Fifty Cases of Abdominal 
Section. 
(SECOND SERIES.) 
BT 
JAMES B. HUNTER, M. D., 
SURGEON TO THE WOMAN’S HOSPITAL; PROFESSOR OF 
GYNAECOLOGY IN THE NEW YORK POLYCLINIC, ETC. 
REPRINTED PROM 
El)t Neto Yorft Jttefiical Journal 
for August SI, 1886. Repr inted from the New York Medical Journal 
for August 21, 1886. 
FIFTY CASES OF ABDOMINAL SECTION 
(SECOND SERIES). 
By JAMES B. HUNTER, M. D., 
SURGEON TO THE WOMAN’S HOSPITAL, NEW YORK ; PROFESSOR OF GYNAECOLOGY 
IN THE NEW YORK POLYCLINIC, ETC. 
In reporting a second series of fifty eases of abdominal 
section I have followed the plan adopted in publishing the 
first fifty cases in the “New York Medical Journal” for 
April 4, 1885. An outline history of each case is given in 
tabular form, with some additional explanatory remarks in 
cases that seem to warrant it. The whole number of cases 
reported is too small for useful generalization ; too small for 
statistical argument; too small to support any theory or 
establish any method. It is not too small, however, to 
afford additional evidence in favor of operating in some 
doubtful cases, in some very bad ones, and in some cases 
where the diagnosis has to bo made chiefly from the symp- 
toms. In certain of the cases of what is appropriately 
known as Tait’s operation the results have been surprisingly 
good, the patients having been rescued after years of in- 
validism and suffering, and restored to the enjoyment of 
perfect health. 
I have little to add to the remarks made in previous 
papers on the method of operating. I still use the spray, 
wherever it can be obtained, for an hour or more before the 2 
FIFTY CASES OF AI5DOMINAL SFX’TION. 
operation. 1 use carbolic acid freely and thoroughly, and 
the bichloride sparingly, unless there are special indications 
for a powerful disinfectant. Water that has been boiled 
is used for all the solutions. For irrigation I have used 
with much satisfaction the double drainage-tube of Dr. II. 
Marion-Sims. 
In every particular I have simply endeavored to do the 
best that was possible for each individual case, and have 
been content to let the statistics take care of themselves. 
Any considerable number of cases of abdominal tumors, 
taken as they come—and especially as they come to the 
Woman’s Hospital—will necessarily include some cases not 
entirely hopeless, but desperately bad and very unpromising. 
It is the duty of the surgeon to do his best in every case 
that admits of operation; to avail himself of every means, 
from whatever source, that promises to help his patient or 
add in the slightest degree to her chances of recovery. 
Only thus can really valuable statistics be obtained. 
In the whole number published there will be found 
seven cases of hysterectomy for uterine fibroids, with two 
deaths; one case of removal by abdominal section of a 
pediculated uterine fibroid, with recovery ; one case of the 
removal of a solid fibroid tumor of the ovary, with recov- 
ery ; thirty-nine cases of completed ovariotomy, with seven 
deaths; and of Tait’s operation, completed, seventeen cases, 
with two deaths. Of the latter operation it is yet too soon 
in the recent cases to judge of the ultimate result, as it 
often requires a year, and sometimes more, for the benefits 
of the operation to become thoroughly established. This is 
true of any operation that brings about the menopause. 
Case I.—This patient had been under observation for two 
months before her admission to hospital. The tumor had been 
pronounced ovarian, but, as it gave rise to no serious symptoms, 
the patient was allowed, at her own request, to wait fora time. FIFTY CASES OF ABDOMINAL SECTION. 
3 
Suddenly she complained of severe pain, and she was immedi- 
ately admitted to hospital. Her temperature was found to vary 
from 101° to 103° F., and her pain was so severe as to require 
the constant use of morphine. The abdomen was very tender 
and the pulse rapid. The diagnosis of inflammation of the cyst 
was made, and the operation was done as early as possible. The 
day of the operation the temperature was 103° in the axilla and 
pulse 140. The surface of the tumor, as seen on making the in- 
cision, was of a dark-purple color, having large veins prominent 
on its surface. On raising the mass, which was on the right 
side, the pedicle was seen to be twisted five times on itself. It 
was transfixed and tied with silk, and the tumor removed. The 
weight of the mass was about three pounds and a half. Tlie 
contents were partly colloid, and there had been recent haemor- 
rhage into the cyst. The tumor had evidently been strangulated 
by the twisting of the pedicle. A small tumor was found on the 
left side also, and removed in tbe same way. The wound was 
closed at once without a drainage-tube. The temperature nine 
hours after the operation was 98'5° and pulse 120. The patient 
made an uninterrupted recovery, the temperature never rising 
above 101°. Seen a year after operation, the patient was in 
perfect health and had grown somewhat stout. 
The case exemplifies one of the dangers of postponing 
operation when an ovarian tumor of any size has been 
clearly made out. Had it not been possible to operate 
until twenty-four hours later, the woman would probably 
have died of peritonitis, from strangulation of the tumor, 
or of rupture of the veins of the cyst. The intestines and 
tumor were very slightly attached by threads of lymph, 
easily broken by the hand. 
Case II.—This patient had suffered for two years from ex- 
treme pain before her period, and a very excessive flow. The 
nature of the mass was distinctly made out by vaginal examina- 
tion several months before the operation. It was increasing in 
size, and the pain was becoming constant. 4 
FIFTY CASES OF ABDOMINAL SECTION. 
Had a large drainage-tube been put in at the time of 
operation, and thorough irrigation kept up, the chance of 
recovery would have been better. The tube was used too 
late. The condition of the patient before operation was 
very unfavorable, as she had long been subject to severe 
luemorrhages and almost constant pain. 
Case III.—There were very dense adhesions in this case, 
the dilated tube hugging one half of tho uterus firmly. The 
uterus was large and globular, having tho appearance of a 
fibroid tumor. There was so little bleeding that no drainage- 
tube was deemed necessary. Recovery was good and uninter- 
rupted. 
