AN INQUIRY INTO THE RELATIVE MERITS OF 
Vayiital Hysterectomy 
AND HIGH AMPUTATION OB PARTIAL EXTIRPATION 
BY 
Galvano-Cautery 
IN 
CANCER OF THE CERVIX UTERI, 
BY 
JOHN BYRNE, M.D., M.R.C.S.E., 
Surgeon-in-chief St. Mary’s Maternity, Chief of Gynaecological Department and President of the 
Faculty of St. Mary’s Hospital. President of the American Gynaecological Society (1891-92.). 
Member and Ex-President of the New York Obstetrical Society, Fellow of 
New York Academy of Medicine. Member and Ex-President of the 
Brooklyn Gynaecological Society. Corresponding Member 
of the Boston Gynaecological Society. Member 
of the Kings County Medical Society. 
Consulting Surgeon to St. John’s Hospital, Long Island City. 
PRESIDENT’S ADDRESS. 
Reprinted from 
The Brooklyn Medical Journal 
October, 1892. VAGINAL HYSTERECTOMY AND HIGH AMPUTATION, OR 
PARTIAL EXTIRPATION BY GALVANO-CAUTERY 
IN CANCER OF CERVIX UTERI. AN IN- 
QUIRY INTO THEIR RELATIVE 
MERITS. 
BY JOHN BYRNE, M. D., M.R.C.S. E, 
President’s Address delivered at the Meeting of the American Gynaecologi- 
cal Society, held in Brooklyn, September, 1892. Published in compliance with 
the request of the American Gynaecological Society. 
Fellows of the America?i Gyncecological Society : 
It is fitting that I should embrace this first opportunity since our 
last meeting to thank you most heartily for the unsolicited honor 
which you have conferred upon me by electing me to preside over your 
deliberations. Indeed, I feel I would be wanting in a due appreciation 
ofsohigha mark of your esteem and confidence, if, while acknowledg- 2 
JOHN BYRNE, M.D., MR.C.S.E. 
mg my obligation, I failed also to solicit your aid and forbearance 
in the discharge of my responsible duties. 
As I call to mind the first meeting of this society sixteen years 
ago, at which the loved and lamented Barker presided, and with 
that grace and intellectual elegance so characteristic of the man, of 
the distinguished and truly representative character of those who 
took a prominent part on that and subsequent occasions, and when 
I think of the chosen ones on whose shoulders from year to year 
the untarnished mantle of our first president has fallen, it surely 
becomes me, not only to express my thanks, but more particularly 
to crave your fraternal indulgence. 
The pleasure of greetingthe members of this society, need I say, 
is heartfelt, and yet, the gratification of welcoming to Brooklyn, for 
the first time, an association so distinguished is not without an 
alloy of regret as memory recalls the many absent ones ; some in 
Europe ably representing the cause of American gynaecology at the 
Congress in Brussels; others detained by pressing professional 
duties; the declining health of one,2 whose brilliant services in the 
past have shed lustre on our organization, and lastly that sorrow 
which the inevitable tribute exacted by death must always engender. 
It is to be regretted that at this stage of our proceedings custom 
should have made it, in a measure, obligatory for me to trespass on 
your valuable time by any formal remarks, however brief. Be- 
cause, when we consider the extent of our programme and the 
number and great practical value of papers to be read and dis- 
cussed, it will readily be conceded that we have no right to waste 
time in the consideration of matters of more general interest. Be- 
sides it is of the first importance that distinguished Fellows, some 
of whom have traveled from distant States, and who have taken 
the trouble to formulate their views and thus further enrich the 
archives of our society, should have ample opportunity afforded 
them for profitable discussion and a free interchange of opinions. 
There is no way by which scientific material can be utilized to 
better advantage than by subjecting the product of individual brain 
and industry to intelligent, honest, and fearless criticism. 
That this feature in our organization has been duly appreciated, 
and, as far as practicable, encouraged I believe, and yet its vast 
importance would seem to warrant the inquiry as to whether or 
not, by some modification of our rules, more time and a wider 
latitude should be allowed in our discussions, because the position 
of this society in the scientific world will depend not only on the 
character of its papers, but in no less a degree on the high tone 
* Dr. Robert Battey. VAGINAL HYSTERECTOMY AND HIGH AMPUTATION, ETC.. 
3 
and freedom of its discussions. I am fully alive to the necessity 
for fixed rules of debate in all well ordered societies, and in a scien- 
tific body like ours that their strict ooservance is essential to order 
and the expeditious disposal of the work mapped out in our pro- 
gramme; nevertheless, when we consider the peculiar nature of 
our organization, the representative character of its members, and 
the long interval between our meetings, it seems to me that no 
more than one-half of the time of each session should be devoted 
to the reading of papers ; that half an hour only should be allowed 
to each, and that the number of papers to be read at each session 
should be limited to three, or in all eighteen. This would allow 
ample but certainly not too much time for discussion, and as there 
is in our association a conspicuous absence of the redoubtable 
medical society orator, endowed with the peculiar faculty of em- 
ploying words to supplant ideas, and who is always ready to 
advance a theory or a reason for everything, except perhaps as to 
how or why he himself should have earned celebrity or even re- 
cognition, there would, I imagine, be no danger that a little more 
liberty as regards time would be abused. 
From these considerations I feel it incumbent upon me to 
occupy as little of your time as may seem to comport with my 
official duties and a due regard for the best interest of our society. 
After what manner I should proceed to obtain this most desirable 
end has been, I assure you, no easy matter for me to decide. To 
attempt an elaborate review of the rise and progress of gynaecology, 
though not without precedent, would, in my opinion, be an un- 
pardonable infliction, and, considering the character of my audience, 
no less “stale, flat and unprofitable” than thread-bare subjects 
usually are. Quite as objectionable also and of questionable taste 
would it be to indulge in laudatory remarks on the work of this 
society and its widespread influence at home and abroad during 
the sixteen years of its existence. Its labors in behalf of suffering 
women, as exemplified in its published transactions, speak volumes, 
aye, sixteen times more convincing than the most elaborate eulogy. 
It is enough to say that from this source alone the student in gynae- 
cology, (for we are all students), may glean the fruit of mature and 
well-digested experience. 
Let this cursory reference to our good deeds suffice for the pres- 
ent. They have become the property of the entire professional 
world, and to that tribunal alone should we look for approbation. 
My distinguished predecessor, Dr. Jackson, in his able address 
at our last meeting, took occasion to allude to certain abuses which 
had crept into the practice of gynaecology. One of these was the 4 
JOHN BYRNE, M.D., M.R.C.S E. 
alarming extent and frequency to which, through the beneficent 
but seductive agency of antiseptics, surgeons have been tempted to 
resort to dangerous and mutilating operations on the sexual organs 
of women. 
This blot on our escutcheon I am happy to believe is rapidly 
becoming effaced, and I refer to it now merely to emphasize his 
forcible and timely warning. Such abuses, however much to be 
deplored, are in a measure inseparable from progress, and must be 
looked upon as the tribute of suffering humanity to science; strictly 
speaking they need but a passing comment, as they are sufficient 
for their own correction. Another equally deplorable cause of 
complaint was the subjecting of young and unmarried women to 
speculum examinations without due cause, and of which at least 
one disgraceful example was detailed. This is an abuse of so grave 
a nature and so pernicious in its tendency as to need no apology 
for again invoking your efforts toward its suppression. It will not 
suffice that we claim for ourselves and those in our special branch 
of medicine a comparative freedom from such abuses, and point to 
the cupidity of the general practitioner as a main source of the 
evil. It is our imperative duty as individuals, and certainly with- 
in the scope and province of societies like ours, to take cognizance 
of and to discountenance it. Instances have but too often come to 
my own knowledge, and must I fear be only too familiar to many 
here present, of moral and physical wrecks originating largely in this 
abominable practice. It is not too much to assert that very many 
of these deluded victims of a sacred confidence thus shamefully 
abused might have their modesty shielded and their infirmities 
cured by the aid of rational and judicious therapeutics, now, alas ! 
so unpopular. Such, I assume, is the opinion of every experienced 
gynaecologist, and the remarks of our revered first president, in his 
address on “Medical Gynaecology” fifteen years ago, were doubt- 
less prompted by his keen appreciation of these facts. His unas- 
sailable propositions touching meddlesome gynaecology were 
based on sound principles and supported by his own large and ripe 
experience. One declares that “flexions in the virgin cause no 
symptoms except a slight dysmenorrhcea unless there be some vitiation 
of the general health, defective nutrition, neurotic disturbances or 
pathological changes other than the flexionAnd again, “ all treat- 
ment, whether local, surgical, or mechanical, will fail in curing uterine 
disease so long as the blood is deficient in its proper proportion of 
nutritive elements, and therefore appropriate constitutional treatment 
is essential to successThe sound principles thus enunciated are as 
applicable to the practice of to-day as they were to that of the past, VA GINAL HYSTERECTOMY AND HIGH AM PUT A TION, E TC. 
5 
and physiological laws, pathological researches, and moral ethics 
unite in demanding their observance by the specialist as well as by 
the general practitioner. Indeed, nothing less than the strongest 
presumption as to the existence of serious pelvic disease, and which 
judicious constitutional treatment has failed to relieve, can warrant 
speculum, or even digital, examinations in young and single 
women. 
I trust I shall not appear as taking advantage of my position, or 
in any manner abusing the privileges due to your courtesy, if I ask 
your attention to a matter which, while it concerns a most impor- 
tant and, alas ! too numerous a class, is one, also, in which I have 
a deep personal interest. It is a subject, moreover, regarding 
which the entire profession of medicine from the earliest period has 
taken a more than ordinary interest, and in its beneficent search 
after some means of relief for the afflicted has always, until of late, 
manifested the most liberal and humane spirit of inquiry. I refer to 
the surgical treatment of cancer of the uterus, and the prevailing 
disposition on the part of the more aggressive and radical members 
of our profession to disregard all means of relief save one, and that 
a dangerous, mutilating, and, as I hope to show, comparatively 
fruitless proceeding at best. 
