[Reprinted from The Medical News, March 17, 1894.] 
HYSTERECTOMY FOR OTHER CONDITIONS 
THAN FIBROID AND MALIGNANT 
TUMORS} 
By CHARLES B. PENROSE. M.D., 
PROFESSOR OF GYNECOLOGY IN THE UNIVERSITY OF PENNSYLVANIA, 
PHILADELPHIA. 
Until very recently the operation of hysterec- 
tomy was confined practically to two conditions, 
malignant disease and fibroma. The improved 
technique and the admirable results obtained in the 
modern operation for these conditions have led to 
its extension to other diseases of the uterus and the 
appendages. The most radical proposition is: to 
remove the uterus in every woman in whom it is 
necessary to remove the uterine appendages. A 
second less radical proposition may be thus stated : 
In any case of pelvic disease when there is necessary 
for cure an operation on the appendages that ren- 
ders the woman sterile, hysterectomy is a valuable 
addition to the operation under the following cir- 
cumstances : when the uterus is diseased; when it is 
likely to become so; when its removal will facilitate 
the operation. 
I have been following this latter plan since June, 
1893, and wish to report my results and conclusions 
1 Read before the College of Physicians of Philadelphia, March 
7, 1894. 2 
to the Fellows of the College with the object of 
obtaining their views upon this new plan of treat- 
ment. 
The number of cases is not large, but represents 
a variety of conditions. In a series of seventy-five 
celiotomies on women for different forms of pelvic 
disease, exclusive of fibroid and malignant tumors, 
I have found it of distinct advantage to remove the 
uterus in fifteen cases, which may be grouped under 
the following headings: 
I. Cases of double salpingitis, generally pyosal- 
pinx, the disease extending into the uterine cornua 
in the form of a hard cheesy nodule, or an abscess 
in the uterine tissue; large uterus, chronic metritis 
and endometritis; profuse irritating vaginal dis- 
charge, probably gonorrheal. 
II. Cases of salpingitis and ovaritis; flexed or 
displaced uterus, with or without adhesions; endo- 
metritis. 
III. Salpingitis of which tuberculosis is the prob- 
able cause. 
IV. Cases of ruptured tubal pregnancy, of pelvic 
abscess, or of any accumulation in the pelvis in which 
the uterus forms part of the wall surrounding the 
accumulation. The removal of the uterus facilitates 
the operation and perfects hemostasis. 
It must be remembered that in all these cases the 
uterus was removed as an addition to an operation 
which rendered the woman sterile. I think that 
we can consider that the removal of the Fallopian 
tubes renders the woman sterile, except in very rare 
instances. 
The gonorrheal cases form a large class represent- 3 
ing the most frequent form of salpingitis, and in 
this disease I think that hysterectomy is a valuable 
addition to the old operation of simple salping- 
ectomy. In several of the gonorrheal cases my 
determination to perform hysterectomy was based 
on the fact that gonococci had been found in the 
discharge from the os uteri. In others the history 
of the case and the presence of gonorrheal lesions, 
such as inflammation of the vulvo-vaginal glands, 
or their ducts, or urethritis, indicated the gonorrheal 
origin of the disease, and finally in other cases 
gonococci were sought for by an assistant in the 
tubal contents during the operation. 
In cases of gonorrheal pyosalpinx the old opera- 
tion of removal of the tubes relieves the woman 
from the danger of rupture into the peritoneum. 
But it does not cure her. The disease continues in 
the endometrium and in the deeper structures of the 
uterine wall, often extending from the tubes into 
the uterine cornua. Careful operators have in these 
cases been in the habit of removing, by a wedge- 
shaped amputation, the proximal end of the Fallo- 
pian tube. This operation, however, requires almost 
the same length of time as hysterectomy, and is not 
followed by perfect bemoslasis. 
The operation of hysterectomy, however, cures 
the woman of the leukorrhea which is often the 
symptom of which she complains the most. 
I have tried by all the means devised to cure gonor- 
rheal endometritis, with but very unsatisfactory re- 
sults. I have never cured it in a case in which pyosal- 
pinx had coexisted. If we leave the uterus in these 
cases the woman continues to have an irritating 4 
infectious discharge, and she is not considered cured 
by herself or by her husband. 
