One Hundred Operations for 
Severe Structural Disease 
of the Abdominal and 
Pelvic Organs of 
Women. 
I. S. STONE, M. D., 
WASHINGTON, D. 0., 
BY 
Clinical Prof. Gynaecology, Georgetown University, D. C.; 
Member Va. Med. Soc.; The American Med. Assn.; 
Southern Surgical and Gynaecological A san.; Fellow 
of the British Gynaecological Society; Member Med. 
Soc. and Med. and Surgical Soc., D. C.; Senior Sur- 
geon to Columbia Hospital for Women, D. C. 
REPRINTED FROM 
arte Neto ¥odt iHeBical journal 
for October 21, 1893. Reprinted from the New York Medical Journal 
for October 21, 1893. 
ONE HUNDRED OPERATIONS 
FOR SEVERE STRUCTURAL DISEASE OF 
THE ABDOMINAL AND PELVIC ORGANS OF WOMEN.* 
By I. S. STONE, M. D., 
WASHINGTON, D. C. 
The author has adopted the usual method of surgeons 
in reporting cases as they occur in practice. It is also con- 
venient, as it furnishes one an opportunity to take into con- 
sideration the propriety of methods and an inventory of 
results. The present list includes my work in this depart- 
ment from November, 1888, until the end of February, 
1893. By far the greater part of this surgery has been 
done in Columbia Hospital in this city, where excellent 
facilities are afforded. 
It is the rule in this hospital to call a consultation of 
the staff to determine if the case in question be a suitable 
one for operation. It is not my purpose to consider 
here the advisability of this rule, but one very excellent 
purpose is accomplished by it-i. e., the prevention of un- 
necessary surgery. There can be only slight danger of a 
charge of too frequent use of the knife or of undertaking 
* Read before the First Pan-American Medical Congress. 
Copyright, 1893, by D. Appleton and Company. 2 
OPERATIONS FOR DISEASES OF PELVIC ORGANS. 
too many easy operations, although there is danger of dis- 
advantage to the patient from delay. On the other hand, 
it is the custom to operate only when life is in danger, or 
when the patient is no longer able to work, and when 
definite and generally extensive disease can be discov- 
ered by any one not necessarily an expert in pelvic exami- 
nation. 
The list shows how large a proportion of cases of pelvic 
abscess, or tubo-ovarian abscess, have been treated. On 
the other hand, it may be seen how rarely have operations 
been performed for "oophoritis," salpingitis, etc. Again, it 
may be observed how seldom operation has been done early 
enough to find only " pyosalpinx." Tn but six cases in 
forty-four, where pus was present, could it be said that the 
disease had not extended beyond the tube, These were 
not necessarily recent cases, for they were in some in- 
stances still "pyosalpinx" after years of waiting and suf- 
fering, and good, bad, and indifferent treatment. The rule 
is nearly correct, however: first elytritis or endometritis, 
then salpingitis, pyosalpinx, tubo-ovarian abscess, and pel- 
vic abscess. The period of time required to accomplish 
these steps in the formation of a pelvic abscess differs 
greatly, and bears intimate relation to the cause of infec- 
tion. Of this I shall not write at present. 
Pelvic Abscess.-Seventeen cases of pelvic abscess were 
treated by radical operation, with five deaths. Of the 
seventeen, seven resulted from infection during or follow- 
ing abortion. In four, quite positive evidence of gonor- 
rhoea was ascertained to have been the cause of infection 
and suppuration. In four, the abscess formed soon after 
delivery at term, and was due to puerperal sepsis. The 
source of infection in the remaining cases could not be 
ascertained. 
The amount of pus in these cases varies greatly, from OPERATIONS FOR DISEASES OF PELVIC ORGANS. 
3 
a small quantity to a quart or more. The quantity of pus 
does not always indicate the extent of disease or bear 
direct relation to the prognosis. 
In more than one case the remnants of ovaries and 
tubes removed were but slight evidence of the severity of 
the operation, or the very critical condition of the patient. 
In not one case could the pus have been reached satisfac- 
torily by aspiration. 
The list includes-with two exceptions-all cases of 
pelvic abscess occurring in my service during two years. 
In one of the cases, not mentioned, occurring in a private 
patient, the abscess was low enough to be reached by vagi- 
nal incision and drainage. She recovered and improved 
greatly, notwithstanding the presence of the diseased ap- 
pendages, which remain and threaten a repetition of the 
suppuration on the other side. In the other exception the 
patient would not consent to operation when requested, left 
the hospital, and returned in a week ill with peritonitis, 
which was not relieved by vaginal incision or later by ab- 
dominal Hushing. The operation in nearly every case in- 
volved the separation of omental adhesions from the anterior 
abdominal wall, as well as from the uterus, bladder, and 
upper wall of the abscess and intestines. In at least 
two the omentum was tied off entirely across the lower 
border. 