Case IV.—The operation in this case was undertaken as a 
last resort, and at the special desire of the patient, who wished 
to have what slight chance there might be of at least prolong- 
ing life. She was failing so rapidly in health that a diagnosis 
of probable malignant disease was made. The tumor was in- 
creasing in size almost perceptibly day by day. Tho patient had 
the appearance of a woman sixty-fivo years of age. 
Case V.—In this case the patient was supposed to bo doing 
well until the day of her death, ten days after the operation. 
There was more pain than usual and much nausea, but the tem- 
perature seldom rose above 99°. The sutures were removed 
on the eighth day, and the wound was dry and looked well. 
Three days later, at 2 p. m., there was a sudden attack of faintness, 
with a very feeble pulse. Under vigorous stimulation, oxygen, 
etc., there was no improvement, and death occurred eight hours 
afterward. The post-mortem showed extensive peritonitis, and 
a large accumulation of pus between the abdominal muscles and 
fascia. There was no communication, as far as could bo ascer- 
tained, between the cavity containing the pus and tho peri- 
tonaeum. The wound was very small, measuring barely two 
inches in length, and was subjected to very little handling or 
sponging. The operation was performed with the most careful 
antiseptic precautions, aud there seemed no reason, external to 
the patient, why recovery should not take place. The unfavor- FIFTY CASES OF ABDOMINAL SECTION. 
5 
able course which followed was probably due in great part to 
the miserable physical condition of the patient, who had been 
an invalid for several years, and had suffered much mental anx- 
iety besides. Her dysmenorrhcea was extreme, and the prostra- 
tion following each period was so great and prolonged that the 
girl was practically bed-ridden, and her life a burden to her. 
This is not the only case in which I have known peri- 
tonitis to develop and lead to a fatal termination with- 
out any marked rise of temperature, or a very rapid pulse. 
Pain is sometimes absent also, and abdominal distension 
is not invariably present. 
Case VII.—Peritonitis developed on the third day and the 
temperature went above 103°. Frequent irrigation by means 
of the drainage-tube regularly brought down the temperature, 
and doubtless saved the patient’s life. 
This patient reported a year after the operation that she was 
perfectly well, free from all pain, and able to support herself 
by work as a teacher. Before the operation she had been in- 
capacitated by pain from doing any work, and for a year had 
been growing surely worse. Life had become intolerable to her. 
For one year she had, by the advice of her physician, made a 
thorough trial of all the remedies usually resorted to in such 
cases, including galvanism, blisters, rest, etc.; and as a last re- 
sort she submitted to the operation. 
One such case as this outweighs a volume of argument 
against the practice of removing ovaries when they arc 
hopelessly diseased, and the patient is ambitious to become 
something more useful than a chronic invalid. 
Case X.—This patient was suffering intense abdominal pain 
the greater part of the time. In 1883 she had the left ovary 
removed for the relief of dysmenorrhcea, but had been no bet- 
ter afterward. In breaking up adhesions, about four inches of 
the small intestine had been removed and the cut ends united. 
Pain continued after the operation. At the earnest request of 
the patient and her husband, an exploratory incision was made, 6 
FIFTY CASES OF ABDOMINAL SECTION. 
and the right ovary and tube were removed. The intestine was 
firmly adherent to the abdominal wall, and the lines of former 
intestinal sutures were plainly visible. Recovery from the opera- 
tion took place without any bad symptoms; but no relief had 
been afforded six months later, when last heard from. 
Case XI.—This woman had been obliged to give up her 
work because of pains at irregular intervals, but frequent and 
severe. Menstruation had been very scanty and infrequent; but 
at the time when it should have come the pain was intolerable. 
Blisters and galvanism were given a fair trial, but had no effect 
whatever. Both ovaries were found to be cystic, and the tubes 
thickened and nearly occluded. The pains have become much 
less severe, and the patient is looking much better and is able 
to do light work and support herself. The periodical pain has 
entirely gone. 
Case XIII.—The metrorrhagia in this case was threatening 
life, and had already seriously affected the general health. In 
the hope of arresting it, the ovaries and tubes had been removed 
by Dr. Thomas one year before, but there was no abatement of 
the symptoms. The uterus was found to be large and vascular, 
and firmly attached to the left horn was a loop of intestine. 
This was detached with the fingers. A wire clamp was applied 
as near the cervix as possible, and the body of the uterus was 
removed. The pedicle was transfixed with long needles and 
cauterized. The wound was closed up directly against the 
stump. Peritonitis threatening, a glass tube was put in the 
next day, but without effect. There was no haemorrhage; but 
the patient died of shock on May 30th. 
Case XIV.—This patient was a lady’s maid, and, though 
making a great effort to do her work, had been obliged to spend 
much of the time in bed, and had been quite unfit for work for 
some months. For two years she had been growing worse; 
she had intolerable pain before menstruation, which was at 
times scanty and at times profuse. 
In September, 1885, she reported that she was perfectly well 
and able to do more than she had done for years, and to enjoy 
her work. Ten months after the operation she continued per- 
fectly well, and looked like another woman, comparatively FIFTY CASES OF ABDOMINAL SECTION. 
7 
stout, and with a clear and ruddy complexion, looking literally 
ten years younger. 
Case XV.—From the time of her marriage, nine years be- 
fore the operation, this patient had been subject to epileptic 
seizures. She was not sure that she had had any well-marked 
attack before marriage. At first the seizures occurred only 
once in the month—at the time of menstruation. The attacks 
then increased in frequency and severity, notwithstanding active 
treatment by bromides and other drugs. For over a year be- 
fore the operation she had been subject to attacks at least once 
a week, and sometimes twice. Her nervous system had suf- 
fered severely, and she had much the appearance of a patient 
exhausted by some malignant disease. The fact that the epi- 
lepsy had at first a direct connection with the menstrual period 
seemed to indicate the propriety of artificially arresting the 
menstrual process. Apart from this consideration, it was evi- 
dent that the ovaries were abnormally large. They proved, on 
removal, to be cystic throughout, and to have undergone de- 
generative change. For three months after the operation there 
were epileptic attacks, but less severe, and much less frequent 
than before. They then diminished in severity and became less 
frequent until nine months after the operation, when they ceased 
entirely. The patient reported June 5, 1886, and had not then 
had an attack of any kind for three months. She had gained 
in weight and health, and felt as she had not done for nine years 
past. 
