TWELVE MONTHS OF ABDOM- 
INAL AND VAGINAL 
SECTION. 
BY 
HENRY T. BYFORD, M. D. 
Presidential address delivered at the annual meeting of 
the Gynaecological Society, of Chicago, 
October 19, 1888. 
From The Chicago Medical Journal and Examiner. TWELVE MONTHS OF ABDOMINAL 
AND VAGINAL SECTION* 
coming laparotomist will lose a patient or 
two in this manner. 
The teaching that the pedicle should al- 
ways be transfixed has diminished the fre- 
quency of haemorrhage, but has not pre- 
vented its occurrence. The kind of knot 
cannot be made to solve the question, for 
haemorrhage has occurred with all kinds of 
knots. In both of my cases of death from 
haemorrhage I followed the directions usu- 
ally given in the books and employed in 
practice, and I attribute the death of one, if 
not both, to my faithfulness in following 
out such advice. I transfixed the pedicle 
in a non-vascular place, and, although I 
tied as tightly as I could, my patient was 
almost pulseless from internal haemorrhage 
four hours afterward. 
I will substantiate the position taken by 
a few quotations. First, from Heger and 
Kaltenbach (Operative Gynakologie, third 
ed., 1880, p. 273): “The pedicle, held be- 
tween two fingers, should be transfixed at a 
non-vascular* place, .... a double 
thread drawn through and each half of the 
pedicle tied by itself, without crossing the 
threads. . . . The threads, at the tying 
of the first knots are always put through 
twice (surgical knot), and drawn with a 
gradually increasing force until they have 
made a deep and permanent furrow; there- 
upon, a second, and even a third, knot is 
tied. Below the partial ligatures we always 
put a ligature about the whole pedicle.” 
BY HENRY T. BYFORD, M. D. 
Gentlemen: I have chosen to lay be- 
fore you on this occasion an abstract of my 
work in abdominal and vaginal section dur- 
ing the year in which I have served you as 
president. As a detailed report of forty-eight 
cases would take up too much of your time, 
I have furnished each of you with a statis- 
tical table of them for your inspection, and 
my remarks will be chiefly of a critical and 
explanatory nature. 
First, as to the percentage of deaths: A 
death-rate of 17 per centum can not be 
considered an unusually large one for 
operations in which the abdominal cavity 
is opened for all sorts of pelvic growths as 
they are met with in gynsecologic practice, 
including malignant and almost hopeless 
cases. Yet this mortality is above twice 
what it ought to have been in this series, 
or ought to be in almost any such series. 
The two deaths from haemorrhage should 
not have occurred. I suppose that almost 
every laparatomist of any experiem e has 
lost one or two patients from haemorrhage, 
and has needed one or both of these acci- 
dents to teach him how to tie the pedicle. 
And until this shall be adequately taught 
somewhere, I suppose that almost every 
* Presidential address delivered at the annual meeting of the 
Gynaecological Society of Chicago, October 19,1888. 
* Italics in these quotations are mine. 4 
THE MEDICAL JOURNAL AND EXAMLNER. 
Next from Olshausen (Handbuch der 
Frauenkrankheiten, Billroth & Lueke, 1886, 
vol. ii., p. 544): “ It is generally accepted 
that thick pedicles must be tied in two, 
three, or, exceptionally, four portions. With 
the ordinary and quite efficient division in 
two halves, one separates the tissues in the 
middle, thinnest portion at a non-vascular 
place. ... In the half on one side 
lies the tube ; in the other, the ovarian liga- 
ment.” The following is Greig Smith’s 
description (Abdominal Surgery, 1887, p. 
167): “The ligature is placed double by 
transfixing with a blunt needle. The inner 
pedicle contains the utero-ovarian liga- 
ment, the Fallopian tube somewhere near 
its isthmus, the spermatic artery and its 
veins, and the small branch which accom- 
panies the Fallopian tube. The outer liga- 
ture lies at the retiring angle where the in- 
fundibulo-pelvic and infradibulo-ovarian 
ligaments meet, takes its half of the meso- 
varium, and also constricts the spermatic 
artery.” 
It will be noticed in these quotations 
that the pedicle is usually to be tied in 
halves and transfixed in a no?i-vascular point, 
which is generally a weak one. In both of 
my fatal cases I transfixed through a non- 
vascular portion, and in the one case 
(ovariotomy), I drew upon the silk as tight- 
ly as I could, while in the other (obphorec- 
tomy), I used Tait’s knot, and thought I got 
it as tight as possible. I opened the abdo- 
men before death in both cases and found 
that the pedicle of the ovarian tumor had 
partly slipped out of the ligature, and that 
the other had not been sufficiently secured. 
I now use the following method, with a 
view to avoiding such accidents, and have 
not found it wanting in safety : I hold the 
pedicle between the thumb and forefinger 
of the left hand so that the Fallopian tube, 
well drawn out, lies on the same side with 
(and against) the ovarian ligament. The 
mesovarium lies against the mesosalpinx. I 
pass the double-threaded needle with one 
thrust through the inner or mesenteric edges 
of both the Fallopian tube and ovarian lig- 
ament, thus getting the ligatures fixed at 
two firm points. I then hand the pedicle 
to an assistant and tie the tube and ovarian 
ligament with one of the threads, and the 
remainder of the pedicle, which is much 
more than half, with the other; and then 
the whole pedicle en masse with one of the 
same threads, preferably the one first 
tied. While drawing the ligatures tight 
with the first or surgical knot of each liga- 
ture, I keep on pulling at the knot while 
the traction upon the pedicle is relaxed by 
the assistant. This is necessary to secure' 
complete collapse and permanent constric- 
tion of the tissues. When the pedicle is 
unusually short and inelastic I transfix, as 
just stated, but, in addition, carry both 
threads before tying through a fold of 
the pedicle at the side opposite the Fal- 
lopian tube and ovarian ligament, and thus 
have a hold at three peripheral points of 
the pedicle, and am insured against slip- 
ping of the ligature. To get a firm hold 
for the ligature, which is inconsistent with 
tying the pedicle in halves, and to relax the 
pedicle while tying, so that it may be made 
to collapse completely, are, it seems to me, 
points that can not be neglected with safety 
in any case, and which ought to be more 
fully explained in the books Fleshy pedi- 
cles must, of course, be ligated in small 
portions, and are not referred to in what I 
said above. 