In posterior displacement, with salpingitis and 
adhesions to the fundus uteri, removal of the uterus 
gives more promise of cure than simple removal of the 
tubes. It is a mistake to suppose that the posterior 
displacement will remain corrected by the tension of 
the broad ligaments following a simple salpingec- 
tomy. In one case in my series the tubes and 
ovaries had been removed some years before my 
operation, and yet the uterus was in a position of 
extreme retroversion, and the pressure of the fundus 
upon the rectum caused such pain that for some 
months before the operation every movement of the 
bowels had been preceded by a hypodermatic injec- 
tion of morphin. Hysterectomy stopped the pains 
and the morphin-habit. 
In tuberculous disease of the tubes I think that 
hysterectomy should always be performed. The 
investigations of Williams (Johns Hopkins Hospital 
Reports, vol. iii) show that in this disease the 
uterus and endometrium are affected in from 40 to 
60 per cent, of the cases. Unfortunately it is at 
present impossible to determine the tuberculous 
character of many cases of salpingitis by the gross 
appearance at the time of operation, and we are 
unable to determine the full extension of the dis- 
ease. 
In a case of salpingectomy performed last Novem- 
ber the microscope showed tuberculous infiltration 
in the tubes extending to the plane of section. Had 
I known this at the time of operation I would have 
removed the uterus. 5 
In one case of suspected tuberculosis I curetted 
the uterus and examined the scrapings before the 
operation and then performed hysterectomy on ac- 
count of the probable tuberculous character of the 
endometritis. 
The fourth class of cases in which the operation is 
facilitated by the addition of hysterectomy is illus- 
strated by a case of ruptured tubal pregnancy. The 
woman had a ruptured tubal pregnancy on the left 
side. The pelvis was filled with old blood-clot 
which was walled in by adherent intestines above 
and by the uterus and broad ligaments in front. 
The abdominal ostium of the right tube was closed, 
and the tubes and ovary were bound down by adhe- 
sions. In this case the removal only of the blood- 
clot and as much of the sac as was practicable 
would have left behind a large bleeding uterus 
destitute on two-thirds of its surface of any perito- 
neal covering—and functionally useless when the 
tubes and ovaries were gone on each side. Its re- 
moval, however, enabled me to secure quick and 
complete hemostasis and to avoid an elaborate 
drainage of the pelvis. 
I know of no way in which the removal of what 
has been called the emasculated uterus injures the 
woman. The results in large numbers of hysterec- 
tomies for carcinomata and fibromata show that 
from the mechanical and functional points of view 
the remaining pelvic contents are uninjured. 
Unlike the ovary, the uterus does not seem in 
any way necessary for the maintenance of womanly 
traits. I think that, in cases of salpingitis requiring 
treatment which renders the woman sterile, the re- 6 
moval of the uterus along with the tubes does her 
less harm, from a psychologic standpoint, than the 
common operation of removing the ovaries with the 
tubes. I think that the ovaries, or parts of them, 
should be left in all cases where practicable, espe- 
cially in young women. 
An objection urged against this form of hyster- 
ectomy is the increased danger of the operation. 
It is undoubtedly true that in some cases the pro- 
longed time of operation, even if only ten or fifteen 
minutes, may be of serious harm to the woman. In 
such cases I consider that the operation is im- 
proper. The determination to remove the uterus 
in the class of cases under consideration should 
depend upon the condition of the woman when she 
is on the operating-table. If her condition is such 
that she can endure the increased operation, then I 
think that hysterectomy is a valuable addition to 
our treatment in all cases of tubal and ovarian dis- 
eases requiring an operation which renders the 
woman sterile, provided that the uterus is itself 
diseased to such an extent that it will not readily 
yield to local treatment; or is so implicated in the 
pathologic condition in the pelvis that its removal 
facilitates the performance of a complete opera- 
tion. 
The statistics with which I am familiar show that 
the removal of the uterus under these circumstances 
is attended with as small a mortality as the operation 
of salpingectomy. All the cases in my own expe- 
rience have recovered.