A REVIEW OF 
FORTY-EIGHT CASES 
OF 
Abdominal Surgery. 
BY 
CLINTON CUSHING, M.D., 
PROFESSOR OF GYNAECOLOGY, COOPER MEDICAL COLLEGE, 
San Francisco, Cal. 
REPRINTED FROM 
ANNALS OF GYNAECOLOGY AND PAEDIATRY, 
NOVEMBER, 1891. A REVIEW OF FORTY-EIGHT CASES 
OF 
ABDOMINAL SURGERY.1 
BY CLINTON CUSHING, M.D., 
OF SAN FRANCISCO, 
Professor of Gynaecology in Cooper Medical College, Fellow op 
the American Association of Obstetricians and Gynecolo- 
gists, Fellow of the British Gynecological Society, 
Consulting Surgeon to the French Hospital, etc. 
Gentlemen : Another year has rolled around and brought 
with it the failures and successes, the anxieties and satisfac- 
tions and the almost invaluable experiences which attend 
surgical operations involving the peritoneal cavity. The ob- 
ject of this communication is to set before you personal 
opinion, based on my own observation, rather than a digest 
of the late literature on the subject. The accompanying 
tables comprise all the abdominal sections that I have made 
during the past year and, as will be seen, include a variety of 
affections. Further experience convinces me that a properly 
managed private hospital will give better results in abdominal 
surgery than where patients are treated in their own homes, 
in boarding-houses and hotels, or in large general hospitals, for 
the surgeon has more perfect control of the environment, the 
nurses and the patient. 
No case, however desperate, has been refused operation ex- 
cept the two following: 
The first was a bad one of double pyelitis, the diagnosis 
being confirmed by catheterizing each ureter and securing 
1 Read at the November meeting of the San Francisco Obstetrical Society. 2 
Forty-eight Cases of Abdominal Surgery. 
urine direct from the kidney without its entering the bladder, 
after the method of Pawlick. 
The second was a case of advanced sarcoma of the pelvic 
cavity in a man. 
There has been no disposition to select favorable cases for 
operation. 
Under the head of "Abdominal Sections for the Removal 
of Ovarian Tumors," the first case was of unusual interest. 
The patient was 54 years of age, and had given birth to one 
child thirty-six years before. She was poor and obliged to 
earn her own living and to support her invalid son. 
She applied at the clinic of Cooper Medical College on 
account of her inability to do further work. Upon examina- 
tion it was found that she had a complete procidentia of the 
uterus and vagina and bladder outside of the vulva; the left 
ovary was calcified and about the size of a hen's egg, and lay 
in Douglas's pouch entirely outside the vulva. The right 
ovary was cystic and about the size of a child's head. 
I placed her in the French Hospital, denuded the anterior 
wall of the vagina the entire length, the surface of denudation 
being an inch in width, the edges of which were united with 
silkworm gut, this procedure much lessening the calibre of 
the vagina. The uterus and ovary and bladder were then 
returned into the cavity of the pelvis, and the perinaeum re- 
paired and closed firmly up to the urethra. The abdomen 
was now opened and the calcified ovary removed, as was the 
cystic tumor of the right ovary; the fundus of the uterus was 
now stitched to the anterior abdominal wall with two deeply 
placed sutures of silkworm gut. 
The convalescence was uninterrupted except by a stitch- 
hole abscess, and she is now, one year later, in excellent 
health. The uterus retains its position, and she is able to 
earn her own living, the only fault being a small ventral 
hernia, doubtless due to the weakening of the line of incision 
by the stitch-hole abscess. 
Case 2 of the same table illustrates the value of free douch- 
ing and drainage. She was 34 years of age and had two 
large, suppurating, colloid cysts of the right ovary. There Forty-eight Cases of Abdominal Surgery. 
3 
were many and firm adhesions, and in separating them the 
sacs broke down, and the abdomen was flooded. After ligation 
of the pedicle, large quantities of hot water, with hydronaph- 
thol, were poured into the cavity of the abdomen and then 
squeezed out, and this process was repeated until the water 
returned quite clear. A drainage tube was inserted and al- 
lowed to remain for forty-eight hours, when it was removed, 
after which the convalescence was uninterrupted. 
Case 3 had been supposed at one time to be an enlarged 
and retroflexed uterus, and a digital examination certainly 
gave that impression, but a bi-manual examination and the 
use of the uterine sound demonstrated that we had to deal 
with an elastic tumor in Douglas's pouch independent of 
the uterus. An ovarian cystic tumor, the size of a small 
cocoanut, was wedged in the pelvis, interfering seriously with 
the function of the rectum and crowding the uterus upward 
and forward. The removal was not difficult and the recovery 
uninterrupted. 
Case 5, in a young girl of 19, was a large ovarian cyst reach- 
ing to the ensiform cartilage. The tumor was symmetrical 
and simulated a pregnancy of nine months, the point of 
interest being irregular contractions of the abdominal muscles, 
which gave the impression to the hand of the movements 
of a foetus. The existence of a firm hymen with a small orifice 
and the absence of any placental bruit or sound of the 
foetal heart made the case sufficiently clear and warranted 
the abdominal section. The tumor proved to be a simple 
ovarian cyst. 
Cases 6 and 7 are good illustrations of the difficulty attend- 
ing the diagnosis of abdominal tumors. In both cases we 
had to deal with a fibroid enlargement of the uterus with 
profuse haemorrhage and a rapidly increasing ovarian cystic 
tumor, which seemed to be a part of the uterus so far as 
could be judged from examination. The diagnosis in both 
cases was a probable fibro-cystic tumor of the uterus. In 
cases of this kind, where the ovarian cyst is firmly attached 
to the uterus, it must always prove a difficult thing to 
make an accurate diagnosis without an abdominal section. Forty-eight Cases of Abdominal Surgery. 