The abscess wall consists of Falloppian tube, ovary, 
broad ligament, pelvic wall, omentum, mesentery, uterus, 
and Douglas's cul-de sac, and involves the bowel in some 
instances nearly to the umbilicus. In no case was the pus 
found within the broad ligament. The tube and ovary, 
having been the first to receive the infection, are generally 
distorted and even disorganized, in some instances forming 
but a small portion of the abscess wall. 
No. 67, a pyaemic mesenteric abscess, had developed 4 
OPERATIONS FOR DISEASES OF PELVIC ORGANS. 
without apparent infection of either tube or broad liga- 
ment. 
Result of Operation in Pelvic Abscess.-Severe shock 
generally follows an operation in each case. This has been 
anticipated as far as was possible by the administration of 
heart tonics and stimulants. Usually an hour is required 
to complete the operation in so formidable an undertaking. 
The temperature is generally reduced by section, and is 
often subnormal and very unreliable, as it fails to indicate 
correctly the extent of sepsis or inflammation. The pulse 
is generally quick, often reaching 140 or more, and is in- 
dicative of shock and exhaustion. 
These symptoms of shock may continue for two or 
even three days; then, if the bowels are open, the patient 
rapidly recovers. 
With the exception of the opium habit in one case, 
which was formed during the many months of suffering 
the poor woman experienced prior to section, I know of 
nothing but perfect results in the cases of patients surviv- 
ing laparotomy for pelvic abscess. 
One woman has, since her recovery, returned to the 
lying-in department of the hospital and safely given birth 
to a child at term. 
Pyosalpinx, Tubo ovarian Abscess, Hydrosalpinx, Cystic 
Ovaries.-In twenty-seven of this list of thirty-four cases 
pus was present and poured out of the abdominal incision 
when the pus sac was ruptured, or when the separation be- 
tween the distal extremity of the tube and the ovary oc- 
curred, which often happens when a tubo-ovarian abscess 
is removed. In the other cases no free pus was present. 
Two of these were purely hydrosalpinx with cysts of the 
corresponding ovary. The others were large cysts of the 
ovary, in one instance containing a pint of fluid. In each 
case the contents were regarded as infectious. The infec- OPERATIONS FOR DISEASES OF PELVIC ORGANS. 
5 
tion in each case had entered the tube and been communi- 
cated to the ovary through the uterine mucosa. No positive 
evidence of tubercle could be ascertained in any case. 
In thirteen the disease was a result of gonorrhoea] in- 
fection. In the other pus cases infection was nearly al- 
ways found due to septic abortion. In a few no cause 
could be ascertained. 
A rise of temperature was observed in nearly every pus 
case prior to section. The pulse was generally quick, and 
pelvic examination revealed pelvic peritonitis with the ever- 
present fixation of the uterus and more or less distinct 
masses on either side of the uterus or filling the pelvis en- 
tirely. 
Immediate Result.-In this list two deaths occurred. 
The first was due to an unsuspected pyaemic uterus from a 
" missed abortion." The patient had only a cystic ovary 
removed and did not have pyosalpinx. The other death 
was due to shock following section. This patient, a Ger- 
man Jewess of poor intelligence, had previously been 
treated in the hospital for mammary abscess. She was 
discharged well. In a week she was back with a severe 
attack of peritonitis, feeble pulse, great pain, and high 
temperature. She improved again, and when an operation 
was finally determined upon another attack of peritonitis 
occurred which the operation failed to relieve. The favor- 
able moment in this case was lost. The patient resisted 
every measure taken for her relief and insisted upon vomit- 
ing or otherwise discharging all food and medicine given 
for her relief. There should be hardly any mortality in 
these cases. 
Final Result.-However much disputation there may 
be as to the propriety of abdominal section for nervous or 
mental disease due to ovarian degeneration or irritation, 
there can be very little plausible objection to operations 6 
OPERATIONS FOR DISEASES OF PELVIC ORGANS. 
for pus. The final result is, as a rule, very satisfactory. 
Some women have all the symptoms due to menopause after 
the removal of large ovarian abscesses which have existed 
for months, and which leave no visible remnant of the 
ovary to be recognized as such. There may be a mere 
shell or thin sac left, yet menstruation may continue at 
regular intervals before and after the operation. 
These consequences, of however great importance, 
should not and do not deter the surgeon who operates to 
save life or even to prevent invalidism. I am quite of the 
opinion that no surgery is of more importance, or attended 
with better results in every way, than that for the suppura- 
tive pelvic disease of women. 
Nos. 21, 35, and 50 required a second operation in each 
instance. No. 21, a blood cyst of the ovary, right side, was 
removed with great difficulty. The left ovary was so small 
and concealed by adhesions that I could not find it. It 
grew to form another blood cyst, which I removed some 
months later. No. 78 : I found the viscera transposed in 
this case, the appendix on the left side. 