The death from heart-failure (explora- 
tory excision) ought not to have occurred, 
for either I ought not to have operated, or, 
having done so, should have pushed stimu- 
lants, nourishment, massage, etc., more vig- 
orously. At present, whenever, after the 
first two or three days’ fasting, the pulse 
becomes soft and compressible, I give some 
stimulants, particularly between the hours 
of 2 and 8 a. m., at which time the temper- 
ature is lowest and the circulation feeblest. 
Rectal alimentation is, of course, employed, 
but is always used with care for fear of in- 
ducing rectal irritation. 
The two deaths from abdominal hyster- 
ectomy occurred in patients who should not ORIGIN A L COMM UNICA TIONS. 
5 
have been operated upon, because the con- 
dition proved to be such that recovery 
after an operation was impossible. Yet, as 
they were both doomed to a speedy, pain- 
ful death if left without interference, and 
were anxious for an operation, I could not 
see my way clear to refusing them what 
seemed a last chance. It is also certain 
that the other fatal ovariotomy ought not 
to have been performed, since cancerous 
deposits existed elsewhere than in the 
ovary. Let us hope that in the future, 
either cases like these three will be oper- 
ated upon sooner, or an increased expe- 
rience will enable us to diagnose more 
completely and determine with greater ac- 
curacy just when it becomes our duty to 
abandon the patient to her disease. 
Had I known how to tie a pedicle, and had 
I known better how to select my cases, six 
of these seven deaths would not have oc- 
curred, and the mortality for the series 
would have been less than 3 per centum. 
But it is, of course, unjustifiable and cow- 
ardly for a surgeon to reject all unpromising 
cases, when he knows that they must 
speedily die if not relieved by an opera- 
tion. 
It will be seen that all of the deaths took 
place among the twenty-seven abdominal 
sections, and none among the twenty-one 
vaginal sections. 
In preparing the patients for the opera- 
tions I usually give five or six grains of 
blue-mass on the second night before, and 
follow it in the morning by a saline aperient. 
The mercurial leaves the secretions in a 
more healthy state than other laxatives, 
and better promotes absorbtion of the gases. 
Unless that works too thoroughly, an enema 
is given the evening before the operation, 
of two ounces of glycerine with four of 
water, and a plain water-enema oh the 
morning of the operation. From one to two 
ounces of brandy or whisky are given half 
an hour before the anaesthetic is adminis- 
tered. I prefer cloroform, but use ether 
because of the difficulty in getting an as- 
sistant who is accustomed to use the former. 
In the after-treatment no morphine is 
given, except for diarrhoea, or occasionally 
one dose immediately alter the operation, 
for excessive nausea or restlessness. Pain, 
due to intestinal peristalsis, is treated by 
aromatics, the rectal tube, and the glycerine- 
and-water enema. 
Vomiting after the operation, even though 
it continue for two or three days, is not 
considered as of serious consequence. But 
secondary vomiting, commencing gently 
after the first has subsided, with regurgita- 
tion at pretty regular intervals and gradu- 
ally increasing in severity, is regarded as 
the forerunner of intestestinal obstruction 
or paralysis, or possibly of peritonitis. I 
then make haste to administer a saline 
aperient before the nausea becomes so 
severe as to prevent its retention. One 
drachm of the granular effervescing citrate 
of magnesia is given every hour until flatus 
or feces pass the anus, or until its action 
can be felt in the bowels by the patient. 
After this has occurred, or if it does not 
occur after ten or twelve drachms have 
been retained, the usual glycerine enema is 
given, and repeated, if neccessary, with the 
addition of a drachm of spirits of turpen- 
tine. In case the saline aperient produces 
much pain it is discontinued and the 
enemas relied upon exclusively. When 
intestinal gases commence to pass off with- 
out the aid of the rectal tube, I consider 
the danger of intestinal obstruction or 
paralysis over for the time, and wait for 
other symptoms, or until near the end of 
the first week, before further disturbing the 
bowels. The effect of the magnesia should 
be to increase the comfort of the patient 
and diminish her pain; if it does not do so, 
it is not, as a rule, indicated. 
In operating, I usually try to obtain as 
thorough asepsis as practicable, but, as a 
rule, do not consider its perfect attainment 
possible. I endeavor to operate so that 
my patient will recover, even if some of the 
ordinary septic germs of the atmosphere be 
introduced into the abdominal cavity, and 
seldom feel certain of completely excluding 6 
THE MEDICAL JOURNAL AND EXAMINER. 
them, except in simplest cases with small 
incisions. The part of the peritoneum with 
which I consider it most dangerous to deal 
is that which covers the intestines. I 
touch them only when absolutely necessary, 
and keep them as nearly constantly out of 
view or exposure to the air, by a covering 
of omentum, sponge, or aseptic cloth, as 
possible. I think the chances for recovery 
in any given properly performed abdomi- 
nal or vaginal section will be bad almost in 
proportion as the intestinal coverings are 
injured or exposed to the air. 
Finally, gentlemen, I will close with re- 
marking that the way of the laparotomist, 
like that of the transgressor, is hard. The 
lot of the ideai antiseptist is unusually so, 
especially if he have that fear of sepsis that 
goes with the so-called aseptic conscience. 
At a recent abdominal section I had to 
make a large incision and spend some 
time in an attempt to control haemorrhage 
in the pelvis. About the time I had got 
the abdominal cavity open an invited 
guest came in, stating that, through a mis- 
take of the messenger, he had just received 
my invitation and had started for the hos- 
pital immediately. He was, of course, un- 
prepared. When I called for ligatures he, 
considering himself an assistant, made a 
grab for them. I had him put them down, 
and gave him a short lecture. Yet in a 
few minutes he had his hand upon the 
edge of the incision, holding an instru- 
ment. After the operation I found among 
my instruments a pair of haemostatic forceps, 
which he had taken out of his pocket-case 
after I had used my last one. Upon leav- 
ing he informed me that the case had been 
an instructive one to him, and, although 
the patient got well without a bad symp- 
tom, it was also an instructive one to me. ORIGIN A L COMM UNICA TIONS. 
