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 THREE lilNDRED AND EIGHTY-FOUR 
 
 
 LAIi^EOTOMIES 
 
 Various diseases, 
 
 WITH TABLES SHOWING THE RESULTS OF THE OPERATIONS 
 
 AND THE SUBSEQUENT HISTORY OF THE PATIENTS. 
 
 A RESUME OF THE WRITEr's EXPERIENCE IN 
 
 ABDOMINAL SURGERY DURING THE 
 
 LAST FIFTEEN YEARS. 
 
 JOHN ROMANS, M. D., 
 
 HARVARD UNIVERSITY CLINICAL INSTRUCTOR IN THE niAGNObIS AND TREATMENT 
 OF OVARIAN TUMORS. SURGEON TO THE MASSACHUSETTS GENERAL HOSPITAL. 
 
 BOSTON: 
 
 NATHAN SAWYER &. SON, PRINTERS, 
 No. 70 State Street. 
 
 1887. 
 

ERRATA. 
 
 On page 6, eighth line from foot, strike out word 
 " respectively." 
 
 In head line of table " Laparotomy for other purposes 
 than the removal of Abdominal Tumors," strike out the 
 word "Abdominal" and insert "Ovarian." 
 
Digitized by tine Internet Arciiive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/threehundredeighOOhoma 
 
CHAPTER I. 
 
 GENERAL METHOD PURSUED IX PREPARING FOR LAPAR- 
 OTOMY. SOME STATISTICAL ACCOUNT OF RESULTS. 
 
 The Laparotomies enumerated in the accompanying 
 tables have been carefully tabulated, and the preparation 
 of these tables has required much correspondence and 
 hard work. I have looked through the tables and have 
 picked out cases, here and there, which seemed to me 
 to be of special interest, and where the usefulness of a 
 rather minute description of the case and its treatment 
 seemed to require it I have given a full narration. 
 
 In what I have to say I will confine myself wholly to 
 mv own experience, without theorizing or quoting au- 
 thorities. I do not do this in a narrow, egotistical way, 
 but because all of you have read and heard all that I 
 have read or heard, and need not be bored by hearing 
 the statements and theories of others at second-hand. 
 
 384 Laparotomies. Of these. Ovariotomies number 
 2S2. Removal of Uterine Tumors, 27. Simple Ex- 
 ploratory Laparotomies, 19. Laparotomies and stitch- 
 ing of Ovarian Cvsts to the skin, 15. Removal of 
 uterine appendages for Fibro-myoma, 5. Removal of 
 uterine appendages for nervous disorders, 5. Pyosal- 
 pinx, I. Tubo-ovarian. i. Abdominal Abscess, i. 
 Removal of immense Lipomas, 2. Intestinal obstruc- 
 tion, 4. Renal Tumor, 3. Perityphlitic Abscess, i. 
 
 I have alwavs regarded Sir Spencer Wells's first 
 volume of Cases of Ovariotomy, published about 1865, 
 as the most valuable book for a beginner to study. 
 
In a very humble wa}', perhaps, this paper and these 
 tables may be of interest to the student and practitioner 
 of abdominal surgery. I have been rather surprised to 
 find that thirty women out of over three hundred, or 
 nearly ten per cent., have ventral hernia. 
 
 The general method I have pursued in preparing for 
 a Laparotomy is the following : 
 
 I have a sufficient number (say six or eight) earthen- 
 ware jars, such as we use in New England for holding 
 pickles, each of which will contain six gallons of fluid ; 
 two or more of them are filled with a solution of corro- 
 sive-sublimate i-iooo ; new sponges are cleansed of 
 their sand and are put to soak in the bi-chloride solution, 
 and left there two or more days ; they are then wrung 
 out drv in a wrincrincr-machine such as is used in a laun- 
 dry. The rubber rollers of the wringing-machine will 
 dry a sponge almost completely, and the compression 
 squeezes out all the dirt that may remain and also all the 
 bi-chloride : this could not be done as thoroughly with the 
 hands, nor does one wish to keep putting his hands into 
 a mercurial solution. iVfter these sponges have been 
 soaked in this mercuric solution, they are cast into a jar 
 containing a solution of carbolic-acid 1.20, and \N'hen 
 wanted are taken out of the jar and wrung out again in 
 the wringer and taken in a clean bag to the operation. 
 I have always used carbolic acid spray and continue to 
 do so ; though I think it unnecessary, yet I hate to give 
 it up. I use an electric light when necessary. 
 
 Of m}' first five unantiseplic ovariotomies all died. 
 Of my antiseptic ovariotomies 248 have recovered and 
 34 have died. About one quarter, probably, of all the 
 fatal cases are to be attributed to some error or careless- 
 ness of mine, to some want of cleanliness, or perhaps to 
 a slightly suppurating hang-nail or other sore on my 
 hands, or to something that might have been avoided. 
 
5 
 
 Perhaps this comes from too much operating within a 
 given time. Deaths for which I am inclined to think I 
 am at fault, have occurred generally towards the end of 
 many daily ovariotomies, when I may have been tired or 
 possibly unclean. To balance these fatal cases of course 
 many unexpected recoveries have occurred. There is 
 also an element which cannot be estimated beforehand, 
 viz: the viability of the patient (if I may say so),- just 
 as it will take many blows to kill one man, any one of 
 which would have killed another less viable man ; so, a 
 moderately severe operation will be fatal in a certain 
 case, and a much more severe one will be innocuous in 
 another case. I mean where both patients seem to be 
 equally healthy. This vitality or viability it is impossible 
 to estimate beforehand. There are other causes of death 
 which are unpreventable. Such a one is the case of death 
 from Acute Mania, No. 6^ ; another one the death from 
 Tetanus ; another the death, sixteen days after the opera- 
 tion, when recovery seemed complete, from thrombus in 
 all the pulmonary arteries, No. 275. Let me illustrate 
 this point. No. 117, a simple, uncomplicated case, died, 
 while cases No. 72, where the bladder was cut open, and 
 No. 260, in which a second operation, including removal 
 of the uterus, was done, and No. 50, complicated with 
 heart disease, curvature of the spine and the removal of 
 not only ovarian but uterine tumors, have recovered. 
 The causes of death have usually been Peritonitis and 
 Septicaemia. You may call it Septic-Peritonitis or 
 Septicaemia, or blood-poisoning, but it is fatal, and I am 
 rather skeptical about deaths from intestinal obstruction 
 of a mechanical nature at'ter Laparotomy, except as the 
 intestines are paralyzed by Peritonitis. There is often 
 a sort of atony of the bowels which is almost equivalent 
 to mechanical obstruction, and which gives rise to great 
 distention and to vomiting, but there is no real strangu- 
 
lation such as you see in Hernia, or at least I have never 
 seen such a case. 
 