No. 35 had oophorectomy done, removal of hydrosal- 
pinx, etc., for menorrhagia and pain, and afterward re- 
quired vaginal hysterectomy for sarcoma of uterus. 
No. 50 : a sinus opened up and infected ligature re- 
moved, which was used in tying off a small myoma attached 
to the fundus uteri. 
With the above-mentioned exceptions, I know of noth- 
ing in any of these cases but a perfect result. 
The author rarely finds a case for operation in the stage 
of primary inflammation. If surgeons generally can detect 
a salpingitis early enough to prevent a gonorrhoeal infec- 
tion of the peritonaeum by a resort to salpingectomy, such 
practice I should consider correct, but it has not been my 
experience to find these cases in hospital or even other OPERATIONS FOR DISEASES OF PELVIC ORGANS. 
7 
practice. The suppurative stage is reached and the case is 
no longer one requiring hot douches, iodine applications, 
etc., but demands surgical treatment. In short, I consider 
salpingitis of infectious character of short duration, and 
not often do many days elapse before pus has formed, when 
it is practically no longer a salpingitis but a pyosalpinx- 
an abscess. 
Oophorectomy for Myoma.-As may be seen in the sum- 
mary, only twice have I operated with the intention of 
checking the growth of uterine myomata. In one case-in 
a young lady-the operation was easily done and gave a 
very good result. The tumor is not growing and her mental 
condition, which was very greatly disturbed, has improved 
until, in fact, she is quite well. She ceased to menstruate, 
and I think the operation will prove a success. 
In the other case a negress had a large pelvis-bound 
myoma with suppurating tubes and ovaries, which were 
with great difficulty removed. The patient had unexpected 
mania for two weeks, beginning a week after the operation. 
She recovered from the operation and returned to her 
home, lived about a year longer, and I have not learned 
the cause of her demise. This case is the only one in 
which I have considered the removal of the tumor an im- 
possibility. It is probable that the patient would have died 
under the operation had entire removal b^en attempted. 
Vaginal Hysterectomy.-Only three cases of uterine car- 
cinoma were thought favorable for complete extirpation. In 
nearly every case sent me by physicians the disease was 
found already too far advanced to hope for a complete ex- 
tirpation and eradication of the disease. 
My earlier experience (1886 to 1888) with this opera- 
tion was confined to cases of which I can say nothing but 
that it was not good practice to attempt complete extirpa- 
tion in such advanced disease. 8 
OPERATIONS FOR DISEASES OF PELVIC ORGANS. 
In one case (No. 81) the uterus was removed for proci- 
dentia. 
Silk ligatures were used in each case. The operation is 
quite an easy one, and should be frequently performed if 
cases are found sufficiently early. In each case the recovery 
was comparatively uneventful. One case required the com- 
bined abdominal and vaginal method, the bladder being torn 
in the operation, it being apparently softened by disease. 
It was immediately sutured, and the patient had perfect 
healing in every respect before she left the hospital. 
Battey's Operation.-In all cases where the ovaries were 
removed for the purpose of curing pain, producing an arti- 
ficial menopause, or preventing impending insanity, it has 
been the unvarying custom of the author not only to have 
careful consultation with his confreres as to the propriety of 
the operation, but to know beyond a reasonable doubt that 
other means of cure have been satisfactorily tried. In 
nearly every case, in addition to this, some abnormal con- 
dition-such as enlargement, prolapse, or other result of 
chronic disease-was discovered before the operation. Five 
cases of this list come under this heading. All the patients 
recovered from the operation. One of them, operated on 
for incipient insanity, recovered well and has been able to 
attend to the duties of her profession constantly since that 
time. Another, the second, appeared greatly benefited at 
first, but in six months committed suicide. I regret to say 
that I was deceived in this case by the friends and physi- 
cian of the patient, who failed to tell me of her previous 
attack of insanity. A third case was not in the least influ- 
enced by a double salpingo-oophorectomy (one ovary being 
quite large from cystic degeneration). 
The other patients had suffered great pain, and were 
anxious to have something done for them at any risk, and, 
although the operation was done after due trial of other OPERATIONS FOR DISEASES OF PELVIC ORGANS. 
9 
remedies and because some disease was believed to have 
been present, yet it was attended with but poor result, as 
they are (two of them) still complaining. 
Uterine Myomata.-Eleven supravaginal hysterectomies 
for myoma, with three deaths. One death was due to 
haemorrhage from a wounded mesentery in a case of com- 
plete extirpation (tumor, twenty pounds). The two other 
patients died of shock and obstructed bowels, with very 
little evidence of peritonitis, five days after the operation. 
Three operations were completed by using the wire clamp; 
one death occurred. Three by the ventrofixation method ; 
one death. Four by complete extirpation ; one death. One 
large, soft, parasitic myoma, operated upon by the Schroeder 
method, ended in recovery. 
