[Reprinted from the New York Journal of Gynaecology and Obstetrics 
for August, 1894. 
REMARKS UPON HYSTERECTOMY WITH DESCRIPTION 
OF SPECIMENS.* 
William M. Polk, M. D. 
i. Hysterectomy by morcellement (fibroid). 
2. Suprapubic hysterectomy for fibroid. 
3. Suprapubic hysterectomy for carcinoma of the cervix. 
I have here a specimen representing removal of the uterus by 
morcellement. I did the operation to-day myself for the first time. 
This specimen is placed in juxtaposition with one removed by the 
suprapubic method. 
The tumor occurred in a woman about thirty-eight years of age and, 
owing to the fact that it had rather loose attachments, it rose well 
above the pelvic brim until it occupied the position of a uterus five 
months pregnant, reaching nearly to the umbilicus. The woman had 
never been married and consequently the case presented the difficul- 
ties which such vaginae usually do. I therefore selected it as a suit- 
able case in which to test the operation. I worked assiduously, and 
yet it took about one hour and twenty minutes to complete the op- 
eration. The operation was more difficult than in the suprapubic 
one, but I am not so sure that the patient was not in better condition ; 
she certainly was in better condition than she would have been after 
an operation of this length above the pelvis. Perhaps it is fairest to 
say, however, that the condition of the two patients from whom these 
specimens were taken was about the same, with the advantage in 
favor of the vaginal operation. 
The great difficulty found was in my inability to control the bleed- 
ing from the tumor. There was no difficulty in controlling the bleed- 
* Read before the New York Obstetrical Society May 15, 1894, 2 
William M. Polk, M. D. 
ing from the vessels of the lower segment of the uterus, because they 
could be ligated at the outset with comparative ease. The ovarian 
vessels could not be so easily reached at first. It is claimed, and 
with justice, that if you make steady traction while operating on 
these fibroids, you will control the bleeding, but every time I cut 
away a piece the tumor would escape from me and there would be a 
gush of blood. Hence, more blood was lost in this case than in the 
suprapubic operation, where practically no haemorrhage takes place. 
I do not pretend to say that one more skilled in this operation would 
not have been able to do it with less haemorrhage. On the whole, I 
think with small fibroids that it is the better way of removing them. 
In the case of the small fibroid here presented and removed by supra- 
pubic operation it would have been better to have removed it by the 
vaginal route, and perhaps it would have been better if I had re- 
moved the larger one above the pelvic brim. This, I believe, is about 
in accord with the opinions of those gentlemen who have perfected 
this method. 
These other specimens simply represent cases of extirpation of the 
uterus for various causes-two for suppurative disease of the append 
ages and the other, a case in which the appendages had been already 
removed and, disagreeable symptoms continuing to recur, the uterus 
was removed. Another is a case of carcinoma of the cervix in which 
I removed the organ from above. I am not quite sure of the propriety 
of operations from above for carcinoma of the cervix, even though it 
does involve the vagina. My reason for doing it here was that I 
could amputate the vagina low down with less haemorrhage than when 
done from below. The case simply illustrates the advantages of re 
moval from above. As to whether or not there is a sufficient advan- 
tage to justify the additional shock which unquestionably accompanies 
the suprapubic method, I am still in doubt.