Some years ago there appeared in our midst a prominent advo- 
cate of hysterectomy fresh from his anti-uterine campaign of sixty- 
six hand-to-hand conflicts and eleven mortuary trophies. Thanks 
to the able, fearless, and timely protest of Dr. Jackson, who by his 
incontrovertible facts and sledge-hammer logic was the first to 
sound the alarm and plant the danger-signal, the great bulk of our 
brethren refused to be swayed by plausible arguments, or to accept 
conclusions which seemed to them wholly unwarranted and to say 
the least, premature. Some there were who, though willing to con- 
cede to hysterectomy a limited field—one strictly within pathologi- 
cal and rational bounds, yet skeptical as to the possible realization 
of hopes then indulged, were, nevertheless, not averse to testing, 
in suitable cases the heroic measures so forcibly advocated. There 
were not a few, however, who, probably finding the supply of re- 
movable ovaries and tubes becoming exhausted, and being unable 
to withstand the robust and persuasive eloquence of one who had 
just come fresh from the seat of war, determined forthwith to buckle 
on their armor and sally forth to do and to publish as many hyster- 
ectomies as they could find patients to submit to and live, but, de 
mortuis nil. By a few of the former class we have been favored 
with the net results of their careful, skilful and conscientious work, 6 
JOHN BYRNE, M.D., M.R.C.S.E. 
and in some noteworthy instances it cannot be denied but that they 
fully sustain the conservative views of Dr. Jackson. 
Thus, in the frank and unqualified statement of a leading mem- 
ber of this society, Dr. Reamy, regarding his experience in twelve 
cases, we have an example—but alas too rare !—of that scrupulous 
regard for the truth and the whole truth, which neither courts ap- 
plause nor shrinks from criticism. Here we are told not only of the 
number who have escaped the more immediate dangers of the oper- 
ation, but, what is of equal significance, the degree to which their 
periods of life expectancy have been curtailed through reckless sur- 
gery. Another equally conscientious and able Fellow8 has not 
hesitated to proclaim, in the face of his well-known skill as an oper- 
ator, four deaths out of sixteen cases. 
In this connection, still another noteworthy example of the dis- 
position on the part of some of our ablest Fellows to “render unto 
Caesar the things that are Caesar’s,” merits special mention and 
earnest commendation. I refer to a paper entitled “The Limits of 
Vaginal Hysterectomy for Cancer of the Uterus,”4 being a clinical 
resume of the work of two accomplished, expert, and painstaking 
operators, and every sentence of which bristles with startling facts 
and keen and unassailable logic. The author of this paper tells us 
that “the writer’s purpose in presenting a paper which partakes of 
the character of a personal confession is simply to abjure an error 
into which he believes he has fallen, fortunately at the outset rather 
than at the end of his professional career.” Who of us could have 
listened to or read this masterly and timely presentation of the sub- 
ject, without a feeling of pride in the reflection that sentiments so 
free from the taint of personal gratification and so fearlessly uttered, 
should have emanated from and actuated one of our own Fellows. 
The result in nineteen cases may be summarized as follows:—Five 
(5) died from operation, and a sixth died on the fourth day from 
disease of the kidneys. Of the thirteen who escaped death, one 
had a recurrence within eighteen months, one in one year, two in 
seven months, one in six months, three in two months, one was 
well at the end of the eleventh month, one no report, and the re- 
maining three (two of four months and one of three weeks) were 
too recent to report as to relapse. 
I allude to the work of these operators as I might to that of 
many others both here and abroad, first, to emphasize the fact that 
though experience and skill are essential in hysterectomy, as in all 
grave surgical operations, they are not the only factors to be con- 
3 Dr Polk. 
<• 11. C. Coe, American Journal of Obstetrics, 1890, pages 587-599. VAGINAL HYSTERECTOMY AND HIGH AMPUTATION, ETC. 
7 
sidered in determining- or accounting for results, and, secondly, as 
a corollary, comparatively indifferent operators may have and as a 
matter of fact are constantly having “runs of luck” which, so far as 
regards cause and effect, may bear no logical relation whatever, 
either to the merits of the surgeon, the work performed, or even its 
advisability. As to why such experienced operators as Olshausen, 
Fritsch, Martin, Hoffmeir, Schroeder and Gusserow should have a 
primary mortality of from ten to twenty per cent., or an average 
for each of over fifteen, while Kaltenbach claims but two-and-a-half 
per cent., and Leopold only five, is a problem which I leave to 
others to solve or explain, for I cannot on any rational grounds, 
and I doubt very much if any of the gentlemen named put much 
faith in the operation of a special Providence. 
The advocates of vaginal hysterectomy for cancer would, I pre- 
sume, indignantly resent a charge so grave as that of misstating or 
misrepresenting facts, suppressing evidence which might conflict 
with preconceived notions, or attempting to belittle or ignore any 
rational measure for the alleviation of human suffering or the pro- 
longation of life. Nevertheless, while advocating and practicing 
extreme surgical measures, to the defects of which they would seem 
to be invincibly blind, they persist in displaying an unworthy and 
unbecoming spirit of intolerance and a lofty contempt for their more 
conservative brethren, of whom it is not unusual for them to speak 
as being “behind the age.” In no one direction has this unfair and 
illiberal spirit been so strikingly manifested as in the manner in 
which this radical element, both here and abroad, has disregarded 
a means of treating uterine cancer which, while it may be con- 
sidered absolutely free from danger, has secured for the sufferer a 
period of exemption from relapse far beyond and in startling con- 
trast to that of hysterectomy. In their struggle for pleas to justify 
hysterectomy they set up the operation of high amputation, as 
practiced by Schroeder and others, as the main target for their criti- 
cism. In this one particular at least, I have no disposition to take 
issue with them, because as between these two operations, whether 
as regards safety or utility, there is but little choice. Therefore, 
when an enthusiastic advocate of hysterectomy6 declares that “to 
his mind there is absolutely no place for high amputation of the 
cervix in cancer of the womb ; ” and, moreover “as compared with 
vaginal hysterectomy, it is more difficult, more dangerous and more 
unreliable,” I am almost inclined to agree with him, so far at least 
as regards its comparative worthlessness as a curative measure for 
* Dr. Krug. 8 
JOHN BYRNE, M.D., M.R.C.S.E. 
uterine cancer. And yet, if Landers’ statistics of high amputation 
of the cervix performed in the ordinary way are to be relied upon, 
and twenty-seven out of a hundred-and-five patients so treated 
were living at the expiration of four years, criticism as to its utility 
comes with a very bad grace from the advocates of total ablation, 
as it much exceeds the best of their own records, as far as I have 
been able to discover. More than this, Winter says, that according 
to his observations after high amputation thirty-eight per cent, were 
well after two years, and twenty-six-and-a-half per cent, had no re- 
currence five years after operation. He also states that the mortality 
after high amputation at the Berlin Klinik (in 155 cases) previous to 
1884 was but six-and-a-half per cent., against eight and nine per 
cent, obtained by combining the operations of Olshausen, Schauta, 
Fritsch, Kaltenbach, Leopold and Gusserow.6 
He, Winter, also gives publicity to a most extraordinary state- 
ment attributed to Fritsch, to the effect that he (Fritsch) has noted 
thirty-six per cent, of cures at the end of five years after hysterec- 
tomy, and Hoffmeir, thirty-three per cent, at the end of four years. 
When we come to examine the statistics in detail it will be 
found, I think, impossible to reconcile this statement with any data 
thus far obtainable. 
Again, Dr. Coe quotes Hoffmeir as stating that he has performed 
fifty vaginal hysterectomies with six deaths, against thirty-three 
amputations with one death, and he affirms that the radical opera- 
tion gives no better ultimate results.1 It is well to remark in this 
connection that there is good reason to surmise that Hoffmeir’s 
amputations were by the galvano-cautery loop, which was his 
method of operating previous to embarking in hysterectomy. 
As to the published transactions of some of our societies, so pro- 
lific of daring exploits in pelvic surgery; the graphic descriptions of 
blood-curdling operations; the number of women, who, through 
the interposition of-Divine Providence, are reported to have escaped 
death after hysterectomy and therefore “ cured ” ; and the elaborate 
papers, loaded with bibliographical excerpts, usually exotic and sup- 
posed to signify deep research on the part of their authors; to see all 
this, I say, one would imagine that any proceeding short of com- 
plete pelvic evisceration had long since ceased to be worthy of the 
slightest consideration. In the most protracted discussions there is 
6 Berlin, klin. Woch., 1891, No. 22. It will be noticed that the operations of 
Martin, Hofmeir, Schroeder and others are excluded from this estimate—unin- 
tentionally, of course. 
7 “The Limits of Vaginal Hysterectomy for Cancer of the Uterus,” by H. 
C. Coe, M.D., N. Y. Journ. of Obstet. 1890, p. 597. VA GINAL HYSTERECTOM Y AND HIGH AMPUTA TION, E TC. 
9 
found to be a remarkable silence regarding any and every other 
means than one of combating uterine cancer, unless it be to con- 
demn or ridicule, as stale and unfit pabulum for our modern gynae- 
cological knights-errant. If, perchance, owing to exhausted 
material, or a desire on the part of some more conservative mem- 
ber to vary the sanguinary monotony of the proceedings, he should 
have the temerity to suggest partial ablation for uterine cancer, in- 
credulity or cold indifference at once takes the place of enthusiasm 
and mutual admiration. He may be confronted with the gratuitous 
assertion that in their later campaigns, in figuring up the killed and 
maimed, the number of the former has been reduced to five per 
cent., with the hopeful prediction that it may become less in the 
future. Or, again, he may be met with some such extraordinary 
statement as that attributed to one of our own Fellows in discus- 
sing Dr. Janvrin’s paper on hysterectomy, and which I hope is a 
misprint, namely, that “according to recent statistics, ten to fifteen 
per cent, remained free from a return of the disease eight or nine 
years after the operation.”8 Now, admitting that the usually am- 
biguous statistics of hysterectomy may be made wonderfully ac- 
commodating by a little effort, let me remark just here, and I speak 
whereof I know, that unless in a very few and exceptionally rare 
instances, and which being subject to the law of all rules, can have 
no logical application to the question involved, there is not to be 
found in the statistics of hysterectomy of any country or language, 
the slightest warrant for either statement. It is customary for 
gentlemen to supplement assertions like these by quoting the 
tables of Leopold or Kaltenbach, one with a primary mortality 
of three-and-a-half, and the other of ’five per cent. Such phe- 
nomenal results can have but little weight when contrasted with 
the experience of the host of equally able and expert operators, as 
Fritsch, Olshausen, Martin, Schroeder, Hoffmeir, Gusserow, and 
others. In fact they are but examples of happy coincidences and 
hair-breadth escapes, with which the history of medicine and sur- 
gery is so replete, and the same remark applies with still greater force 
to “runs of success” in the work of less pretentious exploiters, as 
when five, ten, or even twenty consecutive recoveries are reported 
and duly chronicled as “cures.'’ 