My experience leads me to the conclusion that if opera- 
tors select only such cases as are no longer able to work, 
and who have very large tumors with great pain-which is 
almost positively due to severe complications-just so long 
will the mortality from hysterectomy be high. Per contra, 
if a diagnosis could be made while the growth is still with- 
in the pelvis, and the patient sent to the surgeon for opera- 
tion before complications-adhesions to viscera, etc.-arise, 
the mortality would be greatly reduced. 
In nearly all of my cases severe difficulties were encoun- 
tered which greatly prolonged operation, and to this I at- 
tribute the mortality. Of the eleven hysterectomies, nine 
were done for colored women. Two patients were white 
and made good recoveries. This shows a death-rate in 
negresses of thirty-three per cent. I do not consider them 
good subjects for surgery. 
Hysterorrhaphy ( Ventrofixation).-This operation was 
done in seven cases for prolapse or retro-displaced uteri, and 
in two of them prolapsed, adherent, or diseased ovaries were 
removed. One death occurred which should be charged 10 
OPERATIONS FOR DISEASES OF PELVIC ORGANS. 
against the operator or assistants, not the method. In this 
case a diseased and prolapsed ovary was removed w ithout 
thought of infecting the cavity of the peritonaeum, yet peri- 
tonitis quickly developed and carried off the patient. 1 
have abandoned Alexander's operation for ventrofixation. 
The latter operation is easy of performance and should give 
no mortality. Three buried silkworm-gut sutures are used 
to anchor the uterus to the abdominal wall, which in each 
case have given no trouble and perfectly satisfactory re- 
sults. 
The author has given the names of physicians as refer- 
ence who were formerly or are at present either the medical 
attendant or who know the history of the patient since 
operation. He also takes pleasure in inviting any who 
desire full particulars of any case herein mentioned to call 
upon Dr. J. T. Kelly, resident physician of Columbia Hos- 
pital, my valued and very competent assistant, who will 
answer any inquiry. No. 
Age. 
Disease. 
Cause. 
Result. 
Drainage. 
Remarks. 
Date. 
Reference. 
1 
37 
Salpingitis, ovaritis, 
etc. 
Pelvic peritonitis. 
Recovery. 
Yes. 
Had been an invalid for 
years. 
11, 24, '88 
Dr. Hicks. 
9 
26 
Tubercular peritoni- 
tis. 
Tubercular append- 
ages. 
Died, five days. 
44 
Repeated attacks of peri- 
tonitis for years. 
12, 15, '88 
I. s. s. 
3 
27 
Tubercular kidney. 
Recovered from 
operation. 
44 
N ephrotomy. 
Salpingo-oophorectomy; pa- 
tient attends to usual du- 
ties. 
11, 17, '88 
I. s. s. 
4 
38 
Hysteria, incipient 
insanity. 
Suspected ovarian 
disease. 
Improvement, sat- 
isfactory result. 
No. 
7, 5, '89 
I. s. s. 
5 
33 
Hysteria, menorrha- 
ghia, pelvic pain. 
Cystic ovaries. 
Cure. 
44 
Salpingo-oophorectomy. 
11, '89 
Dr. Christian. 
6 
35 
Menorrhaghia, im- 
pending insanity. 
u 
First, improve- 
ment ; suicide 
later, six months. 
44 
44 44 
6, 16, '90 
I. s. s. 
7 
35 
Ovarian cyst, fifteen 
pounds. 
Dermoid. 
Recovery. 
Yes. 
Many slight adhesions. 
7, '90 
Dr. Taylor. 
8 
29 
Cyst of ovary. 
44 
44 
Cyst ten ounces ; omental 
adhesions. 
9, 11, '89 
i. s. a 
9 
40 
Myoma uteri. 
In negress. 
44 
No. 
Wire clamp. 
11, '90 
Dr. Hoge. 
10 
30 
44 
u 
44 
44 
Ventro-fixation; ten pound 
growth. 
5, '91 
Columbia Hos- 
pital. 
11 
40 
u 
44 
Sinus left from 
ligature. 
44 
Sinus permits pseudo-men- 
struation from stump of 
uterus. 
6, 1, '91 
Do. 
12 
45 
u 
44 
Recovery from op- 
eration. 
44 
Twenty-pound tumor adher- 
ent to everything; pa- 
tient in extremis several 
days; recovery from op- 
eration. Mental condi- 
tion very unsatisfactory 
before and after opera- 
tion. 
6, 11, '91 
Do. 
13 
35 
Parasitic soft myoma, 
eighteen pounds. 
White patient. 
Perfect cure. 
Yes. 
Dropped pedicle, which was 
from right broad liga- 
ment; only a small slen- 
der pedicle from original 
uterine origin, near fundus. 
6, 18, '91 
I. S. S. 
14 
32 
Retroflexion, disor- 
ganized append- 
ages. 
Old chronic inflam- 
mation. 
Recovery. 
No. 
Patient had been an invalid 
for several years. 