7 
6 
Name, and 
Date. 
6 
bQ 
◄ 
| Married or Single. 
| No. of Children. 
No. of Tappings. 
i 
Size and Nature of 
Tumor. 
| One or both 
Ovaries. 
Adhesions. 
Treatment of 
Pedicle. 
Drainage. 
Complications. 
Hospital 
or 
Private. 
Result. 
Reported 
Elsewhere. 
Remarks. 
i 
Mrs. P—th. 
July 14, 1887. 
40 
M 
Multi- 
para. 
1 for 
ascites 
Carcinoma of right 
ovary size of 
man's head, cyst 
of left ovary size 
of fist. 
Both 
Extensive, to 
right abdom- 
inal wall 
Tied with silk 
and dropped 
Yes, 
long rub- 
ber tube 
Ascites 
St. Luke’s 
Hospital 
D. in 
10 lire 
Nf 
Died of shock and exhaustion. 
2 
Mrs. Tho—s. 
Aug. 30,1887. 
27 
M 
4 
0 
Dermoid cyst, size 
of large goose 
esrg. 
Both 
No 
Tied with silk 
and dropped 
No 
F i b r o-myoma o f 
fundus uteri, size 
of small orange. 
Woman’s 
Hospital 
R 
No 
Uneventful recovery. 
3 
Mrs. W— sh. 
Nov. 19,1887. 
48 
M 
Multi- 
para. 
0 
Mouocyst, size of 
man's head, filled 
with chocolate- 
colored fluid. 
One 
Extensive 
omental 
Tied with silk 
and dropped 
No 
Adherent, o uientum 
indurated, size 
and shape of hand 
St. Luke’s 
Hospital 
R 
No 
Removed thickened omentum after 
a multiple juniper catgut ligature. 
4 
Mrs. —. 
Jan. 11, 1888. 
40 
M 
0 
0 
Mouocyst, contain- 
ing 3 pints. 
One, 
right 
No 
Tied with silk 
and dropped 
No 
Urethritis, cystitis, 
insanity. 
St. Luke’s 
Hospital 
R 
No 
Got up at beginning of 5th day, 
changed nightgown, put on skirt, 
and was found at the door twenty 
feet away. Next day temperature 
98 2-5 to 99° Fahr. Got up again on 
10th day. Recovery rapid and un- 
5 
Mrs. P—s. 
Jan. 31, 1888. 
23 
M 
Twins. 
0 
Polycyst, larger 
than a man’s head 
One, 
left 
Slight 
Tied with silk 
and dropped 
No 
Haemorrhage from 
pedicle. 
St. Luke’s 
Hospital 
D. in 
27 hrs 
No 
interrupted. 
Died of htemorrhage. Opened abdo- 
men about six hours after and found 
that the ligature had slipped. Ab- 
dominal cavity full of blood. Sewed 
up broad ligament. Transfusion of 
saline sol. and afterward of blood. 
6 
Mrs. S—1. 
May 29, 1888. 
28 
M 
2 
0 
Dermoid cyst, size 
of woman's head. 
Both 
No 
Tied with silk 
and dropped 
Yes, for 3 
days,glass 
tube 
Metritis 
Woman’s 
Hospital 
R 
No 
Escape of fluid from tumor into incis- 
ion. Washed out abdomen with 
warm water. Smooth recovery. 
d 
Name, and 
Date 
V 
bC 
< 
Married or 
, Single. 
No. of 
Children. 
Size and Nature 
of Tumor. 
One or Both 
Ovaries. 
Adhesions. 
Treatment 
of Pedicle. 
Drainage. 
Complications. 
Hospital or 
Private. 
Result. 
Reported 
Elsewhere. 
Remarks. 
i 
Mrs. M—m 
Aug. 29,1887 
40 
M 
8 
Monocyst size of 
sma 1 egg—long 
pedicle. 
Both 
None 
Tied and 
dropped 
Yes, 
24 hours 
Menorrhagia, retro- 
version, invalid- 
ism. 
St. Luke’s 
Hospital 
R 
Am. Journal 
Ohst. April, 
1888 
Tamponed uterus in position for 2 
days. Cured retroversion and 
symptoms. 
2 
Miss R—e. 
Oct. 2, 1887. 
24 
S 
0 
Dermoid cyst size 
of walnut, right. 
Bolh 
Uterus and 
appendages 
matted to- 
gether. 
Tied and 
dropped. 
Yes, 
40 hours 
Left pyo-salpiux. 
Patient bedridden 
Woman’s 
Hospital 
R 
Am.Journal 
ol Ohst., 
April, 1888, 
9, v. 
Abscess developed in the 4th week 
and discharged into vagina and rec- 
tum . Is now improving in health, 
is menstruating. 
Abdominal Sections for the Removal of Ovarian Tumors. 
Vaginal Sections for the Removal of Ovarian Tumors. 8 
THE MEDICAL JOURNAL AND EXAMINER. 
6 
Name, and 
Dale of 
Operation. 
Married <n 
Single. . 
No. of 
Children 
Pathological Con- 
dition or Symp- 
toms necessitating 
Operation. 
Duration 
of Disease 
nd 
<D 
d > 
2 
M 
p? 
S 
.2 
5 
6 
<1 
Treatment 
of Pedicle. 
Drainage. 
Hospital 
or Private. 
ST CD 
5 Q 
So 1 
Complications 
before or after 
Operation. 
<x> o 
> *- 
k & 
Remarks—Effect of Operation upon 
condition requiring it. 
i 
24 
S 
No 
Tied and 
No 
Woman’s 
R 
None 
No 
Troubled since operation with dark. 
July 21, 1887. 
