A Year's Work in Abdominal Surgery 
WITH A REPORT OF SEVERY NINE 
LAPAROTOMIES DONE IN 1887 
BY 
W. GILL WYLIE, M.D. 
NEW YORK 
Reprinted from The Medical Record, March 31, 1888 
NEW YORK 
TROW'S PRINTING AND BOOKBINDING CO. 
201-213 East Twelfth Street 
1888 A YEAR'S WORK IN ABDOMINAL SURGERY, 
WITH A REPORT OF SEVENTY NINE LAP- 
AROTOMIES DONE IN 1887.1 
By W. GILL WYLIE, M.D 
NEW YORK. 
Reprinted, from The Medical. Record, March 31, 1888. 
At the last annual meeting of this Society I reported one 
hundred and twenty-five laparotomies, fifty-five of which 
had been done in the year 1886. I wish to put on record 
all of my cases of abdominal section, with an accurate 
account of the results, and to show that since we have 
learned the importance of cleanliness, and how to attain it, 
very great progress has been made; and although open- 
ing the peritoneum should always be considered a serious 
undertaking, yet when carefully done it is not a very dan- 
gerous operation, and its field of usefulness can be greatly 
extended and many lives saved when all other means are 
of no avail. 
I have now to report seventy-nine laparotomies done 
during the past year under the following heads. 
Suprapubic Hysterectomies. -/Eight cases, all for 
uterine fibromata. Seven- recovered and one died. This 
one was complicated by syphilitic pyosalpinx. 
Ovariotomies. //Sixteen were for large ovarian tumors, 
j^urteea- recovered and one died. Death was due to an 
acute interstitial nephritis, starting up on a chronic diffuse 
nephritis, the former being caused by the ether. 
1 Read before the New York State Medical Society, February 7, 
1888. 2 
Laparotomies for Removal of the Uterine Append- 
ages.-Forty-one laparotomies were done. Forty recov- 
ered and one died. The autopsy showed chronic and 
beginning of acute interstitial nephritis. /$ 
Miscellaneous Laparotomies.-Fifteen were done. 
Nine recovered and six died. In many of these the op- 
eration was done as a last resort, and with little chance of 
success. Of the six that died, the first was for a large 
septic pelvic abscess, with the patient very weak from pro- 
longed septic peritonitis. Two efforts had been made to 
reach the pus by the vagina, with very imperfect results. 
Patient died of shock. 
The second was a case of abdominal pregnancy, done 
out of town, on a patient too weak from prolonged sepsis 
to be moved. She died of shock. 
The third was an extreme case of ascites, complicated 
by a large umbilical hernia, which was on the point of 
suppurating. There was a cirrhosed liver and diseased 
kidneys. She died of exhaustion on the seventh day. 
The fourth was a case of strangulated hernia in a very 
fat woman. There was stercoraceous vomiting, but her 
general condition was good. The mistake was made in 
giving ether. During the operation she vomited once, 
but the strangulated gut was relieved without difficulty, 
and the operation completed. She came out from ether, 
talked, and seemed in fair condition, but again vomited, 
choked, and died in a few minutes. 
The fifth was the saddest of all. A fine, healthy woman 
had an abortion; on the third day puerperal sepsis devel- 
oped. On the fourth day of the disease I was called in 
consultation. Intra-uterine douches had not been tried; 
they were given every hour through the night; her 
temperature fell from 1045° to normal the next morn- 
ing- 
The family physician hardly thought another consultation 
necessary, but in eight hours her temperature was 1040. 
I saw her and advised laparotomy, but it was deferred 
until her condition was hopeless; pulse, 150; tempera- 3 
ture, 1'05^°. She was literally soaked with sepsis. The 
abdomen was opened, and more than a pint of pus 
was emptied at once. She rallied well, but it was too 
late. 
In puerperal sepsis which threatens life, if washing out 
the uterus every hour with solution i to 60 carbolic acid 
does not control the temperature, and if no lymphangitis 
or phlebitis or septic abscess can be found in the broad 
ligaments to be opened and washed out, then laparotomy 
should be done at once. 
The sixth was another case of a splendid woman lost by 
delay. The case had been seen by Dr. A. Jacobi and Dr. 
E. L. Keyes, and diagnosed as pyelonephritis, and opera- 
tion advised. When I saw her she was in a very feeble 
state, due to septic perinephritic abscess. This I opened 
freely and drained. More than a pint of pus was evacu- 
ated, and the index finger came in contact with a distend- 
ed kidney; this was punctured, and a large amount of 
pus escaped. A calculus could be felt, but the patient 
was too feeble to warrant any attempt at removal. She 
rallied well, and for a week improved, but soon began to 
fail. Nephrectomy was then done, but she died from ex- 
haustion on the sixth day. An attempt was made to re- 
move the stones through the old opening, but it could not 
be done. 
This was my third case of nephrectomy; the other two 
are alive, and in good health. Except in a certain num- 
ber of cases, such as septic perinephritic abscesses, I would 
always elect to remove the kidney by abdominal section. 
When diseased and requiring operation, it is nearly always 
enlarged, and when enlarged, is pushed forward. In my 
two first cases, one reported in my paper referred to, and 
the other-the fourth-in the table of miscellaneous, there 
was no shock, and the operation was no more difficult than 
the removal of any deep-seated abdominal tumor. 
The Results of Operations for Removal of the 
Uterine Appendages for Disease.-Taking all the 
cases that I have operated upon for removal of the ap- 4 
pendages, up to January i, 1888, there are 115 in number 
with 6 deaths: In the first 25 there were 3 deaths; in 
the second 25 there were.2 deaths; in the third 25 there 
were no deaths; in the fourth 25 there were no deaths. 