Another advanced gynaecologist, and one withal for whom 
personally I entertain a high regard, in exhibiting one of the trophies 
of his skill a few months ago, said: “The patient had begun to 
bleed, and I found a little growth as large as a filbert, which I 
8 Dr. Geo. T. Harrison. 10 
JOHN BYRNE, M.D., M.R.C.S.E. 
snipped off and examined. It proved to be malignant, and I re- 
moved the whole uterus. I have put myself on record in favor of the 
total removal of the uterus whenever cancer is discovered and 
proved to exist. When in 1885 this idea was expressed to me by 
Martin it seemed like a shocking doctrine, but when I saw these 
cases relapse after removal of the cervix alone, I decided always to 
cut as far from a cancer as possible.”9 
In the light of my own experience and with some knowledge of 
gynaecological history, unwritten as well as recorded, I must say it 
is hard to find words sufficiently expressive of my horror at the ad- 
vocacy of this truly “shocking doctrine,” and my unqualified dis- 
approval of the fruits of its pernicious teaching. As to the cases 
known to “relapse after removal of the cervix alone,” I have only 
to remark that such experience though sad, was no worse and no 
better than that of Schroeder and others, who still adhere to his 
methods, though as already remarked, an operation which, accord- 
ing to the statement of a pronounced advocate of hysterectomy, 
has afforded over two years to thirty-eight per cent, of cases 
operated upon, and five years to twenty-six-and-a-half per cent., 
should not be so summarily denounced. Moreover, gentlemen, they 
cannot possibly be ignorant as to the splendid results obtained by 
Dr. Baker through high amputation and subsequent cauterization. 
The truth is, the luckless subjects of amputation referred to, were, 
in all probability, denied the benefit of better treatment in obedience 
to the dictum of foreign authorities and obsolete methods. Indeed, 
I cannot hut feel that if in the last decade particularly, these and all 
similarly afflicted women had been subjected to an operation whose 
greatest drawback would seem to be that it had been perfected, prac- 
ticed and described nearer home, and for over twenty years, the re- 
sults might have been different, and there would have been fewer pre- 
texts for putting into practice any 11 shocking doctrine 
In this connection may be noticed another specimen of “shock- 
ing doctrine,” though really unworthy of serious comment. Some 
of our transatlantic masters not to be outdone in the advocacy of 
“shocking doctrines” have recommended, and, indeed, in quite a 
number of cases, resorted to the removal of a large portion of the 
pelvic basin, so as to attack the doomed uterus a posteriori. Who 
knows what the brilliant surgical engineer who originated this for- 
midable method of attacking nature’s heretofore impregnable de- 
fence, if still in the flesh, may next suggest—probably the removal 
of the pubic arch, preparatory to excision of the bladder for cancer 
9 Dr. E. W. Cushing in Annals of Gynecology, vol, v., p. 553. VA GINAL HYSTERECTOMY AND HIGH AMPUTA TION, E TC. 
11 
of that viscus. He might attempt to justify such a proceeding on 
the theory of the conservation, or rather transformation, of natural 
and providential resources. The ureters, for example, might be in- 
serted into the rectum, and thus compensate for the loss of a dis- 
abled bladder by furnishing a perpetual enema. This would thor- 
oughly annihilate constipation, so often a sore trial to defsecating 
humanity. 
But let us now see what are the facts regarding the work at the 
Dresden Klinik, and of which we hear so much now-a-days. 
Edward Leisse, {Archiv./. Gjyncek., Berlin, 1891, xl., p. 261-65. 
Vaginal hysterectomy for cancer at Women’s Klinik, Dresden,) says: 
From October n, 1883 to May 9, 1889, there were eighty 
cases, of which forty-five were living and thirty-five dead, or 43*75 
per cent. Of the deaths directly due to the operation one was from 
sepsis; one was from peritonitis; one was from heart failure ; one 
was from intestinal obstruction; a fifth was from exhaustion; one 
died from phthisis ; two died from insanity. Noted as died, but 
neither date nor cause of death stated, twenty-seven. Total, 
35- 
Of the condition of the forty-five patients who were living at 
the date of report: 
2 were free from recurrence after 7 years. 
(c (i (( *c 6 4‘ 
12 “ “ “ “ 5 
7 <( “ “ “ 4 “ 
(( < < Cf (( 0 u 
V 0 
9 “ “ “ “ 2 “ 
< < < < < < < < j * * 
45 
In this table I notice that the word “ died ” appears twenty- 
eight times without any further explanation, and “no recurrence,” 
or “well” forty-six times, which with the eight deaths above noted, 
brings the number up to eighty-two. However, as in the less com- 
plicated statistics of my own operations, I have discovered in 
simple addition an error of three, (but against me), I need say 
nothing. 
It will be observed by this report that while death has been 
caused or hastened in a large number, 43-75 Per cent., forty-five 
patients only out of eighty being alive at the expiration of two 
years, we have an aggregate exemption from recurrence of 168 12 
JOHN BYRNE, M.D., M.R.C S.E. 
years, or precisely three years, efght months and twenty-four 
days for each. I doubt very much if this brief period of exemption 
would greatly, if at all, exceed the duration of life in most cases of 
cancer of the uterus, if allowed to go untreated. 
But, mark the extraordinary manner in which the compiler of 
these statistics sums up his tables: 
He says of 80 cases operated upon 
45 lived 2 years. 
34 “ 3 
25 “ 4 “ 
18 “ 5 “ 
6 “ 6 
2 “ 7 “ 
Thus presenting an array of figures so attractively linked 
together as to convey the idea that some large but indefinite num- 
ber were made whole through the beneficent agency of hysterec- 
tomy. 
Let us now see what Munchmeyer has to say regarding these 
same eighty cases, in his report of 1890. He had already reported 
forty-eight of the eighty cases, in the Leipzig Journal, vol. xxx, 
and states that six were “cured.” 10 He now (1890) reports sixty- 
two more, making in all no cases of vaginal hysterectomy from 
October 11, 1883 to May 9, 1889. Eighty of these were for cancer, 
including two for sarcoma. Of the eighty, four died from the oper- 
ation and seventy-six survived. Of the seventy-six, fourteen died 
later, leaving sixty-two. Of the fourteen deaths, ten were recur- 
rences, one from consumption, two insanity, and one from heart 
failure. Of the sixty-two, three showed recurrence—probably 
rapid; of the forty-two (of his first series of forty-eight, i.e., from 
October, 1883 to May, 1887, which he had previously reported as 
“cured,”) the following summary is given: 
1 was well after years. 
2 were well “ “ 
2 “ " 4* “ 
3 “ “ 3f “ 
1 “ “ 3i “ 
6 “ “ 3i “ 
2 “ “3 “ 
io Archiv f. Gyrnzk., Berlin, 1889, xxxvi., pp. 424-459. Also, Verhaud 
Deutsche Gesel. f. Gyncek., 1890, pp. 298-310. VAGINAL HYSTERECTOMY AND HIGH AMPUTA TION, ETC. 
13 
3 were well after 2f- years. 
2 “ “ “ 
2 “ “ 2\ “ 
3 “ “2 “ 
3 “ “ “ 
3 “ “ i£ “ 
4 “ “ ij- “ 
37 
“Therefore,” he says, “ forty-two lived longer than two years, 
and of these, twenty-seven were free from recurrence.” 
Now, inasmuch as the list falls short by five cases, and ten have 
had an exemption of but little over one year, it is past my com- 
prehension to understand how forty-two could have been cured 
more than two years. 
This, however, is but one of the many mysterious features of 
statistical construction. To sum up: 
Munchmeyer says there were twelve patients who were free 
from recurrence after three years. 
Leisse says there were only nine. 
Munchmeyer says there were but four from four-and-a-quarter 
to four-and-a-half years. 
Leisse says there were seven over four years. 
Munchmeyer says there was but one after five years.. 
Leisse says there were no less than twelve. 
Munchmeyer records none after five-and-a-half years. 
Leisse says there were three. 
Of the second series of thirty-eight cases operated upon from 
May 24, 1887 to May 9, 1889, all comparatively recent, he reports 
two primary deaths and one recurrence at one month; one at three 
months; one at eight months; one at nine months; two at twenty- 
one months; one “tolerably well.” In all nine; twenty-seven being 
noted as recovered from the operation. 
Some of the “ cured ” cases may possibly be included in Leisse’s 
list between October 11, 1883 and May 10, 1885, as six of the ten 
cases operated upon during that period are noted by Leisse to have 
had no relapse for five years, eleven months and fifteen days, to 
seven years, three months and sixteen days. Thus thirty-seven 
patients out of eighty operated upon had an aggregate period of 
exemption from recurrence of one hundred years and three months, 
which gives to each an average of two years, eight months and 
fifteen days. 14 
JOHN BYRNE, M.D., M.R C.S.E. 
It cannot be denied but by reason of more mature experience 
and improved methods regarding- the technique of hysterectomy, 
the primary mortality has been much reduced within the past four 
or five years, and that the statistics of Dr. Sarah Post, showing a 
mortality of twenty-four per cent., apply more particularly to a 
period anterior to 1888. And yet, if perfection in the technique of 
any operation cannot be attained after so many trials, of what prac- 
tical value I would ask, are all these clinical efforts ? 
Let us then see how the case stands at the latest date. But, 
before proceeding further, I beg to call your attention to some 
of the many examples to be found of the manner in which the 
statistics of hysterectomy are being constantly distorted and 
misrepresented to suit the whims and prejudices of writers. 