7, 2, '91 
Dr. Gott. 
15 
30 
Hystero-epilepsy, pel- 
vic pain, large ova- 
ry, salpingitis. 
Pelvic peritonitis. 
Cure of pelvic 
pain, not of neu- 
rosis ; improve- 
ment. 
44 
Improvement in health; now 
able to work. 
* 
7, '91 
Columbia Hos- 
pital. 
16 
28 
Pelvic abscess. 
Puerperal infection 
at term. 
Recovery. 
Yes. 
Patient sick eight months 
(septicaemia) before opera- 
tion. 
8, '91 
Do. 
17 
Extra-uterine preg- 
nancy. 
Died. 
Patient in collapse all day 
before operation. Fourth 
month, haemorrhage out- 
side sac without rupture. 
9, '91 
Do. 
18 
20 
Suspected tubercular 
peritonitis. 
Recovered from 
operation and 
symptoms im- 
proved. 
Yes. 
Exploratory operation. 
9, '91 
Do. 
19 
32 
Pyosalpinx, chronic 
salpingitis and ova- 
ritis. 
Pelvic peritonitis. 
Recovery. 
No. 
Extensive adhesions. 
10, 5, '91 
Dr. Carr. 
20 
21 
30 
Pyosalpinx. 
Blood cyst of ovary. 
Gonorrhoea. 
44 
Temporary relief. 
44 
Yes. 
Tubes like sausages. 
Patient did well for a time, 
then returned (see No. 78). 
One ovary not found. 
10, 15, '91 
10, 26, '91 
Columbia Hos- 
pital. 
Dr. Moran. 
22 
46 
Fibro-myoma uteri, 
eighteen pounds. 
Negress. 
Died fifth day, 
shock; bowel ob- 
struction, acute 
yellow atrophy 
of liver. 
44 
Ventro fixation ; myomata 
in both broad ligaments. 
11, 9, '91 
Columbia Hos- 
pital. 
23 
30 
Pelvic abscess, many 
ounces of pus. 
Gonorrhoea. 
Died fifth day, 
uraemia. 
44 
No peritonitis after opera- 
tion ; nephritis from spe- 
cific infection. 
11, '91 
I. S. S. 
24 
21 
Pelvic abscess. 
Gonorrhoea. 
Recovery, sinus 
from ligature; af- 
terward closed. 
44 
Appendages and entire pel- 
vis filled with pus. 
11, '91 
I. S. S. 
25 
35 
a 
44 
Recovery. 
44 
Tumor nearly to umbilicus. 
11, 30, '91 
Do. 
26 
32 
44 
Abortion, infection. 
Died twenty-four 
hours, shock. 
44 
12, '91 
Do. 
27 
34 
Cyst of ovary. 
• • • . • 
Recovery. 
No. 
Cyst filled pelvis; every- 
where adherent. 
1, 4, '92 
Do. 
28 
30 
Pyosalpinx. , 
Gonorrhoea. 
44 
44 
Tubes like sausages; pa- 
tient ill sixteen vears. 
1, 7, '92 
Dr. Ritchie. 
29 
24 
Hydrosalpinx. 
44 
44 
44 
Chronic pelvic peritonitis. 
1, 18, '92 
Columbia Hos- 
pital. 
30 
27 
Pelvic abscess. 
Abortion. 
44 
Yes. 
Tumor-like fibroid of uterus 
to umbilicus. 
2, 4, '92 
Do. No. 
Age. 
Disease. 
Cause. 
Result. 
Drainage. 
Remarks. 
Date. 
Reference. 
31 
32 
33 
34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 
48 
49 
50 
51 
52 
53 
54 
55 
56 
57 
40 
24 
25 
19 
25 
36? 
<0 
50 
23 
27 
28 
20 
40 
20 
24 
38 
40 
M 
26 
26 
32 
45 
50-lb. double ovarian 
tumor (multilocu. 
broad lig. cyst). 
Pyosaipinx, tubo-ova- 
rian abscess. 
Pyosaipinx. 
Pelvic abscess. 
Hydrosalpinx, men- 
orrhagia. 
Insanity, cystic ova- 
ry. 
Ascites. 
Dermoid cyst of ova- 
ry, twelve pounds. 
Cystic ovaries, retro- 
flexion and old sal- 
pingitis. 
Cystic ovaries. 
Fibro-myoma uteri, 
twenty pounds. 
Tubo-ovarian ab- 
scess. 
Myoma uteri, pyosai- 
pinx (pus sacs re- 
moved). 
Prolapsus uteri and 
ovary. 
Pelvic abscess. 
Cyst of left kidney, 
forty-eight ounces. 
Pelvic abscess. 
Pelvic abscess, from 
puncture or rupt- 
ure of uterus. 
Unsuspected septic 
uterine contents 
(abortion), cystic 
ovary removed. 
Pyosaipinx, tubo- 
ovarian abscess. 