 Two cases in which I wounded the bladder during 
 ovariotomy recovered, and they are both living in good 
 health, two and six years respectively after the opera- 
 tion. In both cases the bladder was sewn up with silk 
 and in both cases the sutures were left shut up within 
 the abdominal cavity. Of those \vho recovered, nine 
 have since died of abdominal cancer a few months or 
 years after recovery, and thirty have ventral hernia. I 
 have heard of fifteen children born to eleven women 
 out of about two hundred heard from. The sexes do 
 not correspond to the ovaries. The patients' ages have 
 varied from twelve to seventy-three years. In size, the 
 weight of the sac and its contents has varied from a 
 pound to one hundred and eleven and a half pounds. 
 Twisted pedicle occurred, I think, six times. 
 
 The usual length of my incision is about two inches, 
 except in fat people, or where some difficulty in the 
 operation requires more room. I never leave a clamp 
 on the ovarian pedicle, but always tie and burn the stump 
 and drop it back. I have always used silk sutures and 
 am careful to include all the abdominal parietes in the 
 suture, particularly the transversalis fascia. 
 
 Drainage was used in fifteen cases of ovariotomy I 
 think, and I have gradually reduced the size of my 
 drainage tubes. In three cases silk sutures have been 
 discharged at long intervals after recover}^, respectivel}^ 
 I have had one case of Tetanus following a simple un- 
 complicated ovariotomy. Death occurred on the sixth 
 day, the symptoms existing for twenty-four hours before 
 deatli. 
 
 I have had one case of the formation of a stone in the 
 bladder, around the dermoid contents of the tumor dis- 
 charged into the bladder. 
 
Most of my cases have been treated in a private hos- 
 pital, which is simply an ordinar}- dwelling house. 
 During convalescence, the patients have found the lift- 
 ing-machine, figured in Hamilton's Surgerv as Dr. 
 Jenks" Fracture Bed, very useful, portable, light and 
 strong. I have found none of the Fracture-beds such 
 as those of Crosby and others of any special service. I 
 use a catheter as little as possible, preferring to have the 
 patients pass their water voluntarih' from the very first, 
 if possible. 
 
 My greatest number of consecutive recoveries after 
 ovariotomy has been thirty-eight, I think. 
 
 Suppurating cysts of the ovary are spoken of and 
 described not unfrequently. I never saw but one and 
 that had been tapped. I doubt if an ovarian cyst ever 
 suppurates unless there has been at some time a com- 
 munication with the external air, or with some mucous 
 cavity. But there is a fluid containing fat and sebaceous 
 matter, that to the naked e3-e looks exacth' like laudable 
 pus, and can only be distinguished from it by microscop- 
 ical examination. 
 
 The removal of sessile tumors is accomplished by a 
 sort of knack learned by experience, at least it has been 
 by me. You find the cyst covered with peritoneum and 
 immovable, but if you cut through the outer adherent 
 covering of peritoneum at se^•eral points, you will usually 
 strike the familiar-looking w^all of the ovarian cj'st some- 
 where, and may succeed in enucleating it and making a 
 sort of pedicle. 
 
 I recall two cases of swelling of the parotid gland 
 after ovariotomy. Both recovered quickly, and I have 
 not regarded an enlargement of the parotid during con- 
 valescence as of special importance. I may add that 
 cases of parotitis seen in consultation have recovered, 
 and I have generally given a favorable prognosis. 
 
8 
 
 In regard to hysterectomy, my success has not been 
 great. ]Mv cases of removal of uterine fibroid tumors 
 number twenty-seven, with seventeen recoveries and ten 
 deaths. I perform the operation much better than I did 
 years ago, and my later cases have nearly all recovered, 
 but still I am not fond of it and always rather shrink from 
 it. I never do it unless the patient seems in danger of 
 her life from heemorrhage. mechanical pressure, or ex- 
 haustion, or else suffers such pain that life is not worth 
 living. I do not know which is the better way of man- 
 aging the stump, whether intra or extra-peritoneally : I 
 am pretty sure, however, that with me the extra-peritoneal 
 is safer, although I cannot say that a more skillful opera- 
 tor might not make the intra-peritoneal method safe and 
 reliable. 
 
 Encouraged by the recovery of a patient after hyster- 
 ectomy for fibro-myoma in which the stump had been 
 left in the abdomen, I treated the next case intra-perito- 
 neally, with fatal result. The autopsy showed that the 
 stump was the cause of a quite limited peritonitis, and 
 that if it had been left outside the patient would appar- 
 ently have been relieved of the source of blood-poison- 
 ing, and might have recovered. I use a wire ecraseur, 
 either Koeberle's or a longer one, for I find that for the 
 compression of the pedicle Koeberle's screw is not long 
 enough, and one must have se\eral of Koeberle's serre- 
 nceuds or else an instrument with a longer screw, and 
 the latter seems to me simpler. I have used drainage 
 several times after removal of fibroid tumors, but it is 
 usuall}- unnecessary. When the clamp and pin come 
 away, there is usually some fluid in the cavity where the 
 stump was, and this has often a very offensive odor like 
 that of a sewer, but it seems of no consequence, as the 
 patient's temperature and pulse are nearly normal. I 
 suppose there is a septic-putrescence and a non-septic- 
 putrescence ; but at the first glance one would suppose 
 
that an ounce or so of black, offensive fluid between the 
 intestines and the bladder, and within the peritoneal cav- 
 ity, would necessarily set up Septicemia or Peritonitis. 
 
 The smell that I mean is very much like that from 
 macerating bones, and yet there is no Septiceemia and 
 the patient recovers, the hole closing rapidly. I am sat- 
 isfied, on the whole, with the extra-peritoneal treatment 
 of the pedicle by means of a screw serre-nceud, though 
 the intra-peritoneal method is neater. The wire seeks 
 a bed for itself in the part of the tumor where the diam- 
 eter is smallest, and it is almost impossible to keep it 
 from gravitating to this point. It must be kept off the 
 bladder, of course. I had a recovery, however, in one 
 case where two successive wires broke on being tight- 
 ened, and in which I found, twenty-four hours afterward, 
 that a piece of the bladder was in the serre-noeud. The 
 opening in the bladder subsequently closed without 
 suture by keeping a catheter in the urethra ; so I know 
 that when one is unfortunate enough to have taken a 
 piece out of the apex of the bladder, at least an inch in 
 diameter, he may expect recovery if he will keep a 
 Sims' catheter in the bladder and urethra all the time. 
 Mv patient's fistula closed in six weeks. 
 