Follicular enlarge- 
ovaries, 
dropped 
Hospital 
offensive discharge from the ute- 
ment of both ova- 
with 
rus. Svmp oins were relie veil lor 
ries (slight). 
tubes 
a time, but since as bud as ever at 
11 m s, and better a' times. 
2 
Mrs. A.R.R—11 
23 
M 
1 child, 
Small fibroid of fun- 
Several 
Both 
No 
Tied and 
No 
Woman’s 
R 
Pelvic hemato- 
No 
Epilepsy cured for a few weeks, then 
Aug. 10, 1887. 
1 misc. 
dusuteri. Epilepsy, 
years 
ovaries, 
dropped 
Hospital 
cele size of 
returned; but not as bad-as b< fore 
at 6 mo. 
numerous severe 
with 
la»ge oiange, 
operation, and is now improving. 
fits daily, near 
menstrual period. 
tubes 
3 weeks after 
operationpro- 
duced by eat- 
ing bananas; 
absorbed in 
3!4 months. 
Complete cure to date. Had two 
3 
Mrs. McK—a. 
20 
W 
Three 
Periodic hysterical 
Seven 
Both 
No 
Tied and 
No 
Woman's 
Retroplac mem 
No 
Aug. 11, 1887. 
man a, worse at 
years 
ovaries, 
dropped 
Hospital 
and anteflex- 
slight atiacks soon after operation 
menstrual periods. 
with 
ion of ute.us 
— l.one since. In good health. 
Enlarged ovaries. 
ttibi s 
Complete cure. Ovaries nearlv four 
4 
19 
s 
"'ix years, 
since flrsi 
Boih 
No 
Tied and 
No 
St. Luke’s 
R 
Premature me- 
Aug. 29, 1887- 
ovaritis, and en- 
ovaries, 
d ropped 
Hospital 
nopause. Pa- 
Medical 
times natural size > nd each con- 
largement. Pain. 
menstrual 
with 
tient plethoric 
Society. 
verted into a multitude oi cysts 
(See remarks). 
period 
tubes 
1887 
size of peas, uoi e ot which pro- 
jected from the surface. 
5 
Mrs. S—nd. 
19 
w 
One, a 
L. htemato-salpinx. 
One year 
Both 
Extensive, 
Tied and 
No 
St. Luke’s 
R 
Slight attack of 
No 
Condition originated in puerperal 
Sept. 8, 1887. 
year 
Both ovaries about 
ovaries, 
on both 
dropped 
Hospital 
phlebitis (r> 
septicatmia. Now in fair heabh 
before 
4 times normal size 
with 
sides. 
l'ollowingope- 
and improving, but has a small, 
tender lump on right broad liga- 
and inflamed. 
tubes 
ration. Defe- 
cation painful 
for 2 n onths 
ment. 
after Cervical 
stenosis from 
anteflexion, 
with uterine 
colic. 
6 
19 
s 
Ovaritis of long 
standing. Unim- 
proved by p’longed 
Uncertain 
Right 
ovary and 
tube 
No 
Tait's 
No 
St. Luke’s 
D. in 36 
Hsemorrha ge 
from pedicle. 
No 
Abdominal cavity opened 19 hours 
after opera ion, after transfusion 
of marly Oil of saline fluid, and 
Sept. 26, 1887. 
knot 
Hospital 
hours 
treatment. 
found ligature partly off of stump, 
abdomiu.d cav ty full of blood- 
clots. 
7 
Mrs. L—n. 
51 
M 
Multip 
Cyst of right broad 
Several 
Left 
Cyst on left 
Tied and 
Glass tube 
St. Luke's 
R 
None 
No 
Patient Rlightly improved. Drew 
Oct. 6, 1887. 
ligament. Invalid- 
years 
ovary and 
ovary 
dropped 
tor2th’rs. 
Hospital 
the fluid from cyst of broad liga- 
ism unimproved by 
tube 
firmly 
iodoform 
ment by a-piration per vaginam 
treatment. Small 
adherent, 
gauze 48 
Nov 7. 1887, at the place of its 
cyst projecting fin 
causing 
hours 
projection over the cut de sac. 
surface of leftovary 
free 
bleeding. 
longer 
Abdominal walls were so very fat 
that a 1 rge abdominal ineision 
would have been necessary even 
to aspirate the cyst from above. 
Intestines full and tense. 
Abdominal Section for Removal of Uterine Appendages not the Seat of Tumor ORIGIN A L COMM UNICA TIONS. 
9 
6 
fc 
Name, and 
Date of 
Operation. 
03 
u 
< 
Married 
or Single. 
No. of 
Children. 
Pathological Con- 
dition or Symptoms 
necessitating 
Operation. 
Duration 
of 
Disease. 
What re- 
moved. 
Adhesions. 
Treat- 
ment of 
Pedicle. 
Drainage. 
Hospital 
or 
Private. 
Recovery 
or 
Death. 
Compl cations be- 
lore or after 
Operation. 
I Else- 
1 where re- 
ported. 
Remarks—Effect of Operation 
upon condition requiring it. 
8 
Mrs. S—dy. 
Oct. 14, 1887. 
37 
Wid. 
0 
Left hydrosalpinx. 
Enlarged cystic 
ovaries, chronic in- 
validism, unim- 
proved by treat- 
ment. 
14 years 
Both ova- 
ries with 
tubes. 
No 
Tied and 
dropped. 
No 
Woman’s 
Hospital. 
R 
Small hernia fol- 
lowed hut gives no 
trouble Endome- 
tritis before opera- 
tion. 
Chicago 
Gyn. Soc.. 
Nov. 18, 
1887. 
Slow improvement after opera- 
tion. 
9 
Mrs. K—n. 
Dec. 19, 1887. 
22 
M 
0 
Enlarged cystic 
ovaries. Interstitial 
salpiugitis. Disten- 
sion o f veins o f 
right broad liga- 
ment. Excruciat- 
ing dysmenorrhcea. 
2 lA years 
Both ova- 
ries with 
tubes. 
Universal 
and firm. 
Tied and 
dropped. 
Yes, glass 
tube. 
Woman’s 
Hospital. 
D. in 3| 
days. 
