y/.uj \ A TABLE OF ALL THE KNOWN OPERATIONS OF OVARIOTOMY, From 1701 to 1851, COMPRISING TWO HUNDRED AND TWENTY-TWO CASES INCLUDING THEIR SYNOPTICAL HISTORY, ANALYSIS. BY J^ WASHINGTON L. ATLEE, M.D, iJj'l- PROFESSOR OF MEDICAL CHEMISTRY IN THE MEDICAL DEPARTMENT OF PENNSYLVANIA COLLEGE, PHILADELPHIA. ^y Extracted from the Transactions of the American Medical Association, for private distribution. PHILADELPHIA: T. K. AND P. G. COLLINS, PRINTERS. 1851. «*. *<; -£^A wp l?5/ \ M h-" No. OJ Oi ><*. CO to H-" O CO 00 1—' 1—' >_» l-» 1—» h-i 00 00 00 00 Date. CO h-' o o CO CD -a o © © o 3 S tr1 *i p >* B 3 O > a. 3 ft. • 0. a a. o. O sr CL a, CL ft. o a W o p o O CO 5 o 0 c o i O o o 0 © o =5 CB 3 B a. o cb' B B- >-i p_ 0 O sr pjf; CO o CO CO CO 00 CO 00 to Age. h-" ►-. Minor. B o 3' 3 1-1 M M t-1 _. h-> _ _L _ 1—' Major. _, ►_. ,_, _ ^ H-> Unknown. h-■ M Minor. a o CL H- _ Major. ^ _ ,_■ ,_. _ Unknown. Minor. 5' h-' ~ h-' Major. — Unknown. ~ H- 1—' _ Operat' n unfi nished. No tumour. CO 03 Oi C- §• H 3" tr CL a 2,3 s° ? *-< ? a glands Disease ofuteru 3 a cb a B 3-0 < a "p c a" CD o D. S'O P »- • 03 a. ? > > > t> > > 51 V, t> ^ t> s> a. o- a. CL a. a. ET sr sr sr sr 3" B 3 sr B B" m a GO CO CB GO CB CD CB CD CD CB gd o m £3 ft o c S£ 3 p s r-1. So O" CD P B n p fr^S CO o o CO O o B § S-o 0 O" a 5' B- o- Q- zz is p" » B CD *<< T P o ^ 3" o a " B P *3 B CD B S o o B 5 B p D CL 5' o E S- B C B B 5 P S5 re o o s £ ^ o « bd a ^ -^i ^". o <-+. o 00 ^ fcq ^ !^ C) H s O M !zi -^ t"> O0 comprising 222 cases, and giving a synoptical history of each case. M. D., Philadelphia, 1851. ' Cause of death. REMARKS. REFERENCES. Hist, de Societe Roy. de Medecine, 17S3, p. 296, and Edin.Med. Surg. Journ. vol. xviii. p. 532. By incision, the use of tents, and subsequent extirpation of the mortified cyst. Opened the tumour, tore up the cells, fixed it Ibid, and Jeaffreson's Essay, Lond. by ligature to the wound, and obtained a per- Med. Gaz. 1844-5, p. 81. fect cure. Cyst opened, dirty gelatinous fluid withdrawn, Amer. Journ. of Med. Sciences, from and sac removed; wound 3 inches to the left Eclectic Repertory, p. 261. of rectus muscle. Both ovaries affected, cyst opened, bloody and Ibid. gelatinous matter escaped, adhesions to blad- der and uterus, incision in the same place. Incision in linea alba. Ibid. Profuse hemorrhage. Ibid. Peritonitis Incision on the left side. Ibid. Monthly Journ. of For. Med. vol. iii. p. 440: Philad. 1829. Ibid. Gangrene of Extensive adhesions to colon, stomach, and Ibid. intestines peritoneum; one gallon of yellowish-green serum in abdominal cavity. Afterwards became pregnant. Ibid. Peritonit. and Diseased and deformed from infancy; tumour Ibid. gangrene varicose; pedicle 4 inches thick ; ascites. Emptied the cyst and removed it. Amer. Med. Recor. vol. v. p. 124. The uterus was the most voluminous part of Med. and Surg. Memoirs, by N. tumour. Smith; edited by N. R. Smith, p. 231. Sac emptied, but too adherent to be removed ; Ibid. slight peritonitis; sac and abdomen again filled. Emptied the cyst and removed it. N. Amer. Med. Journ. Jan. 1826. New York Journ. of Med. Sept. 1843, p. 169. 6 TABLE OF OPERATIONS OF OVARIOTOMY. •3 Incision. R ^- Died. J! cove red. .2 s Other Adhe- a ■ Time Character of OPERATOR. a a a „ b of diseases sions tumour. ►-' •- 2 C <■ £ -t £ P death 2 ^■ ■- S a g V ■ c c c o c a c c c E ^ *> b •_? •« a - . i as a •:? m t> a bO -j= S E | -- C a ■- " E B, o 2 1£ I => < S ^ u> 3 % 1= S <-, ^ O 2 'Dr. A. G. Smith 1 1 2C do&McDowal 1 1 1 42d d. Conglomert. intestine 21 1823 Mr. Lizars 27 1 ] 1 22 1S25 do 36 1 ] None Ovarian tu-mour 23 1825 do 25 1 1 2d or 3d day Adhes Ovarian tu-mour 2-1 do 34 1 1 1 Solid and vascular 25 Dr. Quittenbaum 1 1 26 1826 Dr. Granville 1 1 1 Adhes. Cyst 27 1827 a 30 . do | 1 40 Dr. Martini 24 1 1 3 days 28 1826 1 1 36 hrs. Adhes. Cartilagin's 29 1828 Dr. DifTenbaugh 40 1 1 1 1 Adhes. Highly vas-cular 30 1829 Dr. D. L. Rogers 20 1 1 Adhes. Cyst 31 Anonymous 48 1 1 1 6th d. Adhes. Cyst 32 33 1830 Dr. Ritter 31 1 l Dr. J. C. Warren 40 1 1 On table 1 None None Cyst Scirrhous 34 35 1833 1834 Mr. Jeaffreson 40 1 1 Mr. King 40 1 i None Cyst 36 1S36 do 37 1 i None Cyst 37 do 1 ] 1 Omental tu- 38 1836 Mr. Dolhoff 23 1 1 2 days None mour Cyst 39 do 27 1 1 1 8 hrs. Adhes. Solid 40 do 23 1 1 1 41 1836 Mr. West 45 1 1 None Cyst 42 do 23 1 i Cyst 43 do 24 1 1 Shatter-ed consti- Cyst 44 do 40 1 i tution 1 Adhes. Cyst 45 Mr. Hargraves 40 1 i 1 Adhes. Multilocular 46 1840 Mr. B. Phillips 21 1 1 6th d. nflam of nuc.coat Jf the ^one cyst Cyst 47,1841 ] Dr. Stilling 22 1 ] iowels 48 1842 ] Dr. C. Clay 46 1 1 STone | Adhes. ''olid and 49 1842 do 57 1 1 fluid I * 1 1 Adhes. Cysts TABLE OF OPERATIONS OF OVARIOTOMY. 7 Cause of death. Secondary hemorrhage Gangrene of peritoneum REMARKS. REFERENCES. Hemorrhage iHemorrhage The animal ligature used gave way prematurely The patient tapped herself 90 times. Deceived by great obesity and distended fulness of bowels. Some hemorrhage; ascites; other ovary dis- eased, but too adherent to be removed. Omental tumour; blood escaped.* Very adherent, incised largely, and carefully emptied. Death attributed to venesection, under the false alarm of peritonitis. Inseparably connected with brim of pelvis ; re- moved a sacculated portion of it. Startled at the size of the base of tumour and flow of blood on puncturing it, and operation abandoned on account of adhesions. Cyst unintentionally opened, emptied, relieved of very extensive adhesions, and removed. Had been tapped 5 times in six months; had a broad base, and not removable from os in- nominatum. First tapped, and 2 weeks after removed ovary. Ligature slipped. Fluid evacuated, sac drawn out and removed. Cyst emptied of 27 pints, drawn out, and re- moved. Peritonitis Sunk Inflammation of mucous coat of large intestines Hemorrhage Cyst emptied of 15 pints and removed. Declined removing it, being solid and fixed in pelvis by adhesions. Cyst emptied of 20 pints, drawn out, and re- moved. Cyst emptied of 24 pints, drawn out, and re- moved. Constitution much shattered previously. Not removed on account of adhesions; had to be tapped afterwards. Not removed on account of adhesions. Extensive ulceration of bowels of some stand- ing ; died from other disease, not 'the opera- tion. Incision 27 inches ; tumour 28 lbs. Extensive adhesions; tumour 24 lbs. New York Journ. of Med. Sept. 1843, p. 169. Ibid. Amer. Med. Recor. vol. viii. p. 23. Churchill's Essay and Jeaffreson's Es- say, in Lon. Med. Gaz.1844-5, p. 81 Ibid. Ibid, and Phillips' Table in Med.- Chirurg. Trans, vol. xxvii. p. 472. Ibid. Velpeau's Oper. Surg. p. 528. Churchill's Essay, from Med. Gaz. Jan. 13, 1843. Ibid. Velpeau's Oper. Surg. p. 528, and London Med. Gaz. 1844-45, p. 81. New York Medical and Phys. Journ. Jan. 1830, p. 285. Churchill's Essay, from Froriep's No- tizen. Ibid. Surg. Observ. on Tumours, by J. C, Warren, p. 590. Churchill's Essay. Ibid. Lancet, Jan. 21, 1837, p. 586. Med.-Chir. Trans, vol. xxvii. p. 473. Braithwaite's Retrospect, Amer. ed. No. 7, p. 99. Ibid. No. 8, p. 101. Ibid. Lancet, Nov. 25, 1S37, p. 307. Lancet, Oct. 14, 1S39. Ibid. Lond. Med. Gaz. 1S44-45, p. 86. Ibid. Ibid. Oct. 9, 1S40. Brit, and For. Med. Rev. Medical Times, No. 160. Ibid. No. 161. . tv = ,,«e terminated fatally in 1850. It was found to be a fibrous tumour of the uterus connected with ■ , a a hv a narrow fold of peritoneum. Both ovaries were small, and in their proper position. The uterus vvas otrophied.-Amer. Jour. Med. Sci., April 1S31, p. 511. 8 TABLE OF OPERATIONS OF OVARIOTOMY. "O Incision. R s- Died. JH covt red. .2 a Other Adhe- Character of i «3 ___ o • Time OPERATOR. a = « Z a of diseases sions tumour. 