Four Cases of Tait’s Operation. 
BY 
JOEL W. HYDE, M. D., 
CONSULTING OBSTETRICIAN TO LONG 
ISLAND COLLBOB HOSPITAL ; CHIEF TO THE DEPART- 
MENT OP OBSTETRICS, ST. MABY’s HOSPITAL, 
BROOKLYN J MEMBER OP KINGS COUNTY 
MEDICAL 80CIBTY, AND MEMBER OP THE 
BROOKLYN PATHOLOGICAL 
SOCIETY. 
REPRINTED FROM 
2Tl)e Ncto Yorit jfftetrical .‘Journal 
for October 17, 1885. Reprinted from the New YorTc, Medical Journal 
for October 17, 1885. 
FOUR CASES OF TAIT’S OPERATION * 
By JOEL W. HYDE, M. D., 
CONSULTING GYNAECOLOGIST AND OBSTETRICIAN TO LONG ISLAND COLLEGE 
HOSPITAL ; CHIEF TO THE DEPARTMENT OF OBSTETRICS, ST. MARY’S HOS- 
PITAL, BROOKLYN ; MEMBER OF KINGS COUNTY MEDICAL SOCIETY, AND 
MEMBER OF THE BROOKLYN PATHOLOGICAL SOCIETY. 
Tait’s operation for the removal of the diseased uterine 
appendages has, during the last decade, passed through all 
the stages of criticism by the profession, from that of as- 
tonishment at its boldness and denunciation of the use of 
so radical a treatment, to that of an almost universal ac- 
knowledgment of its value. 
There are still, however, a few medical men who shake 
their heads and repeat the old threadbare arguments against 
this operation which have been answered a hundred times 
over, and, at last, with statistics so overwhelmingly convin- 
cing, both as to the safety of the operation and its satisfac- 
tory results, that few now deny it its proper place in sur- 
gical history and science. 
Battey first operated in this country (1872) for the re- 
moval of diseased ovaries. Ilis operations failed more fre- 
quently of good results than those of the present day, as 
he found that menstruation often continued uninterrupted. 
* Read before the Brooklyn Pathological Society, April 23, 1885. 2 
FOUR CASES OF TAIT’S OPERATION. 
To hold this function in abeyance was, moreover, the great 
desideratum. 
Tait afterward announced his belief that the Fallopian 
tubes were an important factor in menstruation, and that 
they should also be removed in order to bring about the 
menopause more rapidly ; furthermore, this was necessary, 
as the tubes were as likely as the ovaries to be the seat 
of the disease sought to be remedied by the operation. 
From this came the name of “ Tait’s operation ”; and 
he certainly has the honor of having performed it a greater 
number of times, and with less resulting mortality, than 
any other living surgeon. 
I have reported these cases for two reasons : 1. Because 
the aetiology is, I believe, unique in at least two of them— 
one being of malarial, and another of scarlatinal origin. 2. 
In an operation of so recent adoption and of such gravity, 
the most accurate statistics of all cases should be preserved 
for future use. 
I have, furthermore, purposely delayed this report for 
several months that I might be able to give, not only the 
history of the operations, but also the subsequent condition 
of the patients. 
Case I.—Mrs. M. M., American, aged twenty-nine, married 
nine years. Menstruated first at about fourteen years of age. 
Menses normal, except that they were profuse. ~ At seventeen 
she began to suffer much from dysmenorrhoea, and her flow 
was menorrhagic; still later it became metrorrhagic, it often 
being difficult to define the beginning or ending of a period. 
At eighteen she had an attack of peritonitis, which was so 
severe as to compel quietude in her room for months. 
Subsequently her general health improved somewhat, and 
she married. Her periods of intense suffering soon reappeared, 
however; her menstruation was more irregular, and the pain 
unfitted her for her ordinary household duties. Hystero-epilep- 
tic attacks became frequent, followed by melancholia, at which FOUR CASES OF TAIT’S OPERATION. 
3 
times she exhibited a suicidal intent, and was three times pre- 
vented from taking her life by the watchfulness of friends. 
