anomalies and curiosities of medicine-第196部分

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tient；　a　woman　of　thirty…eight；　five　feet　5　1/2　inches　in　height；　coarse；　with　masculine　features；　having　hair　on　her　upper　lip　and　chin；　and　weighing　199　1/2　pounds；　was　found　in　a　poor…house　in　Trenton；　Missouri；　on　November　26；　1890；　suffering　from　a　colossal　growth　of　the　abdomen。　The　accompanying　illustration　is　from　a　photograph　which　was　taken　at　the　time　of　the　first　interview。　The　measurements　made　at　the　time　were　as　follows：　circumference　at　the　largest　part；　just　below　the　umbilicus；　50　inches；　circumference　just　below　the　mammae；　35　inches；　from　the　xiphoid　cartilage　to　the　symphysis　pubis；　32　inches；　not　including　the　appendum；　which　is　shown　in　the　picture。　Percussion　suggested　a　fluid　within　a　sac。　The　uterus　was　drawn　up　to　the　extent　of　from　12　to　14　inches。　The　woman　walked　with　great　difficulty　and　with　a　waddling　gait；　bending　far　backward　the　better　to　keep　〃the　center　of　gravity　within　the　base；〃　and　to　enable　her　to　sustain　the　enormous　weight　of　the　abdomen。　She　was　compelled　to　pass　her　urine　while　standing。　Attempts　had　been　made　six　and　two　years　before　to　tap　this　woman；　but　only　a　few　drops　of　blood　followed　several　thrusts　of　a　large　trocar。　A　diagnosis　was　made　of　multilocular　ovarian　cyst　or　edematous　myoma　of　the　uterus；　and　on　the　morning　of　December　7；　1890；　an　operation　was　performed。　An　incision　14　inches　in　length　was　first　made　in　the　linea　alba；　below　the　umbilicus；　and　afterward　extended　up　to　the　xiphoid　cartilage。　The　hemorrhage　from　the　abdominal　wall　was　very　free；　and　the　enormously　distended　vessels　required　the　application　of　a　large　number　of　pressure…forceps。　Adhesions　were　found　almost　everywhere　the　most　difficult　to　manage　being　those　of　the　liver　and　diaphragm。　The　broad　ligaments　and　Fallopian　tubes　were　ligated　on　either　side；　the　tumor　turned　out；　the　thick；　heavy　pedicle　transfixed　and　ligated；　and　the　enormous　growth　cut　away。　After　operation　the　woman　was　immediately　placed　on　platform　scales；　and　it　was　found　that　she　had　lost　93　1/2　pounds。　Unfortunately　the　patient　developed　symptoms　of　septicemia　and　died　on　the　fifth　day。　In　looking　over　the　literature　on　this　subject　McIntyre　found　no　mention　of　any　solid　tumor　of　this　size　having　been　removed。　On　April　18；　1881；　Keith；　late　of　Edinburgh；　now　of　London；　successfully　removed　an　edematous　myoma；　together　with　the　uterus；　which　was　42　pounds　in　weight。　In　a　recent　work　Tait　remarks　that　the　largest　uterine　myoma　which　he　ever　removed　weighed　68　pounds；　and　adds　that　it　grew　after　the　menopause。　McIntyre　believes　that　his　tumor；　weighing　93　1/2　pounds；　is　the　largest　yet　reported。　Eastman　reports　the　removal　of　a　fibroid　tumor　of　the　uterus　weighing　60　pounds。　The　patient　recovered　from　the　operation。

It　is　quite　possible　for　a　fibrocyst　of　the　uterus　to　attain　an　enormous　size；　equaling　the　ovarian　cysts。　Stockard　describes　an　instance　of　this　nature　in　a　negress　of　fifty；　the　mother　of　several　children。　About　twelve　years　before　a　cyst　in　the　right　iliac　region　was　tapped。　The　woman　presented　the　following　appearance：　The　navel　hung　below　her　knees；　and　the　skin　near　the　umbilicus　resembled　that　of　an　elephant。　The　abdomen　in　its　largest　circumference　measured　68　inches；　and　27　inches　from　the　ensiform　cartilage　to　the　umbilicus。　The　umbilicus　was　five　inches　in　diameter　and　three　inches　in　length。　Eight　gallons　and　seven　pints　of　fluid　were　removed　by　tapping；　much　remaining。　The　whole　tumor　weighed　135　pounds。　Death　from　exhaustion　followed　on　the　sixth　day　after　the　tapping。