5 ■f £ 5 a death O t. i.' O *j B I- L. O h 1- . c c a o c B C C B 5 3 a c -r; •* a - * a a ■--. -^ v „ ed t£ - ^ C "- J a • - « a o, o £ Q < <5 A \D <5 S s S S tJ o z 5C 184S Dr. C. Clay 39 1 I Adhes Cysts 51 1843 do 47 1 I 1 7th d. Adhes Anomalous 52 1S43 do 45 1 1 Imme diatel; Disease of uterus Adhes Fleshy tu-bercle of uterus 53 1843 do 40 1 1 36 hrs Adhes Cysts 54 1843 do 22 1 J Adhes Cysts 55 1843 do 40 1 1 36 hrs None Cysts 56 j 1843 do 43 1 1 Adhes Cysts 57 1843 do 59 1 1 32 hrs. Adhes Cysts 58 1843 do 45 1 1 Hydatid 59 1843 do 58 1 1 10th d. Pelvic tu-mour 60 1S43 do 1 1 Adhes. 61 1844 do 49 1 1 3 wks. Uterine disease Uterine 62 1842 Mr. Walne 58 1 1 None Many cysts with solid base 63 1843 do 57 1 1 None Cysts 64 1843 do 20 1 1 None Cyst 65 1843 do 54 1 1 1 Adhes. Cysts 66 1843 do 45 1 1 Uterine disease None Cysts, solid and fluid 67 Dr. Ashwell 1 1 1 Cyst [ 68 Mr. Crisp 1 1 Cyst 69 1843 Mr. Morris 1 1 70 1843 Mr. Southam 37 1 1 None Cystic sar-coma 71 1843 Dr. F. Bird 35 1 1 None Cyst Cysts and 72 1843 do 21 1 1 None solid matter 73 1844 do 21 1 1 None Cysts Cysts 74 1844 do 35 1 1 Adhes. 75 1843 Dr. J. L. Atlee 29 1 l Adhes. Cysts and 76 1844 do 42 1 1 5th d. Disease of uterus Adhes. hydatids Fibrous tu- ] mours of 77 1843 Mr. Heath 46 1 1 17 hrs. Disease uterus Uterine tu- | 78 79 1843 1843 Mr. Lane 28 1 1 Mr. Key 19 1 1 9th d. of uterus N'one ^one mour Cyst Multilocular ] 80 L843] Mr. Greenhow 29 1 1 7th d. Disease of sto-mach Adhes. cysts Dense and ] vascular-cellular tu- 81 1843. VIr. B. Cooper 32 1 1 7th d. Maligna't disease of the Adhes. mour Solid and ] cysts 82 844 Dr. W. L. Atlee 61 1 1 6th d. uterus None Bilocular > i cyst TABLE OF OPERATIONS OF OVARIOTOMY. 9 Incision 28 inches; tumour 73 lbs.; very exten- sive adhesions. Adhesions extensive. Tumour and entire uterus, excepting the cervix, removed. Ovarian tumour 26 lbs.; very extensive adhe- sions. Tumour 26 lbs. Tumour 31 lbs.; extensive adhesions. Tumour 54 lbs.; very extensive adhesions. Tumour 24 lbs.; Dr. Clay says recovered from operation. Tumour 26 lbs.; very extensive adhesions. A ligature was applied around the cervix, and the uterus and ovaries removed. Narrow escape, followed by phlegmasia dolens Tumour 28 lbs. Extensive adhesions caused him to desist. Fibrous tumour of uterus resting against incision is supposed to have caused death. Incision 1J in.; sac partially withdrawn; an obstacle presenting, was again returned. Sac punctured, emptied, and excised. Incision 5 inches; cyst emptied, withdrawn, and excised. Followed by slight peritonitis. Many adhesions; sac emptied of firm gelatinous matter and excised; incision 8 inches; tu- mour 35 lbs. Both ovaries removed. Four uterine tumours with thick, vascular pedi- cles; extensive adhesions; hemorrhage from slipping of ligature. The uterus, tumour, and all were removed. Phlegmasia dolens followed operation. Large vessels on tumour. For four years previously, frequent uterine hemorrhage. A portion of omentum had been included in the ligature. Colon involved in a broad pedicle; feeble con- stitution ; both ovaries diseased. Medical Times, No. 162. Ibid. No. 163. Ibid. No. 164. Churchill's Essay. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Lond.Med. Gaz. Ibid. Aug. 11, 1843, p. 699. Ibid. Oct. 13, 1843, p. 47. Ibid. Feb. 23, 1844, p. 686. Ibid. March 10, 1844, p. 723. London Lancet, Nov. 1843, p. 155. Ibid. Dec. 30, 1843, p. 396. Churchill's Essay. Ibid, from Med. Gaz. 1843. Lon. Med. Gaz. Mar. 22, 1844,p. 832. Ibid. Dec. 29, 1843, p. 409. Ibid. Dec. 8, 1S43. Ibid. Aug. 18, 1843, p. 732. Amer. Med. Journ. Jan. 1844, p. 44. Not yet reported. Lond. Med. Gaz. Dec. 8,1843, p. 309. Ibid. 1844-45, p. 84. From Guy's Hosp. Rep. Oct. 1843, p. 473. Med.-Chirurg. Trans, vol. xxvii. p. 88, and Am. Journ. Med. Sci. July, 1844, p. 251. Med.-Chirurg. Trans, vol. xxvii. p. 76, and Amer. Journ. Med. Sci. Apri! 1844, p. 462. Amer. Med. Journ. July, 1S44, p. 43 10 TABLE OF OPERATIONS OF OVARIOTOMY. ; j" 1 -o Incision Re- Died. J: covered 'a Time Other Adhe- Character of itC OPERATOR. c c a B a of diseases. sions. tumour. is c o u a c 6 death. c c E o o a o C c t. a E M a JA a « a « a p. 2 a < sTs S s i S "^ 5 C3 O 55 83 1844 Dr. W. L. Atlee 24 1 None Fibrous tu- mour of the uterus 84 1844 T. Bird 21 1 1 Cyst 85 Ehrhartstein 36 ] i None Solid and cyst 86 Dr. Hopfer 47 1 1 30 hrs. Adhes. Solid 87 do 38 1 i Adhes. Solid 88 Macdonald I i None 89 Chrissmann 1 i None 90 Groth 1 1 91 1843 Mr. Lane 45 1 i Adhes. Solid and fluid 92 1844 do 38 1 i Adhes. Multilocular cyst 93 Morgan 1 1 1 94 A. B. 1 1 1 Adhes. 95 C. D. 22 1 1 1 96 E. F. 1 1 Adhes. 97 G. H. 1 1 98 Case in Gooch 1 i 1 99 1839 Guy's Hospital 1 1 1 Adhes. Cysts 100 1844 Dr. Bowles 26 1 i Adhes. Solid 101 1844 Prof. Webster 37 1 i 1 Adhes. Cyst 102 1844 W.B.Page, Esq. 33 1 i None Cystiform 103 1846 do 39 1 1 12 hrs. Adhes. Cystiform 104 1S45 Mr. Jno. Dickin 18 1 i Adhes. Cystiform 105 1845 Mr. G. Southam 38 1 i ^one Cystiform 106 do 1 1 6th d. Cystiform 107 1S45| Dr. Handyside 20 1 70th d. Cystiform 108 1846 Dr. Fred. Bird 52 1 1 Strong Cystiform selvic adhes. 109 do 1 1 Adhes. Cystiform 110 do 1 1 TABLE OF OPERATIONS OF OVARIOTOMY. 11 Canso of death. REMARKS. REFERENCES. Thick, fleshy pedicle ; followed by violent peri- tonitis ; intestines troublesome. Contents of cyst a light amber colour, and con- tained a very small quantity of albumen. Tumour tapped before extraction. Ascites. Malignant tumour. Portion of fluid removed before extraction. Two tumours; cyst emptied before removal. Cysts emptied before removal. Not removed on account of adhesions. Hemorrhage Peritonitis & constitutional debility [leus and phlebitis of lower limb Not removed on account of adhesions. The patient rapidly recovered from the operation, after the peritoneal cavity had been exposed for 2 hours ; but the disease progressed, and she died from the disease in about 2 months. Cyst opened and withdrawn. Hand introduced into the abdomen. Cyst first tapped and withdrawn ; adhering to several inches of intestine, but, previous to the operation, supposed to be non-adherent; a portion of the pedicle escaped from the liga ture, whence arose the hemorrhage. Multilocular, weighed 28 lbs.; recovered with out a bad symptom. " Ligature came away in three weeks; each artery tied separately ; the whole pedicle was not included; left ovary healthy." Lee on Tumours of the Uterus, p. 271. Exploratory incision; cyst punctured, and re moved 16 or 18 pints of clear lemon-coloured fluid; hand introduced, &c. " Ligature came away on the 49th day; left ovary tapped and extracted." Lee, p. 269. Multilocular cyst with cerebriform solid matter; operation performed under apparently favour able circumstances. « Both ovaries diseased and extracted." Lee, p. 271. « Cyst very thick and filled with cholesterine ; tapped and extracted; there was no pedi- cle, and a small section of the uterus was removed with it." Lee, p. 269. Tumour adherent to pelvis and uterus; a seg- ment of the cyst lell attached. Large tumour wiih very short pedicle. Amer. Med. Journ. April 1845, p. 309, Lond. Med. Gaz. Aug. 16, 1844. Med.-Chir. Trans, vol. xxvii. p. 472, Phillips' Table. Ibid. Ibid. Ibid. Ibid. Ibid. Lond. Med. Gaz. 1844-45, p. 84, Jeaffreson's Table. Med.-Chir. Trans, vol. xxvii. p. 474 Ibid. Ibid. Ibid. Ibid. Ibid. Lond. Med. Gaz. 1844-45. Western Lancet, Oct. 1844. Not reported. Lond. Lancet, April 5, 1844, p. 397, Lond. ed.; or p. 84, Amer. ed. Ibid. Dec. 12, 1846; also, Ranlun Abstract, Amer. ed. No. 5, p. 251, 1847. Provincial Med. and Surg. Journ. Oct 7, 1845; also, Ranking's Abstract, No. 2, p. 188. Ibid. Sept. 10, 1845, p. 561; also, Braithwaite's Retrospect, No. 12, p. 247. Arch. Gen. de Med. vol. xx. p. 92; also, Amer. Journ. Med. Sci. July 1847, p. 234. Edinb. Med. and Surg. Journ. 