Thus, a gentleman we all know and respect says:11 “I am 
thoroughly convinced that the removal of the uterus per vagi- 
nam for cancer far surpasses in its remote ox permanent success not 
only all other operations - for cancer of the womb, but also all 
operations for cancer in other parts of the body.” This opinion is 
substantiated by the remarkable statistics of the Dresden Klinik. 
And how think you that he summarizes these said statistics ? He 
says: “The following are the facts; of eighty patients examined 
over two years after the operation, forty-five were free from re- 
currence; 58.6 per cent, (of fifty-eight patients examined) were well 
after three years; 59.5 per cent, (of forty-two) after four years; 
60 per cent, (of thirty) after five years; 66.6 per cent, (of nine) 
after six years; and the two patients that had survived the operation 
for seven years were perfectly well.” This is another example of 
the many and marvellous statistical contortions which it is found 
expedient to offer in lieu of plain and intelligible “facts.” 
In this connection also, it is impossible to overlook the remark- 
able statement of authors who in one page “favor the removal of 
the entire organ by the vagina, even in cases of cancerous disease of 
the cervix alone, rather than take the chances of a high amputation 
of the cervix, when possibly the disease has already extended beyond 
the internal os” and in the very next approve of amputation, pro- 
vided the operator’s line of incision has gone through entirely healthy 
tissues, when he should reasonably expect to have effected a permanent 
cure. ”12 
In this, one of the very latest and not least pretentious works on 
the diseases of women, we find Leopold’s table of eighty hyster- 
n Dr. Goodell in Med. News, Dec. 5, 1891, p. 641. 
12 Thomas and Mund6, “Diseases of Women.” p. 588-89. VA G1NAL HYSTERECTOMY AND HIGH AMPUTA TION, E TC. 
15 
ectomies, of which four died from the operation, ten from quick 
relapse, and four from other causes, leaving sixty-two to be ac- 
counted for, thus analyzed and authoritatively disposed of, for the 
edification and guidance of its readers: “ Of the sixty-two still 
surviving three only have been attacked by a recurrence; the others 
are “ curedthe time since the operation varying from five-and-a- 
half years to one year and three months.” Thus fifty-nine are 
supposed to be accounted for, and yet he says: 
“ Of seventy-six patients remaining under observation after re- 
covery, there were free from recurrence: 
At 5£ years 3 
4i “ 2 
3f “ 3 
3i “ 1 
3i “ 6 
3 “ 2 
2t “ 3 
At 2i- years 2 
2.JL ‘ c 2 
2 (C 3 
4 “ 3 
4 “ 3 
Below i|- “ 4 
In all thirty-seven cases, the trifling- number of twenty-two not 
being worthy of consideration ! ! Finally, and as if to emphasize 
his admiration for results so phenomenal, that ‘ ‘ one cannot ask for 
much better,” he winds up this extraordinary feat in arithmetic by 
informing his readers that “ it will thus be seen that seventy-two of 
these seventy-six cases were still well without recurrence of the disease 
from one to five-and-a-half years after the operation!!” 
Elsewhere, in quoting Ott approvingly, with thirty operations 
and no deaths, Pean is also credited with twenty-five operations 
and no deaths; whereas, though I am not prepared to question the 
accuracy of Ott’s tables, the truth is, Pean 13 has been charged with 
seven deaths in thirty-eight operations. So if the above statement 
be true, he must have had seven deaths in his later thirteen oper- 
ations, of which, however, I have not been able to find any record. 
Now what does the report of Ott show ? Of the thirty cases 
tabulated, thirteen are recorded “ uncertain.” 
Of non-recurrences one has had no recurrence for two years and 
two months; one for two years and one month; two for one year 
and one month; four for one year. 
Of recurrences, one relapsed at thirteen months: one at eleven 
months; one at ten months; one at nine months; one at five 
months; two at three months; two at one month. Total nine. 
So out of the entire thirty successful (?) operations two only are 
reported to have escaped death or recurrence for over two years, 
13Binne, Weekly Med. Review, St. Louis, xxiv, 1891, p. 201-4. 16 
JOHN BYRNE, M.D., M.R.C.S.E. 
while each of the seventeen cases accounted for has been blest 
with an average period of exemption from recurrence of eight 
months and fourteen days. Would it not occur to anyone of ordinary 
observation or experience that these patients might and doubtless 
would have lived much longer and suffered much less if their 
earthly career had ended before the advent of advanced gynaecology? 
Is it not an insult to the intelligence of the profession to be told by 
anyone aspiring to authorship that reckless clinical work like this 
should be commended or accepted as proof of the blessings in store 
for suffering women through the beneficent agency of hysterec- 
tomy ? 
Before proceeding further, let me call your attention to that other 
and safer method of treating uterine cancer, to which I have 
alluded— 
GALVANO-CAUTERY. 
During a quarter of a century or more following the introduc- 
tion of electro-cauterization by Middledorpf, of Breslau, though the 
practice was then attended with much difficulty, owing to imper- 
fect apparatus, yet its peculiar advantages over destructive chemi- 
cal agents in the treatment of uterine cancer had been repeatedly 
demonstrated. Indeed, it may be said that up to 1880, or there- 
abouts, the choice of proceeding lay between this and high ampu- 
tation of the cervix by scalpel or scissors, as practiced by Schroeder, 
and adopted by others even to the present day. This latter surgi- 
cal measure having soon fallen into merited disrepute, and the diffi- 
culties at first found to attend the practice of electro-cautery not yet 
having been overcome, the time seemed ripe for the introduction 
and advocacy of the more unsparing and admittedly more danger- 
ous operation of total extirpation of the uterus. It may be well 
here to note that during all this time, i.e., since the introduction of 
galvano-cautery, and even up to the present day, while the num- 
ber of those who have given this last-named method a fair and 
practical trial may be enumerated on one's fingers, the more aggres- 
sively radical and too often inexperienced candidates for surgical 
notoriety, who during the last decade seem to have laid siege not 
only to the uterus but to the whole sexual apparatus, may be 
counted by the hundred. 
Some years ago gynaecologists in New York and elsewhere at- 
tempted this method of operating in a limited number of cases, but 
they, like some modern authors who ought to know better, labored 
under the delusion that the entire practice of galvano-cautery con- 
sisted in looping a cervix, recently styled “linear amputation,” or VAGINAL HYSTERECTOMY AND HIGH AMPUTA TION, ETC. 
17 
removing pedunculated tumors. In their clumsy and often abortive 
attempts to operate, they soon discovered that a galvanic battery 
did not possess the automatic qualities of a Swiss music-box; that 
the adaptation of this agent to the requirements of pelvic surgery de- 
manded, in addition to operative dexterity, some patience and a 
very moderate but easily acquired knowledge of a subject not to be 
found in medical text-books. As this naturally involved some ex- 
penditure of time, money and grey matter, another discovery was 
not slow to be reached, though it has been kept a profound secret 
until lately. In fact it is nothing more nor less than that the gal- 
vanic cautery is only applicable “ where the disease is of the cauli- 
dower variety and entirely limited to the intra-vaginal portion of 
the cervix.” 14 As has been so often remarked regarding other great 
discoveries and inventions of subtle minds, one cannot help won- 
dering how, and for so many years too, this valuable piece of infor- 
mation could have escaped the notice of such able workers in this 
field, as Hoffmeir, Powlack, Noeggerath, and others. But this is not 
all, for the writer referred to, probably fearing that he may have 
conceded too much, gravely informs us that “it has seemed to us 
that the stimulant action of heat tended at times to increase the ra- 
pidity of growths of the malignant disease.”15 
“ Now in the names of all the gods at once, 
Upon what meat doth this our Csesar feed 
That he hath grown so great ? ” 
It is safe to say, therefore, as I have stated repeatedly during the 
past twenty years, that as amputation of the cervix, high or low, is 
worse than useless without cauterization, and further, that it is an 
operation by no means free from danger, there are but two surgical 
measures worthy of mention to choose between at the present day. 
These are (i) high amputation, or excision, as the case maybe, by 
galvano-cautery, not only of all diseased parts, but as much more 
and beyond the supposed danger-line as can be safely taken away, 
the same to be followed by a thorough dry-roasting of all exposed 
surfaces; or (2) vaginal hysterectomy, with its more attractive sur- 
gical glamour and ghastly record of lives shortened and often sacri- 
ficed on the altar of what is now-a-days mis-called “progressive 
gynaecology.” 
As to the electric cautery, though its claims to recognition are 
based on no inconsiderable number of carefully observed and duly 
recorded facts, covering a period of a quarter of a century, and to 
be found in the periodical literature of every civilized country, yet, 
14 Thomas and Mund6, p. 581. 
15 Ibid. p. 594. 18 
JOHN BYRNE, M.D., M.R.C.S.E. 
strange as it may appear, comparatively few gynaecologists, in this 
country especially, have taken the trouble to know any thing what- 
ever about it practically, and fewer still have conducted such op- 
erations in a proper manner, or to an extent sufficient to warrant 
any opinion as to its real merits. Thus, I have known an instance 
of a patient having been operated upon before a class of students, 
in the following manner (not in Brooklyn, however): the vaginal 
portion of the cervix having been removed by the cautery loop, the 
uterine cavity was then curetted, but in so rough a manner as to 
induce copious haemorrhage; the bleeding parts were then subjected 
to a stewing process by a thermo-cautery, a tampon applied, and 
the patient soon after transferred in a carriage a considerable dis- 
tance to a hotel. Need it be wondered at that she died from 
haemorrhage within twenty-four hours. This is but one of many 
equally inexcusable and criminal blunders which have come to my 
knowledge from time to time, and thus between the arrogance and 
skepticism of those who are ever ready to condemn what they have 
never even tried to understand, and the opposition of others who 
have demonstrated their own incapacity, galvano-cautery may be 
said to have had a hard fight for recognition. 