And I had a run of 61 consecutive operations without a 
death. 
It seems to me that we have proved that it is not a very 
dangerous operation, so far as loss of life is concerned. 
Now as to the results on the health and life of the patient 
afterward. 
In pyosalpinx there is no reasonable doubt but that it is 
the only way that any real relief can be had in the great 
majority of cases, and that it actually saves lives. The 
number of women who have died from the extension of 
local peritonitis due to pyosalpinx is very much greater 
than is generally known. 
In hydrosalpinx the operation is not so imperatively 
needed, but often nothing short of removal relieves the 
pain of hydrosalpinx. It is nearly always bilateral, and as 
one tube only usually lies low enough to be tapped by the 
vagina, this operation can and should be excluded. 
In catarrhal inflammation, where the tubes are oc- 
cluded by adhesions it is only a question of time for dis- 
turbance to functions and fixation of the uterus by adhe- 
sions in the broad ligament to necessitate removal of the 
appendages to effect a cure. Where there is no occlusion 
of the tubes, except in rare cases of hydatids of the tubes 
they should not be removed unless disease of the ovaries 
or uterus makes it necessary to remove them. 
Hcematosalpinx, if uncomplicated by disease of the 
tubes or ovaries, may not require removal; but, as a rule, 
the hemorrhage is the result of disease, which necessitates 
operation. 
In tubal pregnancy, if diagnosed, or if rupture takes 
place, removal is the best treatment. If tubal pregnancy 
is complicated by disease, hemorrhage, or inflammation, 
laparotomy is frequently the only means of saving life, and 
if uncomplicated, then the operation for removal is at- 5 
tended with very little danger, and makes it certain that no 
further complication will arise. 
As to the removal of the appendages for the purposes of 
stopping the menstrual function. It is justifiable in many 
cases of fibromata of the uterus, for it will nearly always 
stop the further development of the fibromata. Not infre- 
quently the severe pains supposed to be due to the fibroids 
will be found to be caused by associated pyosalpinx. Sub- 
mucous fibromata are not always cured by removing the 
appendages, if these are diseased or adherent, and now 
and then a case of this kind will bleed and increase in size, 
although the ovaries and tubes have been carefully re- 
moved. I make it a rule to curette the lining membrane 
of the uterus in all such cases before resorting to the re- 
moval of the appendages. 
I know of no other uterine disease than fibromata that 
justifies removal of the appendages when normal, except 
perhaps some case of endometritis that cannot be helped 
by any other known treatment. Uterine hemorrhage, when 
due to disease of the uterus, can be stopped by curetting, 
if properly done, with a good steel instrument, although 
the little copper instrument so highly recommended will 
often fail to remove the tissues necessary to stop hemor- 
rhages. 
Dysmenorrhea is undoubtedly due to uterine disease, 
and in almost all cases can be readily cured by either 
dilatation or divulsion, etc.; and removal of the append- 
ages, when healthy, should never be done for uncompli- 
cated dysmenorrhoea. 
Where there is atrophy and degeneration of the uterus, 
with perversion of all the functions, and where menstrua- 
tion prostrates and makes life miserable, removal of the 
appendages may be justifiable when all other means have 
failed to give relief; but it is still doubtful whether the 
characteristic cystic ovaries nearly always found in such 
cases can be called normal. Many of these cases taken 
early can, by dilatation and other stimulating local treat- 
ment, and by proper attention to the general condition, be 6 
developed into strong and relatively healthy women; but 
when over thirty years of age, and bedridden, the operation 
for removal can do little harm, and certainly in some 
cases gives the only relief; but it rarely ever makes strong 
and vigorous women of them. 
In epilepsy, or so-called hystero-epilepsy, the operation 
for the removal of the appendages may seem for a time to 
do good, but rarely effects a cure, and, in my experience, 
in three out of four cases it did no permanent good. In 
such cases, unless I can definitely make out objective signs 
of local disease of either the ovaries or tubes, I will not 
operate. 
I can say the same for all mental diseases that seem 
to be connected with functional disturbance of the tubes 
and ovaries, that is, I will not operate unless I can diag- 
nose by the touch actual disease of the tubes or the ova- 
ries, indicated by adhesions, marked enlargement, or fixa- 
tion. There can be no doubt but that in a certain num- 
ber of cases the operation is followed by marked mental 
depression for a time, which condition would be pretty 
certain to intensify mental disease. Subinvolution of the 
uterus, after labor and abortion, is not infrequently associ- 
ated with serious mental symptoms that can be relieved 
by treatment which restores the uterus to a normal state. 
But the fact of the generative functions being disturbed 
or being abnormal in mental disease, does not necessarily 
imply disease of these organs, or that the generative organs 
have caused the mental disease. 
I have found, as the number of cases operated upon in- 
creases, that about three per cent, continue to menstru- 
ate after removal of the appendages, and I know of two 
cases where, after operation, menstruation ceased for a 
year, and then started up and has been regular ever since. 
A close investigation of these cases that continue to men- 
struate after complete removal of both ovaries and tubes 
has led me to conclude that this occurs in those where 
the adhesions are great, especially where the inflammation 
contracts and shortens the ovarian ligament, and makes it 7 
very difficult to remove the ovary and not leave more or 
less of it in the stump, or where the adhesions make it 
necessary to tear the ovary into pieces to get it out, usually 
a small part being left on the floor of the pelvis or on the 
broad ligament. I do not know of a case where the ova- 
ries and tubes, being entirely free from adhesions, have 
been removed close to the uterus in which menstruation 
returned and remained regular. 