Persistent bloody 
oozing from drain- 
age tube. Obstruc- 
tion of bowels. 
No 
Death caused by obstruction 
of bowels with pelvic perito- 
nitis. Highest temp, during 
first 3 clays, 101 2-5° F.; before 
death, 1022-5°. 
10 
Ellen A—n. 
Jan. 4, 1888. 
24 
S 
Congenital anteflex- 
ion. Incurable dys- 
menorrhcea. Slight- 
est dilatation fol- 
lowed by inflamma- 
tory reaction. 
Since first 
menstru- 
al period 
Both ova- 
ries with 
tubes. 
No 
Tied and 
dropped. 
Yes, glass 
tube. 
St. Luke’s 
Hospital. 
R 
Losing mental pow- 
er; acquiring opi- 
um habit. Becom- 
ing fast a physical 
wreck. 
No 
Recovery is complete. Now 
supports her aged mother. 
11 
Kate B—e. 
Jan. 16,1888. 
24 
s 
Epilepsy at or near 
menstrual periods. 
Loss of mental 
power, slight cystic 
enlargement of L. 
ovary. 
2!4 years 
Both ova- 
ries with 
tubes. 
No 
Tied and 
dropped. 
No 
St. Luke’s 
Hospital. 
R 
Epilepsy so fai 
cured Has an ex- 
udate size of end of 
thumb about right 
stump, preventing 
her from working. 
No 
Has menstruated regularly for 
past 3 months. Still complains 
ot mental weakness, kept up 
perhaps by irritation about 
right stump. 
12 
13 
14 
Mrs. J—n. 
Jan. 22,1888 
Miss McF—n. 
March 26, 1888 
Ida H—h. 
May 21, 1888. 
23 
35 
22 
M 
S 
s 
1 
Prema- 
ture. 
Double ovaritis and 
salpingitis, with 
recurrent acute at- 
tack. Right hema- 
tosalpinx. 
Soft fibro-myoma ot 
fundus uteri size of 
goose egg with per- 
s i s t e n t incurable 
pelvic pains. Slight 
menorrhagia. 
Congenital anteflex- 
ion, with dysmen- 
orrhoea and pelvic 
pains, increasing 
in spite of many 
months of treat- 
ment. 
Since 
birth of 
child 
Symp- 
toms for 
several 
years 
5 years. 
Soon aft- 
er menses 
appeared 
Both ova- 
ries with 
tubes. 
Both ova- 
ries with 
tubes. 
Both ova- 
ries with 
tubes. 
Extensive 
and firm. 
No 
No 
Tied and 
dropped. 
Tied and 
dropped. 
Tied and 
dropped. 
No 
No 
No 
Woman’s 
Hospital. 
St. Luke’s 
Hospital. 
Woman’s 
Hospital. 
R 
R 
R 
Followed in tfree 
months by rheu- 
matic arthritis. 
Endometritis 
chronic before and 
after operation. 
No 
No 
Chicago 
Medical 
Society, 
May 21, 
1888. 
Gradual progressive recovery 
from all but endometritis. 
Left hospital complaining 
slightly of pelvic pains. Men- 
s-es. which were rather pro- 
fuse, had not returned. 
Tenderness about one stump 
for about 3 months. Improv- 
ing. Menses have not re- 
turned. 
15 
Miss P—w. 
June 26, 1888. 
25 
s 
Dysmenorrhcea. In 
curable pelvic pains 
Failure of mental 
power. Enlarged 
ovaries. 
7 years 
Both ova- 
ries with 
tubes. 
No 
Tied and 
dropped. 
No 
Woman’s 
Hospital. 
R 
Cervical endome- 
tritis. Bluish soft- 
ened ulcerated os. 
No 
Ovaries cystic and four times 
their natural size. Left hos- 
pital improved. 
Abdominal Section for Removal of Uterine Appendages not the Seat of Tumor—Concluded. 10 
THE MEDICAL JOURNAL AND EXAMINER. 
© 
% 
Name, and 
Date of 
Operation. 
Age. 
©7l 
"C 0 
5 x 
O 
No. of 
Children. 
Pathological Condition 
or Symptoms necessi- 
tating Operation. 
Duration 
of Disease. 
What 
Removed. 
s 
o 
© 
& 
Treatment 
■ of Pedicle. 
Drainage. 
Hospital 
or Private. 
Recovery 
or Death. 
Complications 
before or af. er 
Operation. 
Effect of Operation 
upon Condition requir- 
ing it. 
Remarks. 
Elsewhere 
Reported. 
i 
Mrs. E. D—ty. 
July 30, 1887. 
35 
M 
Three 
Hysterical mania and 
cephalalgia. Husband 
lel't her on account oi 
supposed insanity. 
Sev- 
eial 
years 
Both 
ovaries 
and 
tubes 
No 
Tied and 
dropped 
Yes, 24 
hours 
Woman’s 
Hospital 
R 
Addicted to opi- 
um habit before 
operation. Re- 
troversion. 
Cured of mania, cepha- 
lalgia and opium habit. 
Last attack of 
cephalaluia and 
mania was the 
day before the 
operation. 
Am. Jour- 
nal Obst. 
April, ’88. 
2 
Mrs. N—n. 
July 31, 1887. 
31 
M 
One,at 8 
months 
OOphoritis. salpingitis. 
Eight hydrosalpinx. 
Husband thought she 
was losing her mind 
Several years’ treat- 
ment without relief. 
Acute attacks. Unable 
to work. 
Many 
yeais 
dat- 
ing 
ft-' m 
con- 
fine- 
ment 
R. ovary 
and tube 
Loosened 
adhesions 
of left 
ovary., 
Uni- 
versal 
and 
firm 
Tied and 
dropped 
Yes. 24 
hours 
St. Luke’s 
Hospital 
R 
Retroversion and 
endometritis be- 
fore operation 
Slight phlebitis 
on right side 
after operation. 
Gradual progressive re- 
lief. Great gain in fi sh 
Able to do her house- 
work. Mental symp- 
toms cured. 
Left o'ary and 
tube should have 
been removed. 
Am. Jour- 
nal Obst. 