As one who has earned the right to speak I claim for this method 
of treating uterine cancer two most important advantages : (i) ab- 
solute freedom from danger, immediate or remote, and (2) a longer 
respite from recurrence of the disease than has yet been shown by 
the most favorable and ingeniously constructed statistics of hyster- 
ectomy. For example, in nearly four hundred cases not a single death 
due to the operation; in forty out of sixty-three cases of cancer of the 
portio vaginalis, twenty-three having strayed away, periods of exemp- 
tion ranging from two to twenty-two years, being an average for each 
one of over nine years. Of eighty-one cases involving the entire cervix, 
—thirty-one were lost sight of, ten relapsed within two years, five had 
no recurrence for two years, eleven for three years, six for four years, 
eight for five years, six for seven years, two for eleven years, one for 
thirteen years, and one for seventeen years. So of forty of this class 
whose histories could be followed up, there ivas an average period of 
exemption for each of nearly six years. And yet, these figures are 
not up to date by any means, because, many of the patients of 
this class, five at least to my personal knowledge, and now residing 
in this city, are entitled to an additional credit of three to four 
years.16 
16 “ A Digest of Twenty Years Experience in the Treatment of Uterine 
Cancer by Galvano-Cautery,” by John Byrne, M.D., Trans. Amer. Gyncecolog- 
cial Soc., vol. xiv., p. 91. VA GINAL HYSTERECTOMY AND HIGH AMPUTA TION, E TC. 
19 
Let us disregard for the present the benefits proved to have been 
derived from galvano-cautery in those desperate and utterly hope- 
less cases of extensive cancerous destruction of the uterus, which 
even a hysterectomist would abandon, and which constitute the 
vast majority of all cases brought to our notice. With regard to the 
question of primary danger atteftding hysterectomy it would be 
irrelevant folly to quote either the history or the statistics of ovariot- 
omy in support of the former. There is no comparison between 
the two operations, especially as regards that which should be the 
main object of all surgical procedures, namely, a more or less com- 
plete restoration to health, or, at the very least, a prolongation of 
life commensurate with the risk involved. 
The only question then worthy of serious consideration in this 
very serious business, so far at least as the ill-fated victims of 
cancer are concerned, is as to which of the two operations, vaginal 
hysterectomy, or that of which the above epitomized record speaks, 
can be said to hold out to the afflicted the greater benefits, imme- 
diate and prospective. 
So far as the question of primary mortality is concerned, we 
will find on further statistical research, that the tables of the Dresden 
Klinik, the glory and boast of our radical brethren, present in this 
one respect a phenomenal experience merely, and, consequently, 
to accept such results as a basis for generalization would be “a 
mockery, a delusion, and a snare.” But were it otherwise, and if 
the success of every hysterectomist, past, present and to come, 
equalled that of Kaltenbach or Leopold, there would still remain to 
be seriously considered, and if possible settled, other questions of 
far-reaching import, namely : (i) Has vaginal hysterectomy for 
uterine cancer conferred upon the unhappy victims of this disease 
a sufficiently long respite from relapse to entitle it to a place in the 
list of justifiable operations? (2) In a large proportion of all cases 
thus far exposed to vaginal hysterectomy, has not suffering been 
increased and life greatly shortened through its agency? And (3) 
may not the relatively small proportion of prolonged non-recurrences 
be reasonably accounted for by possible errors in diagnosis, or 
what might be termed a cacoethes operandi, which could not resist 
the extirpation of an entire uterus though it should have but “a 
little growth on the cervix the size of a filbert 
I repeat, my friends, these are questions which we are morally, 
and in the interest of humanity as well as true progress, bound to 
consider seriously and carefully, and with that view I would ask 
your attention to some further statistics. 20 
JOHN BYRNE, M.IK, M.R.C.S.E. 
Prof. Pozzi n, an able, consistent, and yet impartial advocate of 
this and other radical measures, gives the following table touching 
mortality from hysterectomy previous to 1890: 
Fritsch, 60 operations, 7 deaths. 
Leopold, 42 “ 4 “ 
Olshausen, 47 “ 12 “ 
Schroeder and Hoffmeir, 74 “ 12 “ 
Staude, 22 “ 1 “ 
A. Martin, 66 “ 11 “ 
311 47 or about 15 per cent. 
E. Boerner (Graz) Wien. klin. Woch. 1889, ii. page 272-4, 
quotes :— 
Martin, 66 operations, 11 deaths. 
Fritsch, 63 “ 7 “ 
Schroeder, 60 “ 12 “ 
Leopold, 44 “ 3 “ 
Hoffmeir, 42 “ 4 “ 
275 37 or about 13^—percent. 
Martin in combining operations of Fritsch, Leopold, Olshausen, 
Schroeder, Hoffmeir, Staude and his own, gives a mortality of 
fifteen per cent. And with regard to recurrences Martin has stated 
that out of 214 women operated upon successfully by Leopold, 
Schroeder, Fritsch and himself, only five were living at the end of 
four years.18 
Gusserow19 reports sixty-seven operations from 1883 to 1891, 
sixty-four by himself and three in his absence—seven deaths from 
operation; ten of the operations having been done within six months 
he considered too recent for argument, but well at time of report. 
Of the remaining fifty, sixteen are living, twelve are dead of recur- 
rence—one at three years, four from one year to eighteen months, 
and seven from four to seven months. Of the sixteen living :— 
i well, 8 years after operation. 
1 “ 4i “ 
1 “ 3 “2 mos. “ “ 
17 Pozzi, Paris Edition, 1890, p. 405. 
is Dr Coe. 
19 Berlin, klin. Woch., 1891, xxvii. also in Centralb. f. Aertz. Gist. Ungarn. 
1891, vol. i., p. 207. VA G1NAL HYSTERECTOMY AND HIGH AMPUTA TION, E TC. 
21 
1 well, 3 years after operation. Deaths, 11 per cent. 
5 “ 2 “ to 27 mos. “ “ 
g Cl j Cl C I j g it Cl Cl 
i “ 8 mos. “ “ 
Average respite to each of the sixteen, less than two years; and 
three only have reached a period over three years without recurrence. 
S. S. Zayaitzki, Med. Oboz., Moscow, 1890, xxxiv., p. 381 to 
427, reports sixty-five hysterectomies from June 22, 1883 to Feb- 
ruary 15, 1890, with nineteen deaths from the operation or nearly 
thirty per cent., but gives no particulars except in the first seventeen 
cases, i.e., June 22, 1883 to Dec. 1, 1885. Of these seventeen 
operations there were seven deaths from operation, five were lost 
sight of, and as to the other five:— 
i had no relapse for 7 years. 
1 “ “ “ “5 “ and 7 months. 
1 “ “ “ “ 1 year. 
1 “ “ “ “ 4 months. 
1 “ “ “ “ “ a few months. ” 
As to the forty-eight operations between February 7, 1886, 
and February 15, 1890, nothing is stated regarding recurrence, 
except that it was “rapid” in four cases, and but two primary 
deaths are admitted, one from peritonitis, and one from heart- 
failure20, though elsewhere he acknowledges, as above stated, no 
less than nineteen deaths from the operation or a primary mortality 
of thirty per cent. In forty-two noted as “recovered,” we are left 
to conclude that these patients survived the operation and its im- 
mediate consequences. However this may be, if the history of 
these forty-two cases should have turned out to be anything like 
that of the first seventeen, such experience could hardly be advanced 
as an argument in favor of hysterectomy for uterine cancer. 
ROSSIERS REPORT.21 
Of twenty-five cases from June 30, 1887, to December 29, 1891. 
20Zayaitzki, Med. Oboz., Moscow 1890, xxxiv., p. Note the incon- 
sistency, thus: If seven died in the first seventeen operations and there were 
nineteen deaths in all there must have been twelve primary deaths in these 
forty-eight cases. 
21 G. Rossier Correspbl. Schweiz Aerzt., 1892, xxii., p. 202-212. Woman’s 
Klinik, Basel. 22 
JOHN BYRNE, M.D., M.R.C.S.E. 
2 relapsed within 15 months. 
6 “ “ 11 
1 “ “6 “ 
1 “ “5 “ 
2 “ “4 “ 
12 
Hoche’s 22 table of 150 hysterectomies refers to relapses as fol- 
lows:— 
At the end of three months five were lost to sight, twenty-three 
had relapsed, and 122 had shown no symptoms of relapse. 
At the end of 6 m@s. 6 lost sight of, 20 relapsed or dead 96 no relapse 
“ “ “ “ 9 “ 5 “ “ “ 10 “ “ “ 81 “ “ 
“ “ “ “12 “ 2 “ “ “ 9 “ “ “ 70 “ “ 
“ “ “ “ 18 “ 10 “ “ “ 8 “ “ “ 52 “ “ 
“ “ “ “ 2 yrs. 14 “ “ “ o “ “ “ 38 “ “ 
“ “ “ “ 3 “ 21 “ “ . “ o “ “ “ 17 “ “ 
“ “ “ “ 4 “ 10 “ “ “ 1 “ “ “ 6 “ “ 
Thus at the end of eighteen months, seventy or about forty-seven 
per cent, of the whole were known to have relapsed, and at the ex- 
piration of four years there remained, so far as is known, but six 
without relapse or four per cent, of the whole ! 
N. Flaischlen,23 reports twenty hysterectomies; thirteen of which 
were by Paul Ruge, between December 6, 1884 and March 6, 1890, 
with three deaths, or fifteen per cent. 
Phenomenof, Vrach, St. Petersburg, 1890, xi., p. 1015, 1049 and 
1072, records twenty-three operations from January 1886 to May 
1890 with three deaths, or thirteen per cent. 
L. C. Richelot, Bull. Med. Chir. Soc. Paris 1891, xvii, p. 617, 
in a discussion on vaginal hysterectomy, quotes eighty-six opera- 
tions by eight operators, with twenty-nine deaths, as follows: 
Kirmasson 3 operations, 2 deaths. 
Polaillon 6 “ 2 “ 
22 Pozzi, p. 408. 
23 Deutsch. med. IVoch., 1890, xvi. p. 632, July, 1890. VAGINAL HVSTERECTOM Y AND HIGH AMPUTA TION, ETC. 
23 
Marchand 7 operations, 4 deaths. 
