft pad and flannel band- 
age. It was now four o'clock p. M. and the patient had 
been on the operating table more than an hour. She 
slept for half an hour after being put to bed, and awoke 12 
as if from natural sleep, but feeling some nausea. Be- 
fore commencing the anaesthesia the temperature (by the 
mouth) was found to be 100° and the pulse 108. At 8 
p. m., four hours after the operation, the pulse had risen 
to 132. At 9 p. M. I gave her half a grain of morphia. 
This the stomach rejected soon after, when the dose was 
repeated, and retained, and a tolerably comfortable night 
for the patient followed. 
On the morning of the second day the nausea had in a. 
great measure ceased, and she took some breakfast. 
Capsules containing, each, sulphate of quinine five grains 
and opium one grain, were given morning and evening, 
and under the direction of Dr. W. W. Edgerton, to 
whom the case was now entrusted, were thus continued 
to the 13th inst. The bowels had been freely moved on 
the day before the operation with castor oil, followed at 
night by an opiate, but from that time till the 14th, elev- 
en days after the operation, no movement of the bowels 
had been permitted. On the eleventh day a free evacu- 
ation was had with an enema. From the history of the 
case after the second day, with two registers daily of 
the pulse, temperature and respiration, I am indebted 
to Dr. Edgerton, and it is to his watchfulness and skill 
that much of the ultimate success of the operation must 
be attributed. 
At 4 o'clock on the morning of the second day the 
pulse showed 120, temperature 100. 50 °, respiration 
20. At 8 p. m., same day, pulse 118, temperature 102 ° 
respiration 14. On the third day, at 8 a. m., the pulse 
showed 114, temperature 101. 50°, respiration 15. 
Same day at 8p. m., pulse 114, temperature 102, respira- 
tion 15. After this there was daily almost uniform de- 
clension of the pulse and and increased frequency of 
respiration, with a temperature ranging from 99. 50 ° 
to 100. 50°, up to the tenth day. On the tenth day 
at 8 p. M,. the pulse was 100, the thermometer marked 
102. 50 °, and respiration 17. This was the highest 13 
temperature reached at any time during the illness, 
and from this date a steady declension of pulse and 
temperature followed. 
One half of the abdominal sutures were removed on 
the fifth day, and the remaining ones on the seventh 
day. The clamp came away on the twelfth day. On 
the nineteenth day she left her bed for the first time, and 
on the twenty-eighth day rode a mile into the country. 
In a letter from her husband, dated June 7th, 1877, he 
writes me that her health is better than ever before in 
her life. 
The tumor on examination proved to be composed 
mainly of three large cysts, as before stated, filled with 
a highly albuminous, dark, coffee-colored fluid of the 
consistence of milk, and more than a dozen smaller cysts,, 
some of them no larger than a grape, filled with a thick 
colloid substance that could hardly be made to flow. 
The fluid contents of the three principal cysts measured 
fifty-two pints, and the sac, with the contents of the 
smaller cysts weighed five pounds. The weight of the- 
entire mass was about fifty-seven pounds.