I suppose if the tubes and ovaries were removed be- 
fore puberty, that the effect would be great in changing 
the character and nature of the woman; but when re- 
moved after full development they do not appear to have 
any marked effect on her appearance, character, or tem- 
perament in any manner whatever. 
1he use of large saline enemata during the operation, to 
make up for loss of blood and prevent shock.-In my re- 
port last year I advocated the use of hot water, at 1150 
F., poured freely into the peritoneal cavity during opera- 
tion to prevent shock. During the past year I had two 
cases of profuse bleeding during operation. In one, a 
case of hysterectomy for a large vascular fibromata, sev- 
eral large venous sinuses were torn in lifting out the 
tumor, and as it had a double source of blood supply-one 
from the uterus, the other from enormously distended 
vessels passing into the tumor from the omentum-at least 
three pints of blood were lost before both pedicles could 
be secured. Immediately an eight-ounce salt solution of 
beef peptones was injected into the rectum while I was 
operating, and the injections were repeated every twenty 
minutes till four were given. They were all retained. Al- 
though there was at first marked symptoms of shock, the 
patient quickly rallied, and three hours later all signs of 
shock had disappeared. The enemata were repeated at 
longer intervals, and she made a good recovery. 
The object of the hot saline injections was not merely 
to stimulate reaction or to nourish the patient, but have the 
hot saline solution absorbed and take the place in the cir- 
culation of the volume of blood lost. It is surprising how 8 
much the rectum will absorb under such conditions. I 
have had the opportunity to test this treatment in two for- 
midable cases, and I now propose to give large eight- to ten- 
ounce hot saline enemata during and immediately after lap- 
arotomy or surgical operations, to prevent shock and take 
the place of transfusion whenever loss of blood indicates their 
use. 
Summary of Statistics.-Of the 204 laparotomies no 
were private cases with 12 deaths, but 6 of the 12 were 
in extreme cases under the head of miscellaneous. Tak- 
ing ovariotomies, removal of appendages for disease, and 
hysterectomies, there were six deaths-five in the first 50, 
and only one in the second 50 cases. 
In the 94 cases done in Bellevue Hospital there were 
nine deaths-seven in the first 44, and only two in the last 
50 cases, and both of these had chronic Bright's disease, 
rendered active by the ether or operation. As no cases 
have been refused operation where there was the least 
chance of saving life, either in or out of the hospital, it 
is plain that our methods of operating have greatly im- 
proved. Table I.-Removal op the Uterine Appendages. 
<5 
rt 
d 
z 
I 
2 
3 
4 
5 
6 
7 
8 
9 
IO 
ii 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
- 
23 
24 
25 
26 
27 
28 
29 
30 
c 
.2 
GJ 
O fl 
°o 
0 u 
£ 
Hospital.. 
Hospital.. 
Private... 
Private... 
Hospital.. 
Hospital.. 
Hospital.. 
Hospital.. 
Hospital.. 
Private... 
Hospital.. 
Private... 
Private... 
Hospital.. 
Private... 
Private... 
Hospital.. 
Private... 
Private... 
Private... 
Hospital.. 
Private... 
Private... 
Private... 
Private... 
Hospital.. 
Private... 
Private... 
Hospital.. 
Private., 
Date. 
1887. 
Jan. 24... 
Jan. 31... 
Feb. 19... 
Feb. 23... 
Feb. 24... 
Feb. 28... 
March 5.. 
March 5.. 
March 7.. 
March 30. 
April 2... 
April 9... 
April 13.. 
April 16.. 
April 30.. 
May 5... 
May 28... 
May 30... 
May 30... 
June 11... 
June 11... 
June 20... 
June 20... 
June 25... 
June 30... 
July 26... 
July 30... 
Sept. 14.. 
Sept. 15.. 
Sept. 18.. 
Age. 
Years. 
36 
45 
35 
26 
35 
24 
24 
29 
32 
23 
20 
37 
3° 
22 
32 
30 
19 
40 
26 
29 
3° 
29 
36 
26 
28 
29 
23 
27 
d 
'Ko 
.S 
•a 
*S 
•c 
& 
§ 
w. 
M. 
M. 
M. 
W. 
M. 
M. 
M. 
W. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
M. 
S. 
M. 
M. 
M. 
M. 
S. 
M. 
S. 
M. 
M. 
M. 
M. 
S 
2 
X 
0 
0 
0 
is 
2 
1 
1 
1 
1 
1 
2 
4 
2 
3 
2 
I 
I 
I 
2 
•• i z z z w z : : : z z z : z : : z : : « : w : | No. of abortions. 
tn 
.s 
a 
0 
6 
No. 
No. 
No. 
No. 
No. 
Diagnosis. 
Salpingitis and ovari- 
tis. 
Salpingitis, ovaritis.. 
Salpingitis and ovari- 
tis. 
Cystic ovaries, salpin- 
gitis ? 
Uterine fibroids, pyo- 
salpingitis. 
Ovaritis and salpin- 
gitis. 
Pyosalpingitis and 
ovaritis. 
Salpingitis or disease 
of ovaries. 
Uterine fibroid 
Pyosalpingitis and 
ovaritis. 
Ovaritis and salpin- 
gitis. 
Fibroids 
Ovaritis 
Ovaritis and salpin- 
gitis. 
Fibroid tumor of the 
uterus complicated 
by salpingitis and 
ovaritis. 
Pyosalpingitis and 
cystic degenerated 
ovaries. 
Uterine fibromata 
and cystic ovary. 
Cystic ovaries 
H y s t e r 0 -epilepsy ; 
small ovarian t u- 
mor. 
U terine fibromata... 
Ovaritis, salpingitis, 
and fibroid. 