1846; also, Amer. Journ. Med. Sci. Apri 1846, p. 502. London Lancet, Amer. ed. April 1S46, p. 315. Ibid.; also, Amer. Journ. Med. Sci. Jan. lS51,p. 234. Ibid. 12 TABLE OF OPERATIONS OF OVARIOTOMY. Ill 1847 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 OPERATOR. Dr. Fred. Bird 1846 136 137 do do do do do do do do do do do do do do do do do do do do do do do Dr. J. L. Atlee Dr. Hayny do 33 Re- covered Died. Time of death. Other diseases. 3dd. 3d d. 5th d. 7th d. 2d d. 2d d. 15th d 4th d. 6 wks. Adhe- SUIII.S. Adhes Death impend ing Adhes. Adhes, None Adhes Character of tumour. Cystiform Large sessile tumour Cystiform Adhes Adhes Adhes Cystiform TABLE OF OPERATIONS OF OVARIOTOMY. 13 REMARKS. Multilocular; both ovaries extirpated ; one, of compound character, weighed 20 lbs.; the other, consisting of several cysts, weighed 4 lbs.; both adherent to abdominal walls—the larger one firmly to the omentum, an artery of which was tied ; rapid recovery, without an untoward symptom; menstruation, bcth before and after operation, uninterrupted. London Lancet, Oct. 30,1847, p. 467 ; also, Ranking's Abstract, No. 6, 1848, p. 246. REFERENCES. Ibid. Nov. 23, 1850; also, Amer Journ. Med. Sci. Jan. 1851, p.234 .Inflammation of the lungs Tumour bound down in the pelvis, causing un ceasing suffering; tapping required every 10 or 12 days. Small tumour. Large compound tumour. Very large malignant mass inseparably adherent posteriorly; extreme suffering from distension by solid matter, and rapidly approaching death, rendered the attempted operation jus tillable. Small incision, then tapped. Small incision, then tapped. Incision of rather large size. Small incision to ascertain the character of the adhesions, and of small tumour attached to the cyst, as well as to evacuate the contents ; patient advanced in life and exhausted by suf- fering ; lived 6 weeks. Incision. Incision, then tapped. Incision, then tapped. Incision, then tapped. Incision, then tapped; tapped several times afterwards. Incision, then tapped ; tapped afterwards. Incision, then tapped ; tapped many times after- wards. Incision, not tapped; tapped afterwards and died. Incision to ascertain adhesions, and to remove very viscid contents; died next day from bursting of hepatic abscess into the peritoneal cavity, as proved by autopsy. Small incision, then tapped; alterwards tapped Incision ; colloid. Small incision ; tapped many times afterwards. Incision, then tapped. Incision, then tapped. Multilocular; weighed 45 lbs.; patient got along very well for several days, and took cold on slight exposure, which produced pneumonia. An autopsy was made, and no abdominal or pelvic inflammation was dis covered. Removal impossible from adhesions; no regard paid to temperature during the operation. A portion of the omentum removed with the tumour; no regard paid to temperature dur- ing the operation. Ibid. Ibid. Ibid. Ibid. p. 235. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Not published. Brit, and For. Med. Rev., Forbes's Amer. ed. Jan. 1847, p. 297. Ibid. 1-i TABLE OF OPERATIONS OF OVARIOTOMY. Incision. R V 1 e- Died. %, cov< red. 2 a Other diseases Adhe-sions. OPERATOR. a = C Time a a 3 3 of Character 01 tumour. 55 13S 6 a h b 3 b >. . o ~ a o c t> B •-> m a — b0 m iB a — ' <■ •«; * S, s *■, | £ £ . . S ~j b death. a cop 2 5 a ■- * a c o & g gb o 55 11846 Mr. Solly 20 1 1 11 hrs None Cystiform 13S 1S45 Dr. C. Clay 35 1 ] None Cyst with solid matter 140 1846 do 51 1 1 None Cystiform 141 do 1 1 142 do 1 J 143 do l 1 14th d. Disease of uterus Ovarian and uterine 144 do 1 ] 1 145 do 1 ] 1 146 do 1 ] 1 147 do 1 ] 1 148 do 1 i 149 do 1 i 150 do 1 i 151 do 1 i 152 do 1 i y 153 do 1 i 154 do 1 i 155 do l i 156 do J i 157 do 1 ] 158 do i i 159 do 1 1 160 do l 1 161 do ] 1 162 do ] 1 163 do | 1 164 1848 Drs. Clay and 1 Branson 1 44 hrs. Adhes. Cystiform 165 Mr.W.[B-k-s-w] 1 1 6th d. Exhaus-ion be-fore ope- Sone 166 167 Mr. Lane 1 i do l i ration Adhes. 16s do 1 1 Adhes. Cystiform Cystiform 169 S46 | 3r. Pr. Smith 39 1 1 4 hrs. Chronic ^one Cystiform 170 846 Mr. Arrowsmith 22 j Jeriton. Adhes. Cystiform TABLE OF OPERATIONS OF OVARIOTOMY. 15 Cause of death. REMARKS. REFERENCES. Internal hemorrhage From a fall Unilocular cyst of right ovary ; hemorrhage from slipping of the ligature. "A portion of the pedicle, containing the Fallopian tube, slipped from the ligature, and gave rise to hemor- rhage." Lee, p. 271. " Solid tumour 9 lbs.; fluid and solid 53 lbs.; evacuated the cyst before extraction ; patient returned into Wales 15 days afterwards; sub- ject to the disease 10 or 12 years." Lee, p. 267 " Well 17 days after the operation." Lee, p. 267. Large ovarian tumour with enlargement of uterus; tumour and uterus removed; death from fall on the 14th day; incision had healed, and patient was convalescent. Operation exploratory only ; not finished. do do do do do do do do do Shock of ope- ration Peritonitis Peritonitis Shock of ope- ration Multilocular; largest cyst punctured; adhesions to omentum and bowel; chloroform adminis- tered with happy effect; did well for 24 hours; got suddenly worse in 38 hours; weight of abdominal contents 30 lbs. Exhaustion after 3d day; great tympanitis. Multilocular. Multilocular. " Adhesions to liver, supra-renal capsule, ascending cava, kidney, and intes- tines posteriorly; no adhesions anteriorly." Lee, p. 268. „ . ., Multilocular. " Tumour weighed 20 lbs.; fluid weighed 10 lbs." Lee, p. 271. Multilocular. "An exploratory incision was made, of a few inches in extent, but the ad- hesions were so strong and extensive that the operation was considered unjustifiable; the patient recovered without any untoward symp- tom." Lee, p. 271. Brit, and For. Med. Rev. Forbes, Am ed. Jan. 1847, p. 297; also, Lond. Med. Gaz. July 10, 1846; also, Braithwaite, No. 14, p. 317. Med. Times, No. 282, Feb. 15, 1845, Lee's Table. Ibid. No. 333, Feb. 14, 1846, Lee'i Table. Lee's Table. Ibid. Braithwaite, No. 19, p. 282. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Ibid. Prov. Med. and Surg. Journ.; also, Ranking, No. 9, p. 277. Lee's Table. Ibid.; Phillips's Table. Ibid. Ibid. Ibid. Ibid. 16 TABLE OF OPERATIONS OF OVARIOTOMY. 171 1846 1172 1846 173 1846 174 175 176 OPERATOR. H. E. Burd Mr. W. Ca?sar Hawkins Dr. R. D. Mussey Dr. Ehrhartstein Mr. Bainbrigge 26 Incision Re- covered. 177 178 1844 179 1835 Dr. DifTenbaugh Dr.Woyeikowsk 40 Dr. Bellinger 35 Died. Time of death. Other diseases. lydrops uteri Adhe- sions. None None Adhes, Adhes None Character of tumour. Cystiform Cystiform Cystiform Scirrhus TABLE OF OPERATIONS OF OVARIOTOMY. 17 REMARKS. Multilocular; the largest cyst was tapped after the incision, and over 3 gallons of glairy fluid withdrawn, after which the tumour was drawn out; the pedicle was very thick, requiring 3 strong twine ligatures in different compart- ments, and each vessel was separately tied be- sides ; much alarm was excited subsequently by the frequent occurrence ofcollapse, which was relieved bytheadministration ofopium,ammo- nia, and brandy ; tumour weighed 50 lbs.; the patient was 3 or 4 months gone in pregnancy, and aborted 40 hours after the operation. " Unilocular; ligature came away from the 22d to the 25th day; the wound entirely healed on the 29th day." Lee, p. 271. Operation not completed in consequence of nu merous and extensive adhesions; wound kept open by a tent; a clear liquid came away for several days, then became purulent, diminish- ed gradually, ceased in 3 weeks, closed, and tumour disappeared. A year after, delivered of her 14th child and no return of disease Serum continued to drain for some time from the aperture; afterwards changed to milky fluid, flowed for 9 weeks, wound cicatrized, and patient was cured. Unilocular; incision three inches long; a por- tion of cyst drawn out, contents evacuated ; a portion of cyst then removed, its