Presentation of Post-Operative 
Sequelae and how they 
favor Mortality. 
BY 
Joseph Price, M. D., 
PHILADELPHIA. 
REPRINTED FROM THE 
American Gynaecological and Obstetrical Journal 
for May, 1896. [Reprinted from the American Gynaecological and Obstetrical Journal 
for May, 1896.] 
PRESENTATION OF POST-OPERATIVE SEQUELAE AND 
HOW THEY FAVOR MORTALITY.* 
Joseph Price, M. D., Philadelphia. 
It would be difficult to settle the relative merits of some of our 
gynaecological operations by statistics ; but few operators give every 
patient the one remaining chance for her life, refusing nothing. A 
good number of operators select their patients and operations most 
carefully, excluding some on the ground that their general condition, 
heart, kidneys, or lungs are faulty, and that they will not bear an op- 
eration ; second, that the trouble is malignant or too adherent or 
complicated by visceral attachments. These are the cases that they 
do not even attempt. In the next group they explore by abdominal 
or vaginal incisions or punctures by trocar or aspirator, and again de- 
clare them inoperable—only proper subjects for palliative methods of 
treatment. It is to the last group of cases I desire to particularly 
call your attention. 
We all know how common it is for these patients to drift from one 
operator to another. About all these patients continue to suffer and 
demand radical measures at the hands of some one else. The opera- 
tor, willing and capable of completing these operations, finds them 
thrice more complicated than the same class of troubles before in- 
cision or puncture—the patients exhausted from prolonged drainage, 
septic from imperfect drainage, renal and hepatic disturbance due to 
the prolonged and neglected suppuration, shock more prominent and 
unavoidable, and due chiefly to severing anchored cicatrices at the 
seat of incision or puncture. 
Aside from shock and haemorrhage, the risks of contamination 
of viscera and wound are increased. Again, viscera lesions are multi- 
plied, their repair much more complicated and uncertain. Completed 
primary work by the suprapubic incision gives the lowest mortality, the 
* Read before the Philadelphia Obstetrical Society, March 5, 1896. 
Copyright, 1896, by J. D. Emmet, M. D Joseph Price, M. D. 
most speedy recoveries, and the fewest post-operative complications 
or sequelae. Sinuses at any point above or below, due to either igno- 
rance, neglect, or delay, are both distressing to patient and physicians 
interested ; two or more surgical efforts are necessary to cure or save. 
With this knowledge, why should we timidly and deliberately favor 
such complications in healthy, favorable subjects for complete work 
by timid operations ? Opening the abdomen, stitching abscess or 
sacs, to incision or packing around about with gauze, to incise later 
for drainage and irrigation ! The enucleation of such abscess and 
sacs is easy, safe, and sure, and if viscera is involved, careful freeing 
and repairing, if necessary, results in what we most desire—a cure. 
It would seem by some recent papers and discussions that a rever- 
sion to ancient methods of treatment had taken root at some points. 
Present efforts at the choice and selection of the so-called proper 
cases is to be condemned. It results in the neglect of many patients, 
and increases the mortality by favoring late operations in the hands 
of men willing and capable and possessing a decent surgical con- 
science. The doing of refused, incomplete, and abandoned opera- 
tions is a trying discipline to one familiar with pelvic and abdominal 
disease in its early natural history. 
Years ago the operations for pelvic disease were much easier—less 
complicated than at present. In a large group of operations in my 
own hands done very recently, about everything adjacent to the pel- 
vic inlet from appendix to sigmoid, appendix, csecum, ileum, sigmoid, 
and omentum had been strongly anchored to the underlying speci- 
mens. The last four operations, done in the last four days, were full 
of positive complications, contraindicating vaginal methods of treat- 
ment. Again, while the fixation of large pus tubes and ovarian ab- 
scess are very great, they are just the cases to demonstrate the impor- 
tance of complete methods by the suprapubic incision. All of them 
had been tinkered with for many years. It was not necessary “to 
back down ” or abandon any of them for the modern incomplete 
methods, and I unhesitatingly urge the importance of a more careful 
study of the pathology and adhesions of tubal and ovarian disease, 
the diagnosis and the simplicity of the completed suprapubic methods 
of removal. Ido this that the general practitioner may not be led 
astray and criticise us in our general disagreement in methods and 
results.