There is good reason to expect a permanent cure in 
this case; but the patient will be kept under observation, 
and reported on hereafter. 
Case XVI.—There was found in this case an ovarian tumor 
containing dark, grumous, and colloid contents. The lower half 
of the sac was adherent to the intestines, the uterus, and the 
pelvic brim. Neither removal nor enucleation was possible. 
The free portion of the sac was, therefore, excised, and the re- 
mainder left in place, with a large glass drainage-tube in it, 
reaching to the bottom. The abdominal wound was closed 
round the neck of the sac, the peritonaeum being stitched care- 8 
FIFTY CASES OF ABDOMINAL SECTION. 
fully at the upper and lower angles to the exterior of the cyst 
wall. The cyst was irrigated with carbolized water as often 
as was necessary to keep it sweet—generally every three or 
four hours. The cavity rapidly diminished in depth, and shorter 
tubes were substituted, from time to time, for the long one. 
For some days there were symptoms of peritonitis, but the 
constant use of the cold coil kept the temperature down. 
The patient made a good recovery, was able to do her 
duties as lady’s maid early in August, and has been at work 
ever since. 
Case XVII.—A diagnosis of uterine fibroma had been made 
in this case by two experienced surgeons. There was a mass, 
apparently solid, filling the pelvis and crowding the uterus down. 
With the sound passed into the uterus, however, a slight inde- 
pendent movement could be effected. It had a history of 
having grown entirely within eleven months. Menstruation 
had not been influenced by the tumor. 
On making a small incision, a hard, white, glistening mass 
appeared, flat on one side and convex on the other or lower, and 
having within it a small isolated cyst, which ruptured as the 
mass was raised. The contents looked like ascitic fluid, and 
escaped into the abdominal cavity. The incision was enlarged 
and the tumor easily removed, there being no adhesions and a 
small pedicle, like that of an ovarian cyst. The growth had 
certainly no connection with the uterus, and proved, on exami- 
nation, to be a fibroid tumor of the left ovary, the first case of 
the kind in my experience. The weight of the mass was nearly 
two pounds. The patient made a good recovery. 
Dr. Homans, of Boston, writes me that he met with his 
first case of ovarian fibroid in May, 1885. Mr. Thornton 
reports that the first case he had met with was in the au- 
tumn of 1884. 
Case XVIII.—There is nothing remarkable about this case. 
There was a large cystic ovary, with obstinate retroversion of 
the uterus, and consequent dysmenorrheea. With the removal 
of the ovary the uterus resumed its normal position, and all the FIFTY CASES OF ABDOMINAL SECTION. 
9 
other symptoms have disappeared. Palliative treatment, pes- 
saries, etc., had been tried for eighteen months before the op- 
eration was advised. 
Case XIX.—The operation in this case was peculiarly diffi- 
cult, owing to the very extensive adhesions and the necessity of 
tying a large number of bleeding points. The danger of the 
operation was fully appreciated by the patient, but, as the tumor 
was growing very rapidly, she preferred to incur the risk of its 
removal rather than to die a lingering death. She was already 
much emaciated, and suffered greatly from pain and dyspnoea. 
The operation was done only after consultation with my col- 
leagues in the Woman’s Hospital, but it was not one to be un- 
dertaken by a compiler of favorable statistics. 
Case XXI.—The operation of removing the ovaries and tubes 
was undertaken in this case with the view of arresting menstru- 
ation and thus diminishing the frequency and severity of the 
epileptic attacks, from which the patient had suffered ever since 
she tirst menstruated. Examination under ether revealed slight 
enlargement of the ovaries, but the symptoms, the failing health, 
and the increasing mental disturbance, seemed to render the op- 
eration imperative as holding out the last and only hope. 
The operation lasted thirty minutes, but the patient did not 
at once recover consciousness, and became blue and comatose. 
Heat, dry cups over the back, the faradaic current, and the 
hypodermic use of brandy failed to do any good for several 
hours. The lungs filled with mucus, which there was not power 
enough to expel, and there seemed at one time scarcely a chance 
of recovery. Not until twelve hours after the operation did the 
patient show the least sign of consciousness. About six hours 
later breathing was fully established, and convalescence there- 
after was uninterrupted. 
One point of interest was that, notwithstanding the vig- 
orous manipulations resorted to to induce respiration, and 
the frequent and rather violent movements to which the pa- 
tient was subjected in the anxiety of her several attendants, 
not the slightest symptom of peritonitis followed, and the 
union of the wound was perfect and by first intention. 10 
FIFTY CASES OF ABDOMINAL SECTION. 
Case XXII.—This patient was a strong Irish servant girl, 
who had “ never been sick a day in her life ” until a year ago, 
when she began to have scanty menstruation and severe head- 
aches. The How became less and less. She had an ovarian 
tumor in the right side. There was nothing peculiar about the 
operation. A tube was left in for two days for fear of bleeding. 
Convalescence was uninterrupted, and the patient has been do- 
ing hard work ever since she was discharged. 
Case XXIII.—An exploratory incision was made in this case 
to ascertain if it was possible to remove the ovaries and tubes 
to arrest frequent haemorrhages, and the discharge of large quan- 
tities of offensive pus mixed with hlood. The tubes were found 
to be so firmly attached to the uterus as to seem like a part of 
that organ. To separate them was impossible. The uterus was 
large and vascular. A loop of intestine about four inches in 
length was detached from the tube on the left side. Nothing 
more could be done, so the wound was closed. Though feeble 
and emaciated, the patient made a good recovery, and was almost 
free from a very severe pain from which she had suffered on the 
left side, whenever trie bowels moved. This was attributed to 
the release of the loop of intestine. In other respects the con- 
dition of the patient was not affected by the operation. 