Pelvic pain, uterine 
prolapse. 
Pyosaipinx, cystic 
ovaries. 
Pyosaipinx, tubo- 
ovarian abscess. 
Fibro-myoma uteri 
size of large cocoa- 
nut, mental symp- 
toms. 
Tumor of gall-blad- 
der size of large 
orange. 
Retroflexion of uter- 
us, pain and dys- 
pareunia. 
Large myomatous tu- 
mor, 20 lbs., filling 
entire cavity; preg- 
nancy, 4th month, 
not suspected. 
Gonorrhoea. 
Abortion. 
Movable kidney. 
Negress. 
Gonorrhoea. 
Negress ? 
Nullipara ? 
Abortion, gonor- 
rhoea. 
Blood cyst. 
Puerperal septicae- 
mia. 
Infection by mid- 
wife. 
Abortion, pyaemia. 
Infection. 
Cystic ovaries ; re- 
laxed ligaments. 
Gonorrhoea. 
Gall stones. 
Negress. 
Recovery from op- 
eration. 
Recovery. 
44 
Died. 
Recovered. 
Recovered from 
operation easily; 
mental symp- 
toms not im- 
proved. 
Recovery. 
44 
44 
44 
Died third day, 
shock. 
Recovery. 
Recovered from 
operation. 
Improved. 
Recovery. 
44 
Recovery; patient 
insane for a time 
after return home. 
Recovery. 
Died thirty days. 
Recovered. 
Recovered from 
operation easily, 
improvement in 
health not well. 
Recovered. 
Recovery. 
Mind quite re- 
stored ; tumor 
greatly lessened 
in size at pres- 
ent time. 
Many stones found, 
sinus remained 
since closed. 
Uterus in good po- 
sition, not other- 
wise quite well. 
Died third day, 
haemorrhage from 
mesentery. 
Yes. 
u 
No. 
Yes. 
No. 
44 
Yes. 
a 
No. 
44 
44 
Yes. 
No. 
Yes. 
44 
44 
No, not at 
first; after- 
ward gauze. 
Yes. 
1 c. 
Yes. 
44 
No. 
Yes. 
No. 
Yes, tube 
and gauze. 
In nine months abscess 
formed under broad liga- 
ment (see No. 74). 
Pelvic organs all adherent 
en masse. 
Easy operation and recov- 
ery. 
Shock, third day. 
Patient had uterus removed 
afterward for sarcoma 
(see No. 80). 
Patient in asylum. 
Movable kidney not suspect- 
ed until abdomen was 
opened. 
Cyst ruptured a month be- 
fore operation, every- 
where adherent; twisted 
pedicle; nephritis. 
Operation very difficult, 
owing to adhesions. 
Ovaries size of hen's egg. 
Extra-peritoneal method. 
Bowel involved; fimbria 
adherent to intestine; ne- 
crosis. 
Patient had mania after op- 
eration ; the tumor was 
not removable; patient 
died about a year later. 
Hysterorrhaphy. 
Omentum, bowel, append- 
ages glued together and 
large quantity pus present. 
First suspected sarcoma, but 
no recurrence; patient 
perfectly well; sutured 
sac to abdominal wall. 
The only faecal fistula in 
my first hundred cases; 
fistula closed spontane- 
ously ; patient well. 
Intestinal necrosis; many 
sutures required; easy re- 
covery after second day. 
The uterus was large, very 
pale, and soft, but did not 
know its contents at time 
of operation. 
Small fibroid removed from 
fundus uteri; infected 
sinus, afterward ligature 
removed. 
Chronic neurasthenia. 
Several ounces of pus. 
Salpingo - oophorectomy; 
easy operation and re- 
covery. 
Patient returned, and fur- 
ther search for stones 
(4, 15, '93); cured. 
A cyst of ovary excised, 
sepsis of wound; no pel- 
vic pain at present. 
Complete extirpation; easi- 
ly done save for attach- 
ments to mesentery, which 
were severely injured. 
2, 8, '92 
2, 10, '92 
2, 15, '92 
2, 17, '92 
2, 22, '92 
2, 24, '92 
2, 24, '92 
2, 27, '92 
2, 29, '92 
3, 2, '92 
3, 5, '92 
3, 7, '92 
3, 19, '92 
3, 28, '92 
4, 9, '92 
4, 16, '92 
4, 20, '92 
4, 30, '92 
5, 7, '92 
5, 9, '92 
5, 11, '92 
6, 11, '92 
6, 15, '92 
6, 18, '92 
6, 18, '92 
6, 11, '92 
6, 29, '92 
Columbia Hos- 
pital. 
Dr. Bowen. 
Columbia Hos- 
pital. 
Do. 
Do. 
I. S. S. 
Columbia Hos- 
pital. 
Dr. Frost. 
Columbia Hos- 
pital. 
Do. 
I. S. S. 
Dr. C. G. Stone. 