I first saw Mrs. M. in June, 1883, and had her under 
care for three or four months. Treatment availed nothing 
except to mitigate her sufferings temporarily and disclose 
fully the nature of her disease, which was diagnosticated as 
chronic ovaritis of both sides, with salpingitis of the left 
side. 
Tait’s operation was finally advised, and readily acceded 
to by both patient and friends, as the only hope of future 
relief. 
Operation, November 11, 1883.—An incision of two inches 
and a half was made in the median line, just above the pubes, 
and the abdominal cavity opened. The peritonitic adhesions 
were found to be so dense in every direction—all the viscera 
being matted together—that it required the most patient dis- 
section with fingers, knife-handle, and scissors, before the fun- 
dus uteri could be reached; this was found bound down with 
the Fallopian tubes so firmly that it was necessary to increase 
the abdominal opening sufficiently to pass in the whole hand, 
to reach and tear the ovary from its bed of strong adhesions. 
This accomplished, the tube was transfixed as closely as possible 
to the uterus with a double silk carbolized ligature, one half tied 
on each side, and the left ovary and tube removed. The right 
ovary and tube were then sought and removed by the same 
tedious process, and presented much the same appearance, ex- 
cept that the cysts in the left ovary were larger than in the 
right. The stumps were thoroughly seared with the galvano- 
cautery. The left Fallopian tube was only a little over an inch 
in length, much distended, and gave every evidence of the cor- 
rectness of the diagnosis of salpingitis. The right tube was 
about two inches and a half long, with some dropsical distension 
near inner third. The wound and cavity were now carefully 
cleansed with a two-per-cent, carbolized solution, great care 
being taken to guard against any points of oozing, after which 4: 
FOUR CASES OF TAIT’S OPERATION. 
the abdominal wound was brought together with nine deep 
silver sutures and silk superficial sutures. The dressings used 
were Am Ende’s—naphthalinated dressings of cotton, cotton 
gauze, and jute, completed with a flanuel binder. Sickness at 
the stomach was relieved by small quantities of hot water 
sipped, and pain allayed by opium, large quantities of which 
were used owing to her previous opium habit. This habit she 
had entirely conquered by the third week, and has not resorted 
to it since. The sutures were all removed by the tenth day. 
Her temperature never rose above 100-75° F., and her convales- 
cence was prompt. 
She lias recovered all her former cheerfulness of manner, 
and, while not a robust person, is able to perform the duties 
of her household with a fair modicum of comfort. 
She still continues to menstruate, now eighteen months 
after the operation ; but her periods, which, after the opera- 
tion, were at first five days, have gradually grown to be 
about one day in duration, and a greater lapse of time be- 
tween them. 
Case II.—L. J., American, aged twenty-seven, unmarried. 
Menstruated first at sixteen, always irregularly and profusely. 
Of late years she has suffered intensely with dysmenorrhoea, 
headache, loss of appetite, and especially with pain in the region 
of the sacral plexus. This pain has been of that character that 
she has been unable to lie on her back for several years, and 
what little sleep she obtained was in the genu-pectoral position 
with pillows stuffed up hard against her abdomen. She was 
treated for two years for spinal trouble by a specialist in New 
York, but I have never seen any evidences of such a difficulty. 
There is a very pronounced asymmetry of her body, but I learn 
from her mother that it has existed from her infancy. The 
mammary gland, the thigh, and leg of the left side were very 
much smaller than the corresponding parts on the right side; 
in fact, the whole muscular structure of the left side presented 
an appearance of atrophy. FOUR CASES OF TAIT’S OPERATION. 
5 
There were great tenderness and pain over both iliac regions 
for the greater portion of the time, a general weariness and in- 
ability to do much or enjoy anything. She also had much men- 
tal depression and a desire to resort to extreme measures for 
relief. Examination revealed an eularged and very tender right 
ovary, with a prolapsed left ovary ; both tubal tracts very sen- 
sitive. Tait’s operation advised and performed November 19, 
1883, at Long Island College Hospital. There were no adhe- 
sions except a few which bound down the left ovary in its pro- 
lapsed situation behind the uterus, and which were readily 
separated ; this ovary was considerably less than normal in size. 