4 
In both cases the ovaries were removed and both uterine 
arteries ligated. It is too soon yet to judge of the effect of 
the operation on the fibroid tumors. In Case 7 the uterus 
was curetted and the cervix and perinaeum repaired at the 
same sitting. 
Under the head of " Abdominal Section for Removal of 
Uterine Appendages, not the Seat of Tumor," Case 1 gives 
us a history that, to say the least, is most encouraging. The 
patient was 24 years of age, had pelvic abscess six months be- 
fore, which was opened in the left groin by a surgeon. The 
abscess failed to heal, and the general health was getting 
daily worse. The abdomen was opened, pus tubes removed, 
and the fistulous tract in the groin thoroughly mopped out 
with a mixture of equal parts of Churchill's tincture of 
iodine and carbolic acid. Convalescence was uninterrupted, 
and the fistulous tract promptly healed. Several weeks later 
the fistula reopened, and now an examination with the 
microscope showed the discharges to contain the bacilli of 
tuberculosis. The patient also had a troublesome, hacking 
cough. She was placed under the care of Prof. J. O. Hirsch- 
felder, who at once began the subcutaneous injections of 
Koch's lymph, and afterward used in the same manner can- 
tharides and iodine. Under this treatment the improvement 
was steady, the fistula healed, and now, a year later, she 
is in excellent health. Surely the practice of medicine and 
surgery is making progress when we can report such a case 
as this. 
Case 3 of this table illustrates a proposition, the truth 
of which is conceded by nearly all operators. A woman, 30 
years old, with one child and one miscarriage, had peritonitis 
three years ago, following childbirth, since which time she 
has been an invalid. The uterus was retroverted and fixed 
by adhesions. The tubes and ovaries were prolapsed and very 
sensitive to the touch. She had had much local treatment 
with glycerine tampons and the use of iodine, but without any 
good result; and, while her general appearance would indicate 
a fairly good state of the general health, she was extremely 
hysterical. The abdomen was opened, the adhesions broken Forty-eight Cases of Abdominal Surgery. 
5 
up, the ovaries and tubes removed, and the fundus of the 
uterus fixed to the anterior abdominal wall. The recovery 
from the operation was uninterrupted. The uterus retained 
its normal position, but the pains about the pelvis still con- 
tinue, and the hysterical symptoms have been but little 
relieved. This history corroborates the experience of many 
who have reported similar cases. It proves that the morbid 
conditions of the mind and of the nervous system are not al- 
ways relieved by the removal of diseased ovaries and tubes. 
Case 5 was about as bad as could well be imagined. Re- 
peated attacks of pelvic peritonitis had occurred, ending in 
pelvic abscesses, which had been in existence for one year, 
with the small intestines firmly agglutinated together, form- 
ing a roof over an amount of pelvic disease that was appalling. 
In separating the adhesions, large pus cavities were opened, 
and a flooding of the peritoneal cavity with very offensive 
pus occurred. That the woman should die of septicaemia 
on the sixth day was not surprising. 
Case 9 was one of recurrent pelvic peritonitis where the 
prolapsed ovaries and tubes were firmly adherent. The 
removal of the ovaries and tubes gave no relief from the 
symptoms. Six months later she developed cancer of the 
rectum. 
Case 14 is a good example of a plan that I have heretofore 
pursued in the treatment of diseased ovaries and tubes. The 
uterus was retroverted, firmly fixed and very tender to the 
touch; the left ovary very much enlarged and extremely 
tender. The pain in the pelvis was constant; the menstrual 
period was attended with great distress. The most thorough 
and painstaking efforts were made, extending over eight 
months, to replace the uterus and to lessen the pain and in- 
flammation by local treatment, with practically no good result. 
At the end of that time the abdomen was opened, adhesions 
broken up, tubes and ovaries removed, and the uterus stitched 
to the anterior abdominal wall. The results were all that could 
be desired. This is the plan that has been pursued at the out- 
set in all cases except the very bad ones. 
Case 22 should not have died. It was a case of accidental 6 
Fo^ty-eight Cases of Abdominal Surgery. 
naemorrhage. The ovaries were prolapsed and very cystic and 
tender to the touch. I repaired the perinaeum and removed 
both ovaries and tubes. The following evening the pulse went 
up rapidly till it reached 145. The abdomen was opened and 
the peritoneal cavity found filled with blood. The bleeding 
had occurred from the stump where the right ovary had been 
removed. Another ligature was then applied, the patient 
dying on the fifth day from peritonitis and exhaustion. This 
was my second experience of losing a case from accidental 
haemorrhage. Either the ligature had slipped, or was not tied 
sufficiently tight. 
Case 25 is of more than usual interest. Three years be- 
fore, this patient had pelvic peritonitis and abscess; the ab- 
domen was opened by one of the leading surgeons of New 
England, but, owing to the large number of adhesions, he was 
enabled only partially to remove the diseased pelvic organs, 
the left Fallopian tube and ovary and a part of the right 
Fallopian tube. Four months later the patient was attacked 
with severe convulsions, and a sinus which had opened soon 
after the operation, in the abdominal wound, and commu- 
nicated with an opening in the vagina which was made sub- 
sequently, discharged a large amount of pus in both directions 
continuously. Six months later, on January 10, 1891, two 
gynaecologists, well known to the surgical world, reopened the 
abdomen, in order to cure the sinuses, if possible, and to re- 
lieve adhesions. 
The abdominal sinus was dissected out down to the side of 
the uterus, tied off and cauterized. The very extensive ab- 
dominal adhesions were separated, and an abscess low down 
in the right side of the pelvis was opened and drained. It 
was not deemed advisable to prolong the operation by further 
search for the right ovary or its remnants. She came to 
California last April with health in fair condition. In July, 
1891, the convulsions reappeared with great severity. Upon 
examination a tender elastic mass was found in Douglas's 
pouch. This was markedly increased in size at the time of 
menstruation, and was believed to be the right ovary. 
