Fillers One hundred years ago

Multiple operations on a single patient

BMJ 1999; 319 doi: (Published 18 September 1999) Cite this as: BMJ 1999;319:757

Sir,—The following case, reported by Mercanton, seems to throw into the shade even Mundé's remarkable performance.[1] I mention it here as an example for the prevention of the Continental furor secandi spreading among ourselves.

The patient was an unmarried peasant woman, aged 47, who had suffered from uterine prolapse for four years. For this the following operations were done—anterior colporrhaphy, with perineoplasty, Alexander's operation, excision of the portio vaginalis, and extirpation of the vaginal mucous membrane. Prolapse of the anus having supervened twelve months after the first of these operations, the actual cautery was applied to the recto-anal region. While this lesion was healing, fourteen months after admission, a hard nodule, the size of a nut, was noticed in the left breast, with enlarged axillary glands. For this the breast was extirpated and the axilla cleared sixteen months after her admission into hospital. The tumour proved to be acinous cancer. The uterine prolapse having returned, a further operation—hysteropexy— was done for it. She soon recovered, and left the hospital in good health a month later. She returned three months afterwards with a left ovarian tumour. For this laparotomy was done, and both ovaries being affected with soft cystic cancer, they were removed. A few months afterwards she left the hospital convalescent. Two and a half years later she again came under treatment with an intra-abdominal tumour of the left sacro-iliac region. Laparotomy was again performed, when the sigmoid and rectum were found embedded in a hard mass of cancerous growth, and the peritoneum was infiltrated. Under these circumstances an artificial anus was established at the abdominal wound. From the operation this poor peasant woman again recovered, but subsequently she succumbed to the disease.—I am, etc.

Clifton, Sept. 11th. W. Roger Williams. (BMJ 1899;ii:752)

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