Whether its small size was a part of the general asymmetry, 
previously mentioned as existing in this case, is difficult to de- 
cide, but I believe it to have been so. The right ovary was 
enlarged and distinctly cystic, one small cyst being ruptured 
while attempting to remove it. Both tubes were ligated as 
closely as possible to the uterus with carbolized catgut, seared 
with the cautery, and dropped back into the abdominal cavity. 
The same kind of sutures and dressing were used as in the pre- 
vious case. She was placed back in bed in forty minutes, and, 
aside from some cystitis which developed the second week after 
the operation, convalesced rapidly. 
She left the hospital November 30th, traveling by rail 
quite a distance to her country home. 
Case III.—Mrs. G., aged thirty-five years; married; sterile; 
was always healthy and robust till seventeen years of age, when 
she had an attack of intermittent fever of great severity, the 
effects of which lasted two or three years. Following this she 
began to suffer with dysmenorrhoea, which every year increased 
in intensity, and which later on was complicated with evident 
attacks of localized peritonitis, both pelvic and abdominal. 
There was some constriction of the vagina, and small bands of 
adhesion ran between the cervix and upper vaginal walls on either 
side. Coitus was intolerable; and the most careful digital ex- 
amination produced nausea and fainting, compelling her to keep 
her bed for that day, As far as it was possible to learn from 6 
FOUR CASES OF TAIT’S OPERATION. 
an examination, there was great tenderness of the left ovary; 
the right ovary was undetected, hut an undefined and fluctuat- 
ing mass filled up that region of the pelvis, which was supposed 
to be a cystic ovary. There was much less mobility of the 
uterus than usual. Tait’s operation advised and performed at 
Long Island College Hospital, January 22, 1884. This opera- 
tion was similar to the first in the vast adhesions everywhere 
encountered, and which rendered the whole work, from the 
first incision to the final touch, a blind and difficult dissection. 
The left ovary was first sought and found imbedded in strong 
adhesions near the side of the uterus. The Fallopian tube was 
not over an inch in length, much thickened, and convoluted. 
This was removed as closely as possible to the uterus and the 
stump cauterized. In searching for the right ovary the greatest 
care was used to separate the adhesions which densely involved 
all the tissues of that locality. In this effort, however, a cyst, 
as large as an orange perhaps, was ruptured. All efforts to 
find the right ovary failed, and we adopted the belief that it 
had degenerated into the cyst which had been so unfortunately 
ruptured. No effort was made to dissect out the walls of the 
cyst, which were strongly adherent to the bowels. The tube 
was removed in the same manner as before mentioned. The 
greatest caution was used in the toilet of the abdominal cavity, 
and the wound was closed with eight deep sutures of silver and 
Am Ende’s dressings were applied. Although the operation was 
lengthy and the patient exhibited some shock, she rallied well 
the same afternoon, and, with a five-grain opium suppository, 
passed a comfortable but somewhat restless night. On the fol- 
lowing morning she spoke cheerfully to me, remarking her 
freedom from pain. Pulse was 108, temperature 101°, respira- 
tion 24. At noon, same day, she presented evidence of becom- 
ing rapidly exhausted. Pulse 130, temperature 103°, respira- 
tion 30. Death occurred thirty-one hours after operation. 
No urine was voided by this patient after the opera- 
tion. 
The attempt to relieve the bladder with the catheter was 
twice made, but resulted only in securing about an ounce FOUR CASES OF TAIT’S OPERATION. 
7 
of turbid, bloody urine. The urine in this case had been 
repeatedly subjected to rigid analysis, but nothing was re- 
vealed which necessarily militated against an operation un- 
less, possibly, the scanty amounts of solids found. 
An autopsy was made fourteen hours after death. The 
abdominal wound was apparently beginning to unite by the 
first intention throughout its entire length, and all the deeper 
structures presented a favorable appearance. 
The kidneys were enlarged, and presented marked evi- 
dences of fatty degeneration. 
The right ovary was not found, and it was believed, 
after a careful examination of the ruptured cyst, that it was 
the product of degeneration of the ovary. 