Monod 2 “ 2 “ 
Berger 2 “ 2 “ 
Bouilly 21 “ 4 “ 
Richelot 24 “ 9 “ 
Terrier 21 “ 4 “ 
86 29 or 33.7 per cent. 
Paul Segond, page 688 as above, reported thirty-three hysterec- 
tomies and seven deaths, or over twenty-one per cent. Terrier 
thirty four hysterectomies and eight deaths, or over twenty-three 
per cent. 
Krukenberg24 reports 235 vaginal hysterectomies by various op- 
erators from May 1, 1880 to April, 1891, of which he tabulates 130 
as follows, viz.: in 102 the operation was for cancer of the cervix, 
and in twenty-eight the fundus was the seat of the disease. Of the 
first, sixty-three had no recurrence for periods ranging from two to 
eight years, and in thirty-nine recurrence took place in from one to 
two years; one died from pneumonia, and two operated upon in 
April, 1891 are noted as recovered. In this report 105 cases are not 
accounted for, and it is to be presumed that these represent deaths 
from the operation and quick relapses. 
Moreover, this table being made up of a few selected cases from 
the record of each of a number of leading operators can hardly be 
accepted as a safe basis for generalizing as to the period of exemp- 
tion obtainable by vaginal hysterectomy. For instance, the sixty- 
three operations selected by Krukenberg out of 130 consisted of 
twenty-three by Olshausen, eleven by Hoffmeir, ten by Thorn, six 
by Schroeder, six by Winter, four by Kramer, one by Cohn, one by 
Bencheiser, and one by Reichel; in all sixty-three. 
Of the twenty-eight cases operated upon for cancer of the 
fundus, no less than seven died the first year from recurrence, but 
strange to say, not a single primary death is recorded, the table 
being constructed apparently to show periods of exemption only. 
The period covered for these twenty-eight cases was from Decem- 
ber 1885 to April, 1891. 
24 Zeitsch. f. Geburts. und Gynak,, 1892, xxiii., p. 94-158. University Wo- 
man’s Klin., Berlin. 24 
JOHN BYRNE, M.D., M.R.C.S.E. 
olshausen’s non-recurrences. 
Date Operation. 
Date of Report. 
Respite. 
Remarks. 
May ii, 1887. 
4 4 44 44 
Aug. 
1, 
1891. 
4 yrs- 
3 mos. 
Cancer of vertebra. 
Oct. 
21, 
4 4 
4 
4 4 
5 “ 
June 8, “ 
June 
“ 
4 
4 4 
“ 15, “ 
May 
6, 
1890. 
2 
4 4 
11 mos. 
Recurrence in scar. 
“ 22, “ 
July 
29. 
1891. 
4 
4 4 
1 “ 
“ 13, “ 
4 4 
20, 
4 4 
4 
1 “ 
July 25, “ 
t 4 
9» 
4 4 
4 
4 4 
Aug. 6, “ 
44 
28, 
4 4 
4 
4 4 
Sept. 15, “ 
t c 
7, 
4 4 
3 
4 4 
10 mos. 
Nov. 23, “ 
11 
9, 
4 4 
3 
4 4 
8 “ 
Dec. 2, “ 
44 
7, 
4 4 
3 
4 4 
6 “ 
Jan. 12, 1888. 
11 
27, 
4 4 
3 
4 4 
6 “ 
Feb. 14, “ 
c< 
7, 
4 4 
3 
4 4 
3 “ 
May 7, “ 
June 
29, 
3 
4 4 
“ 3°, “ 
July 
28, 
4 4 , 
3 
4 4 
2 “ 
“ 3°. “ 
Aug. 
25- 
4 4 
3 
4 4 
2 “ 
Nov. 5, “ 
July 
11, 
4 4 
2 
8 “ 
Dec. 26, “ 
June 
5, 
1890. 
1 
4 4 
6 “ 
Jan. 10, 1889. 
July 
4 t 
21, 
1891. 
2 
4 4 
6 “ 
Feb. 4, “ 
7, 
“ 
2 
4 4 
5 “ 
“ 5, “ 
May 
22, 
1890. 
1 
4 4 
3 “ 
March 12, “ 
June 
22, 
1891. 
2 
3 *' 
July 19, “ 
July 
25, 
4 4 
2 
“ 
Seven over four years; eight over three years ; six over 2 years ; 
two over one year. Total twenty-three. 
hoffmeir’s cases. 
Date Operation. 
Date of Report. 
Exemption. 
i. Apl. 8, 1883. 
Oct. 1888. 
4 yrs. rec. j Died 5th year— 
2. June 24, “ 
June 1891. 
8 “ j Recurrence. 
3. Sept. 19, 1885. 
6 “ 
4. Apl. 10, 1886. 
July 20, “ 
5 “ 
5. Aug. 9, “ 
“ 20, “ 
5 “ 
6. “ 16, “ 
Aug. 15, “ 
5 “ 
7. Feby. 3, 1887. 
8. “ 13, “ 
June 
4 “ 
4 “ 
9. Apl. 6, “ 
March 4, “ 
3 “ Died of recurrence. 
10. “ 16, “ 
June “ 
4 “ 
11. “ 20, “ 
“ It 
4 “ 
One over eight years; one over six years; three over five years; 
five over four years; one over three years. Total, eleven. VAGINAL HYSTERECTOMY AND HIGH AMPUTA TION, ETC. 
25 
thorn’s cases. 
Date Operation. 
Date of Report. 
Exemption. 
i. June 24, 
00 
CO 
July 
5, 1889. 
8 
years 
11 
2. “ 11, 
t t 
11 
2, 1891. 
4 
3. “ 21, 
( ( 
Apl. 
25, “ 
4 
11 
4. Aug. 24, 
“ 
Aug. 
7. “ 
4 
< t 
5. Oct. 20, 
t t 
1 ( 
14, “ 
3 
“ 9 mos. 
6. “ 3, 
< t 
July 
9> “ 
3 
“ 9 “ 
7. Nov. 17, 
t t 
3°» “ 
3 
“ 8 “ 
8. Dec. 29, 
“ 
“ 
n, “ 
3 
“ 8 “ 
9. Jany. 20, 
“ 
Aug. 
10, “ 
2 
11 6 “ «5 
10. “ 23, 
‘ ‘ 
July 
8, “ 
3 
“ 6 “ 
Three over four years; five over three years; two over two years. 
Total, ten. 
schroeder’s cases. 
Date Operation. 
Date of Report. 
Exemption. 
i. May 1880. 
May 1884. 
4 years. Died of Apoplexy. 
2. Jany. 1881. 
Feby. 5, 1884. 
3 “ 
3. Dec. 1883. 
Dec. 1885. 
2 “ 
4. May 27, 1884. 
[une 1891. 
7 “ 
5. Oct. 17, 1885. 
11 ct 
15 “8 mos. 
6. May 6, 1886. 
July 
5 “ 2 “ 
One over seven years; two over five years; one over four years; 
one over three years; one over two years. Total, six. 
Date Operation. 
Date of Report. 
Exemption. 
1. March 26, 1886. 
2. May 24, 1889. 
3. June 14, “ 
June 1891. 
May “ 
June 22, “ 
5 yrs. 3 mos. 
2 “ 
2 “ 
4- July 
6, “ 
July 4, 
“ 30, 
2 “ 
5- “ 
17, “ 
2 “ 
6. “ 
24, “ 
“ 7) “ 
2 “ 
winter’s cases. 
One over five years; five over two years. Total, six. 
Date Operation. 
Date of Report. 
Exemption. 
Dec. 6, 1888. 
Jany. 18, 1889. 
March 23, “ 
Apl. 4, “ 
Aug. 4, 1891. 
July 4, “ 
“ 7, “ 
June 28, “ 
2 yrs. 8 mos. 
2 “ 6 “ 
2 “4 “ 4 over 2 years- 
2 “ 2 “ 
kramer’s cases. 
Cohn, one case 1887; recurred 1890; two years exempt. 
Bencheiser, one case; four years; no recurrence. 
Reichel, one case; five years, no recurrence. In all sixty-three 
cases 
25 Recurrence observed in August. 26 
JOHN BYRNE, M.D., M.R.C.S.E. 
In summing up these tables we will observe that 
I case out of 235 operated upon had no recurrence for over 8 years. 
1 (l 44 (. y 44 
X i< u u 44 
y 41 cc cc c c 
17 “ “ “ 4 “ 
44 44 4t 
I9 iX “ “ 2 “ 
2 44 44 44 | 44 
So, these 63 patients, being but 27 per cent, of the whole, had an 
average exemption from relapse of three years and four months for 
each, while nothing whatever is said as to the fate of 172 or 73 per 
cent, of the entire number operated upon. If we take into account 
the probable history of these 172 less fortunate sufferers, and I 
do not see why we should not, and allow one year for each, we 
have an aggregate of 381 years exemption for 235 patients, or 1 
year, 7 months and thirteen days for each. 
Olshausen reported at the International Congress in Berlin, in 
1890, 163 cases of hysterectomy for cancer at the University Wo- 
man's Klinik from May 1, 1887 to May 1, 1890—twenty-two or 
13.5 per cent. died. After two years forty were living, but of the 
entire number who escaped death in the operation (151) only 
nineteen of them were free from recurrence. 
Of his earlier operations, thirty-nine in number, from April, 
1881 to April 1887, six were then living and free from relapse. One 
after three-and-a-half years; one after four years; one after seven 
years; two after eight years, and one after nine years. In exhibit- 
ing the uterus taken from the last named patient he said, “this is the 
longest time that has elapsed after operation, without recurrence.” 
Thus in the space of three years no less than one hundred and 
sixty-three hysterectomies were performed in one institution, and 
at the expiration of two years there were but forty living, nineteen 
without recurrence and twenty-one doubtless much worse than if 
they had never run the gauntlet of hysterectomy. 
Exhibits like these, and statistics are full of them, cannot be 
but discouraging to our advanced and exclusively modern gynae- 
cologists. If like results were generally known to attend the treat- 
ment, medical or surgical, of any other malady, it were better that 
its victims should bear the ills they have, or trust to “the faith 
cure.” In a business point of view it is certainly disheartening 
to the advocates of home industry in this particular line, and it 
behooves our radical advance-guards to look to their coveted laurels. 