Case XXIV.—This was a case of simple, uncomplicated 
ovariotomy. On the second day there were unmistakable evi- 
dences of peritonitis with abdominal distension, which were not 
controlled by the cold coil. At one o’clock in the morning 
of the third day the patient was taken from her bed to the 
operating-room, and the abdominal cavity reopened and washed 
out with a blood-warm one-per-cent, solution of carbolic acid. 
A small quantity of bloody serum was found; a tube was left 
in and irrigation kept up every three hours until the temperature 
fell to 98‘5°. The temperature had been 102°. The tube was 
removed three days later, and the patient had no further trou- 
ble. She was seen in June, 1886, and was perfectly well. 
Case XXV.—The pain complained of by this patient was 
always on the right side. The right ovary was full of cysts, 
and, with the corresponding tube, was removed. The other 
ovary was somewhat cystic, but, at the urgent request of the FIFTY CASES OF ABDOMINAL SECTION 
11 
patient and husband that both ovaries should not be sacrificed, 
unless there was much disease of both, that ovary was left. 
There has since been a return of pain, but now on the left side, 
and the ovary is considerably enlarged. 
I believe that, as a rule, cystic degeneration is not con- 
fined to one ovary, that, once begun, it is progressive, and 
that it is wiser to remove an ovary that gives evidence of 
such disease than to let it remain. See Case XXVI. 
Case XXVI.—The patient and her husband, being very 
anxious to have a family, specially requested that both ovaries 
be not removed, unless there was advanced disease of both. 
The left ovary, though somewhat cystic, was not interfered 
with, in the hope that time and care might effect a favorable 
change. For three months after the operation there was very 
little pain, but the “ same old pain,” as she expressed it, gradu- 
ally returned, and in May, 1886, the patient voluntarily sought 
relief by a second operation, life having become intolerable. 
Had the operation been refused by me, it would have 
been demanded elsewhere, or the patient would have sought 
relief in opium. See Case XLIX. 
Case XXVIII.—This patient entered hospital with a tem- 
perature varying from 102° to 103°, and other evidences of 
acute peritonitis. There was so much tenderness and disten- 
sion that a satisfactory examination could not be made, but it 
was evident that there was a tumor behind and to the right of 
the uterus. On making an incision, it was found that there was 
sloughing of the fundus of the uterus. So much haemorrhage 
followed the attempt to remove the tumor that an elastic liga- 
ture was thrown around the uterus. On the left side were a 
small ovarian cyst and pyosalpinx, and on the right there was 
a tumor or cyst, which had ruptured, giving rise to the sudden 
increase of symptoms of peritonitis, which had made operative 
interference imperative. There had been a tubal pregnancy, 
but, as this was not evident until the specimen had been care- 12 
MFTY CASES OF ABDOMINAL SECTION. 
fully examined, no search was made for the foetus. The patient 
died of shock the day following the operation. 
Had an operation been resorted to before peritonitis de- 
veloped, the result would probably have been different, but 
the condition of the patient on entering hospital was such 
that an unfavorable prognosis was made from the beginning. 
Case XXIX.—This patient (colored) was obliged to give up 
a good position on account of constant pain. The right tube 
was over an inch in diameter and distended with pus. It was 
removed with some difficulty, but the ovary could not be de- 
tached from its surroundings, and was therefore left. The 
drainage-tube was removed in twenty-four hours. Six months 
later the patient was well, and had been working steadily since 
she left the hospital, three weeks after the operation. 
Case XXX.—There was a suspicion of pregnancy in this 
case, on the part of her friends, as she had menstruated only 
once in six months. Severe and constant pain in the right side 
was complained of. Examination revealed a mass on the right 
side. This proved to be the distended tube and a cirrhotic 
ovary. There were no adhesions. Recovery was speedy, but 
some pain persisted for three months. 
Case XXXI.—There was in this case great emaciation with 
a shattered nervous system. Physical pain and mental worry 
had rendered the condition the worst possible one to sustain 
any kind of surgical operation. Had the disease been recog- 
nized earlier, the case would have presented no unusual difficul- 
ties. The pulse before the operation was at times hardly per- 
ceptible; no proper nourishment was takeQ, and the patient 
had come to rely to a great extent on morphine. An ovarian 
tumor as large as a hen’s egg was found on the left side, firmly 
adherent to the uterus. The right ovary was cirrhotic and the 
tube diseased. Both were removed. In removing the tumor 
in the right side, some vessels were torn and the ligatures would 
not hold. A long forceps was applied and left in the wound till 
the third day. A glass drainage-tube was left in also. The 
sutures were removed on the ninth day, and union was perfect. 
The patient was unable to retain nourishment, either by mouth FIFTY CASES OF ABDOMINAL SECTION. 
13 
or rectum, and an uncontrollable dysentery set in on the ninth 
day. Death from exhaustion occurred on the tenth day. 
Case XXXII.—There was in this case a large parovarian 
cyst, very firmly adherent, and there was also marked disease 
of both ovaries, which contained a number of cysts of various 
sizes and very little healthy tissue. The cyst was emptied 
and removed, with some difficulty, and both ovaries and tubes 
were also removed. A tube was left in the region that had been 
occupied by the cyst. The usual antiseptic precautions were 
observed in this case with more than usual rigor, and the sur- 
roundings were all that could be desired. The patient rallied 
well after the operation ; but there was a sudden development 
of peritonitis of the ungovernable type, and, notwithstanding 
the prompt application of the cold coil, large doses of antipy- 
rine, etc., the temperature continued to rise till it reached 107°, 
and death occurred on the third day. 