edges fixed to outerwound, and suppuration induced; on the 5th day the discharge became purulent, and was maintained so by stimulant injec tions ; in three months the discharge greatly diminished, and the general health was com pletely restored. Adhesions were such that the tumour was merely punctured after incision ; a sanious matter continued to discharge for some time after, and patient ultimately recovered. Tumour weighed 6£ lbs.; woman in labour; had gone three months beyond her time; uterus forced out of the vagina; trocar re- moved 35 litres of yellowish fluid ; day after removed tumour by incision from 3 inches above the umbilicus to the pubis,and 30 litres more of fluid; no bad symptoms followed; she walked home to a neighbouring town the 25th day afterwards. She was delivered of a boy 13 months afterwards, and of another boy in December 1846. Incision extended nearly to the ensiform car tilage; the tumour was removed by cutting the round and broad ligaments; two arteries of considerable size were tied with animal ligature, both ends of which were cut off close to the knot; a tumour in the pelvis was formed by the uterus distended with a large quantity of dark watery fluid, which escaped through a rent made by the finger through its posterior wall. The patient was still living in good health May, 1847; menstruation never returned. REFERENCES London Med. Gaz. April, 1847; also, Ranking, No. 5, p. 249. Lee's Table. Med. Gaz. Oct. 30, 1846. Amer. Journ. of Med. Sciences, Feb 1838, p. 380. Arch. GeneraledeMedecine,vol. xxxi. p. 427; also, Amer. Journ. Med Sciences, July, 1847, p. 233. Prov. Med. Journ. Dec. 16, 1846; also, Braithwaite, No. 5, p. 250. Arch. Generale de Medecine, vol.xx. p. 92; also, Amer. Journ. Med Sciences, July, 1847, p. 234. Journ. de Mud. et de Chirurg.; also, Amer. Journ. Med. Sciences, Oct. 1S47, p. 484. South. Journ. Med. and Pharm. Ma 1847 ; also, Wood's Quarterly Re- trospect, July, 1847, p. 21. 18 TABLE OF OPERATIONS OF OVARIOTOMY. 182 183 1846 1848 1701 OPERATOR. Dr. Bellinger Anonymous Dr. S. Parkman Dr. R. Houstoun 184 1848 Dr. H. Miller 185 186 1848 H. G. Potter 1848 Dr. J. Deane Incision. 27 58 37 36 43 Re- covered Died. E ' ■" n — ! S O 55 Time of death. Other diseases. 5th d. 12 hrs. 17th d. Disease of uterus Adhe- sions. Adhes, None Character of tumour Several tu- mours Uterine Uterine Adhes. Adhc Cystiform Cystiform Cystiform Uterine TABLE OF OPERATIONS OF OVARIOTOMY. 19 Cause of death. REMARKS. REFERENCES. Operation abandoned from finding the peri- toneum adherent along the line of the incision Peritonitis Hemorrhage The lateral ligaments were divided, were very vascular, and many arteries were tied with animal ligatures; the neck of the uterus was cut across about three-fourths of an inch above the os tincae, and the entire tumour [the uterus] removed ; there had been no in- ternal hemorrhage. Fibrous tumour developed in the fundus of the uterus weighing nearly 9 lbs.; pedicle formed by the body of the uterus about 2 inches in diameter; the left Fallopian tube removed with the tumour; both ovaries were left in the pelvis ; supposed to have contained fluid ; attempts at tapping; wrong diagnosis; con- tained only a clear serous fluid in its inter- stices or meshes; half of the pedicle was not firmly constricted by the ligature, and patient sunk from hemorrhage. With a strong fir stick, wrapped with lint, and thrust into the cyst, turning and winding it, above two yards Jong of a substance like glue . was drawn out, which was followed by quarts of such matter, and several hydatids larger than an orange ; dressed by interrupted suture. Lived in perfect health until 1714. Multilocular; extensive adhesions to omentum and parietes easily loosened ; two cysts punc- tured to diminish the size, from which flowed a whitish, ropy, albuminous-looking fluid ; the emptied tumour weighed 9i lbs.; chloroform employed. Diarrhoea and Both ovaries diseased ; incision from 20 to 24 peritonitis inches long; both cysts emptied before being tied; only two-thirds of the right cyst re- moved ; autopsy discovered that this tumour was firmly united to the bladder and uterus and walls of the pelvis ; peritonize symptoms were almost entirely absent, although the bowels were found agglutinated together, and several ounces of pus were found in the pel vis; chloroform employed. Fibrous tumour of the uterus; the tumour, whose length was about 8 or 9 inches, and breadth 5 or 6 inches, embraced the entire left half of the uterus, from which it was con- sidered impossible to separate it, and, there- fore, the further prosecution of the operation was deemed impracticable; chloroform was used, but its effects were considered very de- leterious; the symptoms for several days were very alarming, but she finally recovered from the greatest perils. South. Journ. Med. and Pharm. May. 1847; also, Wood's Quarterly Re- trospect, July, 1847, p. 22. Ibid. Amer. Journ. Med. Sciences, April, 1848, p. 371. Philosoph. Trans. Abridged, vol. vii. p. 541; also, Amer. Journ. Med Sciences, April, 1849, p. 534. West. Journ. of Med. and Surg. July, 1848, p. 38. Lond. Med. Gaz. June 23,1S48; also, Amer. Journ. Med. Sciences, July, 1849, p. 205. Boston Med. and Surg. Journ. Oct. 11, 1848; also, Amer. Journ. Med. Sciences, Jan. 1849, p. 258. 20 TABLE OF OPERATIONS OF OVARIOTOMY. 187 1849 188 1848 189 190 191 192 1850 1848 193 194 OPERATOR. Dr. J. Deane Dr. P. J.Buchner do do do Dr. D. Meeker M. H. Larry Mr. Arnott 45 32 lcision. Re- covered. Died. J I Time of death. 12th d Other diseases. 6th d. 6 hrs. 74 hrs, Adhe- sions. None Character of tumour Cystiform \dhes. Cystiform Adhes, Adhes, Adhes. Fibrous tu- mour Cystiform Pilous ova- rium Cystiform TABLE OF OPERATIONS OF OVARIOTOMY. 21 REMARKS. REFERENCES. Incision from pubis to sternum nearly ; incision completed after tapping the cyst, which col- lapsed into the pelvis; the small intestines were highly injected, congested, or inflamed ; in other respects all the viscera healthy. Things went on well for a week, and on the 4th day union was accomplished ; afterwards, inflammation of the intestines, constipation, and vomiting supervened, and death. A post- mortem examination revealed gangrene of the intestines and parts adjacent to pedicle; weight about 40 lbs. Multilocular. The large sac being extensively adherent to the peritoneum, it was unavoida- bly punctured, and 18 pints of a dirty, opaque, cream-coloured fluid, of the consistence of pus, discharged ; after this the posterior wall of the cyst was divided, and several bands of organized lymph severed by the knife; the sac was now torn from its adhesions, which extended above and below the umbilicus and across to the linea semilunaris. The patient remarked that the act of separating the sac from the walls of the belly reminded her of tearing the leaf lard from pork. From another cyst 6 pints of fluid were removed, and this was another division of the tumour adhering extensively to the peritoneum and omentum, which was ruptured and bled freely, requiring ligatures. The pedicle was on the right side, embrrcing the Fallopian tube and ovary, and about 2 inches in diameter, and highly vascular; this was also adherent to the fundus uteri; patient did not lose 4 ounces of blood; operation lasted 1* hours; tumour weighed 28J lbs.; solid part 4.i lbs. Weight of tumour 4i lbs. Many alarming and dangerous symptoms fol- lowed. Multilocular; incision 22 inches; adhesions to parietes, omentum, and small intestines rea- dily separated ; pedicle to the right ovary 2* inches broad, and 2 inches in length; opera- tion lasted 45 minutes; the ligature slipped from half the pedicle, the cavity filled with fluid blood, and the patient was exhausted by the hemorrhage ; the tumour weighed 40 lbs. S ounces. Multilocular; extensive adhesions, on which account the operation was not completed. Dr. Clay attributes the failure to the small inci- sions. Dr. James Deane's Letter to me, dated Greenfield, Mass., April 8, 1851. Western Lancet and Hosp. Reporter, Oct. 1848, p. 201. Ibid. p. 213. Amer. Journ. Med. Sciences, Oct. 1850, p. 560. Ibid, from Ohio Med. and Surg. Journ. Sept. 1850. Supplement to Boston Med. and Surg. Journ. Sept. 6, 184S, p. 116. Mem de l'Acad. Roy. de Med. tomes xii. and xiii. Paris, 1S46-48. Med. Gaz. and Obstet. Rec. No. 12 ; also, Ranking's Abstract, Dec. 1848, p. 246. 