Ovarian　cysts；　of　which　by　far　the　greater　number　are　of　the　glandular　variety；　form　extremely　large　tumors；　ovarian　dropsies　of　enormous　dimensions　are　recorded　repeatedly　throughout　medical　literature。　Among　the　older　writers　Ford　mentions　an　instance　of　ovarian　dropsy　from　which；　by　repeated　operations；　2786　pints　of　water　were　drawn。　Martineau　describes　a　remarkable　case　of　twenty…five　years'　duration；　in　which　80　paracenteses　were　performed　and　6630　pints　of　fluid　were　withdrawn。　In　one　year　alone　495　pints　were　withdrawn。　Tozzetti　mentions　an　ovarian　tumor　weighing　150　pounds。　Morand　speaks　of　an　ovarian　cyst　from　which；　in　ten　months；　427　pounds　of　fluid　were　withdrawn。　There　are　old　records　of　tubal　cysts　weighing　over　100　pounds。　Normand　speaks　of　an　ovary　degenerating　into　a　scirrhous　mass　weighing　55　pounds。　Among　recent　operations　Briddon　describes　the　removal　of　an　ovarian　cyst　which　weighed　152　pounds；　death　resulting。　Helmuth　mentions　an　ovarian　cyst　from　which；　in　12　tappings；　559　pounds　of　fluid　were　withdrawn。　Delivery　was　effected　by　instrumental　aid。　The　tumor　of　70　pounds　was　removed　and　death　followed。　McGillicuddy　mentions　a　case　of　ovarian　cyst　containing　132　pounds　of　fluid。　The　patient　was　a　woman　of　twenty…eight　whose　abdomen　at　the　umbilicus　measured　69　inches　in　circumference　and　47　inches　from　the　sternum　to　the　pubes。　Before　the　operation　the　great　tumor　hung　down　as　far　as　the　knees；　the　abdominal　wall　chafing　the　thighs。　Figure　263　shows　the　appearance　of　a　large　ovarian　cyst　weighing　149　pounds。　The　emaciation　of　the　subject　is　particularly　noticeable。　Reifsnyder　describes　a　native　Chinese　woman　affected　with　an　ovarian　tumor　seen　at　the　Margaret　Williamson　Hospital　at　Shanghai。　She　was　four　feet　eight　inches　in　height；　and　twenty…five　years　of　age。　The　tumor　had　been　growing　for　six　years　until　the　circumference　at　the　umbilicus　measured　five　feet　7　3/4　inches；　88　quarts　of　fluid　were　drawn　off　and　the　woman　recovered。　In　the　College　of　Physicians；　Philadelphia；　there　are　photographs　of　this　case；　with　an　inscription　saying　that　the　patient　was　a　young　Chinese　woman　who　measured　but　four　feet　eight　inches　in　height；　while　her　girth　was　increased　by　an　ovarian　cyst　to　five　feet　9　1/8　inches。　The　tumor　was　removed　and　weighed　182　1/2　pounds；　it　contained　22　gallons　of　fluid。　Figure　265　shows　the　appearance　of　the　woman　two　months　after　the　operation；　when　the　girth　was　reduced　to　normal。　Stone　performed　ovariotomy　on　a　girl　of　fifteen；　removing　a　tumor　weighing　81　1/2　pounds。　Ranney　speaks　of　the　successful　removal　of　a　unilocular　tumor　weighing　95　pounds；　and　Wall　tells　of　a　death　after　removal　of　an　ovarian　tumor　of　the　same　weight。　Rodenstein　portrays　the　appearance　of　a　patient　of　forty…five　after　death　from　an　enormous　glandular　ovarian　cystoma。　The　tumor　was　three　feet　high；　covered　the　breasts；　extended　to　the　knees；　and　weighed　146　pounds。　Kelly　speaks　of　a　cyst　weighing　116　pounds；　Keith　one　of　89　1/2　pounds；　Gregory；　80　pounds；　Boerstler；　65　pounds；　Bixby；　70　pounds；　and　Alston　a　tumor　of　70　pounds　removed　in　the　second　operation　of　ovariotomy。

Dayot　reports　the　removal　of　an　enormous　ovarian　cyst　from　a　girl　of　seventeen。　The　tumor　had　been　present　three　years；　but　the　patient　and　her　family　refused　an　operation　until　the　size　of　the　tumor　alarmed　them。　Its　largest　circumference　was　five　feet　11　inches。　The　distance　from　the　xiphoid　to　the　symphysis　pubis　was　three　feet。　The　tumor　was　covered　with　veins　the　size　of　the　little　finger。　The　apex　of　the　heart　was　pushed　to　the　3d　interspace　and　the　umbilicus　had　disappeared。　There　were　65　quarts　of　a　thick；　brown　fluid　in。　the　tumor。　The　patient　recovered　in　twenty…five　days。

Cullingworth　of　St。　Thomas　Hospital；　London；　successfully　removed　from　a　girl　of　sixteen　an　ovarian　cyst　weighing　over　80　pounds。　The　patient　was　admitted　to　the　hospital　April　30；　1895。　She　gave　a　history　of　a　single　menstruation；　which　took　place　in　March　or　April；　1893；　and　said　that　in　the　latter　month　she　noticed　that　she　was　growing　large。　She　was　tapped　at　Christmas；　1893；　when　a　large　quantity　of　fluid　was　removed；　and　again　in　February；　1894；　and　a　third　time　in　May；　1894；　but　without　useful　results。　For　the　previous　six　months　she　had　been　almost　entirely　bedridden　because　of　the　great　size　of　the　tumor。　There　were　no　symptoms　referring　to　the　bladder　and　rectum。　At　the　time　she　entered　the　hospital　she　was　much　emaciated；　the　eyes　were　sunken；　and　her　cheeks　had　a　livid　hue。　The　chest　was　thin　and　the　lower　ribs　were　everted；　dulness　began　at　the　lower　border　of　the　3d　cartilage；　and　the　apex…beat　was　best　felt　in　the　third　space。　Liver…dulness　began　at　the　4th　rib　cartilage　in　the　nipple　line。　The　abdomen　was　enormously　distended；　and　covered　by　large　veins　running　from　below　upward　to　the　thorax。　About　3　1/2　inches　above　the　umbilicus　there　was　a　sulcus　with　its　convexity　downward。　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　1/2　pounds　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　1/20　grain　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　ol