Dr. Gibson. 
Columbia Hos 
pital. 
Do. 
Do. 
Dr. Ewing. 
Dr. Moran. 
Dr. Smith. 
Columbia Hos- 
pital. 
Dr. Nourse. 
Columbia Hos- 
pital. 
Do. 
I. S. S. 
Dr. C. G. Stone. 
I. S. S. 
Columbia Host- 
pital. No 
Age. 
35 
60 
23 
23 
28 
32 
32 
33 
33 
40? 
39 
19 
21 
•• 
26 
25 
Disease. Cause. 
Result. 
Drainage. 
Remarks. 
Date. 
Reference. 
58 
59 
60 
61 
62 
63 
64 
65 
66 
67 
68 
69 
70 
71 
72 
73 
74 
75 
76 
77 
78 
79 
80 
81 
Sarcoma uteri, entire 
uterus involved; 
tumor nearly to 
umbilicus, five 
pounds. 
Pyosalpinx, one fim- 
bria attached to 
intestine; necrosis 
and danger of rupt- 
ure ; omentum ne- 
crotic and large 
amount of it re- 
moved. 
Cancer of uterus. 
Suspected haemor- 
rhage, intra - ab- 
dominal. 
Intra-abdominal 
haemorrhage. 
Old .sinus, from in- 
fected ligature (see 
No. 50). 
Suspected pyone- 
phrosis or calculus 
of ureter, cystitis. 
Pyosalpinx, tubo- 
ovarian abscess. 
Pyosalpinx. 
Pyaemic abscess, lim- 
ited to bowels and 
mesentery. 
Myoma uteri, twelve 
pounds. 
Ovarian cyst, fifteen 
pounds. 
Pelvic abscess, size 
of cocoanut; right 
tubo-ovarian ab- 
scess. 
Pelvic and ovarian 
pain, cystic ovary, 
rgiht side, removed. 
Retroflexion, cystic 
ovary removed. 
Pelvic abscess, 
opened prior to 
operation. 
Pelvic abscess, ex- 
traperitoneal. 
Old salpingitis and 
ovaritis. 
Congenital displace- 
ment of ovaries, 
salpingitis. 
Pelvic abscess, sep- 
tic peritonitis. 
Blood cyst of ovary, 
transposition of 
viscera. 
Suspected abdomin- 
al pregnancy, high 
temperature, haem- 
orrhage from bow- 
els, etc. 
Uterine haemorrhage, 
sarcoma uteri, pre- 
vious operation 
(see No. 35). 
Procidentia, cysto- 
rectocele. 
Patient had an intra- 
uterine fibroid re- 
moved a year pre- 
vious ; recurrence 
eight months af- 
terward. 
Infection. 
4 
Abortion. 
Suspected extra-uter- 
ine pregnancy. 
After removal of 
small fibroid liga- 
ture infected. 
Infection. 
Gonorrhoea. 
Abortion, sepsis. 
Negress. 
Puerperal septicae- 
mia, eleven months 
since last child. 
Abortion. 
" Adenoid " growth 
below broad liga- 
ment. 
Pelvic peritonitis. 
Abortion, sepsis. 
Pelvic peritonitis. 
Relaxation of uterus 
gave effect of child 
floating in abdom- 
inal cavity. 
Excessive childbear- 
ing. 
Recovery without 
incident ten 
months since; 
better health 
than for years. 
Recovery from op- 
eration, and last 
report quite well. 
Recovery; blad- 
der involved, af- 
terward closed; 
well nearly one 
year after. 
Recovery without 
incident. 
Recovery. 
Sinus closed. 
Nothing found. 
Recovery. 
G 
Died third day. 
Recovered. 
a 
g 
Recovered from 
operation, symp- 
toms as before. 
Recovery. 
g 
Died two days, 
shock and sep- 
sis. 
Recovery. 
G 
Died, shock, third 
day. 
Recovered from 
operation. 
All symptoms sub- 
sided ; subse- 
quent delivery 
per vias natu- 
rales. 
Recovered from 
operation. 
Perfect result. 
Yes, tube 
and gauze. 
Yes, tube 
and gauze 
packing. 
Yes, per 
vaginam. 
No. 
Yes. 
No. 
« G 
Yes, gauze 
and glass 
tube. 
Yes. 
G 
G 
G 
Yes, gauze 
and tube; 
much haem- 
orrhage. 
No. 
« 
Yes. 
G 
No. 
G 
Yes. 
G 
No. 
Yes. 
No. 
Complete extirpation of 
uterus, ovaries, etc.; pa- 
tient has gained many 
pounds of flesh. 
The tube had adhered to 
bowel as high as crest of 
ilium, six inches from 
cornua of uterus. 
The growth was not pri- 
marily of cervix, "but of 
middle portion at and 
above the internal os. 