The abdomen was opened on September 3, and after break- Forty-eight Cases of Abdominal Surgery. 
7 
ing up many adhesions between the small intestines and the 
pelvic organs, the patient was placed in the Trendelenberg 
position, and the right ovary, much enlarged and cystic, was 
found completely buried in lymph at the bottom of Douglas's 
pouch. This was removed, and the patient made an uninter- 
rupted recovery, with the exception of a convulsion during 
the third week. She is now free from pain, and there has 
been no return of the convulsions. Menstruation has occurred 
once since the operation, but it is believed that this function 
will now cease. 
Case 26 was an extremely bad one. The abdomen had been 
opened fourteen months before for the relief of pyosalpinx 
and some diseased tissue removed. When I saw her, she was 
much emaciated, with a fistula discharging pus into the 
vagina, and another discharging through the anterior ab- 
dominal wall above the pubes. The abdominal section resulted 
in the breaking up of many adhesions and the removal of 
both ovaries which were the seat of abscess. She died from 
shock at the end of twenty-four hours. 
Under the head of "Abdominal Section for Uterine 
Fibroids," Number 1 illustrates how easily a subperitoneal 
fibroid can be enucleated. The tumor, a soft fibroid, grew 
from the posterior wall of the uterus and was apparently a 
part of this organ. The patient was placed in the Trend- 
elenburg position and the intestines protected by sponges, 
the fundus seized with a volsellum and drawn up out of the 
pelvis; the peritonaeum was laid open and the tumor peeled 
out with the finger-tips without difficulty. The opposing 
surfaces from which the tumor was removed were drawn 
together with chromicised catgut. Pelvic abscess formed 
at the site of the operation, eventuating in a faecal fistula. 
Perfect recovery ensued at the end of six weeks. 
Case 2 was a remarkable example of multiple fibroids. 
There were four subperitoneal pedunculated fibroids, and 
seven subperitoneal non-pedunculated fibroids, the tumors 
varying in size from a pigeon's egg to that of a large cocoanut. 
The pedunculated fibroids were ligated and removed, and the 
others enucleated and the uterine arteries ligated, to prevent 8 
Forty-eight Cases of Abdominal Surgery. 
the development of additional growths. Recovery was un- 
interrupted. 
Case 3 was a large interstitial uterine fibroid in a woman 
who was very anaemic from excessive loss of blood. The 
operation was done according to Schroeder's method. The 
woman died at the end of eighteen hours. 
The two cases of vaginal hysterectomy were both done 
for cancer of the cervix. Pressure forceps were used in- 
stead of ligatures. In Case I the disease returned in three 
months, and she has since died. Case 2 is in excellent health. 
I would here take occasion to state that the case I reported 
two years ago, where I extirpated the uterus for epithelioma 
of the cervix and sarcoma of the body of the uterus, has written 
me in the past few days that she is in excellent health, with- 
out any return of the disease. 
Under "Laparotomies for Other Diseases of Abdominal 
Organs," Case 1 was moribund from suppurative peritonitis. 
Upon opening the abdomen, the omentum was found 
gangrenous, and the stench was horrible. The exploratory 
incision and the removal of part of the gangrenous omentum 
probably did not hasten the death, which occurred twelve 
hours afterward. 
Case 6 was a tubal pregnancy of about six weeks. The 
tube ruptured and peritonitis supervened, and upon opening 
the abdomen it was found filled with blood-clots. Both 
tubes were diseased and adherent from former attacks of 
pelvic peritonitis. The uterus was retroverted and fixed. The 
diseased tubes and ovaries were removed, the adhesions 
broken up, and the fundus stitched to the anterior abdominal 
wall. Uninterrupted recovery followed, and the uterus re- 
tained its normal position. 
Case 10 was a suppurating kidney of four months' standing. 
The right kidney was involved and was sufficiently enlarged 
to extend two inches to the left of the median line. A free 
incision was made, extending from the edge of the lumbar 
muscle just below the last rib, downward and forward nearly 
to the linea alba, directly over the prominent part of the 
tumor. The peritonaeum was opened, the hand introduced and Forty-eight Cases of Abdominal Surgery). 
9 
the condition of the left kidney ascertained. This being found 
normal, the adhesions between the diseased kidney, which was 
nothing but a large sac of pus, were broken up, and the pedicle, 
which consisted of the renal vessels, ligated. In separating 
the adhesions, the sac was partially ruptured, and some pus 
flowed over the site of the wound. Two drainage tubes were 
introduced, but were removed on the third day, the patient 
making an uninterrupted recovery, returning to her home at 
the end of the third week. 
A very important part of the management of cases of ab- 
dominal surgery is the treatment of adhesions; for, when they 
are great in number and are firm and well organized, the 
violence done and the time required to dispose of them add 
greatly to the danger of the operation. Experience here is of 
immense advantage in order to know how far one may go in 
breaking up adhesions without risk to the organs involved. 
Where the adhesions are somewhat pliable, they can be broken 
up rapidly and safely with the fingers, and, in many cases, it is 
surprising what an amount of work can be done in a few 
minutes without serious damage. In a case of pelvic abscess 
or pyosalpinx, where everything is matted together, I find that 
the better way is to go steadily on in the separation of the ad- 
hesions, being governed by the sense of touch, and paying no 
attention to the bleeding until the work is done, when, with 
compression forceps and with ligatures, if needed, the oozing 
is controlled. In this way much time is saved, and the abdomen 
sooner closed and the ether sooner withheld, two very im- 
portant elements. Unless the adhesions are unusually large 
and firm, there is usually but little difficulty in controlling the 
haemorrhage by packing the pelvis with sponges wrung out 
in hot water and left in situ until the sutures in the abdominal 
wound are introduced. 
THE MANAGEMENT OF ADHESIONS. 