 Of cases of ovarian tumor, uncomplicated except by 
 adhesion in which I could not or thought I could not (for 
 I can get a cyst out now that I could not have removed 
 five or six years ago) remove the cysts, and which I 
 have stitched to the abdominal walls or fastened outside, 
 I have had nine. Of these all have completely recov- 
 ered. In these cases, the cysts had grown under the 
 peritoneum, and were adherent to the intestines, to the 
 broad lio-ament or uterus, and in one instance the wall 
 of the cyst and its peritoneal adhesions in the right iliac 
 region were over two inches thick and very dense, and 
 yet the patient recovered, and is perfectly well and hearty 
 to-day. If in these cases you can strike the cyst wall 
 
 2 
 
lO 
 
 without too much hgemorrhage or violence, you can gen- 
 erally remove the cyst. Of cases where I have opened 
 the abdomen and tapped or more or less emptied the 
 cyst, I have had several, nearly all of which died. 
 These partial operations are generally bad surgery, and 
 a man does them less and less the more he operates. Of 
 cases of collections of pus in the abdominal cavit}^ I have 
 had but one, and that was treated successfully by Lapar- 
 otomy and drainage. Of cases of abscess in the ovary 
 and salpingitis of gonorrhoeal origin, I have had one 
 case, successfully treated by removal of both tubes and 
 one ovary, the other ovary being so imbedded in the 
 pelvic tissues as to be immovable. The patient recov- 
 ered. Of removal of large intra-abdominal fatt}^ tumors, 
 sub-peritoneal, I have had two. They each weighed 
 over fifty pounds and were many-lobed. One occurred 
 in a man and the other in a woman, and both were fatal. 
 In connection with the subject of intestinal obstruction 
 it may not be improper for me to say that I have had one 
 case of an operation for the closure of a Meckel's Divert- 
 iculum (Omphalo-Mesenteric Remains). In this case, 
 the mucous membrane projecting at the umbilicus was 
 pulled up and cut off, and the skin within the umbilical 
 cicatrix, over a diameter of about a quarter of an inch, 
 was removed, and the denuded surfaces united by silver 
 sutures. The patient was an infant about five months 
 old. The cure was complete. Another case, interesting 
 in connection with this, was a case of Laparotomy with 
 intestinal obstruction, caused by Meckel's Diverticulum 
 in a young man of twenty-one years. I failed to find 
 the obstructing band, owing to m}^ ignorance at the time 
 of the causation of intestinal obstruction by the Diverti- 
 culum, and the case resulted fatally. It is described at 
 length by Prof. Fitz in the American Journal of Med- 
 ical Science for July, 1884. Once during ovariotomy I 
 removed a portion of a cancerous omentum, and the 
 
II 
 
 patient has experienced up to the present time, one and 
 a half years from the date of the operation, no trouble, 
 and has been in perfect health. 
 
 I have had one very remarkable case of cure of tuber- 
 cular peritonitis and dropsy by Laparotomy, the patient 
 being now fat and healthy, three years after the opera- 
 tion. Fluid was discharged from the wound for about 
 eight months, and there is now a discharge of about a 
 half a drachm a day from a short sinus. 
 
 Of removals of the Kidney for Sarcoma, Cancer or 
 Abscess, depending on calculous nephritis, I have had 
 three cases, all of which were fatal. The operations 
 seemingly went off very well, but no urine excepting a 
 few ounces was secreted up to the time of death, about 
 two da3's in each case. Almost complete suppression 
 had taken place in these cases. 
 
 Of the formation of an ardficial anus, for Cancer, 
 either by Lumbar Colotomy or anterially in the pubic 
 region, I have had five cases, three of which were suc- 
 cessful, the life of the patients being rendered comfort- 
 able for man}' months. 
 
 I have had many cases of operation for Strangulated 
 Hernia, which I suppose ought hardly to be mentioned 
 in a paper on Laparotomy. 
 
 I have successfully removed a fibroid tumor in the 
 abdominal fascia and peritoneum of the right lumbar 
 region, the size of a small placenta, by Laparotomy. 
 The patient is now in good health four years after opera- 
 tion. As some of the peritoneum was removed, and its 
 edges could not be brought together, there has been a 
 troublesome rupture. This is the only case of fibroma 
 of the peritoneum I have ever seen. 
 
CHAPTER II. 
 
 OVARIOTOMIES 
 
 Illusti'ative Cases. 
 
 Case No. IX. Remarkable as having no pedicle. 
 It was a cyst of the broad ligament, and as the woman 
 coughed, after the peritoneum was opened and the cyst 
 tapped, the cyst was expelled and dropped on the floor 
 without a vessel being tied or an}- force, except the 
 gentlest assistance, being used. The operation from 
 the first incision, till all the sutures had been tied, was 
 ten minutes. Tlie C3'st measured 36 inches in circum- 
 ference. 
 
 Case No. X. Acute peritonitis at time of operation, 
 September 29, 1878. Confined Nov. 16, 1879, after a 
 normal labor. Child, a girl. Ovar\' remaining, the 
 right. 
 
 Cases Nos. XII and XIII. Both died subsequently 
 to recovery of abdominal cancer, and one also with 
 thoracic cancer. Their deaths occurred, one in six 
 months, and one in five months after recovery. 
 
 Case No. XIX. Is only of interest as having men- 
 struated for two years irregularly, after the removal of 
 both ovaries. 
 
 Case No. XXIX. Cyst of left broad ligament, died 
 of cancer of stomach within a year. 
 
13 
 
 Case No. XXXI. Was confined in October, 1881, 
 fourteen months after Ovariotomy. Child, a girl. Ovary- 
 remaining, the right. 
 
 Case No. XXXIII. Is remarkable as having had 40 
 ounces of serum removed by aspiration from the left 
 thoracic cavity, on account of acute pleurisy, on the 
 fourth day after Ovariotomy. 
 
 Case No. XXXV. Died of abdominal cancer nine 
 months after recovery. 
 
 Case No. L. Is remarkable on account of her recov- 
 ery. She had severe cardiac disease, great deformity 
 from curvature of the spine, and at the operation three 
 tumors were removed, a solid tumor of the right ovary, 
 a dermoid tumor of the same, and a fibroid tumor of the 
 uterus. She died three years later of heart disease. 
 
 Case No. LVI. Is remarkable as requiring colotomy, 
 or rectotomy, for cancer of the bowel, Dec. 21, 1881, 
 seven months after recovery. The artificial anus was 
 made in the pubic region. Her life was very comfort- 
 able for many months. She died of abdominal cancer, 
 in November, 1882. 
 
 Case No. LXI. Died several months after recovery, 
 from cancer of the stomach. 
 
 Case No. LXVII. Is exceptional as having died of 
 Acute Mania, on the eighth day after Ovariotomy. A 
 careful autopsy found everything going on well in the 
 peritoneal cavity, and no recognizable cause for death. 
 I think the case might be disregarded as one of fatal 
 Ovariotomy, but I have thought it right to put it in the 
 table as such. 
 
14 
 
 Case No. LXXII. Is an instance of a most fortunate 
 uninterrupted recovery after an incision of the bladder. 
 The convalescence was extraordinarily devoid of fever, 
 the temperature never rising above 99°. A Sims' 
 catheter was kept in the urethra for nine days. The 
 bladder wound was sewed up with a continuous suture 
 of carbolized silk, and was closed tight at the time of 
 the operation. The patient is now, six years after the 
 operation, in perfect health, and has never had a symp- 
 tom of vesical or other trouble. 
 