Enlarged sensitive 
ovaries. 
Salpingitis and ovari- 
tis. 
Fibroid of uterus and 
ovarian neuralgia. 
Fibromata 
Ovaritis and salpin 
gitis. 
Peritoneal adhesions 
fixing uterus back- 
w a r d, obstructing 
rectum; ovaritis. 
Old p.ritoneal adhe- 
sions fixing uterus 
backward and ob- 
structing rectum. 
Ovaritis and pyosal- 
pingitis. 
Fibromata 
Operation. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Removal of ap- 
pendages on 
left. 
Complete r e - 
moval of ap- 
pendages. 
Complete re- 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Removal of 
left tube and 
ovary. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e 
moval of ap- 
pendages. 
Lap arotomy; 
separation of 
adhesions. 
Separation 0 f 
adhesions, of 
appendages, 
and uterus. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
p e n d a ges ; 
curetting. 
V 
fl 
.s 
'fl 
Q 
No. 
Yes. 
No. 
No. 
Yes. 
No. 
Yes. 
No. 
No. 
Yes. 
No. 
No. 
No. 
Yes. 
No. 
No. 
No. 
No. 
No. 
No. 
Yes. 
No. 
No. 
No. 
Yes. 
No. 
No. 
Yes. 
Yes. 
No. 
Results. 
Recovery 
Recovery 
Recovered 
without bad 
symptom. 
Recovered 
without bad 
symptom. 
Recovery 
Recovery .... 
Recovered 
without trou- 
ble. 
Recovered 
without bad 
symptom. 
Recovery 
Recovered.... 
Recovery 
Recovered; no 
trouble. 
Recovered; no 
trouble. 
Recovery 
Recovered ; no 
trouble. 
Recovered ; no 
trouble. 
Recovery 
Recovered; no 
trouble. 
Recovery 
Recovery 
Recovery 
Recovered; no 
trouble. 
Recovered.... 
Recovered.... 
Recovered.... 
Recovery.. .. 
Recovered.... 
Recovered.... 
Recovery 
Recovered.... 
Remarks. 
Has had severe pain in back and left iliac region for four 
years, making her totally unfit for work; cystic ovaries 
and catarrhal salpingitis. 
History of peritonitis after miscarriage. Intestines very ad- 
herent to uterus and its appendages. Tubes occluded and 
much thickened, ovaries both very adherent. 
Had symptoms of repeated attacks of local peritonitis, and 
bed-ridden for three years. 
Both ovaries enlarged and prolapsed. Has always had dys- 
menorrhoea, which became worse after the birth of her 
child, so that she spends much time in bed. 
Small fibroids on left side, posterior and anterior walls. 
Right tube contained pus. Both ovaries and left tube in- 
flamed. 
Left ovary cystic, size small orange; tube also enlarged and 
inflamed; right side normal. 
Both tubes enlarged, firmly adherent. Ovaries cystic, and 
rolled up in broad ligaments. 
Small fibroid on uterus, and left ovary enlarged and very 
hard, having undergone fibroid degeneration. Intense lo- 
cal pain since miscarriage. Could not stand local treat- 
ment. 
For several years suffered greatly with pains in pelvis and 
thighs, and profuse and irregular hemorrhage. Fibroid 
in posterior wall. 
Tubes occluded and strongly adherent with the ovaries and 
broad ligaments. Ovaries undergoing suppurative inflam- 
mation. 
Severe pain in left iliac region, especially during menstru- 
ation. Left ovary bound to mesentery and had a small 
haematoma attached. 
For three years has been very feeble on account of severe 
uterine hemorrhage. Curetting was tried. 
For past four years been in bed with symptoms of repeated 
attacks of local peritonitis. Under constant treatment. 
Uterus retroverted. Ovaries prolapsed, adherent, and en- 
larged. 
After using vaginal injection, ten months ago, had symptoms 
of local peritonitis. Uterus bound down by adherent ap- 
pendages. Left ovary cystic, tubes occluded. 
Fibroid size of orange m posterior wall of uterus. Uterus, 
tubes, and ovaries matted together in bottom of pelvis. 
Tubes distended with muco-pus. Ovaries cystic. Five 
years practically in bed and under constant treatment for 
pain. Severe hemorrhages for several months. Very feeble 
condition. 
Tubes contain muco-pus, adherent and occluded ; ovaries 
adherent, and had cystic degeneration. Had worn pes- 
saries for retroversion, but without much relief. Several 
attacks of local peritonitis lately. 
Has had constant pain in left inguinal region for sixteen 
months; severer during menstruation. Has been in insane 
asylum for five months. Fibroids in anterior wall; right 
tube dilated, and ovary cystic. 
Five years bed-ridden. Several months in a hospital; had 
cervix sewed up; had become an opium eater. 
Ovarian tumor, size of orange, filled with dark, bloody fluid 
on right side. Left ovary much atrophied and hardened. 
Clear history of epileptiform convulsions monthly. 
Left tube much enlarged; ovary, size of egg; four small 
fibromata on fundus. 
Pa tient more or less unfit for work on account of pain in pel- 
vis for eight years. Uterus seemed to be about three times 
normal size from fibroid. Appendages bound down by ad- 
hesions on both sides. 
Elongated fibroid-degenerated ovaries. Severe dysmenor- 
rhoea. 
Occluded adherent tubes and cystic ovaries. 
Uterus studded with small fibroids. Constant pain for years. 
Small fibroids on ovaries also. 
Fibroid size of three and a half months' pregnancy. Enor- 
mous enlargement of veins of broad ligament. Violent hem- 
orrhages, not controlled by curetting. 