LIGATURES AND SUTURES. 
When there is no pus with no infection of the peritonaeum, 
I can conceive of no better ligature than the one I here show 10 
Forty-eight Cases of Abdominal Surgery. 
you-heavy, loosely twisted, Chinese silk which I have had 
made at the silk factory to order. The advantages of this 
ligature are, first, that it is very strong, and next, that, being 
soft, it does not cut the tissues to which it is applied, and 
lastly, the knot does not slip, as is the case with a hard 
twisted thread. To make it antiseptic I drop it into a solution 
of i to 500 of corrosive sublimate in pure alcohol till it be- 
comes thoroughly soaked. Where the peritonaeum has become 
infected with pus or filth, chromicised catgut is a better 
material, for it is sufficiently durable to answer every purpose 
and is not so likely to be followed by fistula. 
DRAINAGE. 
This question I believe to be an important one. When the 
peritoneal cavity has become contaminated with pus which 
cannot be thoroughly removed, or where many adhesions 
have been broken up, or where some oozing of blood is going 
on, drainage is imperative. It is true that some unpromising 
cases go on to recovery without drainage, but when it is 
indicated as above, there can be no question but that the 
patient is safer with it than without it. The rule laid down 
to my students is that whenever the question arises whether 
drainage should be used or not, always use it. At the end 
of forty-eight hours, if the discharge of serum and blood has 
ceased and no pus exists, the tube is removed. So firmly am 
I convinced of the value of drainage that I would , refuse to 
operate in bad cases unless I could have this advantage, if 
needed. 
FLUSHING THE PERITONEAL CAVITY. 
Where there has been extensive soiling of the peritoneal 
cavity with pus from the breaking of an abscess in the at- 
tempt at removal, I apply catgut ligatures where required and 
sponge out the pus and blood. I then flush out the Abdominal 
cavity thoroughly with a saturated solution of hydronaph- 
thol in hot water, removing thereby a quantity of blood-clot 
and debris that is often surprising. This is repeated until 
the water returns clear, and all the water that cannot be Forty-eight Cases of Abdominal Surgery. 
11 
squeezed out is removed with sponges, and the pelvic cavity 
packed with sponges squeezed out in hot water and left 
tn situ while the sutures are being placed in the abdominal 
wall. I have never regretted flushing out the abdominal 
cavity, and I can see no objection to it. 
Further observation convinces me that all abdominal 
surgery should be conducted on the strictest antiseptic prin- 
ciple. Certain I am that the most expert operator will lose 
cases, if he ignore the germ theory, that otherwise would 
have been saved. We now know perfectly well that the 
peritonaeum is capable of digesting quantities of blood and 
rubbish if only it be not infected with septic material. I still 
continue to use hydronaphthol as an antiseptic and have every 
reason to be satisfied with it; but this does not prevent me 
from taking every precaution as to cleanliness independ- 
ently of the antiseptic remedy. 
ANTISEPTICS. 
ANTESTHETICS. 
Squibb's ether has been universally used, and I would not 
willingly give it up for any other anaesthetic, believing, as 
I do, that, in any case where the question of shock is in- 
volved, and, particularly, if the operation be a prolonged one, 
we have no anaesthetic of equal value. 
MULTIPLE OPERATIONS AT ONE SITTING. 
For the past two years I have frequently done several 
operations at one sitting. I have repeatedly repaired the 
cervix and perinaeum and curetted the cavity of the uterus 
before opening the abdomen for the removal of pus tubes, 
and afterward stitched the fundus of the uterus to the 
anterior abdominal wall with silkworm gut, and have thus far 
seen no cause to regret doing so. 
When we consider the number of surgeons who essay intra- 
peritoneal operations, it is remarkable how few have achieved 
ELEMENTS OF SUCCESS IN ABDOMINAL SURGERY. 12 
Forty-eight Cases of Abdominal Surgery. 
exceptional success as judged by modern standards. Doubt- 
less, familiarity with the work is an important factor, but this 
means abundant material. Good judgment as well as skilful 
diagnosis is also necessary, but back of and beyond this there 
is something else. Not every man can paint a good picture; 
not every man can write good music; not every man can be 
a good mechanic; and no amount of opportunity and training 
will make all who attempt it successful in surgical matters. 
There must be a combination of certain qualities of the hand, 
the eye and the brain which are inherent in the man, and 
then these qualities must be trained and sharpened by ad- 
versity to success, doubly dear when achieved. There must be 
courage that never flags, and there must be resources of a 
kind to meet unexpected emergencies. It has been my good 
fortune to witness the operations of nearly all the leading 
surgeons who practise abdominal surgery in the large cities 
of this country and of Europe, and also to discuss with them 
some of the principles which they advocate. The point which 
most attracted my attention was the simplicity of their pro- 
cedure-few instruments, few assistants, few appliances. All 
seemed so simple and easy, but I knew full well the sea of 
trial they were forced to wade through before this simplicity 
and perfection was arrived at. Thomas Keith, of Edinburgh, 
one of the most successful surgeons living, on a winter night 
six years ago, told me the story of his trials during thirty 
years. It was a never-ending fight for better ways and means, 
with death and disaster staring him in the face at every step. 
His story was like a romance, but the struggle has well-nigh 
destroyed him, for his health is irretrievably broken. The 
newer generation of abdominal surgeons have much to be 
thankful for; and it should never be forgotten, in our present 
success, what we owe to the courage and devotion of such 
men as McDowell, Sims, Atlee, Thomas and Peaslee; and 
of Keith, Tait and Spencer Wells; and Schroeder, Martin, 
Winkel and Leopold and a host of others on the Continent. ABDOMINAL SECTIONS FOR THE REMOVAL OF OVARIAN TUMORS. 
Name of 
Medical 
Attendant. 
Date 
of 
Operation. 
