File:Interstate medical journal (1919) (14783973973).jpg

Identifier: interstatemedica2619unse (find matches)
Title: Interstate medical journal
Year: 1919 (1910s)
Authors:
Subjects: Medicine
Publisher: St. Louis, : Interstate Medical Journal
Contributing Library: The College of Physicians of Philadelphia Historical Medical Library
Digitizing Sponsor: The College of Physicians of Philadelphia and the National Endowment for the Humanities

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. The ab-domen was flat on percussion, and fluctuation was easily felt. Avery large ovarian cyst was diagnosed, and its removal was ad-vised. The advice was taken under consideration, but declined.She claimed afterward that an elderly physician in the neighborhoodadvised her not to have it removed because the fatty layer of theabdominal wall would probably not heal. As she did not want arunning sore the remainder of her life, she declined an operation. 102 INTERSTATE MEDICAL JOURNAL I saw the patient again on September 18, 1917, or twelve yearsafterward. She was addicted to the use of morphine, and took largequantities each day. She was then 52 years old, and had ceased tomenstruate at 42. After menstruation ceased, the tumor did notget any larger, but gradually sagged down until it hung down overthe thighs and extended to the knees (Figs. 1, 2). The umbilicuscannot be seen in the picture because it was on the lower end ofthe mass. It seemed as if there had been more stretching of the
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Fig. 1.—Before operation. Side view. abdominal wall between the umbilicus and the costal margin thanbetween the umbilicus and the symphysis, but this may have beenmore apparent than real. I am sorry that I had not heard the paperof McLean1 at the time of the operation, so that I could have deter-mined whether the stretching of the abdominal wall was just belowthe semi-lunar folds of Douglas, as he claims it always is in pen- 1The Extreme Pendulous Abdomen and Its Surgical Treatment by a NewThree-Flap Operation. Neil John McLean (Western Surgical Association Trans-actions, page 49). Collins: Large Ovarian Cyst 103 dulous abdomens. Of course, this was an unusual case of pen-dulous abdomen. She also had a goiter, which can be seen in thepicture. It had now been twenty-five years since the patient had firstnoticed the tumor, and she was tired of carrying it and was willingto have it removed. While we expected dense adhesions, the removalof the large tumor would probably not present very

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