 Case No. LXXVI. Is remarkable on account of the 
 age of the patient at the time of the operation, and her 
 uninterrupted good health since. She is now hale and 
 hearty at the age of 79. 
 
 Case No. LXXVII. In this case a recurrence of 
 the disease, gelatinous cancer, took place, and more or 
 less fluid was discharged after recovery, through the 
 abdominal cicatrix, and through the bladder. The tu- 
 mor was a burst gelatinous dermoid cyst, and weighed 
 35 pounds. This material was scooped out and sponged 
 out as thoroughly as possible. The patient was much 
 relieved by the operation, and gained flesh and strength. 
 Two years after her recovery, I removed a calculus from 
 the bladder, the nucleus being a hair which had prob- 
 ably remained in the peritoneal cavity, after the opera- 
 tion, and had found its way into the bladder. She died 
 in 1885, four years after Ovariotomy, of general abdom- 
 inal cancer. 
 
 Case No. LXXX. Is a case of the most rapid recur- 
 rence of cancer after Ovariotomy, that has occurred 
 among my cases. There were masses of cancerous- 
 looking nodules in the abdominal parietes, which were 
 cut throuirh in making the incision. The tumor was 
 
T5 
 
 sarcomatous-looking, and more solid than cystic. It 
 weighed 26 pounds. The operation having been done 
 on March 14, 1S82, the patient died on May 19, with 
 large, rapidly-growing soft, sarcomatous tumors in the 
 abdomen. Another remarkable occurrence in the case, 
 and one that will hardly be credited, was the occurrence 
 of two well-formed vaccination vesicles, which appeared 
 spontaneously on the cicatrices of two successful vacci- 
 nations done eight years before. These vesicles ran a 
 normal course. The late Dr. Henry A. Martin was 
 kind enough to confirm my diagnosis, and told me that 
 the occurrence of similar spontaneous vaccine disease 
 had once or twice been recorded. There was no possi- 
 bility of contagion. The patient was ill, confined to her 
 bed, and had no visitors, and no one in the house had 
 been vaccinated recently. I think the element of con- 
 tagious inoculation is entirely excluded, and the case 
 may be received as one of spontaneous vaccine disease, 
 appearing in an old cicatrix, and caused in some unex- 
 plained way by the patient's condition. It is perhaps 
 unnecessary for me to say that the observation is unique 
 in my experience, and it will be interesting to know if 
 others have observed any similar phenomenon after 
 Ovariotomy. 
 
 Case No. LXXXI. Recovered rapidly in 1882, and 
 after enjoying four years of health, noticed that she was 
 growing larger. She put herself under my care in 
 1887, and I made an exploratory incision to remove an 
 adherent tumor of the other (the left) ovary, but I could 
 do nothing, and she died in a few days of peritonitis. 
 
 Case No. LXXXII. Was one of the largest tumors 
 I have removed, the solid and fluid contents removed 
 a few days before, and at the operation, weighing 105 
 pounds. The patient is now, five years later, in robust 
 health. 
 
i6 
 
 Case No. LXXXIV. Although the posterior surface 
 and right side ot^ uterus was " peeled " and denuded of its 
 peritoneal covering, and tied and sewn, and burnt to 
 control hgemorrhage, pregnancy has taken place twice, 
 once in 1883, and once in 1885. The first child was a 
 female, and the second a male. The ovary remaining 
 was the right. 
 
 Case No. LXXXIX. This lady had a very rapid 
 recovery following Ovariotomy, in 1882, the temperature 
 only once rising above the normal. In 1884 she sent 
 for me and I found her very feeble, emaciated, with a 
 large, hard nodulated tumor filling the pelvis and lower 
 abdominal region, and projecting into and through the 
 cicatrix of the abdominal incision ; the inguinal glands 
 were also affected, and there had been haemorrhage 
 from the surface of the tumor. Vomiting was almost 
 constant. Nothing could be done in the w^ay of an 
 operation, and she died in June. 
 
 Case No. CII. Was one of suppurating cyst in a 
 woman 37 3^ears old. She had been tapped three weeks 
 before the operation. Her temperature was high, loi'' 
 before operation, and rapidly fell to normal. Her re- 
 covery w^as rapid. 
 
 Case No. CIV. Was one accompanied by heemor- 
 rhage during the operation from two arteries near the 
 aorta in the left lumbar region. Her convalescence was 
 accompanied by a high temperature, rising to 104" on 
 the 7th day, and by a severe and constant diarrhoea 
 and more or less dysentery ; but she left for home on 
 the 25th day, and has since been remarkably well. 
 
 Case No. CVII. One of dermoid tumor, followed 
 by death from cancer, three months after the operation. 
 
17 
 
 Case No. CXVIII. Was one of normal recovery 
 after Ovariotomy in a woman 68 years old. This was 
 followed by a return of the disease in the other ovary 
 and a large ventral hernia. In 1887 a tumor of the left 
 ovary, together with the adherent uterus, was removed; 
 the hernia was cured and the patient, now seventy-three 
 years old, went home well. 
 
 Case No. CXXXVIII. Was confined in August, 
 1886, three years after Ovariotomy ; child, a female ; 
 labor easy and rapid ; left ovary remaining. 
 
 Case No. CXLII. Recovered after removal of a 
 large tumor of the right ovary in 1883. She has been 
 confined twice since ; once in 1884, and once in 1885 ; 
 both children were females. The left ovary remained. 
 
 Case No. CXLIV. Is remarkable for two circum- 
 stances. The discharge of a ligature of silk from the 
 wound two years after recovery, and a desire for sexual 
 intercourse since Ovariotomy, whereas, before the re- 
 moval of the ovary she had no desire, and in fact dis- 
 gust. The silk is coarse and strong and is absolutely 
 unchanged, the knot being as perfect as when tied, and 
 the ends and edges as sharply defined as when cut ofii" 
 by the scissors two years before. 
 
 Case No. CLXIV. Is one of the cases that died 
 subsequentl}^ of abdominal cancer, two years after op- 
 eration. 
 
 Case No. CLXVII. Is not properly a death after 
 Ovariotomy, as cancer of the omentum, bowels, ovary, 
 and bladder was present, and a cancerous mass was 
 removed from the bladder and the bladder opened; but 
 the ovary was removed, and so I have called it a death 
 from Ovariotomy. 
 
 3 
 
i8 
 
 Case No. CLXXII. One of multilocular cyst of the 
 left ovary. Was confined June 5, 1886, nineteen months 
 after Ovariotomy. Child, a male. The right ovary re- 
 maining. 
 