22 TABLE OF OPERATIONS OF OVARIOTOMY 195 OPERATOR. 1S47 Dr. Vangirard 196 1S49 197 199 200 201 202 1849 1849 1849 1849 1850 1850 203 1850 Dr. W. L. Atlee do do do do do do do 25 29 33 25 43 39 30 48 40 Re- covered, Died. Time of death. Proci- dentia uteri Disease of uterus 6th d. 3dd. 3dd. Other diseases. Adhe- sions Disease of uterus Obstruct. bowels; death im- pending Ascites & anasarca death im- pending Adhes None Adhes. Cystiform Fibrous tu- mour of ovary Uterine tu- mour Cystiform None None Adhes, Adhes. Adhes Character of tumour. Uterine tu- mour Fibrous tu- mour of uterus Cystiform Cystiform Cystiform TABLE OF OPERATIONS OF OVARIOTOMY. 23 REMARKS. Tapped 50 times in 3| years; the cyst was first tapped, and then removed; the tumour was cartilaginous, gelatinous, and cerebriform; weight 9 lbs.; ether inhaled; incision to the left of, and parallel with the linea alba; the pedicle was attached to the left side. The patient was well at the end of a month. Extensive and very firm adhesions to the bones of the pelvis, and to the iliac vessels; Pou- part's ligament was imbedded in the tumour and stretched across it; complete procidentia uteri; chloroform 1 part, ether 2 parts, ad- ministered ; recovery without an unpleasant symptom ; pregnant twice since. The uterus was enlarged, and, in consequence, the tumour was not removed ; the right ovary was as large as an orange, and the left one was also diseased ; chloroform mixture administer- ed ; rapid recovery; operation exploratory. One large cyst extensively adherent to the omentum by its anterior surface ; 4 gallons of chocolate-coloured fluid removed one week before ; weight of tumour 40 lbs.; chloroform mixture given; rapid recovery. Has been married since, and has given birth to a fine healthy daughter, after an easy parturition of about 3 hours. The uterus was enlarged, and had large cysti- form bodies incorporated with it, therefore not removed; chloroform mixture; rapid re- covery ; operation exploratory. Fibrous tumour attached to the fundus of the uterus with a dense pedicle; weight 6 lbs.; chloroform mixture ; rapid recovery ; menses on at the time of the operation, and continued without interruption. Extensive adhesions; two round strong vascu lar cords bound the cyst to the recto-vaginal cul-de-sac, requiring ligatures; patient ate an orange on the evening of the 4th day, up to which time she was doing well, and soon after inflammation set in ; chloroform mixture. Multilocular; the cyst was inseparably adher ent to the intestines and uterus; the adher- ent portions of the cyst were detached from the main tumour, and permitted to remain ; spermatic artery cut and tied; weight of tu- mour 28 lbs.; chloroform mixture ; the bowels had been obstructed for several days before the operation, and it was performed only with the view of arresting the progress of approach- ing death. The cyst weighed 25 lbs., exclusive of about 2 gallons of serum from the peritoneal cavity; had been tapped for ascites 5 times before; the lower limbs were anasarcous and ulcer- ated, weeping away immense quantities of water; the omentum was much thickened, cedematous, and spread over the cyst, and almost inseparably adherent; the uterus was also extensively adherent; chloroform mix- ture. The operation was performed with thei same view as the case above. REFERENCES. Journ. des Scien. Medico-Chirurg.; also, Ranking's Abstract, Dec. 1848, p. 246, and No. 9, p. 275, and No. 8, p. 246. Amer. Journ. Med. 1849, p. 336. Sciences, Oct, Ibid. April, 1850, p. 318. Ibid. p. 328. Not yet published. Not yet published. Not yet published. Not yet published. Not yet published. 24 TABLE OF OPERATIONS OF OVARIOTOMY. 55 204 1850 205 1850 206 1850 207 1850 208 209 210 211 1851 1849 OPERATOR. Dr. W.L. Atlee do do do do Dr. Bayles Anonymous Mr. Tueffard Incision. 37 42 28 29 40 Re- covered, Died. a -^ I J2 ■ a Time of death. Other diseases. Adhe- sions. Character of tumour. Disease of uterus 30th d 3dd. Anaemia Preg- nancy None Adhes Adhes, Adhes, Cystiform Adhes. Adhes. Uterine tu- mour Cystiform Cystiform Cystiform Extra- uterine foetation TABLE OF OPERATIONS OF OVARIOTOMY. 2o REMARKS. The uterus was enlarged ; chloroform mixture, which produced a state of catalepsy, render- ing it extremely troublesome with the intes- tines; they were forced out, and could scarce- ly be returned ; a favourable recovery, and improved health since the operation. Multilocular; adhesions to the whole front of the abdomen and to the omentum ; a patch of the cyst, as large as the palm of the hand, was left adhering to the walls of the abdomen at the umbilicus; pedicle 3 or 4 inches long, round, and as thick as the little finger; first cut the pedicle, and then picked out the vessels and tied them separately; weight of tumour 25 lbs.; chloroform mixture; rapid recovery. Multilocular; patient greatly enfeebled by pre- vious disease; adhesions to the intestines, uterus, bladder, rectum, and whole basin of the pelvis; a part of the cyst was left attached to the colon; several cysts broke while re- moving them and flooded the intestines; pedicle about 4 inches long and slender; ap- plied no ligature; used torsion; pulse 130 at time of operation ; tumour 15 lbs.; chloro- form mixture; rapid recovery. Multilocular; had been tapped 16 times; 56 lbs. of fluid removed at one tapping ; the mass of the tumour was composed of two immense cysts; it weighed 81 lbs.; she was 2 months gone in pregnancy at the time of the opera- tion; she recovered from the operation, but this was followed by such great irritability of stomach, in consequence of a state of preg- nancy, that she could not be nourished, and she died, 30 days after, of starvation; no miscarriage ; chloroform mixture. Multilocular; incision from sternum to pubis, nearly, very firm and extensive adhesions; some peritoneal effusion; pedicle about 6 inches broad, filled with varicose veins; one of the cysts, a large one, was filled with par- tially-washed crassamentum; weight of tu- mour 35£ lbs.; chloroform mixture. Tumour weighed 18 lbs. Tumour weighed 26 lbs. The tumour consisted of an extra-uterine fetus; this was the 6th pregnancy; the fetal move- ments were perceptible up to the 6th month, then ceased, and were followed by hemor- rhage and excessive pain. Six months after this, the tumour was discovered in the right groin; at the operation two cysts were re- moved ; one was filled with adipocire, closely adherent, and joining one cavity with the uterus, its fundus being destroyed ; the other cyst contained the limbs and trunk of a fetus, the head and upper extremities having es- caped into the general cavity of the peri- toneum, and adhering firmly; both were re- moved ; ether administered ; perfect recovery. Not yet published. Not yet published. Not yet published. Trans, of Amer. Med. Assoc, vol. iii. p. 379. Baltimore Paper. Ranking's Abstract, vol. ix. p. 279; also, Amer. Journ. Med. Sciences, Oct. 1849, p. 522. o 3 o w M 3" . P > 93 O 5 ' a> p Si 3 p ro 3 No. Cj w a o O hi « 93 > H M o rsi = I -sq----- 3 1 U I — IS 4 I - I A(re. I Major. | Unknown. - | Ma. | Unknown. Minor. Major. | Unknown. | Operat'n unfinished. | No tumour. c~>3 