Death was undoubtedly due in this case to the condition 
of the kidneys.* 
Cask IV.—Pyosalpinx.—E. II., twenty-three years of age, 
single, very delicate, and of nervous temperament. Had suf- 
fered almost from her first menstrual period, which began at an 
unusually early age. 
Two or three years prior to this she had a severe attack of 
scarlet fever, followed by scarlatinal nephritis and dropsy. At 
* The operation in Case III was delayed from week to week on ac- 
count of renal insufficiency. 
Random specimens of urine showed nothing abnormal; but an ex- 
amination of the total “ out-put ” for twenty-four hours invariably pre- 
sented evidence of defective elimination of waste products. 
Thus, for December 14, 1883: 
Total quantity, 950 cubic centimetres; specific gravity, 1*019; sol- 
ids, 38 grammes; urea, 19'6 grammes. 
Acid; no albumin; no sugar; little coloring matter; oxalate of 
lime and a little pus in the sediment. 
Numerous subsequent examinations merely served to verify the first 
analysis.' The condition of the patient grew more and more unsup- 
portable, and it was finally decided to grant her petition for the dernier 
ressort. 8 
FOUR CASES OF TAIT’S OPERATION. 
this time some of the pelvic pains seemed to have originated, 
which, later on, as menstruation developed, became the more 
acute and fixed pains of her present disease. 
I may say here, parenthetically, that, if scarlet fever can in- 
vade one portion of the genito-urinary apparatus, I think it fair 
to assume that other portions may also be affected, and I see no 
reason why the ovaries and Fallopian tubes should be exempt. 
In this case menstruation was irregular—generally at inter- 
vals of about three weeks—and rarely lasted less than ten days. 
Her suffering at these times evoked the pity of all her friends, 
and they sought relief for her from numerous members of the 
profession. All the characteristic symptoms of localized pain, 
reflex irritation, nervousness, and weakness, which are indica- 
tive of ovarian and tubal disease, were abundantly manifest. 
Two unusual concomitants of her disease attracted my atten- 
tion : 
First. As her periods approached, the lymphatic glands of 
the lower portion of her body and thighs became tender, and, 
in a day or two, this was followed by a general tumefaction of 
all the adjacent tissues. The labia were two or three times 
their normal size, and both limbs were swollen and painful to 
move. The inguinal region was specially sensitive. This seems 
to have been a rhythmic neurosis, dependent entirely upon 
the regular periods of pelvic engorgement and excitement to 
reproduce it. 
Second. After the second or third day of menstruation the 
discharge would vary at times from the normal appearance 
and become muco-purulent and exceedingly offensive—so much 
so as to suggest the foetid odor of malignant disease. 
These two conditions would be maintained to the close of 
each period, then subside, giving no further inconvenience till 
the succeeding period. 
Examination in this case revealed the cervix pressing against 
the neck of the bladder and rather firmly fixed by previous in- 
flammatory processes, moderate retroflexion with prolapsus of 
left ovary, and great fullness and tenderness over tubal tracts 
and ovaries. 
Operation, March 3, 1885.—This was accomplished rapidly. FOUR CASES OF TAIT’S OPERATION. 
9 
Some evidences of chronic pelvic peritonitis, deep-seated, but 
not sufficient to delay materially the operation. Both ovaries 
slightly enlarged, intensely engorged, and full of small cysts. 
These were removed, together with the tubes, as close to the 
uterus as it was possible to clamp and ligate. 
Recovery from the effect of the operation was exceed- 
ingly prompt. The wound healed by the first intention, 
the temperature or pulse never rising above 100°. 
Three months have elapsed now, and she has had no 
return of menstruation, beyond a slight molimen which ap- 
peared for two or three days after the operation. She, 
however, suffered from an attack of the rhythmic neurosis, 
previously mentioned, when her first month came around, 
but it was confined to one leg only, rather than both, as 
heretofore. This neurosis will probably soon cease entirely, 
as it is hoped and believed the majority of her previous dis- 
comforts will do. 
Resume.—There were four patients—two married and 
two unmarried. 