 Case No. CXCIV. Was a very severe one. The 
 cvst had grown into the broad ligament and liad no 
 pedicle. It was forcibly and violently enucleated, and 
 there was much hemorrhage. The pedicle, such as it 
 was, was a part of the uterus, and many ligatures were 
 applied. A drainage tube was used. I expected a fatal 
 result, but the patient reacted well and has since enjoyed 
 good health, with the exception that a sinus has remained 
 in the course of the wound. In June, 1885, fourteen 
 months after the operation, the first suture of silk was 
 discharged ; and subsequently five more ligatures have 
 been discharged, the knots being firm, and the silk 
 sound. These ligatures were discharged in January, 
 May, October, and December, 1S86, and in January, 
 1887. 
 
 Case No. CXCV. Was a successful hysterectomy, 
 as well as an Ovariotomy. 
 
 Case No. CXCVI. Was m}^ first fibroid tumor of the 
 ovary, and had been considered a fibroid tumor of the 
 uterus, by myself and other ovariotomists elsewhere. 
 
 Case No. CXCVIII. Was one of rapid development 
 of abdominal cancer, with ascites, and death tour months 
 after recovery. 
 
 Case No. CCVIII. Was the second case of fibroid 
 tumor of the ovary, and with it were connected cysts, 
 but the primary tumor which filled the pelvis was fibroid 
 in its structure. This case and No. CXCVI are the 
 only libroid tumors of the ovary I ever saw. 
 
19 
 
 Case No. CCX. Is remarkable in many ways. She 
 had been tapped eighteen times. The fluid from the 
 more recent tappings had been ascitic, she was emaci- 
 ated and leeble, and her abdomen contained much fluid, 
 and at least two hard tumors that felt like flbroids, and 
 were very close to, if not a part of, the uterus. On open- 
 ing the abdomen in the usual place, the abdominal walls 
 seemed more thick and vascular than usual, and yet be- 
 neath them could be felt the ascidc fluid. On cutdng 
 deeper, a tissue, looking like the lining membrane of the 
 bladder, was seen. The incision at this point was aban- 
 doned, and a new one made at the umbilicus ; here the 
 normal peritoneum was easily opened. About twenty 
 pounds of ascitic fluid ran out, and when the abdominal 
 cavity was empty of fluid two papillomatous tumors of 
 the ovaries were seen. The right was the larger; both 
 had been burst for some time, and papillomatous mate- 
 rial extended beyond the cyst wall of each. After the 
 pedicles had been tied close to the uterus, the bladder 
 was inspected. It was found that the wall of the bladder 
 was a part of the anterior abdominal parietes, and that 
 it had been opened for an extent of about four inches. 
 The outer walls of the bladder were sewn together, 
 about twelve interrupted sutures of silk being put in. 
 Care was used so as not to include the mucous mem- 
 brane. A drainage tube was used in the abdominal 
 cavity, and a catheter was kept in the bladder. On the 
 whole, the operation was completed in a satisfactor}' and 
 workmanlike manner. This incorporation of the blad- 
 der with the abdominal parietes and its extent upwards 
 towards the umbilicus is an anatomical anomaly ot great 
 awkwardness to the ovariotomist. The convalescence 
 was tedious, and accompanied by much pain and some 
 considerable suppuration, but the patient went home 
 after six weeks, and now writes that her health (two 
 years after the operation) is perfect, but that the cicatrix 
 has never entirely closed. 
 
20 
 
 Case No. CCXII. Is remarkable as being the only 
 cyst of the broad ligament that contained papillomatous 
 masses, the ovary not being affected. The wall of 
 the cyst was quite thick, perhaps half an inch thick, 
 whereas the walls of most cysts of the broad ligament 
 are thin and rather delicate. 
 
 Case No. CCXIII. Was one of twisted pedicle. 
 The patient was 62 years old. On opening the abdo- 
 men, the cyst was seen adherent and blackish on the 
 surface. The pedicle fon the left side) was found to be 
 tightly twisted four times, and was rigid and white. 
 The vessels were all plugged and no ligature was 
 required. 
 
 Cases Nos. CCXV and CCXVI. Were both simple 
 cases in healthy 3^oung women, both were fatal, and were, 
 it will be seen, consecutive ; the same cause of Septicism 
 was present in both cases. They occurred during al- 
 most daily operating, and their fatal results are to be 
 attributed to some fault of mine, but exactly what I don't 
 know. 
 
 Case No. CCXVIII. Was confined November i, 
 1886, thirteen months after her recovery from Ovariotomy. 
 The child was a female, the left ovar}^ remaining. 
 
 Case No. CCXXII. Was one of rapid recovery in a 
 lady 61 years old. It is remarkable as being the only 
 one I have seen and tried to relieve of intestinal obstruc- 
 tion caused by the operation. I was called in April, 
 1886 (four months after her recovery), on account of 
 symptoms of obstruction which had existed for several 
 days. On opening the abdomen I found the small in- 
 testine adherent at intervals to the cicatrix in the perito- 
 neum ; through the openings between the intestine and 
 
21 
 
 the abdominal wall several loops of intestine had passed, 
 then had become strangulated and sphacelated, and 
 there was more or less offensive blackish fluid in the ab- 
 dominal cavity. An artificial anus was made and gave 
 relief, but the patient died in a few days. 
 
 Case No. CCXXVIII. Recovered, and went home 
 towards the last of February, 1886. She was delivered 
 of a child, a female, December 13, 1886, less than ten 
 months after leaving for home, and just ten and a half 
 months after Ovariotomy on January 27, 1886. The 
 ovarv remaining was the left. This is very quick work, 
 Ovariotomy, recover}^ impregnation and delivery, all 
 within eleven months. 
 
 Case No. CCXXIX. Should not be counted among 
 the Ovariotomies. The patient was in articulo mortis, 
 and the cyst, a gangrenous one with a twisted pedicle, 
 was only removed because I knew that I should feel at 
 the autopsy as if I ought to have removed the cyst while 
 the patient was alive, even if recovery seemed im- 
 possible. 
 
 Case No. CCXXXVIII. Was another case of twisted 
 pedicle. 
 
 Case No. CCXL. Was a double Ovariotomy, with 
 ascites and myxomatous tumors. A piece of omentum, 
 thick and apparently cancerous, about an inch and a 
 half in diameter, was removed also. Ovariotomy was 
 done in April, 1886, and now, July, 1887, she is in ex- 
 cellent health. On deep pressure, a small movable 
 tumor can be felt in the right umbilical or iliac region, 
 but the omental tumor has apparently not increased in 
 size. 
 
22 
 
 Case No. CCLI. A simple enough operation, ex- 
 cept that a hard (dermoid?) tumor, about the size of an 
 English walnut and without a pedicle, was removed 
 Irom the peritoneal region above the bladder ; perhaps 
 this was the left ovary which had become detached at 
 some former time. The tumor was a multilocular one 
 of the right ovary with adhesions, and the patient did 
 perfectly well till the fifth day, when she began to have 
 stiffness of the jaws and spasms of a convulsive nature. 
 She died on the sixth day of Tetanus. 
 