S'O re " P3 3^ « 3 c s 33 o o -«r- TABLE OF OPERATIONS OF OVARIOTOMY. Multilocular; left ovary; weight of tumour 14 lbs.; rapid recovery; the cysts tapped before their removal. Multilocular; adhesions slight; pedicle very broad and vascular; weight of tumour 40 lbs.; rapid recovery. Complete procidentia uteri; three vessels of the omentum tied, and ligatures cut off close to the knot; about 20 ounces of serum in the peritoneal cavity; weight of tumour 7 lbs.; circumference 23 inches ; chloroform given. Multilocular; had been previously tapped ; a multilocular tumour was first removed, weigh- ing 8 lbs.; afterwards a fibrous tumour was removed from deep in the pelvis, weighing i lb. The pedicle was severed half an inch from the ligature, which slipped off while, sponging the wound, and alarming hemorrhage resulted ; the vessel was immediately secured by trans- fixing the pedicle with an armed ligature; weight of tumour 18 lbs.; chloroform given. The tumour was adherent to the anterior walls of the abdomen; incision 3 inches; a free in cision was made into the tumour, and a por tion of its interior removed; a few minute hydatids discovered; the wound was left open, and a tent introduced ; a large amount of pus was discharged for a long time, and the tu- mour entirely disappeared. April 10th, 1849, a healthy daughter born. Had been tapped 9 times; last time, 10 days before the operation, 5 gallons of fluid re- moved ; walls of the abdomen oedematous; 3 ligatures were applied to the left broad liga ment. Incision 3 inches; cyst tapped, and drawn out 130 ounces of brown-coloured, ropy, viscid fluid; woman as large as at the 8th month of pregnancy. Both ovaries removed; weight of left ovary, with the contents, 29 lbs.; of right, 10 drachms; menses returned 72 hours after operation, and continued 3 days; 4 ligatures; 3 came away by untying themselves, and 1 with a loop; unmarried; anaesthesia. Operation unfinished in consequence of adhe- sions ; tumour diminished to half its size ra- pidly after the operation. Tumour in the walls of uterus; large veins covering it; chloroform mixture. Prov. Med. and Surg. Journ. Sept. 5, 1849; also, Amer. Journ. Med. Sciences, Jan. 1850, p. 221. Ibid. Sept. 19, 1849; also, Amer. Journ. Med. Sciences, Jan. 1850, p. 220. New York Journ. of Med. and Collat. Sciences, March, 1850, p. 159. Boston Med. and Surg. Journ. Jan.23, 1850, p. 503. Dr. Marsh's Pamphlet. Amer. Journ. Med. Sciences, July, 1850, p. 267. Med. Examiner, Nov. 1850, p. 630. London Lancet, Nov. 23, 1850; also, Amer. Journ. Med. Sciences, Jan. 1851, p. 226. Amer. Journ. Med. Sciences, April, 1851, p. 371. Prov. Med. and Surg. Journ. Jan. 8, 1851; also, Amer. Journ. Med. Sciences, April, 1851, p. 509. From Dr. Mussey himself. 28 ANALYSIS OF THE CAi^ES OF OVARIOTOMY. Analysis of the 222 Cases of Ovariotomy in the above Table. By Washington L. Atlee, M. D., Philadelphia. I. Of these 222 cases, 52 were of the minor section, 153 of the major, and 17 unknown. II. Of the 52 minor operations, 39 recovered, and 13 died, or 1 in every 4, or 25 cases in 100. III. Of the 153 major operations, 95 recovered, and 58 died, or 1 in every 2?|, or 37.91 cases in 100. IV. Of the 17 unknown sections, 12 recovered, and 5 died, or 1 in every 3|, or 29.41 cases in 100. V. Of the 222 cases, 146 recovered, and 76 died, or 1 in every 2||, or 33.78 cases in 100. VI. Of the 222 cases, 57 were not completed, or 1 in every 3j|, or 25.68 cases in 100. VII. Of the 222 cases, there was no tumour in 6, or 1 in every 37, or 2.7 cases in 100. VIII. Of the 57 unfinished operations, 24 were the large section, 27 the small, and 6 unknown. IX. Of the 24 unfinished large sections, 17 recovered, and 7 died, or 1 in every 3f, or 29.17 cases in 100. The proportion of unfinished operations in the large sections, is as 24 to 153, or 15.69 cases in 100. X. Of the 27 unfinished minor sections, 23 recovered, and 4 died, or 1 in every 6|, or 14.81 cases in 100. The proportion of unfinished operations in the small sections, is as 27 to 52, or 51.92 cases in 100. XL Of the 6 unfinished unknown sections, 5 recovered and 1 died, or 1 in every 6, or 16| cases in 100. XII. Of the 57 unfinished operations, 45 recovered, and 12 died, or 1 in every 4f, or 21.05 cases in 100. XIII. Of the 57 unfinished operations, 25 were merely explora- tory, all of which recovered. XIV. Of the 6 operations in which no tumour was found, 5 were major, and 1 minor; 3 of the former recovered, 2 died ; and the minor recovered; making 4 recoveries, 2 deaths, or 1 in every 3. XV. In 27 cases, other important diseases co-existed. The parti- cular diseases were the following :— 13 cases in which the uterus was diseased. 2 " of procidentia uteri. ANALYSIS OF THE CASES OF OVARIOTOMY. 29 1 case 1 u 1 a 1 a 1 it 1 a 1 a 1 a 1 u 1 a 1 a 1 a 27 of hydrops uteri. pregnancy. anaemia. ascites and anasarca. obstructed bowels. chronic peritonitis. exhaustion before operation. impending death. disease of the stomach. inflammation of the mucous coat of the bowel. shattered constitution. tuberculated liver and scirrhous mesenteric glands. XArI. In 5 of the cases complicated with other diseases, the operation was left unfinished; 4 of these patients recovered, 1 died. Of the remaining 22 cases, 5 recovered, 17 died ; 24 of these cases were the major, 2 the minor, and 1 the unknown section. XVII. In 83 cases, there were adhesions; in 47, none; in 92, not stated. Of the first, 49 recovered, 34 died, or 1 in every 2£§, or 40.96 cases in 100. Of the non-adherent cases, 33 recovered, 14 died, or 1 in every 3T6:,, or 29.79 cases in 100. XVIII. The causes of death have been particularly noted in 49 cases. The following is the result:— 14 patients died from peritonitis. 13 6 1 patient 1 1 1 1 1 1 " 1 " 1 " 1 hemorrhage. exhaustion. shock of operation. inflammation of mucous coat of large in- testine. gangrene of intestines. gangrene of peritoneum. peritonitis and gangrene. inflammation of the lungs. peritonitis and constitutional debility. ileus and phlebitis of lower limb. diarrhoea and peritonitis. inflammation and gangrene of intestines. fibrous tumour of the uterus resting against incision. 30 ANALYSIS OF THE CASES OF OVARIOTOMY. 1 patient died from venesection, under a false alarm of peritonitis. 1 " " " bursting of hepatic abscess into the peritoneal cavity. 1 " " a fall after convalescence. 1 " " inanition from irritable stomach, in conse- quence of pregnancy. 49 XIX. The exact time of death after the operation in the 76 un- successful cases is mentioned in 57, and is as follows : — 1 patient died in 70 days after the operation. 2 patients a "42 a a a a 1 patient a " 30 a a a a 1 " a "21 a n u a 1 " a "17 a t. a tt 1 " it "15 a a a tt 1 " a " 14 a n it a 1 " it "12 a it a it 1 " a " 10 a a tt a 1 " a " 9 a a a a 4 patients a " 7 a tt a a 7 " a " 6 it a tt a 3 " a " 5 a a a a 1 patient it " 4 it a a a 9 patients a " 3 it a a a 4 " a " 2 a a a a 5 " a " 36 hours tt a a 1 patient a "32 a it a a 1 " a "30 a a a a 1 " a "17 a a a tt 1 " a "14 a a a a 2 patients a "12 it a a a 1 patient n "11 a a a a 1 " a " 8 tt a a a 1 " a " 6 a a tt a 1 " it " 5 a a a a 1 " it " 4 tt a a a 2 patients " immediately " « a 57 ANALYSIS OF THE CASES OF OVARIOTOMY. 31 < XX. The average time of death in the 57 cases stated, is 7.33 days. XXI. The character of the disease, for which gastrotomy has been performed, has been stated in 150 cases, and is as follows :— 86 cases cystiform tumours of the ovary. 30 " solid tumours, viz. :— "10 uterine tumours. 3 fibrous tumours of the uterus. 1 fleshy tubercle of the uterus. 1 fibrous tumour. 7 solid tumours. 6 solid ovarian tumours. 1 cartilaginous and lardaceous. 1 cartilaginous. 9 " cysts with solid matter. 2 " ovarian tumours. 1 case ovarian and uterine. 