Suffered for past twelve years with pains in right iliac region, 
which have been getting worse and unbearable, with men- 
struation. Both ovaries and tubes inflamed and bound 
down, especially on right side. 
Except for adhesions, appendages apparently normal. Par- 
tial intestinal obstruction ; constant backache. 
Appendages apparently about normal, except from adhe- 
sions. 
Has had hemorrhage for a year; two months ago had severe 
pain in left iliac region, and a few days later noticed a 
lump. Left tube and ovary contained about five ounces of 
pus. Sac of abscess was very adherent, especially to rec- 
tum. Right appendages also very adherent; abdomen 
washed out with water ; temperature, ioo°. 
Ovaries twice normal size and fibroid-degenerated, having 
several small fibroids dependent from them. Fibroma in 
left cornu of uterus, of size of orange, and several smaller 
ones in posterior wall. Table I.-Continued. 
3 
operation 
armed. 
Date. 
Age. 
or single. 
.L 
c £ 
0 0 
appings. 
Diagnosis. 
Operation. 
0 
hfi 
Results. 
Remarks. 
X 
| No. of 
Where 
perf 
Marriec 
£ 
.0 
d 
* 
0 
X 
Draina 
• 
3i 
32 
33 
Hospital.. 
Hospital.. 
Hospital.. 
Private... 
Hospital.. 
Private... 
Private... 
Private... 
1887,. 
Oct. 1.... 
Oct 8.... 
Oct. 8.... 
Years. 
26 
34 
S. 
W. 
M. 
3 
Ovarian neuralgia... 
Uterine fibroids 
Cystic ovaries 
Removal of left 
of append- 
ages. 
Complete r e - 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete re- 
moval 01 
right tube 
and ovary. 
Complete re- 
moval of ap- 
pendages. 
Complete r e - 
moval of ap- 
pendages. 
Complete re- 
moval with 
abscess. 
Removal of left 
No. 
No. 
No. 
Recovery 
Recovery 
Recovery 
Ever since puberty has had more or less pain in left iliac re- 
gion, which has become worse and worse, especially during 
menstruation. Pain incapacitates her for work. Left ovary 
much atrophied. 
Painful fibromata with uterine displacement, and hemor- 
rhagia. 
Constant pain. Both ovaries atrophied and cystic. 
Left tube and ovary removed previously. Large tube oc- 
cluded ; cystic ovary size of orange, containing coffee-col- 
ored fluid. 
Multiple, irregular, and painful fibromata seven in number 
Autopsy showed no signs of sepsis or peritonitis. Kidneys 
in state of chronic interstitial nephritis. With six other 
cases was poisoned by sewer-gas after operation. 
Both tubes much enlarged, one containing about two ounces 
of pus; ovaries much inflamed and cystic ; many adhe- 
sions. 
Bed-ridden for several years. Seven attacks of peritonitis 
in two years. Abscess held fifteen ounces. 
Constant pain left side. Unable to walk without increase of 
pain. Ovary size of a duck's egg. 
Constant pain. 
Tumor size of a large orange in the right broad ligament, 
and one the size of a lemon in the left. Large abscess, 
tubes large and cheesy. 
Repeated attacks of local peritonitis-constant pain. 
34 
35 
Oct. 12... 
Oct. 15... 
29 
M. 
M. 
2 
I 
No. 
Salpingitis and en- 
larged cystic ovary 
right side. 
Uterine fibroid ; mul- 
Yes. 
No. 
Recovery 
Died 
36 
37 
38 
Oct. 23... 
Nov. 1... 
Nov. 23.. 
38 
36 
38 
M. 
M. 
S. 
3 
6 
tiple. 
Pyosalpingitis both 
sides. 
Double pyosalpinx 
and ovaritis. 
Ovaritis. Left side 
Yes. 
Yes. 
Yes. 
Recovery 
Recovery 
Recovery 
Recovered. 1.. 
39 
Hospital.. 
Private... 
Hospital.. 
Nov. 12.. 
W. 
haematocele. 
Cystic ovaritis 
ovaryand 
tube. 
Complete re- 
moval of ap- 
pendages. 
Complete re- 
moval of ap- 
pendages. 
Complete re- 
moval of ap- 
pendages. 
No. 
40 
41 
Dec. 1.... 
Dec. 12... 
:: ; r * • 
25 
46 
M. 
M. 
I 
2 
I 
4 
Double pyosalpinx ; 
ovaritis; tubercu- 
lar? 
Atrophied and adher- 
ent ovary; uterine 
fibroma. 
Yes. 
Yes. 
Recovered.... 
Recovered.... 
Table II.-Ovariotomies. 
* w w o \o oo * m O' m * • w w kI No. of case. 
a 
o 
rt -d 
u v 
1M. 
£ 
Hospital.. 
Private... 
Private... 
Private... 
Private... 
Private,.. 
Hospital.. 
Private... 
Private... 
Private... 
Private... 
Private... 
Date. 
1887. 
Jan. 22. .. 
Jan. 26... 
Feb. 23... 
March 17. 
March 21. 
April 27 .. 
May 10... 
May 21.. . 
May 30... 
July 20... 
Sept. 2i.. 
Sept. 22.. 
Age. 
Years. 
3° 
52 
26 
3i 
37 
21 
27 
21 
19 
48 
33 
57 
2 g g W w » g g g g g g I Married or sin- 
1 g>e. 
„ : | No. of children. 
: „ | No. of abortions. 
; | No. of tappings. 
Diagnosis. 
Intra- ligamentous 
cyst? 
Parovarian cyst. 
Ovarian tumor ? 
Ovarian tumor; as- 
cites. 
Ovarian tumor size 
of full-term preg- 
nancy. 