Case XXXIV.—The operation was undertaken as a last re- 
sort, all other means of relieving the patient having utterly 
failed. There was an indistinguishable mass where the uterus 
and ovaries should be felt. Nothing could be done but to close 
the wound. 
Case XXXV.—In this case, one of multiple uterine fibroid, 
galvano-puncture had been tried thoroughly, but with little 
appreciable effect. Several months had been devoted to that 
treatment, first by Dr. J. N. Freeman, of Brooklyn; afterward 
by myself after Dr. Freeman’s method. As the tumors were 
increasing rapidly in size, it was decided to do Hegar’s opera- 
tion, if possible. It was found to be impossible, because the 
ovaries and tubes were firmly adherent to and imbedded in the 
growth. The entire mass, with the uterus, was, therefore, 
raised and removed at the junction of the cervix. The pedicle 
was transfixed and treated externally, the wound being closed 
above and below it, the peritoneum having been separately 
stitched to the periphery of the pedicle. The patient made a 
good recovery. 
Case XXXVI.—This case was carefully examined several 
times by myself and others accustomed to the diagnosis of ab- 
dominal tumors, and 'the only difference of opinion was as to 14 
FIFTY CASES OF ABDOMINAL SECTION: 
whether it was a fibroid of the uterus or a fibro-cyst. It proved 
to be a nmltilocular ovarian tumor, with a thick wall and col- 
loid contents. The cyst was very tense, and gave on palpation 
exactly the impression given by a solid mass. General perito- 
nitis followed the operation, notwithstanding the use of the 
drainage-tube and the cold coil, and the patient died on the sev- 
enth day. 
Case XXXYII.—There was such absolute fixation of the 
whole mass that it was not deemed practicable to remove it. 
One large cyst was emptied and washed out, but no solid por- 
tion of the tumor was removed. The patient recovered, and 
when discharged was feeling bettor, probably from the dimin- 
ished size of the mass. 
Case XXXVIII.—The feature of chief interest in this case 
is the fact that the disease of the ovaries was recognized fully 
a year before the operation, and that it was steadily progress- 
ing. All the other remedies for the disease were tried, and the 
only measure that from the first could havo been of any avail 
was postponed till the patient was exhausted, bloodless, and 
broken down from haemorrhage and pain. 
Had the operation been done six months earlier, there 
is a strong probability that the patient would now have 
been alive and well. 
Case XXXIX.—In this case the doubt as to whether the 
growth was an ovarian or a fibroid tumor was set at rest only 
by an exploratory incision, which showed the existence of both. 
Case XL1I.—Partial relief was afforded to severe intestinal 
pain by the loosening up of about five inches of intestine. The 
ovaries and tubes were so matted together by old inflammation 
that they could not be removed. 
Case XLV.—Both ovaries and tubes were removed. The 
right ovary was markedly cystic ; the left less so. The patient 
was relieved at once of severe pain, and, two months after the 
operation, was able to do some work for her own support. 
Case XLVI.—Atliough there were firm adhesions in this 
case, there was no haemorrhage after sponging thoroughly, and FIFTY CASES OF ABDOMINAL SECTION. 
15 
therefore no drainage-tube was used. The pain, which was 
more than usual for so small a tumor, was probably due to the 
adhesions, as the mass was bound down deep in the pelvis, and 
was increasing in size. 
Case XLV1I.—This patient bad been practically bed-ridden 
for a year, and had suffered much before that time, having had 
repeated attacks of pelvic cellulitis. She attributed her first at- 
tack to an attempt made to straighten and dilate the uterine 
canal for the relief of dysmenorrhcea. Six months before the 
operation, when she first came under observation, there was a 
mass on the right of the uterus, giving obscure fluctuation, and 
evidently fixed, as was the uterus. The patient had intense pain 
before each period, a rather profuse flow, with partial relief, and 
afterward a constant discharge of highly offensive pus, some- 
times amounting to six or eight ounces in the twenty-four hours. 
There was extreme prostration. The operation was undertaken 
as a last resort. It was found on making the incision that re- 
moval of the tumor would be absolutely impossible. The upper 
side presented a convex aspect and the wall was apparently not 
thicker than thin paper. This ruptured during examination. 
The cavity was thoroughly cleansed, and the inner wall of the 
dilated tube was sponged out. A Sims drainage-tube was left 
in and the irrigation kept up at short intervals. Peritonitis de- 
veloped and proved fatal on the third day. 
In this case an early operation, six months or a year be- 
fore, when the patient was in a much better physical condi- 
tion, would have afforded a better chance of recovery. The 
question of puncturing the tube or abscess through the vagina 
was often considered, but it did not seem practicable, and, 
as there was a free discharge of pus via the uterine canal, 
was not particularly necessary. As the operation proved, it 
would have been very difficult to reach the tube by a vaginal 
incision, and a long wound would have been exposed to in- 
fection by the offensive discharge. 
Case XLYIII.—This case was very like Case XYI. A por- 
tion of the cyst wall only could be removed. That which re- 16 
FIFTY CASKS OF ABDOMINAL SECTION. 
raained was drained. The abdominal cavity was carefully closed 
and the walls of the tumor were secured in the wound. The 
patient made an excellent recovery. On June 15th there was 
only a small sinus, about two inches deep, remaining, and it was 
gradually filling up. 
Case XLIX.—See Case XXVI. The patient, only two weeks 
after the operation, felt herself entirely relieved from a certain 
pain that she had experienced for months before. It is of course 
much too early to form any opinion as to what the ultimate re- 
sult will be. 
Case L.—This patient might have recovered had not bron- 
chitis set in. The operation was longer than usual, in conse- 
quence of the attempt to close the uterine pedicle by the intra- 
peritoneal method. A wedge-shaped portion was removed and 
the edges were accurately adjusted by two sets of sutures, deep 
and superficial. On relaxing the ligature, there was so much 
haemorrhage that it was necessary, though other efforts were 
made to control it, to reapply the elastic ligature and secure the 
pedicle outside, transfixing it with long needles in the usual way. 