TQ 
O 
Married or 
Sinsle | 
Number of 
Children 
Size and Nature 
of 
Tumor. 
One or both 
Ovaries 
Adhesions. 
Treat- 
ment of 
Pedicle. 
Drainage 
Complica- 
tions. 
Hospital or 
Private 
Result. 
Remarks. 
1 
1 
Dr. C. Cushing, 
San I rancisco 
[Nov. 5, 1890 
1 
54 
1 M 
One 
Cystic tumor of right 
ovary,size of child's head. 
Both 
! Yes. 
Tied and 
dropped. 
No. 
Complete prociden- 
tia of left ovary, 
uterus and bladder, 
Hospital. 
Recovery. 
Left ovary calcified , 
stitched fundus of uterus 
to anterior abdom'l wall, 
outside of vulva. 
and repaired perineum. 
2 
Dr. Robertson, 
Jan. 19, 1891 
34 
M. 
Two 
Cystic tumor of right 
One 
Yes. 
Tied and 
Yes. 
None. 
Hospital. 
Recovery. 
Sac broke down in re- 
ovary, suppurating. Size 
of eight months' preg- 
dropped. 
moval; abdomen freely 
washed out with hydro- 
nancj 
napthol and water. 
3 
Dr. J. D. Whitney, 
San Francisco 
Feb. 9, 1891 
30 
M. 
None 
Cyst of right ovary, size 
of cocoanut. 
One 
Many and 
firm. 
Tied and 
dropped. 
No. 
None. 
Hospital. 
Recovery. 
4 
Dr. Cameron, 
Red Bluff 
April 6, 1891 
19 
8. 
None 
Large cyst of left ovary. 
One 
None. 
Tied and 
dropped. 
No. 
None. 
Private 
Hospital. 
Recovery. 
Dr. Worthington, 
Los Angeles 
Sept. 5, 1891 
O. 
None 
Cyst of left ovary, size 
of uterus at full term of 
One 
None. 
Tied and 
dropped. 
No. 
None. 
Hospital. 
Recovery. 
Menstruation had been 
absent seven months ; 
pregnancy. 
returned three months 
after operation. 
6 
Dr. C. E. Cooper, 
San Francisco 
Sept. 14,1891 
52 
M. 
Eight 
Cystic tumor of left 
ovary,size of eight months 
Both 
None. 
Tied and 
dropped. 
No. 
Uterine hemorrhage 
excessive for 3 vears; 
Hospital. 
Recovery. 
Ligated uterine arteries. 
pregnancy. 
intramural fibroids. 
Dr. C. Cushing, 
San Francisco 
Sept.28,1891, 
36 
M. 
Two 
Cyst of left broad liga- 
ment, size of child's head. 
Both 
None. 
Tied and 
dropped. 
No. 
Laceration of cervix 
and perineum; intra- 
Hospital. 
Recovery. 
Repaired laceration of 
cervix and perineum. 
mural fibroids of ute- 
rus. 
ABDOMINAL SECTION FOR UTERINE FEBROIDS. 
- - - . - 
Name of 
Medical 
Attendant. 
Date 
of 
1 Operation. 
> 
ct> 
Married or 
Sinarle r 
Number of 
Children 
Pathological 
Condition or 
Symptoms 
necessitating 
Operation. 
Duration of 
Disease 
Nature of 
Operation. 
Adhesions... 
Drainage . ... 
Hospital 
or 
Private. 
1 Recovery or 
Death 
Complications 
before and 
' after. 
Remarks and 
Su bsequent 
History. 
i 
Dr. 
W. F. Chene.v, 
Oct. 6, 1890 
21 
I M. 
None 
Elastic tumor in Doug- 
18 mos. 
Abdominal section and 
None 
None 
Hospital 
Recovery 
Operation followed 
Perfect recovery. 
San F rancisco 
las pouch, causing much 
e'nucleation of tumor 
by pelvic abscess and 
pain. 
from posterior wall of 
uterus. 
fecal fistula. 
2 
Dr. F. Bazan, 
Feb.24,1891 
33 
M. 
None 
11 subserous uterine 
2 years. 
Four pedunculated fi- 
None 
None 
Private 
Recovery 
None. 
Cure perfect. 
San Francisco 
fibroids. 
broids ligated ; seven 
non - pedunculated fib- 
roids enucleated ligat'd 
the uterine arteries. 
3 
Dr. 
T. S. Adams, 
June 18,1891 
44 
M. 
Two 
Large intramural fibroid 
7 years. 
Amputation of tumor 
None 
None 
Private 
Death 
None. 
Death from shock 
Oakland 
Excessive metorrhagia. 
and uterus; ligation of 
Hospital 
and exhaustion from 
uterine arteries; Schro- 
prev's loss of blood 
- 
- 
eders operat'n on stump 
■ 
VAGINAL HYSTERECTOMY. 
!Z 
© 
Name of 
Medical 
Attendant. 
Date 
1 of 
| Operation. 
> 
CR 
o 
I1 Married or 
Single 
Number of 
'children 
Pathological 
Condition or 
Symptoms 
necessitating 
Operation. 
Duration of 
Disease 
Nature of 
Operation. 
j Adhesions.... 
g. 
B 
g 
Hospital 
or 
Private. 
Recovery or 
Death 
Complications 
before and 
after. 
Remarks and 
Subsequent 
History. 
■ 
1 
Dr. W. T. Garwood, 
1 
Dec. 9, 1890 
58 
M. 
Two 
Epithelioma of cervix 
3 mo's. 
Complete extirpation. 
None 
None 
Private 
Recovery 
None. 
Disease returned in 
San Francisco 
uteri. 
Hospital 
three months. Death 
after ten months. 
2 
Dr. H. W. Felton, 
'May 26, 1891 
55 
M. 
Nine 
Epithelioma of cervix 
Un- 
Total extirpation. 