1 " fibrous and cellular. 1 " lardaceous and cysts. 1 " pelvic tumour. 1 " large sessile tumour. 1 " several tumours. 1 " dense and vascular cellular tumour. 1 " cysts and hydatids. 1 " hydatid. 1 " highly vascular tumour. 1 " pilous ovarium. 1 " cyst with bone, hair, &c. 1 " cysts with extra-uterine foetus. 1 " cyst of an abscess of an ovary. 1 " omental tumour. 1 " conglomerated intestine. 1 " anomalous. 6 cases no tumour found. 150 XXII. Of the 86 cases of cystiform tumour, 57 recovered, and 29 died, or 1 in every 2H|, or 33.72 cases in 100. XXIII- Of the 30 solid tumours, 17 recovered, and 13 died, or 1 in every 2,'s, or 43.33 cases in 100. X.XIV. Of the 27 cases complicated with other diseases, 11 [viz: 3 o2 ANALYSIS OF THE CASES OF OVARIOTOMY. Nos. 13, 43, 46, 52, 61, 77, 116, 165, 181, 202, 203] may fairly be considered to have been improper for the operation. Some of these ought to have remained unfinished. Three of them were done to ward off impending death. Throwing these 11 cases, all fatal, out of the estimate, would leave 211 legitimate cases, and this would make 146 recoveries, and 65 deaths, or 1 in every 3^f, or 30.81 cases in 100. XXV. Throwing out the whole number of cases complicated with other diseases, would leave 195 cases, 137 recoveries, and 58 deaths, or 1 in every 3f|, or 29.74 cases in 100. XXVI. Under the head of the 18th paragraph, I have stated that death occurred in 6 cases as follows :— No. 27 from venesection under the false alarm of peritonitis. other diseases, not the operation. bursting of hepatic abscess into the peritoneal cavity. pneumonia after convalescence and exposure. a fall after convalescence. inanition from irritability of stomach arising from 46 129 135 143 207 pregnancy XXVII. Under the head of the 19th paragraph, I have stated that the time of death after the operation, in 3 cases, was as fol- lows :— No. 20 in 42 days after the operation. " 107 " 70 " " « « " 137 " 42 " " " « XXVIII. As the fatal termination in these 9 cases cannot be considered as the result of the operation, they ought to be classified under the head of recoveries. This would make 155 recoveries, and [minus the 11 cases in the 24th paragraph] 56 deaths, or 1 in every 3f §, or 26.54 cases in 100. XXIX. In the above table, I have included all the exploratory operations, because they were commenced, no doubt, with the view of completing them, provided circumstances would justify it They therefore, properly come under the head of unfinished operations' implying a section of the peritoneum, and involving the hazard of such an opening. XXX. The rate of mortality, therefore, according to the above analysis, for the operation of Ovariotomy, is 26J per cent WASHINGTON L. ATLEE, No. 3 Colonnade Bow, Pbilada, May 1, 1851. 0hestnut Str'eeL APPENDIX. The foregoing Table is a continuation of one published in the Amer. Journ. of Med. Sciences for April 1845, and has been ex- tracted from the Transactions of the Amer. Med. Association, for private distribution. In connection with it, certain occurrences have transpired, to which I shall take this occasion to refer. In a communication made to the Amer. Journ. of Med. Sciences for April 1850, I called attention to the fact, that the table had been used without acknowledgment by an author in London, and after- wards by one in Philadelphia, the latter gentleman accrediting its authorship to the former. The following is an extract from that communication:— " Before concluding this paper, I trust it will not be thought improper, in connection with the above statistics, to allude to a matter of a personal charac- ter. In the Amer. Journ. of Med. Sciences for April 1845, p. 330, I published a table of cases of ovariotomy that had occurred up to that date, the construc- tion of which cost much trouble, time, and labour. This table was prepared, at first, solely for my own use, for the convenience of reference; but, believing that it would be of service to the profession in the discussion of the question of ovariotomy, I offered it for publication. In January, 1847, ' A Dissertation upon Tumours of the Uterus and its Appendages' was published by Mr. Thomas Saf- ford Lee, London, for which the ' Jacksonian Prize' was awarded. It is a valuable publication, the most complete epitome of knowledge on ovarian dropsy we possess, and enters into the question of gastrotomy more fully than any treatise of the kind. At page 183, Mr. Lee says, ' I have carefully collected into a tabular form all the known operations for the extraction of the ovary,' and then, with the addition of a few cases which occurred since April, 1845, he gives, as the result of his own labour, the very table which I had published in 1845, omitting any acknowledgment whatever. After Mr. Lee enters upon the dis- cussion of the question, on page 188, ' What are the results of the operation al- ready performed/' he makes use, very frequently, of the facts which I had col- lected, adopting my arrangement of them, and even my language, without any reference to the source whence he mainly drew the information, upon which were founded the valuable deductions in his book. Feeling aggrieved that my labours had been appropriated without that credit having been awarded, to which 1 was justly entitled, I addressed a letter to Mr. Lee, appealing to his 34 APPENDIX. sense of justice, and calling his attention to the omission. Mr. Lee promptly replied, assuring me of his regret that such an omission should have occurred, and sincerely hoped that I would not consider it a wilful one, acknowledging his indebtedness to me, and promising, should occasion offer, in a second edi- tion of his work, to do me ample justice for this temporary omission. From the gentlemanlike character of Mr. Lee's letter, I was satisfied that the omission was not intentional, and felt willing to let the correction be made by himself at the proper time, and so had determined. I think it necessary, however, in jus- tice to myself, to refer to this subject at this time, inasmuch as a distinguished American author has since given to Mr. Lee the credit of presenting those very facts to the profession. In a work, entitled ' Females and their Diseases—a series of Letters to 7iis Class,' by Charles D. Meigs, M. D., &c. &c, Philadelphia, 1848, p. 315, are these words: 'Facts are the things that teach—and I shall close this letter by laying before you the tabular view presented by Dr. T. S. Lee, who, I am sure, will not object to my using so great liberty with his work, the more especially as it may assist in spreading further and wider the knowledge he has been at so great pains to collect, and make it both more pub- lic and useful at once.' Then follows my table with this head, ' Table, by Dr. Lee;' and the several succeeding pages, through which the table is continued, have, each one, this title: ' Dr. Lee's Table.' As both Dr. Meigs' book and the Amer. Med. Journ. have a wide circulation among American practitioners, it will be perfectly competent for them to compare Mr. Lee's table of 1847 with my table of 1845, and decide who 'presented the tabular views/ and who ' has been at so great pains to collect the knowledge' therein contained." Dr. Meigs' attention having been so particularly called to this matter, it was expected that he would, from ethical considera- tions alone, have taken an early opportunity to render an ex- planation, or at least to correct a mistake he may have inadver- tently fallen into. An excellent opportunity has been afforded in the second edition of his book recently published, but he omits the table altogether, giving no reason for the omission; and although he has ceased to call it Dr. Lee's table, he still insinuates that Mr. Lee presented it to the profession by using the following lan- guage, the only reference, by the way, that he has made to it: " The same valuable work" [Lee on Tumours of the Uterus] " con- tains a table of one hundred and eighteen operations for the removal of the ovary, with the results." I regret that Dr. Meigs has thought proper to adopt this course, as it manifests intentional injustice to- wards me, and places me under the unpleasant necessity of making an exposition, which, under other circumstances, I would gladly have avoided. This studied indifference characterizing Dr. Meigs' second edition of his book throws suspicion upon the purity of his motives in attributing to Mr. Lee, in the first edition, the author- APPENDIX. 