Up to now, their best efforts have been put forward in scouring the 
country for material wherewith to break the record, and in some VAGINAL HYSTERECTOMY AND HIGH AMPUTA TION, ETC. 
27 
individual instances with considerable promise of success. Fail- 
ure, however, if it should come, would be most disastrous; during 
their eager pursuit for notoriety, the whole business might become 
to say the least unpopular, each hysterectomist might find him- 
self in the position of Shakspeare’s swarthy Venetian: his first, 
second or third series of ten, fifty or one hundred operations, on 
paper, might spoil on his hands; or, like an off-style article of 
ladies’ head-wear, become such a drug in the market that no 
amount of professional advertising would enable him to turn his 
wares to profitable account. 
Per contra, Kaltenbach (Halle) tested the credulity of his audi- 
ence at the same time by stating that he had but two deaths in 
eighty operations. A phenomenal experience truly, but an equally 
delusive and dangerous precedent, as the following tables will 
show. 
Name. 
Number 
Operations. 
Primary 
Deaths. 
Per Cent. 
i . Olshausen 
163 
22 
13.5 
2. Kaltenbach 
80 
2 
2.5 
3. Leopold 
80 
4 
5- 
4. Martin 26 
i34 
22 
16.5 
5. Hoff'meir 
42 
4 
9-5 
6. Fritsch 
63 
7 
11. 
7. Schroeder 
60 
12 
20. 
8. Gusserow 
67 
7 
10.5 
9. Schauta 
55 
5 
9- 
10. Zayaitzki 
65 
T9 
29. 
11. Bouilly 
5i 
16 
31. 
12. Terrier 
34 
8 
23 -5 
13. P. Sdgond 
33 
7 
21. 
14. Sanger 
17 
2 
11.8 
944 
137 
14-5 
BRITISH OPERATIONS. 
Name 
Operations. 
Primary Deaths. 
i. Sinclair 
42 
5 
2. Purcell 
11 
4 
3. Braithwaite 
11 
1 
4. Murphy 
1 
1 
5. Beaufoot 
2 
1 
6. Cullingworth 
4 
1 
7. Lawrabon 
2 
1 
8. Nesbitt 
1 
1 
74 
15, over 20 per cent. 
26 Quoted by Ott, Annals de Tocologie, Paris, 1889, xxxii, pp. 241-271, and 
327-334- 28 
JOHN BYRNE, M.D., M.R.C.S.E. 
Name. 
Operations. 
Deaths. 
Price 
53 
3 
Boldt 
36 
3 
Cushing 
38 
4 
Coe and Hunter 
19 
5 
Byford, Martin and Nelson 
20 
1 
Krug 
7 
1 
Reamy 
12 
2 
Wylie 
20 
1 
Eastman 
13 
3 
Reed 
11 
3 
Polk 
16 
4 
Montgomery 
6’ 
1 
Winning 
4 
3 
16 operators. 
255 
34, over 13 per cent. 
AMERICAN OPERATIONS. 
Operators. 
Operations. 
Deaths. 
Per Cent. 
European (continental).. 
14 
944 
137 
14-5 
British 
S 
74 
15 
20. 
United States 
16 
255 
34 
13- 
Total 
38 
1273 
186 
14.6 
Further comment on these statistics, even did time permit, 
would seem to be uncalled for. They speak for themselves, and, 
in my opinion, so emphatically, that “ they who run may read.” 
The lessons which they teach are plain and of vital importance, 
and the following conclusions, in part essentially those arrived at by 
Dr. Jackson five years ago, would seem to me to be fully substan- 
tiated by the array of glaring though distorted clinical facts here 
presented. 
1. The ambiguous manner in which the statistical tables of vaginal 
hysterectomy have been constructed, is so misleading and, in some in- 
stances so suggestive of erroneous inferences as to render their com- 
pilers open to a charge of SUPPRESSIO VERI or SUGGEST/O 
FALSI. 
2. Any operation known to be attended or followed by an average 
primary mortality of over fourteen per cent, in the hands of the most 
experienced surgeons, is a grave and a dangerous one, and demands 
for its justification a large percentage of PERMANENT CURES. 
3. The frequency and rapidity ivith which recurrence takes place 
after vaginal hysterectomy for cancer, even when the disease has ap- peared to be limited and circumscribed, prove conclusively that it can 
lay no just claim to this essential feature. 
4. As the average period of life in cancer of the uterus, when not 
operated upon, is not less than two years but often more, suffering 
has not been lessened but aggravated, and life has not been prolonged 
but shortened, in the vast majority of all cases thus far subjected to 
vaginal hysterectomy. 
5. As in twenty-eight cases of vaginal hysterectomy for cancer of 
the fundus at the Berlin Klinik, no less than seven died from recurrence 
within twelve months, the regional grounds on which some have con- 
conceded to this operation even a limited field are inconsistent with facts, 
and therefore not tenable. 
6. As the operation is, in many respects, more dangerous than the 
disease for which it is undertaken, and, as the majority of all patients 
afflicted with uterine cancer would live longer without than with it, it is 
not a safe nor a useful operation and as such is unjustifiable. 
7. On several occasions during the past twenty years, and more 
particularly in a paper read before this society three years ago, ample 
and convincing proof, clinical and statistical, was presented, as to the 
claims and unique characteristics of the electric cautery in the treat- 
ment of uterine cancer, and further observation has been more than 
confirmatory of opinions then advanced. 
8. Amputation of a cancerous cervix by the cautery knife is free 
from danger, a safeguard against all infection, traumatic or septic, 
and, what is of still greater importance, it is destructive to latent cancer- 
cell proliferation in tissues far beyond the line of incision; hence, much 
more is comprised in the operation than the mere removal of a part 
or parts more actively involved in the work of destruction. 
9. Any method of operating for which advantages so vital and so 
far-reaching can be claimed and established, and which thus distin- 
guish it from all others, renders its adoption on the part of those who 
undertake to operate for cancer of the uterus no less than a MORAL 
OBLIGATION. 
I have often been asked to explain what at first thought ap- 
peared to be a transparent incongruity, namely, why better results 
should follow or be claimed for amputation of a cancerous cervix 
by galvano cautery, than for the same operation by other means, 
or, above all, the extirpation of the entire uterus by any of the 
methods ordinarily resorted to. At first I could do little more 
than to point to clinical facts and venture to surmise that coinci- 
dent with either of the latter surgical procedures, there might take 
place a traumatic infection in parametric tissues, which, though 
apparently healthy, were, in all probability, already predisposed 
VA GINAL HYSTERECTOMY AND HIGH AMPUTA TION, E TC. 
29 30 
JOHN BYRNE, M.D., M.R.C.S.E. 
in some especial manner to pathological changes. Increased 
experience in the treatment of uterine cancer by galvano cautery 
renders it more than probable that this will be found to be the only 
rational hypothesis, and one which is strongly fortified by clinical 
observation. 
Moreover, I am of the opinion that in the parametric tissue of many 
cancerous uteri, and much beyond what might seem to be the limit of disease, 
there exist some morbid cell changes due to faulty nutrition, or cancer germs, 
but, in so undeveloped a state as to be inappreciable even by the aid of the 
most powerful microscope. Under such circumstances there is surely noth- 
ing unreasonable in surmising that cell proliferation, hitherto slow, or 
almost dormant, would be hastened, and that formative processes, so respon- 
sive to any kind of irritation, would be roused into active life through the 
traumatic stimulus of an operation, and the exposure of more or less exten- 
sive raw surfaces. On the other hand, in the progress of an amputation 
by cautery, and where the heated knife is so long, and repeatedly applied, 
(for such operations must be slow) the effects of the heat on outlying struc- 
tures may be imagined by the shriveled and comparatively small size of what 
had been, before operation, a voluminous cervix. In no other manner do I 
think it possible to explain certain phenomena following these operations by 
galvano-cautery, e. g., (l) absence of fever and almost all pain, pelvic or 
peritoneal; (2) the almost universal immunity of the scar tissue after cauter- 
ization from secondary attack in the event of recurrence of the disease, 
and (j>) in the case of relapse, the long respite obtained from reappearance 
of the disease in remote parts, even in the more unpromising cases of un- 
doubted circum-uterine infiltration. 
In conclusion, I feel that I owe you an apology for trespassing 
to so unusual a degree on your kindness and patience. My aim 
has been to arrive at some reasonable and truthful interpretation of 
the statistics of hysterectomy, and at the same time to urge the 
claims of a method of treating uterine cancer, which, I believe, 
has not received that consideration to which it has for many years 
been proved to be entitled. 
It is a matter for regret, and a source of surprise to many, that 
while European authorities have not failed to chronicle from time 
to time certain facts connected with the treatment of uterine cancer 
by galvano-cautery, as observed and duly recorded in this country, 
some of our American authors, unmindful of their obligations, have 
assumed the responsibility of withholding from their readers almost 
everything of consequence connected with the subject. The caus- 
tic remarks of a medical friend in noticing this unaccountable 
omission, though severe, can hardly be said to be much out of 
place. He writes me as follows: “ Any author who wilfully sup- VAGINAL HYSTERECTOMY AND HIGH AMPUTATION, ETC. 
31 
presses some of the most important facts in current literature, and 
bearing on a subject which he presumes to discuss, displays a reckless 
disregard for his own reputation, as well as for the opinions and rights 
of others. 
“ The musty records of Braun and Schroeder may savor of ancient 
history, but if leavened with a passing reference to the more modern views 
of Reamy and Baker, just for appearance sake, the subject will have been 
dealt with in a sufficiently exhaustive manner to meet all reasonable demands 
of the American reader and the American market. ‘ O Tempora / O 
Mores ! ’ ” 
But, my friends, it is, I regret to say, the besetting passion of 
the time in society discussions, scientific papers, and even in more 
or less but usually more pretentious works, to so trade on the 
opinions of foreign writers, that it would seem as if gynsecology 
had forfeited its right to “ a local habitation and a name,” in this 
great republic of the west. Indeed, at the present day, it would 
seem as if nothing in the way of reckless surgery could be too 
impracticable or too absurd for commendation and imitation when 
permissible, provided it emanate from some “ professor” however 
obscure, if only hailing from some university town in Europe. 