April, ’88. 
3 
Mrs. S—r. 
Aug. 11, 1887. 
42 
M 
Three 
R. ovary enlarged and 
neuralgic, lying in rec- 
to-uterine pouch Bed- 
ridden. Mental condi- 
tion bordering on in- 
sanity. Failure of 
treatment. 
Two 
years 
Both 
ovaries 
and 
tubes 
No 
Tied and 
dropped 
Yes, 24 
hours 
Woman’s 
Hospital 
R 
Had been in asy- 
lum foran attack 
of insanity. Re- 
troflexion. 
Gradual uninterrupted 
recovery, almost com- 
plete when last heard 
from. 
Am. Jour- 
nal Obst. 
April, ’88. 
4 
Mrs. Annie C. 
Aug. 17, 1887. 
24 
M 
Two 
Hoematoma of R. ovary 
size of hickory nut. 
Bilateral ovaritis and 
salpingitis. Bedridden 
3 years. 
Three 
years 
Both 
ovaries 
and 
tubes 
Univer- 
sal and 
firm. 
(See re- 
marks.) 
Tied and 
dropped 
Yes. two 
days 
St. Luke’s 
Hospital 
R 
Gradual recovery. Ex- 
amined in July, 1888, 
and found cure com- 
plete. 
A porton of right 
tube left. 
Am. Jour- 
nal Obst. 
April, ’88. 
5 
Mrs. C—n. 
Sept. 8, 1887. 
13 
M 
One, 
20 years 
old 
R. ovary in recto-uterine 
pouch. L. ovary en- 
larged and cystic. L. 
tube hypertrophied. 
20 
years 
Both 
ovaries 
and 
tubes 
No 
Tied and 
dropped 
Yes, 24 
hours 
St. Luke’s 
Hospital 
R 
Light anteflexion. 
Able to work out two 
months after operation. 
Re tro version 
cured b y tam- 
poning after op- 
eration. 
Am. Jour- 
nal Obst. 
April, ’88. 
6 
Mrs. J—n. 
Sept. 26, 1887. 
34 
M 
One 
R. ovary in recto-uterine 
pom In Both enlarged 
and cystic. 
Since 
birth 
of 
child 
Both 
ovaries 
and 
tubes 
No 
Tied and 
dropped 
Yes, 48 
hours 
St. Luke’s 
Hospital 
R 
Retroversion. 
Rapid complete relief. 
Am. Jour- 
nal Obst. 
April, ’88. 
7 
Mrs. C. E. F. 
Oct. 18, 1887. 
28 
M 
Two 
R. ovary enlarged and 
in recto-uterine pouch. 
Inability to be on feet 
any length of time. 
Four 
years 
Right 
ovary 
and 
tube 
No 
Tied and 
dropped 
Yes, 24 
hours. 
Woman’s 
Hospital 
R 
Retroversion. 
Rapid cure. 
Retroversion 
cured. 
Am. Jour- 
nal Obst. 
April, ’88. 
8 
9 
Mrs. J—n. 
Jan. 14, 1888. 
Mrs. H—d. 
Feb. 6, 1888. 
42 
22 
M 
M 
One, 
16 years 
old 
One , 
2*4 yrs. 
old 
Chronic inflammation of 
appendages. Frequent 
acute attacks. R. ovary 
enlarged and cystic. 
R. ovary size of small 
hen’s egg, prolapsed. 
Pain ana disability. 
Failure of treatment. 
16 
years 
214 
years 
Both 
ovaries 
and 
tubes 
Right ov- 
ary and 
tube 
No 
No 
Tied and 
dropped 
Tied and 
dropped 
Yes, 30 
hours. 
Yes, 24 
hours. 
Woman’s 
Hospital 
St. Luke’s 
Hospital 
R 
R 
Retroversion be 
fore, pneumonia 
during, convales- 
cence. 
Relieved until the retro- 
version recurred two 
months after operation 
while going up stairs. 
Symptoms then recur- 
red and have improved 
slowly since. 
Immediate, complete 
and permanent relief. 
Uterus tamponed 
in position for 
2!4 days and re- 
mained in fair 
position for two 
months. 
Am. Jour- 
nal Obst. 
April, ’88. 
Am. Jour- 
nal Obst. 
April, ’88. 
Vaginal Section for Removal of Uterine Appendages not the Seat of Tumor. ORIGINAL COMMUNICATIONS. 
11 
d 
fc 
Name, and 
Date of 
Operation. 
d 
< 
•B 0) 
.S-sb 
ts 
No. of 
Children. 
Pathological Condi- 
tion or Symptoms 
necessitating Operation 
Duration 
of 
Disease. 
What 
Removed 
Ad- 
hesions. 
Treat- 
ment of 
Pedicle. 
Drain- 
age. 
Hospital 
or 
Private. 
Recovery 
or 
Death. 
Complications before 
or after Operation. 
Effect of Operation upon 
Condition tequir- 
ing it. 
Elsewhere 
Reported. 
10 
Mrs. J. E. D. 
Feb. 16,1888. 
26 
M 
0 
Left tube contained 4 
ounces of serum; Left 
ovary half au ounce; 
Riuht ovary and tube 
enlarged and prolapsed 
Several 
yearc*. 
Both ova- 
ries and 
tubes 
On left 
side. 
Tied and 
dropped 
Yes, 
30 hrs. 
Private 
R 
Retroversion before. 
Abscess in recto-uter- 
ine pouch, due to a 
small effusion of blood 
after operation. 
Patient passed from ob- 
eer\ ation. 
Am. J o ur- 
nal Obst., 
Apr., 1888. 
11 
Mrs. J. H. E. 
Apr. 21, 1888. 
28 
M 
0 
L. hsematosalpinx. Left 
ovary 4 1 imes natural 
size. R. append ager- 
diseased. Prolonged 
invaliuism. 
12 years, 
since a 
fall. 
Both ova- 
ries and 
tubes 
Extensive 
and firm 
on both 
sides. 
Tied and 
dropped 
Yes, 
48 hrs. 