The post-mortem showed some peritonitis, bronchitis, and hy- 
postatic pneumonia in the lower portion of both lungs. 6 
fc 
1 Whole 
| No. 
Date. 
Place. 
Age. 
t-. 
c 
'Sa 
•p w 
eS-S 
. 
O G 
-G.2 
■&.£ 
G “ 
a, G 
hT"4 
Weight of 
tumor. 
Character 
of tumor. 
® G 
O 
TTG 
< 
Indica- 
tions for 
operation. 
Pedicle. 
Drainage- 
tube. 
Result. 
Remakks. 
In. 
Lbs 
i 
51 
Feb. 26, 
Woman’s 
25 
M. 
3 
Multilocular 
Verv firm 
Pain & haem- 
Tied 
Tube 
Death. 
Right tube distended with foetid pus, 
1885. 
Hospital. 
ovarian cyst 
and ex- 
orrhage. 
with 
2d day. 
but removed intact. Patient much 
and double 
1 pyosalpinx. 
tensive. 
silk. 
reduced by previous haemorrhages. 
9 
52 
Feb. 27, 
U 
26 
M. 
3 
4 
Multilocular 
Slight. 
Pain, perito- 
U 
None. 
Recovery 
Pedicle twisted five times. Haem- 
1885. 
ovarian 
nitis. 
orrhage into cyst. Peritonitis at 
cyst. 
time of operation. 
3 
53 
Mch. 15, 
U 
28 
M. 
3£ 
Haemato- 
Firm. 
Pain k haem- 
44 
U 
Removed left tube and ovary. 
1885. 
salpinx. 
orrhage. 
4 
54 
Mch. 23, 
44 
51 
M. 
64 
12 
Sarcoma of 
Very firm 
Pain, rapid 
u 
U 
Death 20 
Severe haemorrhage from vessels 
1885. 
ovary, semi- 
and gen- 
growth of tu- 
hrs. aftei 
in adhesions, which gave way in 
solid. 
eral. 
mor, failing 
operation 
the forceps. 
health. 
of shock. 
5 
55 
April 12, 
Private 
24 
S. 
2 
Cystic ova- 
None. 
Pain and fail- 
u 
“ 
Died Apr. 
Operation remarkably easy. Much 
1885. 
case. 
ries. 
ing health, 
22d, of 
suffering after operation, and nau- 
dysmenor- 
perito- 
sea, but temp’tuie not high at any 
rhoea. 
nitis. 
time. Pulse failed suddenly on 
22d, and patient died in collapse 
eight hours later. 
6 
56 
April 13, 
St. Eliza- 
32 
M. 
3 
Cystic ova- 
Very 
Dysmenor- 
a 
Tube. 
Recovery. 
The tube was removed April 20th. 
1885. 
beth’s 
ries & pyo- 
firm. 
rhoea. 
No bad symptoms. Temperature 
Hospital. 
salpinx. 
never above 100J°. Both ovaries 
and tubes were removed. 
7 
57 
April 18, 
Private 
20 
S. 
4 
Cystic ova- 
None. 
Severe and in 
a 
U 
“ 
Severe haemorrhage during operation 
1885. 
case. 
ries. 
creasing dys- 
from tearing of left broad ligament. 
menorrhcea. 
Peritonitis followed, and irrigation 
was very thoroughly employed. 
8 
58 
April 20, 
Woman’s 
23 
M. 
3 
Double pyo- 
Firm and 
Dysmenor- 
i. 
U 
U 
Severe haemorrhage during operation 
1885. 
Hospital.1 
salpinx and 
vascular. 
rhoea. 
from torn adhesions. 
both ovaries 
- 
cystic. 
9 
59 
April 21, 
U 
57 
M. 
4 
17 
Multilocular 
Firm 
Increasing 
“ 
None. 
Death 
Not a single bad symptom up to April 
1885. 
ovarian 
parietal. 
size of tumor 
May 3d. 
28th, when diarrhoea and dysentery 
began. Died of exhaustion. 
cyst. 
10 
60 
April 26, 
St. Eliza- 
52 
M. 
3 
Right tube 
Intest, ad- 
Intense pain. 
“ 
U 
Recovery. 
The patient had operation in 1883. 
1885. 
beth’s 
and ovary. 
herent to 
Left ovary and 4 inches of the 
Hospital. 
parietes, 
etc. 
None. 
0 
intestine removed. 
11 
61 
May 5, 
Woman’s 
26 
S. 
24 
Cystic ova- 
Pain and fail- 
u 
«• 
U 
Had menstruated three times only in 
1885. 
Hospital. 
ries. 
ing health. 
last two years. One year after op- 
eration, much better, and improved 
physically. Not free from pain. 
12 
62 
May 15, 
“ 
42 
M . 
6 
n* 
Multiple 
It 
Pain k liaem- 
Left 
Tube. 
U 
The wound was closed up to the ped- 
1885. 
fibroid. 
orrhage. 
outside 
icle, which was first cauterized 
and later treated with iodoform. 
13 
63 
May 28, 
“ 
30 
M. 
4 
Uterus re- 
Int’stines 
Obstinate 
Ecra- 
None. 
Death 
Ovaries removed by Dr. Thomas a 
1885. 
moved at 
to uterus. 
menorrhagia. 
seur k 
May 30, 
year before for menorrhagia, but 
cervix. 
1 wire. 
shock. 
without relief. 
14 
64 
May 30, 
U 
34 
S. 
24 
Cystic ova- 
Firm on 
Constant pain, 
Tied 
Tube. 
Recovery. 
Patient had been unable to do her 
1885. 
ries. 
right side 
dysmenor- 
with 
work. In bed with pain much of 
15 
65 
rhoea. 
silk. 
the time. Excessively nervous and 
despondent. Much nausea. 
May 30, 
St. Eliza- 
29 
M. 
H 
Both ov’ries 
None. 