Ovaritis ? 
Osteosarcoma at- 
tached to sacrum 
size of large child's 
head fixed in pel- 
vis. 
Two elastic tumors- 
one on either side 
of pelvis. 
Small ovarian tumor, 
complicated by 
hystero-epilepsy. 
Multilocular ovarian 
tumor. 
Ovarian tumor. 
Ovarian tumor. 
Operation. 
Ovariotomy. 
Ovariotomy. 
Removal of pa- 
p i 1 lomatous 
fluid and 
material by 
laparotomy. 
0 v a r iotomy ; 
removal of 
several gal- 
lons of fluid 
and myxo- 
matous ma- 
terial. 
0 v a r iotomy ; 
both ovaries. 
0 v a r iotomy ; 
typical par- 
ovarian tu- 
mor. 
Ova r iotomy; 
solid tumor; 
sarcoma ? 
O v a r i otomy, 
c 0 mplicated 
by preg- 
nancy, fourth 
month. 
0 v a r i otomy, 
both sides. 
O v a r i otomy, 
both sides. 
O v a r iotomy ; 
p a p i 1 loma- 
10 u s sac 
had bursted; 
both ovaries 
removed. 
0 v a r i otomy, 
right side. 
6 
§ 
Q 
Yes. 
No. 
Yes. 
Yes. 
Yes. 
No. 
Yes. 
No. 
No. 
No. 
Yes. 
No. 
Results. 
Died on fourth 
day fr 0 m 
s u p pression 
of urine. 
Recovered; no 
temperature. 
Recovered ; re- 
lieved and 
improved by 
drainage. 
R e c 0 v e red ; 
much i m- 
proved by 
p er ma nent 
drainage. 
R e c 0 v e red ; 
hemorrhage. 
Recovered; no 
temperature. 
Recovered; no 
temperature. 
R e c 0 v e red ; 
without tem- 
perature; 
p r e g n ancy 
not dis- 
turbed. 
R e c 0 v e red ; 
without tem- 
perature. 
Recovered; no 
temperature. 
Recovered. 
R e c 0 v e red ; 
without tem- 
perature. 
Remarks. 
Cyst size of cocoanut imbedded in broad ligament of right 
side. Autopsy revealed chronic and acute diffused ne- 
phritis and cirrhosed liver. 
Parovarian cyst size of cocoanut was buried in right broad 
ligament. 
Greatly distended fluid from ascites due to bursting of papil- 
lomatous ovarian tumor. Omentum, intestines, etc., all 
covered with papilloma. Drained for six weeks. 
Omentum, intestines greatly enlarged by hundreds of jelly- 
like masses. Myxomatous material. 
Tumor was removed without difficulty. Drainage-tube 
showed hemorrhage three hours after operation. Patient 
collapsed and pulseless. Abdomen opened and quarts of 
clots turned out. Pedicle needle had split a vessel; re- 
tied. Patient made good recovery. 
Local peritonitis around a parovarian cyst size of duck's 
egg ; had to remove tube and ovary with it. 
Diagnosed by several as osteo-sarcoma and incurable. Pel- 
vis filled by fixed very hard solid tumor. With abdomen 
open, very difficult to dislodge; the pedicle not larger than 
thumb. No adhesion, only wedged in the pelvis. Ten 
months after Operation no signs of return. 
Ovarian tumor size of child's head. Uterus distended by 
pregnancy, fourth month. 
Clear history of epileptiform convulsions monthly. Ovarian 
tumor size of orange made out. 
Simple multilocular cyst, twenty-five pounds; some omental 
adhesions. 
Papillomatous growth had burst the sac and caused perito- 
nitis and very extensive adhesions. 
Simple multilocular cyst, twenty pounds. Sortie omental 
adhesions. 
1 
*• 
3 
1 
2 Table II.-Continued. 
No. of case. I 
Where operation 
performed. 
Date. 
Age. 
Married or sin- 
gle. 
No. of children. 
No. of abortions, j 
No. of tappings. 
Diagnosis. • 
Operation. 
Drainage. 
Results. 
Remarks. 
Hospital.. 
Private... 
Private... 
Hospital.. 
Private... 
1887. 
Years. 
43 
28 
S. 
Ovarian cyst. 
Fibroma 1 Dermoid 
O v a r i otomy, 
both ovaries. 
O variotomy, 
both sides. 
O v a r i otomy, 
Yes. 
R e c 0 v ered ; 
Simple ovarian tumor, ten pounds. Both ovaries cystic. 
High temperature due to sewer-gas poisoning. Several 
others affected by it. 
Case long standing. Much local pain. Dermoid both sides 
-one size of cocoanut. Hair, bones, etc. 
Twelve years' standing. Diagnosed as fibroma. Dermoid 
both sides-one fifteen pounds. Hair, bones, etc. Pvo- 
salpinx both sides. 
Leg oedematous. Several quarts of ascitic fluid removed. 
Dermoid cyst size of an orange, hard and rough; long 
pedicle. Hair, bone, etc. 
Bedridden for several years. Intense local pain. Cyst size 
x3 
14 
Oct. 77... 
Oct. 27... 
Nov. 28... 
Dec. 29... 
M. 
No. 
temperature, 
104°. 
Recovered ; no 
4° 
3° 
23 
M. 
cyst? 
Dermoid cyst? Fi- 
Yes. 
temperature. 
R e c 0 v e red ; 
*5 
S. 
broma ? 
Dermoid cyst; asci- 
both sides. 
Ovariotomy. 
Yes. 
slight tem- 
perature. 
R e c 0 v e red ; 
17 
S. 
tes. 
Parovarian cyst. 