 Case No. CCLII. Is the largest I have ever re- 
 moved; the tumor and contents weighing iiij pounds. 
 The patient recovered. 
 
 Case No. CCLXI. Is remarkable as being a second 
 Ovariotomy on a patient 72 years old, and with a large 
 ventral hernia, and in whom the uterus had to be re- 
 moved with the tumor. The case was successful and 
 the hernia w^as cured. Drainage was used. 
 
 Case No. CCLXII. Was another case where the 
 uterus was removed with the ovarian tumor. It was 
 successful. 
 
 Case No. CCLXXIX. I have called a recovery with 
 a question mark. The operation was done on May 20, 
 1887; from May 23d till June 13, twenty-one days, her 
 temperature was normal and her pulse was generally 
 between 70° and 80° ; her appetite was good. On June 
 13, she awoke early and demanded an early breakfast, 
 and eat, perhaps inordinately, of bread, oatmeal, and 
 hashed veal stewed in butter. An hour later she had 
 the juice of an orange. At 10, A. M., she complained 
 of severe pain in the stomach, and later vomited. Her 
 temperature rose to 105°, and her pulse to 174"^, and she 
 
23 
 
 died. There was no autopsy. The patient was a hun- 
 dred miles or more from Boston, and I am at a loss to 
 account for the sudden death. Her sister and husband 
 thought it was severe indigestion caused by the veal. It 
 is unfortunate that there was no autopsy. 
 
 Case No. CCLXXXV. I have also called a recovery 
 with a question mark. For three days after the opera- 
 tion, her temperature was about ioi°. pulse ioo°, but 
 from that time on pulse and temperature were both nor- 
 mal. Drainage tube removed on sixth day. On the 
 sixteenth day after operation, she sat up out of bed 
 for the first time. After being up for about three quar- 
 ters of an hour, she complained of difficulty in breath- 
 ing, which rapidlv increased; she grew purple in the 
 face, and died in an hour from her seizure. Autopsy 
 showed both lungs filled with emboli, completely occlud- 
 ing the air passages. The origin of the embolism was 
 not discovered. She had complained of some pain in 
 her legs, not an uncommon symptom after Ovariotomy, 
 but there never had been any swelling. A careful ex- 
 amination of the femoral arteries failed to show any 
 starting-point for the trouble. 
 
CHAPTER III. 
 
 CYSTS, STITCHED TO SKIN, UNCOMPLICATED EXCEPT 
 BY ADHESIONS. 
 
 CYSTS, COMPLICATED WITH OTHER DISEASES, AND 
 STITCHED TO SKIN. 
 
 I have been very agreeably disappointed, of late 
 years, in the results following the drainage of ovarian 
 cysts which could not be removed. I think 1 have 
 stitched adherent ovarian or parovarian cysts to the 
 edges of the incision, and have drained them and 
 syringed them out patiently for several weeks eight 
 times, and of these cases all have recovered. 
 
 The first of these cases was operated upon in the 
 centre of Massachusetts, and I had nothing to do with 
 the after treatment. The drainage tube was removed 
 soon, and the patient recovered and gained flesh and 
 strength, but in less than a year the growth increased, 
 or a new tumor was produced, and an attempt to remove 
 this tumor resulted fatally. 
 
 The second case was much relieved, but died subse- 
 quently of cancer of uterus and liver, which existed 
 probably at the time of the laparotomy. 
 
 The third case was one of the broad ligament, com- 
 plicated with tubercular peritonitis, and the patient is 
 now, three years after operation, well and strong. 
 
 The fourth case was one of adherent papilloma, the 
 opening never entirely closed, and the patient subse- 
 quently died of consumption a few months after opera- 
 tion. 
 
 The fifth case was one of the right broad ligament, 
 and the patient is now well, two years after operation. 
 
^5 
 
 The sixth case is now in good health, stout and strong. 
 There is still a sinus, with a pin-hole opening, discharg- 
 ing a drachm or two of pus a day. 
 
 The seventh case, one of double ovariotomy and 
 stitching the cyst of the left ovary to the skin, recovered, 
 contrary to my expectations, and is now well. 
 
 The eighth case also recovered. 
 
 Cases of Tumors corn-plicated with other Diseases, and 
 in zuhich the Cysts were stitched to the Skin. 
 
 Of these there are seven, all fatal. 
 
 The first case was one of uterine cyst of large size ; 
 both ovaries had been removed on account of cystic dis- 
 ease two years previously. The patient died on the 
 thirteenth day after the operation of Septicaemia. 
 
 The second case was one of ovarian tumor and uterine 
 tumor. The ovarian tumor weighed forty-five pounds, 
 and when this had been removed a large uterine fibro- 
 cyst came into view. This latter was opened, emptied, 
 and as it could not be removed, its edges were sewn to 
 the skin and drained. Death occurred on the fifth day. 
 
 The third case recovered so as to leave hospital and 
 go home, but died soon afterwards ; the tumor was a very 
 adherent one of uncertain origin. There was no au- 
 topsy. 
 
 The fourth case was one of malignant uterine tumor, 
 irremovable. The operation was fatal on the second day 
 from shock. 
 
 The fifth case was one of extra-uterine pregnancy of 
 seven years' duration. The cyst was emptied of about 
 four pounds of offensive yellowish-green fatty fluid, and 
 the complete skeleton of an adult foetus. The case is 
 reported in the Boston Medical and Surgical Journal, 
 Vol. CXIV, page 457, and the bones, beautifully mounted 
 by Dr. O. K. Newell, are in the Warren Museum. 
 
 4 
 
26 
 
 The sixth case was one of adherent ovarian tumor 
 complicated with a uterine fibroid. The latter was re- 
 moved, the stump being treated intra-peritoneally. The 
 case was rapidly fatal. 
 
 The seventh case was one of tubo-ovarian cyst, with 
 hydrosalpinx on the other side, chronic pelvic peritonitis, 
 fibro-myoma, and polypus of the uterus. The tubo- 
 ovarian cyst was punctured and stitched to the skin. At 
 the autopsy, purulent peritonitis, granular degeneration 
 of the kidneys, and the affections above-mentioned were 
 found. Death occurred on the thirteenth day. 
 
CHAPTER IV. 
 
 LAPAROTOMIES FOR THE REMOVAL OF UTERINE 
 TUMORS. 
 
 My hysterectomies and removal of uterine tumors 
 number twenty-seven. It will be seen that although the 
 record is not brilliant, and does not compare in any way 
 with Dr. Keith's wonderful list, yet out of the last seven- 
 teen, fourteen recovered, and none of the cases were 
 done except for the reason that life was a burden, and 
 death was impending. Familiarity with the operation 
 has made me more skillful. 
 