Epilepsy. 
U 
None. 
U 
Epileptic attacks every two or three 
1885. 
beth’s 
(cystic) and 
davs, becoming worse. See note. 
Hospital. 
U 
tubes. 
Firm and 
16 
66 
June 5, 
41 
O 
Ovarian. 
Size & weight 
Not 
Tube 
u 
Impossible to remove cyst entirely; 
1885. 
Colloid con- 
extensive 
of tumor. 
reach’d 
in cyst. 
part cut off and rest drained. 
tents. 
17 
67 
June 18, 
Private 
25 
S. 
H 
2 
Solid tumor 
None. 
Sense of 
Tied 
None. 
u 
Had been pronounced a fibroid of 
1886. 
case. 
of left 
weight. 
with 
uterus; proved to be a fibroid tu- 
ovary. 
silk. 
mor of the ovary. 
18 
68 
July 29, 
U 
28 
M. 
n 
Cvstic left 
None. 
Pain & sense 
U 
None. 
u 
Left ovary and tube only removed. 
1885. 
ovary. 
of weight. 
19 
69 
Sept. 19, 
Woman’s 
42 
M. 
8 
22 
Fibro-cyst. 
Verv firm 
Pain & growth 
Elastic 
Tube. : 
Death. 
The adhesions were so numerous and 
1885. 
Hospital. 
adhesions 
of tumor. 
ligat’re 
firm that haemorrhage was un- 
avoidable. Death from shock. 
20 
70 
Sept. 30, 
u 
38 
S. 
4 
12 
Multilocular 
None. 
Rapid growth 
Tied 
None. 
U 
Peritonitis. 
1885. 
ovarian cyst 
of tumor. 
with 
silk. 
21 
71 
Oct. 17, 
Private 
19 
S. 
2 
Cystic 
None. 
Epilepsy. 
“ 
U 
Recovery J 
Patient nearly died from effects of 
72 
1885. 
case. 
ovaries. 
ether. No report yet as to the 
epilepsy. 
22 
Oct. 27, 
St. Eliza- 
32 
s. 
3 1 
1 
Ovarian 
Slight. 
Pain. 
“ 
Tube. 
“ 
Tube removed Oct. 30th. Tempera- 
1885. 
beth’s 
cyst, right 
ture did not exceed 99°. 
73 
Hospital. 
side. 
23 1 
Oct. 30, 
Private 
48 
M. 
3 I 
Pyosalpinx. 
Verv 
Metrorrhagia 
U 
None. I 
Impossible to separate tubes from 
1885. 
case. 
strong & 
ixt’nsive. 
and pain. 
uterus, which they surrounded. 
Detached a loop of intestine. 
24 
74 
Nov. 2, 
St. Eliza- 
30 
M. 
3 
4 
Small ova- 
Moderate 
Pain and dvs-| 
Tied 
Tube 1 
leeovery. 
’eritonitis developed on 2d dav. On 
1885. 
beth’s 
oz. 
rian cyst, 
menorrlioea. 
with 1 
on 3d 
3d day opened, washed out, and 
Hospital. 
left side. 
silk, j 
day. | 
left in tube. Coil used first. 
FIFTY OASES OF ABDOMINAL SECTION.—(Second Series.)  
• 
c *c 
0> o 
CD | 
o d 
% 5 
6 
jifc 
c; 
<6 
Place. 
1 
. *1 
t£ 
- 
s a»ii 
3 $ 
!lj.l 
5.5 d 
-3 S 
tumor 
— _ 
C3 
6 ° 
il 
< 
Indica- 
tions fc 
operati 
Pedicle 
03 • 
•P 
2 s 
■g Remarks. 
25 1 
75 
Nov. 13, 
St. Eliza- 
32 
M. 
In. 
2* 
Cystic right 
Firm pa- 
Pain and dys- 
Tied 
Tube. 
iecovery. Tube removed on 3d dav. No un- 
1885. 
beth’s | 
ovary. 
ietalfr’m 
menorrhoea. 
with 
favorable symptoms. 
Hospital. 
old peri- 
silk. 
tonitis. 
26 
76 
Nov. 15, ’ 
Woman’s 
26 
M. 
2i 
Ov’rv&tube 
Firm on 
Pain and dvs- 
“ 
None. 1 
“ The left ovary was somewhat cystic. 
1885. 
Hospital. 
on right side 
one side. 
menorrhoea. 
See Case XLIX. 
removed. 
27 
77 
Nov. 19, 
44 
31 
M. 
Both ova- 
None. 
Pain and dys- 
44 
44 
44 
1885. 
ries cystic. 
menorrhcea. 
28 
78 
Nov. 24, 
44 
28 
M. 
H 
10 
Tubal preg- 
Firm. 
Peritonitis. 
Elastic 
Tube. 
Death. Uterus removed with the tumor. 
1885. 
oz. 
nancy. 
lig’ture 
k wire. 
Sloughing of uterus. 
29 
79 
Dec. 8, 
St. Eliza- 
25 
M. 
2 
Pvosalpinx, 
U 
Severe pain. 
Tied 
44 
Recovery. Did not remove ovary on account of 
1885. 
beth’s 
right. 
with 
adhesions. Tube full of pus. 
Hospital. 
U 
silk. 
30 
80 
Dec. 11, 
35 
S. j 
2 
Right ovary 
None. 
Severe pain in 
44 
None. 
“ Had menstruated but once since 
1885. 
cirrhotic; 
ovary & tube 
right side, 
amenorrhoea. 
J «iy- 
removed. 
31 
81 
Jan. 2, 
“ 
24 
M. 
4 
4 
Ovarian tu- 
Very firm 
Pain and dvs- 
(4 
Tube. 
Death on Right ovary and tube diseased and 
1886. 
OZ. 
mor and 
and ex- 
menorrhoea. 
10th day. removed. On left side ovarian tu- 
pyosalpinx. 
tensive. 
mor firmly adherent to uterus, etc. 