O v a r i otomy, 
No. 
highest tem- 
p e r a t u r e, 
IOI^°. 
Recovered. 
both sides. 
of a large orange. 
Table III.-Suprapubic Hysterectomies. 
No. of case. | 
Where operation 
performed. 
Date. 
Age. 
Married or sin- 
gle. 
No. of children. | 
No. of abortions. | 
No. of tappings. 
Diagnosis. 
Operation. 
Drainage. 
Results. 
Remarks. 
Hospital.. 
Hospital. 
Private... 
Private... 
Hospital.. 
Private... 
Hospital.. 
1887. 
Jan. 12... 
March 19. 
May 26... 
June 6 ... 
June 6 ... 
Oct. 13... 
Oct. 15... 
Years. 
38 
28 
M. 
Painful uterine fibro- 
Hysterectomy; 
No. 
Recovered; 
Local pain and hemorrhage. Solid tumor filling pelvis and 
abdomen above umbilicus. Large fibroma, involving ute- 
rus, twenty pounds. 
Abdomen distended by a large vascular fibroma, twenty- 
three pounds. Severe hemorrhage and local pain. Im- 
mense veins attach the tumor to omentum. Pedicle in- 
volves right cornua of uterus. Ligated with silk and 
sewed in abdominal wound. 
Two tumors size of man's head, and third size of fist below 
vaginal junction. Broad ligaments and large tumorscut 
away. Small tumor enucleated. Patient size of full-term 
pregnancy before operation. 
Fibroid size of head of six-year-old child. Tubes and ovaries 
imbedded in side of tumor. Pyosalpinx. Dense adhesions. 
Pedicle through the tubes. Patient feeble. Died fourth 
day, with high temperature. No distention or sign of 
peritonitis. 
In six months tumor grew as large as eight months' preg- 
2 
3 
4 
5 
6 
7 
M. 
S. 
1 
ma. 
Uterine fibromata. 
Multiple fibromata. 
Fibroma size of a 
child's head. Old 
salpingitis syphi- 
litic. 
U terine fibroma; 
s u prapubic; 
pedicle ex- 
tra perito- 
neal. 
S u p r a p u bic 
myomotomy; 
h y s t erecto- 
my; pedicle 
extra perito- 
neal. 
S u p r a p u bic 
No. 
No. 
highest tem- 
perature, 
IOI°. 
Recovered; 
highest tem- 
perature, 
100.5°. 
Recovered; 
35 
37 
54 
34 
M. 
M. 
1 
h y s t erecto- 
my ; enucle- 
a tion of 
fi b r 0 m a ; 
pedicle ex- 
tra - perito- 
neal. 
S u p r a p u bic 
h y s t erecto- 
my; pedicle 
extra perito- 
neal. 
S u p r a p u bic 
h y s t erecto- 
my; pedicle 
secured ex- 
tra perito- 
neal. 
S u p r a p u bic 
h y s t erecto- 
• my; pedicle 
secured ex- 
tra perito- 
neal. 
S u p r a p u bic 
h y s t erecto- 
my; pedicle 
secured ex- 
tra perito- 
neal. 
No. 
No. 
no tempera- 
ture. 
Died fourth 
day of sep- 
sis. 
Recovered; 
S. 
s. 
rapid growth. 
Uterine fibromata. 
Cystic degenera- 
tion. 
Uterine fibroma. 
No. 
Yes. 
highest tem- 
p e ratu re, 
IOI°. 
Recovered; 
no tempera- 
ture. 
Recovered; 
nancy. Dragging pains. Fifteen vascular fibroma were 
removed without difficulty. 
Tumor for several years. Since menopause, two years ago, 
it has rapidly increased in size. Fibroma twenty pounds, 
involving whole uterus. Removed in centre was a cyst of 
a pint of clear straw-colored fluid. 
Abdomen as large as eight months' pregnancy. Severe 
uterine hemorrhage. Much local pain. Large, very vas- 
cular, lobulated fibroma; eighteen pounds. Extensive 
adhesion. Large sinus. Great loss of blood. Hot saline 
rectal enemata during and after operation every twenty 
minutes. Twenty ounces or more absorbed and shock pre- 
vented. 
highest tem- 
perature, 
101.2°. 
Table IV. -Laparotomies-Miscellaneous. 
No. of case. 1 
Where operation 
performed. 
Date. 
Age. 
Married or sin- 
gle. 
No. of children. 
No. of abortions. 
No. of tappings. 
Diagnosis. 
Operation. 
Drainage. 
Results. 
Remarks. • 
I 
Private... 
Private... 
1887. 
Jan. 6 
Jan. 16 
Feb. 10 
Years. 
44 
37 
M. 
M. 
1 
Small ventral hernia 
one year after sim- 
ple ovariotomy. 
Large septic pelvic 
abscess filled left 
side of pelvis. 
Abdominal p r e g - 
nancy; child had 
been killed by hypo- 
dermics of morphia 
at seven and a half 
months ; septic for 
several weeks. 
L a p a r 01 omy 
for cure of 
ventral her- 
nia. 
Lap arotomy; 
No. 
Yes. 
Recovered. 
Without 
temperature. 
Died in twenty- 
No drainage-tube. Patient very fat, and had a severe cough 
soon after the ovariotomy. 
Abscess in left side of pelvis, involving the tube, ovary, rec- 
tum, and side of uterus. Patient had septic peritonitis at 
the time of operation. 
Patient weak from sepsis of several weeks' duration. Greatly 
distended. No loss of blood during the operation. Sponges 
left in cavity by mistake. 
3 
Private... 
32 
M. 
1 
•• 
emptying 
and draining 
abscess. 
