[Reprinted from the American Gynecological and Obstetrical Journal for February, 1896.] PORRO’S OPERATION. W. H. Haskin, M. D., New York. On February io, 1893, I was asked to assist Dr. C. von Hoffman at the above operation, and, as the case presented some peculiar points, it may be interesting to those interested in obstetrical surgery. Two years previous Dr. Henry Gibbons, Jr., had performed Caesarean section and saved the mother’s life, the child dying shortly after removal. Having been called by her attending physician after the woman was in pain, when we arrived the os uteri was already moderately distended. There was no nurse, nor, in fact, any convenience in the house, so the wash boiler was first scrubbed with carbolic acid and then used to prepare boiling water and at the same time to sterilize all the instruments, ligatures, and dressings to be used. The kitchen table was prepared for the patient, and, after cleansing her body as well as possible, she was put on it and operated upon. A long incision was made in the median line and carried well up above the umbilicus. Owing to extensive adhesions, the uterus was turned out only after hard work and many ligatures. Sutures were then placed to close the abdominal incision above the uterus, in order to protect the intestines. After placing a strong elastic ligature around the neck, the incision into the uterus was made, the child ex- tracted, and the ligatures immediately drawn tight. There was no haemorrhage except that contained in the uterus with its placenta. It was then decided to remove the uterus and appendages rather than the appendages only, because of the very extensive absorbing surface which would have to be left after the former adhesions were broken through. Deep silk ligatures were then passed on either side so as to in- clude the uterine and ovarian arteries, together with the abdominal walls. After these were secured the elastic ligature around the neck was removed. Haemorrhage from the right ovarian artery was con- trolled by another ligature. The fundus and part of the cervix were then removed with the knife and a conical section taken out of the Copyright, 1896, by J. D. Emmet, M. D. 2 W II. Haskin, M. D. remaining stump. The remaining cervical canal was touched with pure carbolic, and the exposed surfaces of the cervix were brought together by buried catgut sutures so as to form a small fundus over the cervix. The abdominal cavity was carefully closed around the stump and an antiseptic dressing applied over all. After six hours it was noticed that there was still some arterial bleeding on the right side, but it was readily stopped by catgut liga- ture. Recovery was very rapid, and the temperature did not go over ioi° F. at any time. All ligatures were removed at the end of eighteen days. The child did well from day of birth, being fed on Mellin’s Food. A letter from Dr. von Hoffman, dated May 26, 1893, says that both child and mother were well and strong, and that the latter had symp- toms of changing life. The following measurements were taken : Height 49 inches. Ant. sup. spines of the ilei 25 centimetres. Crests of the ilei 28 Troehanter 30 External conjugate diam. (Baudeloque).. 16 True conjugate An interesting circumstance was the discovery of five silver su- tures in' the uterine wall, which had been placed there at the previ- ous operation. As there was no nurse present, the child was wrapped in a blanket and placed near the fire until the operation was com- pleted. Dr. Kirschoffer administered ether, and boiled water was the only fluid used during the operation. 7 East Forty-first Street.