Patient in collapse when 
brought in hospital; 
amount of blood very un- 
certain, hence the explor- 
atory opening. 
Abdomen distended with 
blood; no foetus found. 
Patient had been an inva- 
lid, and hence the ex- 
ploration. 
Aristol over adhesions; per- 
fect result. 
Normal recovery. 
Operation had no effect in 
minimizing sepsis; tubes 
not enlarged. 
Complete extirpation. 
Multilocular cyst. 
This case was in a morphia 
habitue; critically ill for 
a week after section. 
Neurasthenic case. 
Hysterorrhaphy, ovary pro- 
lapsed and held under 
the uterus. 
Disorganized appendages. 
See case No. 31. Had ova- 
riotomy done, both broad 
ligaments removed. 
Uneventful recovery. 
Battey operation ; normal 
convalescence. 
Should have merely washed 
out abdomen instead of 
completing operation (for- 
ty minutes). 
Appendix found on left 
side ; general adhesions 
throughout pelvis, in- 
cluding intestines, uterus, 
bladder, etc. 
Temperature to 105° day 
before section; two dis- 
charges of blood from 
bowels; patient had been 
curetted and cervix closed 
since pregnancy suspected. 
Patient still has some vagi- 
nal haemorrhage. (Since 
the above, patient well.) 
Hysterorrhaphy, ventro-fixa- 
tion. 
7, 13, '92 
Patient still 
well, Septem- 
ber, 1893. 
7, 20, '92 
7, 28, '92 
9, 1, '92 
9, 3, '92 
9, 10, '92 
9, '92 
9, 17, '92 
9, 22, '92 
9, 24, '92 
10, 12, '92 
10, 8, '92 
10, 12, '92 
10, 22, '92 
10, 22, '92 
10, 26, '92 
10, 29, '92 
11, 5,'92 
11, 5,'92 
11, '92 
11, 12, '92 
11, 13, '92 
11, 17, '92 
11, 19, '92 
Dr. Ames. 
Dr. Smith. 
Dr. Hicks. 
Columbia Hos- 
pital. 
Do. 
Do. 
Do. 
Do. 
Do. 
Dr. C. G. Stone. 
Columbia Hos- 
pital. 
Dr. Walsh. 
Dr. Beatty. 
Dr. Speiden. 
Columbia Hos- 
pital. 
Do. 
Do. 
Dr. Love. 
Columbia Hos- 
pital. 
Do. 
Dr. Moran. 
Dr. Walsh. 
Columbia Hos- 
pital. 
Do. HO 
96 
97 
98 
99 
100 
10 
33 
32 
35 
30 
Ovarian tumor, twen- 
ty pounds. 
Myoma uteri, four 
pounds. 
Tubo-ovarian ab- 
scess, pyosalpinx. 
Tubo-ovarian ab- 
scess, pyosalpinx. 
Retroflexio uteri, cys- 
tic right ovary. 
Retroflexion, salpin- 
gitis, ovaritis, etc. 
Negress. 
Gonorrhoea. 
u 
Excessive childbear- 
ing. 
Recovery unevent- 
ful. 
Recovery. 
u 
u 
Died. 
Recovery. 
Yes. 
Il 
ll 
ll 
No. 
ll 
Twisted pedicle. 
Complete extirpation by ab- 
dominal method. 
Patient had been ill since 
first attack of gonorrhoea; 
result far better than ex- 
pected ; complete and sat- 
isfactory cure. 
Patient unexpectedly de- 
veloped peritonitis and 
died; the cystic ovary 
may have infected the 
peritonaeum. 
Hysterorrhaphy; salpingo- 
oophorectomy. 
2, 5, '93 
2, 11, '93 
2, 15, '93 
2, 20, '93 
Dr. Batson. 
Columbia Hos- 
pital. 
Dr. C. G. Stone. 
Columbia Hos- 
pital. 
Do. 
Do. 
Summary. 
Cases. 
Deaths. 
Cases. 
Deaths. 
Pelvic abscess 
Extraperitoneal abscess 
Pyaemic intra-abdominal abscess 
Tubo-ovarian abscess 
Pyosalpinx 
Hydrosalpinx 
Cystic ovary (pyaemic uterus) 
Cystic ovaries (infectious) 
Ovarian tumor 
Myoma uteri 
Hysterorrhaphy 
Exploratory section 
Inguinal hernia... 
17 
1 
1 
21 
6 
2 
1 
3 
6 
11 
7 
5 
1 
5 
1 
1 
1 
1 
3 
1 
Vaginal hysterectomy 
Oophorectomy for uterine myoma 
Old sinus 
Cholelithotomy 
Cyst of kidney 
Nephrotomy 
Extra-uterine pregnancy 
Abdominal haemorrhage 
Battey's operation 
Tubercular peritonitis 
Total 
4 
2 
1 
1 
1 
1 
1 
1 
5 
1 
1 
1 
100 
15 The New York Medical Journal. 
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