None 
None 
Private 
Recovery 
Vesico-vaginal fistu- 
No unfavorable re- 
Salinas 
uterine. 
known. 
Hospital 
la on 6th day; ope- 
port since operation. 
ration on 20th day. 
Recovery. 
ABDOMINAL SECTION FOR OTHER DISEASES OF ABDOMINAL ORGANS. 
21 
Date 
of 
Operation. 
> 
o 
Married or 
Single...... 
Number of 
Children 
Pathological 
Condition or 
Symptoms 
necessitating 
Operation. 
Duration of 
Disease 
Nature of 
Operation. 
Hospital 
or 
Private. 
Recovery or 
' Death 
Complications 
before or 
after. 
Remarks and 
Subsequent 
History. 
© 
Name of 
Medical 
Attendant. 
1 
Dr. L. Bazet, 
San Francisco 
Oct. 19, 1890 
24 
S. 
One 
Suppurative peritonitis. 
One 
week. 
Exploratory incision ; 
removal of gangrenous 
fallopian tubes and ovar's 
and portion of omentum. 
Yes. 
Hospital. 
Death. 
Pyo-salpynx pre- 
ceding attack of 
peritonitis. 
Bad case of suppurative per- 
itonitis, with many tissues in 
state ot gangrene. Patient 
died 16 hours after operation 
from exhaustion. 
2 
Dr. D. L. Ross, 
Redwood City 
Feb. 17,1891 
30 
M. 
Three 
Lasceration of cervix 
and perineum. Prolapse 
of both ovaries. Enlarg'd 
and retroflexed uterus. 
3 years. 
Repair of perineum and 
cervix; fundus of uterus 
stitched to anterior ab- 
dominal wall. 
No. 
Private 
Hospital. 
Recovery. 
None. 
Excellent cure. 
3 
Dr. E. M. Griffith, 
San Francisco 
June 16,1891 
27 
M. 
None 
Prolapse of both ova- 
ries. Retroversion of the 
uterus. 
3 years. 
Stitched uterus and ova 
ries to anterior abdomi- 
nal wall. 
No. 
Private 
Hospital. 
Recovery. 
None. 
( Operation successful. Pain 
- about rectum and pelvis 
( not relieved. 
4 
Dr. C. E. Cooper, 
San Francisco 
June 23,1891 
28 
M. 
Three 
Malignant stricture of 
rectum. 
1 year. 
' Artificial anus in left 
groin. 
No. 
Hospital. 
Recovery. 
None. 
5 
Dr. C. Cushing, 
San Francisco 
June 29,1891 
33 
M. 
None 
Retroversion and fixa- 
tion of uterus, with great 
pain. 
9 years. 
Separation of adhesions; 
fundus stitched to anteri- 
or abdominal wall. 
No. 
Hospital. 
Recovery. 
None. 
6 
Dr. H. Gibbons, Jr. 
San Francisco 
July 1, 1891 
38 
M. 
None 
Ruptured tubal preg- 
nancy. 
1 month 
Removal of diseased ova- 
ries and tubes and many 
blood clots; stitched uter- 
us to abdominal wall. 
Yes. 
Private. 
Recovery- 
uninter- 
rupted. 
None. 
7 
Dr. R. Caldwell, 
San Jose 
July 30,1891 
29 
M. 
Four 
Laceration of cervix and 
perineum ; retroversion 
and fixation of uterus; 
prolapse of left ovary. 
2 years. 
Repair of cervix and pe- 
rineum ; separation of ad- 
hesions; stitched uterus 
to anterior abdom'l wall. 
No. 
Private 
Hospital. 
Recovery-. 
None. 
8 
Dr. C. E. Cooper, 
San Francisco 
Jnly 20,1891 
33 
M. 
One 
Retroversion and fixa- 
tion of uterus; laceration 
of perineum and prolapse 
of left ovary. 
lOyears. 
Right round ligament 
shortened; stitched fund- 
us of uterus to anterior 
abdom'l wall; perineum 
repaired. 
No. 
Private 
Hospital. 
Recovery. 
Fistula in groin 
■f'm buried stitch 
in round ligam't. 
Unable to find left round 
ligament. 
9 
Dr. C. L. Anderson, 
Santa Cruz 
Sept. 8, 1891 
19 
S. 
None 
Suppurative tubercular 
peritonitis. 
10 mos. 
Laparotomy and dr'nage. 
Yes. 
Hospital. 
Oct. 14th, 
improving 
None. 
Abdomen contained one and 
a half gallons pus. 
10 
Dr. Jas. Simpson, 
San Francisco 
Sept. 9, 1891 
25 
s. 
None 
Suppurating kidney; 
size of large cocoanut. 
3 mos. 
Abdominal section and 
nephrectomy. 
Yes. 
Private 
Hospital. 
Recovery. 
None. 
Recovery- complete and un- 
interrupted. 
ABDOMINAL SECTION FOR REMOVAL OF UTERINE APPENDAGES NOT THE SEAT OF 
p 
Name of 
Medical 
Attendant. 
1 
o> 
Date : 
of ' 
Operation. 
, Married or 
Single 
Number of 
Children 
Pathological 
Condition or 
Symptoms 
necessitating 
Operation. 
Duration of 
Disease 
What 
Removed 
|Adhesion8 .... 
Treatment of 
Pedicle 
Drainage j 
Hospital 
or 
Private. 
Recovery or 
Death 
Complica- 
tions before or 
after 
Operation. 
Remarks 
Effects of Opera- 
lions upon condi- 
tion requiring it. 
11 
)r. Roscnstirn, S 
San Francisco! 
ept. 29,1891)30 
M. 
One 
Pyo-salpynx. 
6 mos. 
Both tubes 
nd ovaries. 
Many. 
Tied and 1 
Dropped, 1 
No. 
Hospital. 
Recovery. 