Three lived, one died. 
Two had extensive peritonitic adhesions; two had none. 
Two have never menstruated since they were operated 
upon. One has continued to menstruate till the present 
time (about eighteen months), although the function has 
about ceased. 
The one in whom the menstrual function has continued 
was one in whom the adhesions were very extensive; and 
perhaps this fact alone may have a bearing on the question 
of her prolonged menstruation. The two in whom the 
function ceased so promptly had no adhesions. 
The prominent features of these cases are: 
Case I.—Hystero-epilepsy. The prolonged menstrua- 
tion after the operation. 
Case II.—The asymmetry of the body. 10 
FOUR CASES OF TAIT’S OPERATION. 
Case III.—Salpingitis resulting from very severe mala- 
rial attack. Death from unsuspected renal disease. 
Case IV.—Scarlatinal pyosalpinx. 
The case of the last patient was particularly instructive 
from the peculiarities of the rhythmic neurosis and the foetid 
discharge mentioned. I regret that I did not subject this 
discharge to Professor Ferguson’s microscopical test for 
columnar ciliated epithelium, as it Would have probably 
decided the question whether it was a drainage from a 
pyosalpinx, or the offensive discharge and detritus of a 
dysmenorrhoeal membrane. 
There appears to have been no special or positive evi- 
dence of gonorrhoeal infection in a single one of these cases. 
I fully believe in the correctness of Dr. Noeggeratli’s state- 
ment, that there are great numbers of women who suffer 
from inflammations of the uterus and its annexa as a result, 
of latent gonorrhoea, and I have now under my care ladies 
whose history makes it almost positively certain that their 
cases belong to this class; but the cases reported in this 
per show that a considerable proportion at least may be 
autogenetic. 
Mr. Lawson Tait has remarked that cases of diseased 
ovaries and oviducts can be relieved by nothing short of 
removal of the diseased organs; moreover, that these cases 
exist in great numbers, forming n large proportion of those- 
in which the patients wander about from one practitioner' 
to another seeking relief. 
Mr. Tait has also supplemented this affirmation with a 
recent history of a large number of cases in which he has 
successfully removed the uterine appendages. 
In the treatment, internal medication is practically value- 
less ; nevertheless, we temporize with these cases for a while, 
using every fair endeavor to relieve pain and restore the 
function to a normal state. In early cases, where the FOUR CASES OF TAIT’S OFERATION. 
11 
patients are surrounded by every comfort and care, some 
are relieved, but the mass of them never find relief short of 
an operation. 
In the study of Tait’s operation and the causes which 
have demanded so heroic treatment the whole profession 
must be interested. They are no longer obliged to turn 
away women who beg for something—anything—to relieve 
their sufferings, by telling them “ there is nothing more 
that can be done for you.” 
I believe there is scarcely an operation known to sur- 
gery which invites better ultimate results; the only trouble 
is, they expect these good results too soon. 
This operation results in a climacteric to the patient. I 
think as much time should be allowed for a full recovery of 
the general health after an operation of this nature as would 
be required in the case of an ordinary natural climacteric. 
There are few women who do not feel nerve and pain 
discomforts for many months at the menopause, and these 
discomforts are in exact ratio to the amount of possible 
disease existing in the uterus and its appendages at that 
time. 
Since to bring about a menopause at an earlier age, by 
an operation for a disease, is an unnatural change, we may 
readily realize that at least as much time should be allowed 
for general recovery in the latter case as in the former. 
I have been forcibly impressed with the enthusiasm with 
which the few upon whom I have performed this operation 
have accepted this serious alternative; in fact, after a short 
consideration of the subject, they have been unwilling to be 
put off with any other suggestions ; they immediately see 
something tangible in this and are willing to risk their lives 
for the great stakes. 
Fortunately, we are able to encourage them with almost 
a certainty of success. 12 
FOUR CASES OF TAIT’S OPERATION. 
All of these patients who are living have already demon- 
strated the success of the operation upon them. I happen 
to have seen during the past month two of them who live 
out of town; while neither is robust, both are free from the 
terrible distress in which they languished for so many 
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