Is it not, I submit, quite time that this unpardonable syco- 
phancy, this pitiable servility, should cease to offend the intelli- 
gence, common sense, and patience of the bulk of our profession ? 
Aping erudition is surely no proof of merit. There was a time, 
and it is not so very long ago, when it was not uncommon to hear 
America referred to as the birthplace of advanced and progressive 
gynaecology, and when the gifted and lamented Sims and our 
distinguished Fellow, Emmet, were demonstrating to the world the 
curability of ailments, which, until their time, were deemed beyond 
the resources of art. Nevertheless, at that very epoch, and as if 
oblivious to ail this, articles on the accidents of parturition con- 
tinued to be written, and text-books published for a considerable 
time, without note or comment on matters with which all here had 
been long familiar. As a noteworthy example, about twenty years 
ago the late Professor Charles Budd amused some members of the 
Obstetrical Society of New York, by stating as part of his expe- 
rience on visiting a large metropolitan hospital in Europe the pre- 
vious season, that he saw the surgeon on duty displaying his skill 
before a class by rubbing the edges of a vesico-vaginal fistula with 
a stick of nitrate of silver. At this very time we were probably 
extolling and practicing Freund’s operation, or Nussbaum’s method 
of exploring the abdominal viscera by a hand and arm forced 
through the rectum. Indeed, nearly ten years elapsed before the 32 
JOHN BYRNE, M.D., M.R.C.S.E. 
most important of the beneficent fruits of Sims’ genius could be 
said to be appreciated, and even now some of our European idols, 
in return for our worship, would fain belittle, and through misrep- 
resentation of its author’s explicit views and directions, condemn one 
of the most valuable operations in the whole field of minor gynae- 
cology. I refer to Emmet’s operation for laceration of the cervix. 
Let it not be imagined that this outspoken reference to a deli- 
cate subject springs from any illiberal spirit. Far be it from me to 
say ought thht might detract from the well-deserved fame of 
illustrious European gynaecologists, to whose labors and original 
investigations we owe much, but, while admiring the verdure of 
far off fields let us cease to act as if our own were a barren waste. 
Medical science in all its departments must necessarily be cosmo- 
politan in the widest sense. Hence, on matters professional, we 
should be actuated by no selfish consideration, wedded to no hobby, 
faction, clique or country, swayed by no predilection, and influ- 
enced by no prejudice, but sink every inferior motive before the 
main object, Principle. Lettruth, honor, candor and liberality be the 
only stepping stones to the genuine dignity and nobility of our calling. 
Pros Tyriosve mihi nullo discrimine agetur. 
RULES TO BE OBSERVED IN PERFORMING HIGH AMPU- 
TATION AND OTHER OPERATIVE MEASURES 
FOR CANCER OF THE UTERUS BY 
GALVANO-CAUTERY. 
BY JOHN BYRNE, M. D., M. R. C. S. E. 
The American Gynaecological Society at its late meeting in 
Brooklyn, departing from the rule hitherto strictly observed of con- 
fining all papers to its volume of transactions, unanimously resolved 
to authorize and recommend the publication of the President’s ad- 
dress in one of the medical journals. 
To this resolution was also added the request that the president 
would include or add thereto some brief description of his method 
of performing high amputation of the cervix, or otherwise treating 
uterine cancer. 
In compliance with this request, therefore, I have prepared the 
following: 
Note.—The illustrations of this Article are, by permission, from advance sheets 
of the “ International System of Electro-Therapeutics,” by Horatio R. Bigelow, 
M.D. Figs. 4 and 8 are from photographs by H. V. Byrne, M.D. RULES IN PERFORMING HIGH AMPUTATION, ETC. 
33 
It is well known to all who have had much experience with 
uterine cancer that in a very large percentage of the cases met with, 
whether in private or hospital practice, the disease is found to have 
already progressed so far that palliative results or a brief respite 
from suffering and death is all that can be hoped for from any treat- 
ment. In such cases, as for example when the entire cervix has 
been destroyed and the corpus uteri as well as the parametric tissues 
are found to be involved, my course has been as follows: First, to 
remove all softened and broken-down tissue by the free use of a 
sharp curette, and having sponged the cavity repeatedly with a 
mixture of one part of commercial acetic acid, three parts of glycerine, 
and carbolic acid sufficient to represent eight per cent, of the whole, 
I then pack the cavity with absorbent cotton and allow it to remain 
for a few minutes or longer as the case may be. On removing 
this, if all bleeding is found to have ceased, and the cavity fairly 
dry, cauterization may be proceeded with. If, however, oozing of 
blood to any extent should still continue, it will be best to pass into 
the cavity a properly rolled tampon saturated with the above 
styptic, and allowed to remain for forty-eight hours before the 
application of the cautery. 
Kersten & Co., Brooklyn. 
Fig. i. 
Cauterization in all such cases should be conducted in the fol- 
lowing manner: 
The diseased organ should be exposed to view and the vagina 
protected by a Sims’ speculum, and an anterior and two lateral retrac- 
tors, and it may be necessary to seize the edges of the excavation by 
one or more volsella. Before introducing the cautery electrode a 
wad of absorbent cotton is to be passed into the cavity, held for a 
moment, and immediately, on being withdrawn, the dome-shaped 
instrument, Fig. i, brought to a cherry-red heat, is to be rapidly and 
repeatedly passed over the bottom of the cavity mainly. The latter is 
then to be again dried by wads of absorbent cotton held in dressing 
forceps, and cauterization resumed as in the first instance. This 
process is to be repeated over and over again, until the deeper parts 
of the cavity have become dry and charred, when the sides are 
to be treated in precisely the same manner, and roasted to the same 
crisp condition. The seat of operation will now present the ap- 
pearance of a perfectly black and dry cavity. All ragged and over- 
lapping edges are next to be trimmed off by the cautery knife, a 34 
firmly rolled tampon of suitable size with thread attached, and 
saturated with the above styptic compound, is now to be placed in 
the cavity, and, finally, a supporting vaginal tampon is to be ap- 
plied and the patient removed to bed. The vaginal tampon may be 
removed on the following day, but the other had better be allowed 
to remain for forty-eight hours or longer. The subsequent treat- 
ment will consist of vaginal douches twice daily of carbolized 
water. 
JOHN BYRNE, M.D., M.R.C.S.E. 
In conditions admitting of high amputation, the following is the 
method usually resorted to : The uterus is to be exposed and the 
vaginal walls protected in the manner already described. The di- 
verging volsellum, Fig. 2, being passed well into the cervical canal, 
HIGH AMPUTATION. 
Kersten & Co., Brooklyn. 
should now be expanded to a proper degree and locked, so as to 
afford complete control of the uterus during the entire operation. 
By alternate traction and upward pressure of the uterus, an accu- 
rate idea may now be obtained as to the proper point to begin the 
circular incision, so as to avoid injuring the bladder or opening into 
the cul-de-sac of Douglass. As to the latter, however, should it be 
found that the disease has involved the retro-uterine tissues, and 
that its excision or destruction by the cautery cannot be effected 
without opening into the peritoneal cavity, there need be no hesita- 
tion in doing so, as I have never known any harm to come from it 
whether done accidentally or by design. Should it be evident at 
the outset that the operation, in order to be thorough, must include 
a portion of the cul-de-sac, it will be better to make the line of in- 
cision anterior to this, until the cervix has been removed, and leave 
the excision of the retro-uterine parts by the cautery knife, to be the 
final proceeding. Under these circumstances all that will be needed 
will be an antiseptic tampon properly applied. 
Fig. 2. 
Kersten & Co., Brooklyn. 
Fig. 3. 
In proceeding to make the circular incision the cautery knife, 
Fig. 3, slightly curved and cold, should be applied close up to the Fig. 4. 
Fig. 5. Fig 6. Fig. 7. 
Fig. 8. RULES IN PERFORMING HIGH AMPUTATION, ETC. 
35 
vaginal junction, and from the moment that the current is turned on, 
should be kept in contact with the parts being incised. Fig. 4. Be- 
fore removing the electrode for any purpose such as change of 
position, or altering the curve of the knife, the current should first 
be stopped and the instrument again placed in position while cool 
before resuming incision. In other words, if the knife, though 
heated only to a dull rtd, be applied to parts at all vascular, haemorrhage 
more or less will certainly follow; whereas, the cool platinum blade being 
already in contact with moisture as the current is being transformed into 
heat, vessels are shrunken or closed erven before they are severed. 
This is a very important point and should never be lost sight of 
in all cautery operations. 
The circular incision having being made to the depth say of a 
quarter of an inch, it will now be observed that by increased trac- 
tion the uterus may be drawn much farther downward, and by 
directing the knife upward and inward the amputation may be 
carried to any desired extent (Figs. 5 and 6). In cases calling for 
amputation above the os internum, it will be better to excise and 
remove the cervix first, then, by dilating the upper canal sufficient 
to admit the diverging volsellum, once more proceed as in the first 
instance, taking care, however, to keep within bounds (Figs. 7 and 8). 
It will be found that the cupped stump can now be drawn down 
and made to project as a more or less convex body. 
In all cases the dome-shaped electrode (Fig. 1) should be passed 
over the entire cavity repeatedly so as to render the cauterization 
still more complete. 
It is important to add that, in carrying the knife toward the sides 
of the cervix, circular and other arterial branches are apt to be en- 
countered, and hence, in this locality particularly, a high degree of 
heat in the platinum blade is to be carefully avoided. As an ad- 
ditional security against haemorrhage, the convexity of the knife 
should be pressed against the external surface of each particular 
section cut, so as to close vessels more effectually. 
It is well to state that the metallic parts of the electrode for the 
distance of about two inches should be covered with a strip of thin flannel, 
so that the vagina may be protected from injury through the reflected heat. Dr. Jno. Byrne’s8 Cautery Battery 
SOLE MANUFACTURERS 
3T. IKHEHRSTIEIISr <Sc CO., 
198 JORALEMON ST., BROOKLYN, N. Y. 
Send for descriptive circular of this and other Surgical Instruments.