Woman’s 
Hospital 
R 
Fracture of coccyx. Re- 
troversion. Small ab- 
scess in cellular tissue 
about stitches dis- 
charged ten days after 
the operation and gave 
no more trouble 
Gradual improvement. 
Feels better than before 
operation. 
No 
12 
Mrs. Me E. 
Apr. 26, 1888. 
38 
M 
1 
Both ovaries enlarged 
L. in recto-utenne 
pouch. Beth tubes in- 
durated and occluded. 
Persistent incurab 1 e 
pelvic pains. 
Since mis- 
carriage 
5 yrs. ago. 
Both ova- 
ries and 
tubes 
Slight of 
left tube. 
Tied and 
dropped 
Yes, 
32 hrs. 
Woman’s 
Hospital 
R 
Retroversion. Exudate, 
size of chestnut, was 
found at site of L. 
stump 3 weeks after 
operation, which was 
rapidly absorbed. 
Complete relief for three 
weeks, when the temp, 
went up to 100° F., and 
severe pains came on 
Patient felt too well and 
exercised too much. Im- 
proving rapidly when she 
left hospital 
No 
o 
fc 
Name, and 
Date of 
Operation. 
6 
< 
Married 
or Single 
No. of 
Children. 
Pathological Condition 
and Symptoms 
necessitating Operation. 
Duratien 
of 
Disease 
Nature of Operation. 
Adhesions. 
Drainage. 
Hospital 
or 
Private. 
Recovery 
or 
Death. 
Complications be- 
fore and after. 
Remarks 
and subsequent 
History. 
Elsewhere 
Reported. 
1 
Mrs. W—n. 
40 
M 
4 and 4 
Fibro-sarcoma of uterus 
B years. 
Amputation and fixation 
Intestinal 
Yes. 
Woman’s 
Died from 
Unsuccessful at- 
Stump was size 
Chicago 
Aug 4,1787. 
misc. 
size of man’s head. Pain 
of stump in wound with 
all over it; 
Hospital. 
exhaustion 
tempt at removal 
of a man’s thigh. 
Gyn. Soc., 
and rapid growth. 
use of elastic ligature. 
also attach- 
in 3B hours 
had Been made 2 
Had been diair- 
Nov., 1888. 
ed to pelvic 
months before. 
nosed to be a fi- 
wall. 
bro-myoma. 
2 
Mrs. E—tt 
34 
M 
i 
Fibro-cystic myoma size 
7 years. 
Amputation, treatment of 
L. tube ad- 
Double.One 
Woman’s 
Died of 
Broad lig. drawn 
No 
Jan 2, 1888. 
of uterus at 9 mo. Half 
pedicle after Schroder's 
herent to 
tube in ab- 
Hospital. 
exhaustion 
up over turn or so 
pint of watery fluid in 
(intraperitoneal). Left 
tissues at 
dorninal 
in 48 hours 
as to render liga- 
right tube. Lefttubecon- 
tube could not be remov- 
base of 
cavity, an- 
with com- 
tion almost im- 
tamed a quart and had 
ed, and was stitched into 
broad lig. 
other in L. 
mencing 
possible. 
grown down between 
external wound. 
Fallopian 
rise of temp 
folds of broad ligament 
tube. 
to pelvic floor. _ 
3 
32 
s 
Discov- 
Yes, tube 
St. Luke’s 
R 
May2,1888. 
fibro-myomata of uterus 
ered 5 
lig. and extraperitoneal 
cept in 
above and 
Hospitai. 
Gyn. Soc., 
with a development un- 
years 
treatment of stump after 
broad lig. 
iodoform 
May, 1888. 
der left broad lig. size 
ago. 
Hegar Bladder dissected 
and to biad- 
guaze be- 
of woman’s head. 
from anterior surface. 
der. 
low stum >. 
Vaginal Section for Removal of Uterine Appendages not the Seat of Tumor—Concluded. 
Abdominal Hysterectomy. 12 
THE MEDICAL JOURNAL AND EXAMINER. 
6 
Name, and 
Date of 
Operation. 
i 
a5 
bi 
< 
Married or 
Single. 
No. of 
Children. 
Pathological Con- 
dition or Symptoms 
necessitating 
Operation. 
Duration 
of 
Disease. 
Nature of Operation. 
Adhesions. 
Drainage. 
Hospital 
or 
Private. 
Recovery 
or 
Death. 
Complications before 
or after. 
Remarks 
and 
Subsequent 
History. 
Elsewhere 
Reported. 
i 
Mrs. St—n. 
29 
M 
1 
Carcinoma of cervix. 
Over a 
Multiple ligatures of 
No 
Iodoform 
St. Luke’s 
R 
Cervix was amputated 
No return. In good 
Chicago Medi- 
August 3,1887. 
year. 
stumps with silk; cat- 
gut ligature about 
vaginal incision. 
Left vaginal and per- 
gauze. 
Hospital. 
several mos. before. 
health. 
cal Soc , 1887. 
itoneal wound open. 
• - * 
? 
Miss Pn—ps. 
Dec. 7, 1887. 
57 
S 
Papilloma of cervix 
and posterior vaginal 
No 
Iodoform 
R 
Chicago Gyne- 
cological Soci- 
ered 1 
ceps to each broad 
gauze 
Hospital. 
two months; death 
wall, undergoing sar- 
year 
ligament. Catgutlig- 
in nine or ten mos. 
ety, Dec., ’88. 
comatuus degenera- 
before. 
ature to vessels about 
tion. 
vaginal incision. 
3 
Mrs. G—n. 
47 
M 
2. 
Fibro-sarcomaof 
8 or 10 
Multiple silk lig .ture 
No 
Iodoform 
Woman’s 
R 
Was curetted four 
So far, well 
Chicago Gyme- 
Jan. 5, 1888. 
last 25 
whole uterus, with 
years. 
of stump. Catgut and 
gauze. 
Hospital. 
times, viz.: 6$, 41, 2 
years and 1 month 
cological Soci- 
years 
ulceration of cavity. 
two hemostatic for- 
ety, Mar., ’88. 
ago. 
