Chest complications in abdominal disease : a study in diagnosis : the first Hunterian lecture of the Hunterian Society session 1901-2 / by J. Mitchell Bruce, M.A., L.L.D., M.D., F.R.C.P.

  • Bruce, J. Mitchell (John Mitchell), 1846-1929
Date:
1902
Catalogue details

Licence: In copyright

Credit: Chest complications in abdominal disease : a study in diagnosis : the first Hunterian lecture of the Hunterian Society session 1901-2 / by J. Mitchell Bruce, M.A., L.L.D., M.D., F.R.C.P. Source: Wellcome Collection.

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    spleen was seen lying on tlie uterus. It proved to be a subserous myoma with a slender pedicle. It was not until I bad exposed the spleen that I succeeded in con¬ vincing the onlookers that the mass was really the tumour and not the spleen. On several occasions in performing splenectomy for “ wandering” spleen, I have found this viscus in the pelvis in contact with, and displacing the uterus. It must also be remembered that bias often counts for much in erroneous diagnosis. McGrraw has recorded a good instance, in which a woman in the fifth month of pregnancy complained of severe pain in the belly, which led to the detection of a “lump” in the left lumbar region. The case was seen by a gynaecologist and a surgeon in consultation and regarded as a renal tumour. Coeliotomy was performed, and the lump proved to be a sessile sub- serous fibroid weighing four pounds. It was successfully removed, and the pregnancy went to term and ended happily. A woman under my own care, four months pregnant, complained of pain due to a lump in the left iliac fossa. This was thought to be a pyosalpinx by one gynaecologist and regarded as an ovarian cyst by another; I regarded it as a sessile fibroid, and so it proved at the operation, when I was able to remove it, and the patient recovered without disturbance. Of the various signs on which reliance is placed in the diagnosis of “fibroid” the two most important are profuse menstruation and often metrorrhagia associated with a tumour incorporated with the uterus. Any condition which can produce a combination of these two signs usually renders diagnosis as uncertain as navigation in a fog. This combination is very common in diseases of the Fallopian tubes and especially in tubal pregnancy, and it comes to pass that of all pelvic swellings liable to be mis¬ taken for fibroids, pyosalpinx, gravid tubes, and mesometric pregnancy hold the first place. Quite a large number of records may be gathered from the literature of the last