There was dulness over the whole abdomen, except at the sides parallel with the lumbar spines, and a resonant band over the stomach. The greatest girth was 54 1/2 inches. By vaginal examination the cervix was found to be pulled up and obliterated;the anterior vaginal wall was bulged downward by the tumor. On May 3d abdominal section was performed. An incision eight inches long was made in the mid-line of the abdomen. A cystic tumor, formed of small cysts in its upper part and of somewhat larger ones in the lower part, was revealed. It was adherent to the abdominal wall, liver, spleen, and omentum. The adhesions were separated and the cyst tapped with a large trocar, and then the septa between the cysts were broken down with the fingers. The pedicle was rather small and was tied in the usual way, and the tumor was removed. Its seat of origin was the left ovary. The right ovary and the uterus were healthy, but poorly developed.
The tumor weighed between 80 and 90 pounds,--the patient having weighed 170 pounds on the night before the operation and 79 1/2pounds a week after the operation. Alarming symptoms of collapse were present during the night after the operation, but the patient responded to stimulation by hypodermic injections of 1/20grain of strychnin and of brandy, and after the first twenty-four hours the recovery was uninterrupted. Cullingworth thinks that the most interesting points in the case are: the age of the patient, the enormous size of the tumor, and the advice given by the surgeon who first attended the patient (insisting that no operation should be performed). This case shows anew the uselessness of tapping ovarian cysts.
In the records of enormous dropsies much material of interest is to be found, and a few of the most interesting cases on record will be cited. In the older times, when the knowledge of the etiology and pathology of dropsies was obscure, we find the records of the most extraordinary cases. Before the Royal Society, in 1746, Glass of Oxford read the report of a case of preternatural size of the abdomen, and stated that the dropsy was due to the absence of one kidney. The circumference of the abdomen was six feet four inches, and the distance from the xiphoid to the os pubis measured four feet 1/2 inch. In this remarkable case 30 gallons of fluid were drawn off from the abdomen after death. Bartholinus mentions a dropsy of 120 pounds;and Gockelius one of 180 pounds; there is recorded an instance of a dropsy of 149 pounds. There is an old record of a woman of fifty who had suffered from ascites for thirty years. She had been punctured 154 times, and each time about 20 pints were drawn off. During each of two pregnancies she was punctured three or four times; one of her children was still living. It has been said that there was a case in Paris of a person who was punctured 300 times for ascites. Scott reports a case of ascites in which 928 pints of water were drawn off in 24 successive tappings, from February, 1777, to May, 1778. Quoted by Hufeland, Van Wy mentions 1256 pounds of fluid being drawn from the abdomen of a woman in five years. Kaltschmid describes a case of ascites in which, in 12 paracenteses, 500 pounds of fluid were removed. In 1721 Morand reported two cases of ascites in one of which, by the means of 57paracenteses, 970 pounds of fluid were drawn off in twenty-two months. In the other case 1708 pounds of fluid issued in ten months. There is a record of 484 pounds of "pus" being discharged during a dropsy.
The Philosophical Transactions contain the account of a case of hydronephrosis in which there were 240 pounds of water in the sac. There are several cases on record in which ovarian dropsies have weighed over 100 pounds; and Blanchard mentions a uterine dropsy of 80 pounds.
The Ephemerides contains an account of a case of hydrocephalus in which there were 24 pounds of fluid, and similar cases have been noted.
Elliotson reports what he calls the largest quantity of pus from the liver on record. His patient was a man of thirty-eight, a victim of hydatid disease of the liver, from whom he withdrew one gallon of offensive material.
Lieutaud cites a case, reported by Blanchard, in which, in a case of hydatid disease, the stomach contained 90 pounds of fluid.
Ankylosis of the articulations, a rare and curious anomaly, has been seen in the human fetus by Richaud, Joulin, Bird, and Becourt. Ankylosis of all the joints, with muscular atrophy, gives rise to a condition that has been popularly termed "ossified man." A case of this nature is described, the patient being a raftsman, aged seventeen, who suffered with inflammatory symptoms of the right great toe, which were followed in the next ten years by progressive involvement of all the joints of the extremities, and of the vertebrae and temporo-maxillary articulations, with accompanying signs of acute articular rheumatism. At the age of thirty-one the pains had subsided, leaving him completely disabled. All the joints except the fingers and toes had become ankylosed, and from nonusage the muscles had atrophied. There were no dislocations, anesthesia, or bedsores, and the viscera were normal; there were apparently no gouty deposits, as an examination of the urine was negative.
J. R. Bass, the well-known "ossified man" of the dime museums, has been examined by many physicians, and was quite intelligent and cheerful in spite of his complete ankylosis. Figure 269represents his appearance in 1887.