L a p a rotomy; 
foetus, placen- 
ta, and sev- 
eral quarts of 
decompos- 
ing fluid re- 
moved. 
Yes. 
six hours of 
shock and 
sepsis. 
Died in thirty- 
six hours of 
shock and 
sepsis. Table IV.-Continued. 
8 
: operation 
formed. 
Date. 
Age. 
0 . 
V 
T3 'bh 
children. 
VI 
s 
O 
•g 
O 
d 
tappings. 
Diagnosis. 
Operation. 
V 
bjo 
Results. 
Remarks. 
6 
Where 
per 
1 
d 
s 
| No. of 
| No. of 
| No. of 
G 
'd 
Q 
4 
Private... 
1887. 
March 10... 
Years. 
? 
Enlarged and dis- 
placed kidney; 
p y e 1 0 - nephritis ; 
septic attacks ; re- 
nal calculus. 
Ascitesfrom myxoma; 
peritonitis. 
Nephrectomy.. 
L a p a r 0 tomy 
and perma- 
nent drainage 
for several 
weeks. 
Lap aro tomy 
for hemor- 
rhage from 
stump after 
ovariotomy. 
H e r n i 0 t omy 
for strangu- 
lated umbili- 
cal herni 
L a p a rotomy; 
emptying 
more than a 
pint of pus, 
and washing 
and draining 
peritoneum. 
L a p a rotomy; 
breaking up 
adhesions. 
Exploratory 
laparotomy. 
Yes. 
Yes. 
Recovered; no 
shock; high- 
est tempera- 
ture, 101°. 
Recovered; no 
temperature. 
Imbedded in the calicis was an irregular, mixed, hard stone, 
100 grains. Chronic diffuse and acute nephritis ; pyelitis. 
Patient, one year after, perfectly well. 
Several months before ovariotomy had been done. One cyst 
had burst, and myxomatous matter escaped in abdomen. 
5 
Private. .. 
March 17... 
M. 
6 
Private... 
March 21... 
M. 
Collapse from hemor- 
rhage three and a 
half hours after 
ovariotomy. 
Strangulated umbili- 
cal hernia. 
Suppurative p u e r - 
peral peritonitis ; 
sepsis. 
Chronic pelvic peri- 
tonitis ; partial in- 
testinal obstruc- 
tion. 
Carcinoma of liver ?.. 
Yes. 
No. 
c 
Yes. 
No. 
No. 
Recovered.... 
Died one hour 
after opera- 
tion ; vomit- 
ed matter in 
trachea. 
Died of shock 
and sepsis 
in twenty 
hours. 
Recovered.... 
Recovered; no 
bad results 
from opera- 
tion. 
Died on fifth 
day; urae- 
mia ; s u p - 
pression. 
Not less than two quarts of clots and serum were turned out 
of the abdomen. The pedicle-needle had split a vein in the 
stump ; when held up it did not bleed. Retied. Hot 
saline douches were used to prevent death from shock. 
Very fat woman. Operation completed. Patient revived 
from ether and choked to death on stercoraceous matter. 
Septic peritonitis of several days. Temperature, 105at 
the time of operation. Inter-uterine injections failed. Lapa- 
rotomy deferred. Sepsis extreme. 
Pelvic pains and intestinal obstruction relieved. 
Cancer of liver and gall bladder. 
7 
Private... 
March 28... 
M. 
8 
9 
IO 
Private... 
Hospital.. 
Hospital.. 
April 30 .... 
May 12 
May 19 
51 
50 
M. 
M. 
M. 
I 
14 
3 
1 
II 
Private... 
May 21 
34 
M. 
Abdominal dropsy 
and large ventral 
hernia; Bright's 
disease. 
L a p a rotomy; 
removal 0 f 
fluid; closing 
hernia; drain- 
Yes. 
Contracted liver-size of hand. Ether caused acute conges- 
tion of kidneys. 
12 
Private... 
July 1 
M. 
Ascites ; myxoma ; 
peritonitis. 
Sarcoma ? 
age. 
L a p a rotomy ; 
perman ent 
drainage. 
Exploratory' in- 
cision. 
Yes. 
Recovered; 
Second time the abdomen filled with fluid. Every' organ has 
myxoma growing on it. Omentum a large solid mass. 
Sarcoma involved uterus and broad ligaments and intestines. 
Wound closed. 
13 
Private... 
Sept. 4 
50 
M. 
No. 
relieved by 
drainage. 
Recovered; no 
bad effects 
from opera- 
tion. 
Died in five 
days of sep- 
sis and ex- 
haustion. 
Recovered; no 
bad effects 
from opera- 
tion. 
»4 
15 
Private... 
Private... 
Dec. 17 
Dec. 21 
28 
23 
M. 
M. 
2 
I 
? 
I 
Renal calculi; pyelo- 
nephritis ; p e r i - 
nephritic abscess ; 
septicaemia. 
Necrosis of pelvic 
bones. 
Perityphlitic abscess. 
L a p a rotomy; 
nephrectomy. 
Exploratory in- 
cision. 
Incision and 
drainage; 
pint of fetid 
pus. 
Yes. 
No. 
Three weeks before had opened a large septic perinephritic 
abscess. Kidney enlarged; calicis filled with three large 
stones, 125 grains. Patient very weak from sepsis. 
No pelvic abscess found. Deformed pelvic bones and old 
periostitis. Wound closed. 
Private... 
Dec. 31 
37 
M.1 
\ es. 
Recove red 
without bad 
symptoms. 
days. At the time of operation no temperature, good 
pulse; bowels moved naturally. Under ether the tumor 
was felt. Nucleus came away the second week. Recovery 
complete. 
1 Male.