 Case No. III. Was a supra-vaginal remov^al of a 
 two-horned uterus (uterus bicornis), one horn of which 
 was dilated and did not communicate with the vagina. 
 A number of pounds of dark, bloody fluid was contained 
 in this cavity and in the distended fallopian tube. The 
 stump was treated extra-peri toneally, and convales- 
 cence was rapid. The patient's age was eighteen. She 
 is now, four years after the operation, well and working 
 hard. The operation was done to relieve agonizing 
 pain. 
 
 Case No. VII. Is a very remarkable one, in which 
 four pounds of tumor which could not be removed at the 
 time of the operation, was gradually extruded through 
 the wound after the wire of the serre-noeud had come off. 
 The patient w^as a married woman 36 years old ; never 
 pregnant. The tumor reached above the umbilicus and 
 was mostly on the left side. Menorrhagia was contin- 
 uous, and at times violent, and had been going on for 
 eight years, and was attended with excruciating pain. 
 
28 
 
 Laparotomy was done on the 12th of June, 1884. The 
 tumor had grown under and into the left broad ligament; 
 the intestine was adherent to the apex of the tumor. 
 Koeberle's serre-noeud was adjusted around the growth 
 and the wire pushed down into the pelvis as far as pos- 
 sible. The loop had above it the right ovary and tube, 
 but not the left, and the latter I was not able to feel. 
 The wire was tightened as much as possible, and when 
 screwed home another serre-nceud was put on and the 
 first one was removed. This case showed the advantage 
 of always having two serre-noeuds and induced me to 
 get one with a longer screw. When I could compress 
 no longer, I passed a long pin through the stump to keep 
 it outside. Only about half the tumor was removed, the 
 left side of the pelvis being still filled with the growth. 
 The top of the uterine cavity was opened. The clamp 
 came away on the fifth day. And now began the very 
 remarkable course of this case, which had so far been 
 like so many others. The remaining portion of the 
 tumor began to push out of the abdominal wound through 
 the hole left by the stump, and as it rapidly grew larger 
 and larger, elastic ligatures were tied around its base, 
 daily, on and after July 15. On the i8th of July, i. e., 
 thirty-two days after the clamp had come oft', the pro- 
 truding mass was pretty well pediculated. It was about 
 as large as my head, vascular-looking, and was the por- 
 tion of the tumor left behind at the time of the operation, 
 and had not onl}' been extruded, b}' uterine contraction I 
 suppose, but had nearly doubled in size. I now tied a 
 strong ligature of silk around the base of the tumor and 
 cut the protruding part away with strong scissors. The 
 tumor removed weighed four po7uids. Some constitu- 
 tional shock, vomiting, and a rise of temperature followed 
 the removal of the tumor, but this soon subsided. In Jan- 
 uary, 1885, she was well, fat and free from pain, and has 
 continued so ever since. In February, 1885, occurred the 
 
last uterine flow, and nothing has been seen since. The 
 body of the uterus covered with a smooth cicatrix comes 
 up against the abdominal scar at the seat of the incision, 
 and there is now a small ventral hernia below it. So 
 far as I know, this case is unique, though I do not know 
 why the uterus should not be able to squeeze out a fibroid 
 through an incision from above, as well as through one 
 made from the vagina. This case I watched with great 
 interest, and the outcome has been very fortunate, for 
 these partial removals of uterine tumors are apt to be 
 unfortunate in their terminations. 
 
 Case No. XIII. Was one of the few in which drain- 
 age was used after hysterectomy. The patient was 30 
 years old, and the tumor was the size of an adult head. 
 She is now (July, 1887) well and strong. 
 
 Case No. XXIV. Besides being a large tumor (38 
 pounds), is remarkable for its happy result, the top of 
 the bladder having been taken off by the serre-noeud. 
 The wire came away on the third day, and the urine 
 flowed from the wound, only a little remaining" in the 
 bladder ; after various plans had been tried, I finally 
 decided to keep a Sims' self-retaining catheter in the 
 bladder continuously. This was done successfully with- 
 out any cystitis ; the hole filled up very slowly, its healing 
 being retarded by occasional overflows of urine, but at 
 length, after about seven weeks, the patient went home 
 with the sinus solidly healed and able to retain her urine 
 the normal length of time. 
 
 Case No. XXVI. The operation in this case restored 
 a patient to a life of comfort, and relieved her of great 
 suffering and debility. The patient was a married 
 woman 51 years old; she had had three children, of 
 whom the youngest was 15. In appearance she was 
 
very pale and aneemic. Her flowing had always been 
 excessive except during the year 1882. when electrolysis 
 had been employed and masses of sloughing tissue had 
 passed out of the uterus into the vagina with great pain. 
 Her tumor, which at that time was the size of a cocoa- 
 nut, entirelv disappeared after the electrolysis, and 
 although ver}^ ill for many weeks she recovered and was 
 comfortable, so far as the menorrhagia was concerned, 
 for a year. In 1883 the flowing and pain recommenced 
 and have kept on increasing. February 12. 1887, 
 hysterectomy was done, the stump being treated extra- 
 peritoneallv. At that time the woman was very pale 
 from excessive flowing, there was a mitral murmur, her 
 left leg was swollen, she was short of breath and had 
 constant abdominal pain. The operation was simple, 
 except that three wires broke while being tightened. 
 Recovery was rapid and she went home free from pain. 
 
CHAPTER V. 
 
 REMOVAL OF UTERINE APPENDAGES FOR FIBROID 
 TUMORS. 
 
 Case No. I. A married woman 33 years old. I 
 thought the tumor ovarian from its apparent fluctuation. 
 At the operation, October 15. 1884, the tumor was found 
 to be the uterus symmetrically enlarged and looked like 
 the impregnated uterus. It was apparentl}^ full of fluid, 
 but none could be obtained by aspiration. When the 
 abdomen was opened the tumor was tense, but when the 
 operation was finished it was quite flaccid ; both ovaries 
 and tubes were removed ; there was a slight quantitv of 
 ascitic fluid. Her monthly sickness has been profuse at 
 times, and there has been more or less constant slight 
 flowing for weeks. A serious flooding spell occurred in 
 June. 1886, since which time the catamenia have ceased. 
 The tumor is now (July, 1887) rather smaller than it 
 was three years ago. 
 
 Case No. H. Was a great success. The patient 
 was a married woman 44 years old. Catamenia always 
 irregular. At times she has been in Insane hospitals, 
 and has had delusions. At each menstrual period she is 
 very violent and suffers greatlv. Has had several at- 
 tacks of severe uterine hemorrhage requiring plugging. 
 The abdomen was very tender, and was occupied by a 
 tumor which was solid and extended from the cavity of 
 the pelvis, which it nearly filled, to the umbilicus. She 
 stated that she could no longer bear the continual pain 
 and the monthly agony of menstruation. A few ounces 
 of serum ran out on opening the abdomen, January 18, 
 1885, and the tumor above-mentioned came into view. 
 