1 terns size of small 
ceps below. Wound 
before operation 
fist. 
open. 
Thickening ol right 
broad ligament. 
4 
Mrs. Gold—t. 
55 
M 
2, 
Adenoma of fun 'ns 
Un- 
Retroverted uterus 
No 
Iodoform 
Woman’s 
R 
Cystocele before and 
Perfectly well, ex- 
Chicago Gyme- 
March 4,1888. 
oldest 
and posterior uterine 
known, 
and applied multiple 
gauze. 
Hospital. 
after. 
cept cystocele. 
cological Soci- 
17 years 
wall undergoing can- 
but over 
ligatures. Wound left 
ety, Mar., ’88. 
cerous degeneration. 
a year. 
open. 
5 
Mrs. Florence 
J-s. 
43 
M 
4, 
Multiple ligatures. 
Catgut to lower ves- 
No 
R 
Chicago Gyne- 
cological Soci- 
oldest 
tial fibro-myomata. 
years. 
gauze. 
Hospital. 
Mar. 25, 1888. 
19 years 
Incurable stenosis. 
sels. 
ety, April, ’88. 
Several years of suf- 
fering and ineffectual 
local treatment. 
6 
Mrs. O’B—n. 
25 
M 
2, 
Cervical carcinoma 
Not 
Anteverted uterus and 
Loop of in- 
Iodoform 
Woman’s 
R 
Left ovary enlarged 
No sign of a return 
Chicago Gyme- 
May 17, 1688. 
younger 
involving posterior 
well 
applied a medium 
testine tied 
gauze. 
Hospital. 
and adherent to bot- 
so far. 
cological Soci- 
2 years 
wall of uterus, t > int. 
since 
and a large sized pair 
oil and sep- 
tom of pelvis. Its 
ety, May, ’88. 
old. 
os, and entire thick- 
birth of 
of forceps to each 
arated. Left 
ligature sloughed 
ness. 
last 
broad ligament. Cat- 
ovary em- 
out in three months. 
child. 
gut below. Took out 
bedded in 
left ovary with liga- 
ment cut short. 
lymph. 
7 
Miss McN. 
June 9, 1888. 
42 
S 
Subserous fibro-myo 
ma of posterior wal 
A year 
or 
Multiple ligature of 
broad ligament. Cat- 
No 
R 
Unilocular cystoma of 
left ovary also re- 
Chicago Medi- 
cal Society, 
gauze. 
Hospital. 
r 
of cervix, size of 
longer. 
gut lor lower vessels. 
moved, leaving liga- 
June, 1888. 
goose egg. 
ture hanging in va- 
gina. 
Vaginal Hysterectomy. ORIGIN A L COMM UNICA TIO NS. 
13 
o’ 
fc 
Name, and 
Date of 
Operation. 
© 
< 
Married oi 
Single. 
No. of 
Children. 
Pathological Condition or 
Symptoms necessitating 
Operation. 
Duration 
of 
Disease. 
Nature of Operation. 
Drainage. 
Hospital 
or 
Private. 
Recovery or 
Death. 
Complications 
Before or After. 
Subsequent History and 
Remarks. 
1 
Mrs. Dr. —. 
Oct. 7, 1888. 
30 
M 
On<*, 
prema- 
ture. 
Chronic salpingitis, ovaritis 
and retroversion with fix- 
ation. Failure of pro- 
longed course of treatment 
to relieve pain and restore 
her to usefulness. 
About 
6 years. 
Small median incision and 
separating adhesion of 
uterus to rectum. Could 
not release the tubes nor 
find the ovaries. 
No 
Woman’s 
Hospital. 
Recovery. 
Weak heart, almost died 
from ether. Had a pelvic 
abscess discharge into 
rectum at beginning of 
disease. 
Is now somewhat better 
than before the operation. 
2 
Mrs. At—1. 
Dec. 21, 1887. 
28 
M 
0 
Menorrhasia, pains. Failure 
of mental and physical 
vigor, unrelieved by treat- 
ment. Apparent enlarge- 
ment of tubes. 
Several 
years. 
Median incision about 3 
inches long. Found the 
intestines matted about 
tubes, and the haemor- 
rhage so profuse upon the 
least attempt at separation 
that I tied the bleeding 
vessels and desisted. 
Glass 
tube for 
3 days. 
Woman’s 
Hospital. 
Death at end of 
8th day, of 
h< art failure. 
Weak heart. Came near 
collapsing several times 
on operating table. 
Pulse always above 100. 
Died at 8 a. m. while having 
her shoulders raised to 
take nourishment. Had 
had an unusually smooth 
recovery and felt perfectly 
well just before being 
raised. 
3 
Mrs. W G. 
McC-. 
Mar. 24, la88. 
20 
M 
0 
Chronic incurable pelvic 
symptoms referable to ap- 
pendages and incurable 
by prolonged treatment. 
Mind slightly affected. 
Several 
years. 
Median incision about 3 
inches. Parovarian evst 
of left broad lig. size of 
goose egg. R. appendages 
buried in lymph, and 
could not be separated. 
Separated a few adhesions 
Glass 
tube for 
3 days. 
St. Luke’s 
Hospital. 
Recovery. 
Piece of omentum size of 
Lima bean got into 
drainage tube and was 
torn out in removing it 
with considerable pain, 
but no after effects. 
Husband thinks her mind 
greatly improved. 
Whole 
No. 
Recovered. 
Died. 
Per cent. 
Recovery. 
Per cent. 
Deaths. 
Abdominal Ovariotomies 
Vaginal Ovariotomies 
6 
2 
4 
2 
2 
0 
6G.66 
100.00 
33.33 
Abdominal Oophorectomies 
15 
13 
2 
84.62 
15.88 
Vaginal Oophorectomies 
12 
12 
0 
100.00 
Abdominal Hysterectomies 
3 
1 
2 
33.33 
66.66 
Vaginal H\sterectomies 
7 
0 
100 00 
Exploratory Incisions 
3 
2 
1 
66.66 
33.33 
48 
41 
7 
82.92 
17.08 
Exploratory Laparotomies. 
Summary.