Pelvic abscess 
opening in left 
groin. 
Recovery perfect. 
J, 
Dr. Gross, , 
San Francisco 
Jo.. 6. 1890 25 
1- 
None 
Pyo-salpynx. 
1 year. 
Both tubes 
ind ovaries. 
Many. 
Tied and [ 
Dropped , 
No. 
Private 
Hospital. 
Recovery.| 
None. 
Stitched fundus of 
uterus to anterior 
abdominal wall. 
3 
>r. Geo. Reynolds, |I 
Alameda' 
7ov. 8, 1890 30 
M. 
One 
j 
Pyo-salpynx, with pro- : 
apse and adhesions of 
ovaries inDouglas pouch. | 
years. 
Both tubes 
wd ovaries. 
Yes. 
Tied and ) 
Dropped, j 
No. 
Private 
Hospital. 
Recovery. 
Several attacks 
of pelvic perito- 
nitis. 
Hysterical and 
nervous symptoms 
not relieved. 
4 
Or. S. Assonya, 
San Fianciseo. 
Sov.10,1890 17 
S. 
None ] 
Pyo-salpynx, tubes pro-1 
apsed in Douglas pouch 
and adherent. 
6 mos. 
Both tubes : 
and ovaries. 1 
Uni- 
versal. ! 
Tied and | 
Dropped. 
T'es. 
Private 
Hospital. 
Recovery. 
Severe previous 
attacks of pelvic 
inflammation. 
Tubercular pus 
in tubes. 
J 
Dr. J. Parker, 
Salinas 
Nov 27,1890 4< 
1 
1 M. i 
One 
Double pyo-salpynx. 1 
1 year. | 
Both tubes 
and ovaries. 
Uni- 
versal. 
Tied and 
Dropped. 
Yes. 
Private 
Hospital. 
Died. 
None. 
Death on 6th day 
of septicemia. 
6 
Dr. E. L. Paulding, ' 
Arroyo Grando 
Nov. 29,1890 3 
» M. 
Four 
Cystic ovaries; chronic 6 years, 
salpyngitis ; retroversion 
of uterus; laceration of! 
cervix and perineum. 
Both ovaries 
and tubes 
Many. 
Tied and 
Dropped. 
No. 
Private 
Hospital. 
Recovery. 
None. 
Repaired cervix 
and perineum and 
stitched fundus to 
anterior wall. 
7 
Dr. Walliser. 
San Francisco 
Dec. 10,1990 '25, M. 
i 
None 
Hydro-salpynx, size of 
turkey's egg, with great 
pain. 
2 years 
Right tube 
and ovary. 
Firm 
Tied and 
Dropped 
No 
Private 
Hospital 
Recovery. 
None. 
Cure. 
§ 
Dr. Schaeffer, 
Tehachapi 
Jan. 2, 1891 2 
8 M. 
None 
Chronic salpyngitis and 
ovaritis. 
10 years 
Both ovaries 
and tubes 
Many 
Tied and 
Dropped. 
No. 
Private 
Hospital. 
Recovery. 
Rapid action of 
heart due to dis- 
turbed condition 
Cure. 
of sympa t h e t i c 
nervous system. 
9 
Dr. W. Tait. 
San Francisco 
Jan. 22, 1891 2 
3 M. 
. None 
Ovaries and tubes pro- 
lapsed and adherent in 
Douglas pouch. 
10 years 
Both ovaries 
and tubes. 
Many. 
Tied and 
Dropped. 
No. 
French 
Hospital. 
Recovery. 
Developed can- 
cer of rectum, six 
months later. 
Had continued 
pelvic pain after 
operation. 
1( 
Dr. C. Cushing, 
San Francisco 
March2,18911! 
28 M. 
Two 
Pyo-salpynx. 
10 years 
Left ovary 
and tube. 
Yes. 
Tied and 
Dropped. 
No. 
Private 
Hospital. 
Recovery. 
Lacer a t i o n of 
cervix and per- 
mian stenosis of 
Dilated cervix 
and curetted uter- 
us and repaired 
cervical canal. 
perineum at same 
sitting. 
1 
Dr. L. C. Lane, 
San Franciscc 
March5>1891 
24 M. 
None 
1 Chronic ovaritis and sal- 
pyngitis, following gon 
orrhea. 
2 years 
Ovaries 
and tubes. 
Many. 
Tied and 
Dropped. 
No. 
Private 
Hospital. 
Recovery. 
None 
1 
2 No medicalattendan 
M'ch 12,1891 
38 M 
None 
Prolapse and fixation o 
both ovaries; retrover 
15 year 
Ovaries 
and tubes. 
Many. 
Tied and 
Dropped. 
No. 
Private 
Hospital. 
Recovery 
Repeated attacks 
of pelvic peritonitis 
before operation. 
for some years. 
sion and fixation of uter 
Much improved 
1 
3 Dr. C. Cushing, 
San Francisc 
M'ch 17,1891 
37 M 
None 
us; chronic salpyngitis. 
Chronic salpyngitisanc 
cystic ovary. 
20 yeai 
s Both tubes 
and ovaries 
None. 
Tied and 
Dropped. 
No. 
Private 
Hospital 
Recovery 
None. 
in health but still 
suffering from ner- 
vous symptoms. 
1 
4 Dr. J. 0. Hirschfelde 
San Francisc 
r April 7,1891 
3 
44 M 
Non 
Pyo-salpynx and cysti 
ovaries. 
10 year 
s Tubes and 
ovaries. 
Many. 
Tied and 
Dropped. 
No. 
Private 
Hospital. 
Recovery 
Retroversion anc 
fixation of uterus. 
Stitched uterus to 
anterior abdominal 
wall. 
1 
. -. 
abdominal section for removal or UTERINE APPENDAGES not the seat of tumor. 
p 
Name of 
Medical 
Attendant. ' C 
>1 02 
®s B' 
® re 
Date : I » 
of 1 : 
fperation. ; 
Number of 
Children ... 