32 
82 
Jan. 11, 
Private 
28 
S. 
4 
8 
Parovarian 
Very firm 
Pain and dys- 
u 
“ 
Death 3d Acute general peritonitis. 
1886. 
case. 
OZ. 
and ovarian 
menorrhoea. 
day. 
cysts. 
33 
83 
Jan. 12, 
St. Eliza- 
28 
M. 
2 
Cystic right 
None. 
Pain and dys- 
44 
44 
Recovery. Right ovary and tube removed. 
1886. 
beth’s 
Hospital. 
ovary. 
menorrhoea. 
Ovary much diseased. 
34 
84 
Jan. 16, 
Private 
41 
M. 
3 
Chronic 
Very firm 
Severe pain. 
None. 
“ The ovaries and uterus were bound 
1886. 
case. 
ovaritis. 
together in one mass. Impossible 
to make any impression on it. 
36 
85 
Jan. 19, 
Woman’s 
30 
S. 
6 
12 
Uterus and 
None. 
Pain & haem- 
Elastic 
44 
“ Used elastic ligature and transfixed. 
1886. 
Hospital. 
lbs. 
fibroma. 
orrhage. 
ligat’re 
Tied 
36 
86 
Feb. 8, 
44 
36 
M. 
4 
4 
Multilocular 
Slight. 
i Rapid growth 
Tube. 
Death Tumor was diagnosed as fibroid or 
1886. 
lbs. 
ovarian 
in size. 
with 
Feb. 14. fibro-evst by all who examined pa- 
cvst, col- 
silk. 
tient. Punctured the abdomen. 
87 
loid. 
Death was from general peritonitis. 
37 
Feb. 12, 
U 
42 
M. 
Cysto-sar- 
Firm. 
Pain k growth 
44 
Recovery. Not certain before operation whether 
1886. 
coma of 
of tumor. 
growth was of uterine or ovarian 
ovary ? 
origin. Removed fluid onlv. 
38 
88 
Feb. 14, 
u 
S. 
2i 
Cystic ova- 
Very firm 
Pain. 
Tied 
“ 
Death Died of sheer exhaustion. Verv weak 
1886. 
ries. 
with 
5th day. before the operation, which was 
silk. 
advised six months earlier. 
39 
8S 
Feb. 14, 
u 
42 
M. 
n 
Sm’ll fibroid 
Dvsmenor- 
None. 
Recovery- Ovarian and fibroid tumors and tube 
on right side bound in one mass. 
1886. 
tumor in 
to permit 
rhoea. 
light of 
uter’s k cys- 
removal. 
Impossible to remove it. 
tic ovary. 
40 
90 
Mch. 1, 
44 
27 
S. 
4 
1 
Dermoid 
None. 
Constant pain 
Tied 
44 
“ Had been suffering five years. Men- 
1886. 
lb. 
cyst on 
with 
struation scanty. 
right side. 
silk. 
41 
91 
Mch. 8, 
“ 
22 
M. 
2i 
Cystic ova- 
Slight. 
Pain and dvs 
“ 
Tube. 
44 
1886. 
ries. 
menorrhoea. 
42 
92 
Mch. 27, 
Private 
32 
M. 
4 
Chronic 
Verv firm 
Pain. 
44 
“ Detached 5 inches of intestine, as in 
1886. 
case. 
ovaritis. 
Case XXII1. Removed nothing. 
43 
93 
Apr. 21, 
Woman’s 
25 
M. 
2i 
Cystic ov. & 
Slight. 
Pain and dys 
Tied 
None. 
Recovery. Left ovary and tube only removed. 
1886. 
Hospital 
diseasdtube 
menorrhoea. 
with 
on left side. 
silk. 
44 
94 
Apr. 25, 
44 
19 
S. 
2 
Right ovary 
None. 
Pain. 
“ 
44 
“ Small supplementary ovary on left 
1886. 
cystic, left 
side. Both ovaries and tubes re- 
cirrhotic. 
moved. 
45 
95 
Apr. 25, 
u 
19 
M. 
4 
Cystic ovary 
Firm. 
Pain. 
44 
44 
“ Relief from almost constant pain, 
1886. 
Mav 3, 
on ri’htside, 
pyosalpinx. 
which had lasted six months. 
46 
96 
u 
30 
M. 
2* 
8 
Ovarian 
44 
Pain and sense 
4‘ 
44 
“ Ovarian tumor on left side. Cystic 
1886. 
OZ. 
cyst and 
of fullness. 
ovary on other. Removed both, 
47 
May 5, 
Private 
salpingitis. 
and tubes. 
97 
29 
M. 
1 4 
Pyosalp’x, 
Very firm 
Pain and con 
Tube. 
Death Right tube ruptured while attempt- 
1886. 
case. 
pelvic ab- 
stant discli’rge 
3d day. ing to remove it. Impossible to 
Mav 12, 
scess. 
of pus. 
get it out. 
48 
98 
Woman’s 
48 
M. 
n 
Ovarian 
“ 
Increasing 
Tube 
Recovery- Case like No. 16. Removed about two 
1886. 
Hospital 
tumor. 
size of tumor. 
in cyst 
thirds of cvst. Drained the rest. 
49 
99 
May 31, 
26 
M. 
n 
Ovaritis. 
Slight. 
Pain. 
Tied 
None. 
“ Right ovary and tube removed Nov. 
1886. 
with 
15, 1885. Left ovary and tube 
60 
1CH 
June 3, 
silk. 
removed at this operation. 
U 
47 
M. 
6A 
2 
Fibroid am 
Exten- 
Pain and men 
Elastic 
Death. Bronchitis developed earlv, and the 
1886. 
lbs 
uterus. 
sive. 
orrhagia. 
lig. k 
lungs acted badlv. Some peri- 
needles 
tonitis. 
FIFTY CASES OF ABDOMINAL SECTION (,Second Series—continued). REASONS WnY 
Physicians shonld Mscrile 
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