35 ship of my table—and especially so, when certain circumstances are viewed in connection with it. The circumstances are these:— 1st. My table was published in the Amer. Med. Journ., which is the principal medical periodical of this country, and is issued in the city of Philadelphia, where the author of the above work resides. 2d. Only two years afterwards, soon after Mr. Lee's book was issued, and at the very time that it was in the hands of Dr. Meigs, the following editorial notice appeared in the Medical News, for May 1847, a periodical also published in Philadelphia:— " Plagiarism.—A volume ' On Tumours of the Uterus and its Appendages, by Thomas S. Lee,' which received the Jacksonian prize, has very recently (1847) been published in London. If any one will look over its pages, and particularly over table No. 11, and the deductions drawn from it, commencing on page 183, and compare it with a similar synopsis, published in the Amer. Med. Journ. for April 1845, p. 330, he will there find a table of the same kind, having the same arrangement, similar headings, and even the same language, with full references, by Dr. W. L. Atlee, of this city, yet we cannot discover that Mr. Lee has made any acknowledgment to Dr. Atlee. On the contrary, he assumes the authorship in these words, page 183: ' Ihave carefully collected into a tabular form all the known operations for the extraction of the ovary!' We happen to know that the construction of this table cost Dr. Atlee much time, trouble, and labour. His careful synopsis of the leading features of each case, with the references to authorities, was peculiarly valuable to the profession in the consideration of this important question. It is evident, on the pages of Mr. Lee's work, that he has availed himself extensively of this aid, and we reo-ret that he did not think it best to award justice to whom it is strictly due. It would appear from the foot-notes, page 270, that Dr. Atlee's table was before him. The only original matter furnished by Mr. Lee is the addi- tion of some cases occurring since the publication of Dr. Atlee's table, and arranged under the same head. He has failed, however, in noting all. So entirely has he depended upon Dr. Atlee's table, that he has not even added four recent cases, occurring in his own country, and noticed in the journals be- fore his work went to press." 3d. The American Medical Association being in session in Phila- delphia at the same time, this copy of the Medical News, which contained a great deal on the subject of Medical Reform, was dis- tributed, by the publishers, in large numbers, among the delegates in attendance. 4th. Dr. Meigs was a delegate at this meeting of the Association, and represented the College of Physicians. 5th. Dr. Meigs commenced writing his book the very same month. 36 APPENDIX. I merely state the facts. The profession may draw their own in- ferences. Since matters have been made to occupy this position by the American author, I regret that the calamity, which is afflicting Mr. Lee, is likely to prevent him from being ever capable of placing him- self, in this transaction, before the profession, in such a light as, 1 think, he was desirous of doing. I know that I shall be doing jus- tice to him to extract from his private letter to me what he intended to state more publicly had the state of his health permitted. He writes:— " 2 Upper Gordon Street, Easton Square, London. "June 21, 1847. " My dear Sir :— " You must have perceived, on perusing my book, that my intention was, throughout, to give a full acknowledgment to every author, who had at afl added to my information; and I can assure you that I am extremely sorry that you, who have done so much for the operation of gastrotomy, should have been omitted. I sincerely hope that you will consider it an omission, and not a wilful one."..... "I had actually drawn up a table, essentially like your own—of which I have a manuscript—before I had seen your pub- lication ; this, however, only comprehended a few of the particulars. I was dissatisfied with it, and, about the same time, I saw yours, and the arrange- ment being so good and accorded so entirely with my own views, that I im- mediately adapted my report to it. I retained the similarity of expression, because I found that little or nothing could be added to your description." ..... "I am indebted to you for the excellent arrangement of your tables, and if occasion offers, in a second edition of my work, I hope to do you ample justice for this temporary omission." " I feel greatly obliged to you for the opinion you have expressed on my work, and hope you will accept a copy from the author. I have enclosed one in the parcel of Wiley & Putnam, Paternoster Row, London, and allow me again to assure you, I shall always feel indebted for your kindness and urbanity in this matter. " Believe me, " Yours, very respectfully, "THOMAS SAFFORD LEE." " To Dr. W. L. Atlee." The British and Foreign Medico-Chirurgical Review, October 1850, p. 549, thus notices the subject:— " Statistics of Ovariotomy.—Dr. Atlee has just cause for finding fault with Mr. Safford Lee in this matter, for it seems the statistics he published in his -work, and which have been so frequently quoted, were taken, without acknow- ledgment, from a paper prepared, with great labour, by Dr. Atlee, and pub- lished in the American Journal for 1845. Mr. Lee has since apologized for an APPENDIX. 37 omission, which, occurring in a work supposed to be so peculiarly composed of an author's own materials as a prize essay, was a very culpable one." It is clear, therefore, that Mr. Lee made use of my labours as his own, without acknowledgment. It is clear, also, that Mr. Lee, were he now able, would make a satisfactory reparation. It is clear that Dr. Meigs went to London for statistics that ori- ginated in Philadelphia, and credited a foreigner with the presenta- tion of facts which were previously given to the profession by a fellow-citizen—and this, too, in the face of prominent notices of the plagiarism. It is clear, also, that, notwithstanding Dr. Meigs had his attention called to the subject after the publication of the first edition of his book, he persists in the endeavour to perpetuate the wrong, in the second edition, by studiously avoiding its correction, and by obliquely hinting that the " tabular view" was presented by Mr. Lee. Finally, it is clear that Dr. Meigs, although he had the oppor- tunity and was able to make amends, is yet, unlike Mr. Lee, unwill- ing to do justice " between members of the confraternity to which he and I belong." Dr. Meigs, in the same chapter of his book in which he discusses the " morals of surgery," observes, that "there are two ways to hurt the profession, which any one may perpend. One is to act immorally and unconscientious^." Whether Dr. Meigs has laid himself open to such a charge, or even to a worse, is easily decided by the above exposition, and the ordinary rules of ethics. WASHINGTON L. ATLEE, No. 3 Colonnade How, Philada., Sept. 2, 1851. Chestnut Street. ■*:;'.iietSei-:>' •' /■ . ■M* M«i