Married or 
Pathological 
Condition or 
Symptoms 
necessitating 
Operation. 
: Duration of 
Disease 
What 
1 Removed 
1 
I 
Adhesions... 
Treatment of! 
Pedicle 1 
1 
! 
1 
Drainage 1 
Hospital 
or 
Private. 
Q 1 
» £ 
• ct> 
C 1 
Complica- 
tions before or 
after 
Operation. 
Remarks 
Effects of Opera- 
tions upon condi- 
tion requiring it. 
15 D 
r. A. H. Taylor, A 
pril21,1891 23 J 
[. None 
Suppurating hemato- 
year. 
Right tube 
rnd ovary. 
Yes. ' 
Tied and 
Dropped. 
Yes. 
French 1 
Hospital, i 
Recovery.' 
C 
Peritonitis before 
peration. 
Perfect recovery. 
16 1 
San Francisco' 
Irs. Dr. Gydison, [A 
pri!25,1891 30 M. Three 
saipj iia. 
Salpyugitis and cystic 1 
2 years 
a 
Both tubes 
nd ovaries. 
Yes. 
Tied and 
dropped. 
No. 
Private 
Hospital 
Recovery. 
None. 
Excellent cure. 
17 1 
Salinas' 
)r. Edwards, N 
Salinas. 
[ay 5, 1891 41' 
1 
VI. ' Two 
1 
ovaries. 
j Ovaries prolapsed, ad- 
herent and cystic; perin 
eum lacerated ; homorr- 
years. 
Tubes and 
ovaries. 
Many. 
Tied and 
Dropped. 
No. 
Private 
Hospital. 
Recovery. 
None. 
Repaired perine- 
um and removed 
hemorrhoids. 
Health restored. 
1 
oids. 
18 
Dr. C. Cushing, | 
San Francisco j. 
une 8, 1891 42 
M. Three 
• 
Double pyo-salpynx; 
etroversion and fixation 
y ears. 
Tubes and 
ovaries. 
Many. 
Tied and 
Dropped. 
No. 
Private 
Hospital. 
Recovery. 
None. 
Stitched fundus 
of uterus to an- 
terior abdominal 
wall. Restoration 
>f uterus. 
to health. 
» 
Dr. C. E. Cooper, 
San Francisco 
I 1 
June 13,1831 23 
S. None 
Double pyo-salpynx; 
rente pelvic peritonitis. 
6 mos. 
Tubes and 
ovaries. 
Many. 
Tied and 
Dropped. 
Yes. 
Private 
Horpital. 
Recovery. 
None. 
Perfect recovery 
20 
Dr. Bailey, 
San Francisco 
I une 29,1891 32 
M. Two 
Double pyo-salpynx. 
1 year. 
Tubes and 
ovaries and 
Many. 
Tied and 
Dropped. 
Yes. 
Private 
Hospital. 
Recovery. 
Adhesion of ver- 
miform appendix 
to right ovary. 
Very bad case. 
vermiform 
21 
Dr. Callandreau, 
San Francisco 
i i 
.July 2, 1891 27 
1 
M. None 
Pyo-salpynx. 
18 mos. 
appendix. 
Tubes and 
Ovaries. 
Yes.' 
Tied and 
Dropped. 
No. 
Private 
Hospital. 
Recovery. 
1 
Pneumo-thorax. 
22 
No medical attendant 
July 30,1891 33 
M. Four 
Prolapse and fixation ol 
both ovaries: laceratioi 
3 years. 
Both ovaries 
and tubes. 
Yes. 
Tied and 
Dropped. 
No. 
Private 
H ospital. 
Death f'm 
exhaust'n. 
Hemorrhage from 
stump. 
Rep'red perineum; 
abbominal hemor- 
rhage. Opened ab- 
domen foll'ng day. 
of perineum. 
Put new ligatures 
on the stump. 
23 
Dr. C. W. Card, 
San Francisco 
/Vug. 10,1891 35 
M. ! Two 
Pyo-salpynx; perito 
nitis. 
15 weeks 
Both tubes 
and ovaries 
Very 
bad. 
Tied and 
Dropped. 
Yes. 
Private. 
Recovery. 
Lacerat'n of smal 
intestines clos'd by 
catgut sutures. 
Recovery unin- 
terrupted. 
2 
Dr. B. F. Clark, 
San Franciscc 
' Aug. 24,1891 23 
M. None 
Double pyo-salpynx. 
10 weeks 
Tubes and 
ovaries. 
Uni- 
versal. 
Tied and 
Dropped 
48 hrs 
Private 
Hospital 
Recovery 
None. 
Good cure. 
2 
Dr. C. E. Cooper, 
San Francisci 
Sept. 3, 1891 27 
, M. None 
Right ovary cystic an 
buried in lymph in Doug 
las pouch. 
1 3 years 
Right ovary 
Firm 
and Uni 
versal 
Tied and 
Dropped 
Yes. 
Private 
Hospital 
Recovery 
None 
Abd omen had 
been twice opened 
before, and unsuc- 
cessful effort made 
to remove ovary. 
2 
6 Dr. B. F. Clark, 
San Francisc 
o Sei t. 21,1891 24 
M. One 
Pelvic abscess openin 
into vagina and throug 
anterior abdominal wal 
g 18 mos 
h 
Ovaries 
and Tubes. 
Uni- 
versal. 
Tied am 
Dropped 
Yes. 
Fre ch 
Hosp tai 
Death. 
Laceration of rec 
turn and small in 
testine. Injury re 
paired with catgut 
. Abdomen had 
. been opened one 
. year before by an- 
other surgeon. 
Patient did not 
both ovaries suppuratin 
g 
j 
rally from shock. 
:- 
_ - 
-- 
-