32 
 
 It was a uterine fibroid. The ovaries and tubes were 
 easily seized and removed. She recovered rapidly. 
 Her depression left her, she was free from pain, men- 
 struation entirely ceased, and the tumor diminished in 
 size rapidly. On September i8, she came to my office, 
 bright and well ; I could not feel the tumor b}' external 
 examination. She was very grateful, and had been 
 cured not only of the tumor, but of her mental troubles. 
 She is still (July, 1887) in perfect health. 
 
 Case No. III. Was a case of removal of the ap- 
 pendages for great hgemorrhage accompanying a fibroid, 
 about the size of a large orange, in a patient 34 vears 
 old. The patient was very much blanched. She had 
 known of the existence of the tumor for three years. 
 The abdomen was opened August 25, 1885. The omen- 
 tum came into view, and under it was a symmetrical 
 round fibroid filling the pelvic brim. With considerable 
 difficult}' and force the uterine appendages were dragged 
 up and removed. I could not get a sponge down be- 
 tween the pelvic brim and the tumor, and so could not 
 sponge out the pelvis. The patient recovered rapidl}^ 
 May 13, 1886, she was well and strong, and had gained 
 twenty-four pounds of flesh. For three months after the 
 operation she had flowed unceasingly, but the whole 
 amount was nothing to what she formerly had at one 
 menstruation. From November, 1885, till February, 
 1886, the flowing wholly ceased ; then she began to flow 
 and continued to do so till May, 1886, since wliich time 
 I have not seen her. From August, 1885, till May, 
 1886, i. e., nine months, she said she had not lost one 
 tenth part of the blood she lost during the preceding 
 nine months. 
 
 Case No. IV. Was one of extreme anaemia and suf- 
 fering. I had to pull the tumor out of the abdomen to 
 
33 
 
 get at the ovaries, and then found them imbedded in the 
 tumor. I dug them out and tied the pedicles, and 
 pushed the tumor back. The whole operation required 
 much force, and hysterectom}^ ought to have been done 
 instead. The patient died on the third day. 
 
 Case No. V. A married woman 36 years old. 
 Had been flowing freely for fourteen 3"ears, and now 
 worse than ever. There was a fibroid about the size of 
 an ordinary orange. Both ovaries and parts of both 
 tubes removed on January 21, 1886. She recovered 
 rapidly, the uterine flowing has been unchecked, and in 
 December, 1886, when I last heard from her, she was 
 much discouraged, and was flowing as badl}^, if not 
 worse, than before the operation. 
 
CHAPTER VI. 
 
 REMOVAL OF UTERINE APPENDAGES FOR THE CURE 
 OF NERVOUS DISORDERS. 
 
 Case No. I. I saw the patient, a single young lady 
 22 years old, in March, 1883. Briefly her previous his- 
 tory was the following: — She was taken ill in ]March. 
 1877. and has since been most of the time in bed, suffer- 
 ing severe pain in the let't ovarian region. Her menstru- 
 ation had always been irregular, and was accompanied. 
 at times, by sudden severe spasmodic pain in the left iliac 
 fossa. These attacks were accompanied by confusion of 
 ideas, and severe pain and tenderness along the spinal 
 column. At one time, she became to all appearance in- 
 sane, at times melancholy, at others destructive, and again 
 abusive ; her whole body at times became rigid. (Hys- 
 teria.) This state of things lasted for about six weeks. 
 when she returned suddenly to a normal state of mind, and 
 became bright and intelligent. After a few months she 
 became ill again, and complained of the pain mentioned 
 above as being very exquisite. The least touch on the 
 left side of the abdomen seemed to cause pain. Spec- 
 ialists in cerebral, nervous, and uterine diseases were 
 consulted. The general conclusion was reported to me 
 as being that she might obtain some relief from palliative 
 measures. Morphia was given to her and she became 
 addicted to the use of the drug. She was for three 
 months in a Water-cure establishment in Maine, in 1879. 
 In January, 1881, she went to the Adams Nervine As}''- 
 lum in Boston, and remained four months. In May, 
 1882. she went to Dr. Ring's Sanitarium at Arlington 
 Heights, near Lexington. Mass., and I saw her there. 
 During these seven years there were some months when 
 
35 
 
 she could be partly about the house, but most of the 
 time she was in bed. The uterus was very small and 
 undeveloped, and an imperfectly defined body near the 
 posterior portion of the cervix, on the left side, was 
 thought to be possibly a prolapsed ovaiy. Pressure on 
 this substance caused, apparently, agonizing pain. Re- 
 moval of the ovaries was suggested to her, and she ea- 
 gerly desired it to be done if there was a shadow of hope 
 that it would benefit her. After hearing this history, 
 and consulting with Drs. J. T. G. Nichols, Ring, and 
 Westcott, I agreed with them that removal of the ovaries 
 would be a justifiable procedure, a safe operation and 
 perhaps beneficial. 
 
 The operation was done March 26, 1883. Her con- 
 valescence was normal, except that the left parotid gland 
 became swollen on the fourth day, but this gradually sub- 
 sided. At the end of two weeks she could walk about, 
 and she went home at the end of six weeks. Her mind 
 had become perfectly clear. The pain and soreness in 
 the left iliac region had nearly gone, and she felt very 
 glad that the operation had been done. So far as I 
 could see there was nothing remarkable about the ova- 
 ries and tubes removed. One of the ovaries was smaller 
 than the other, and both contained small cysts ; the 
 lining of the Fallopian tubes was fatty, but there was 
 nothing to account for all the pain and nervous phenom- 
 ena. The immediate relief of the operation was great, 
 and for about a year the patient was very comfortable, 
 but not strong. She never has had any of the old 
 severe pain in the iliac region, and the relief from this 
 seems to be due to the moral or physical effect of the 
 operation, at any rate to the operation. In 1884, she 
 had a time when her hysterical symptoms returned, and 
 she recommenced the use of morphia, but this was again 
 given up and she recovered. , In answer to a circular 
 sent in December, 1886, she writes, after saying that she 
 
36 
 
 has never menstruated, •' The operation was very suc- 
 cessful in its resuhs. excepting an adhesion to the bowels 
 and great trouble with constipation. Up to a year ago 
 last summer (i. e., 1885), my health was better than for 
 years, but owing to overwork, and a fall which injured 
 the spine, I have been confined to my bed ever since 
 that time." Of course she does not know whether there 
 is an adhesion or not. but she does know that there is 
 constipation. Now. looking at the present condition of 
 the patient, in bed and confined to her bed now for two 
 years past, I cannot see that the operation has been of 
 much, if any, permanent good, though I ought in fairness 
 to say that she and her family feel that it has been very 
 beneficial. 
 
 Case No. II. This case is a brilliant one. The 
 patient was 19 vears old. In her childhood she was 
 easily excited and not easily managed, subject to par- 
 oxysms of temper, in which she would scream, throw 
 herself about, break furniture, and tear her clothing. 
 At eight or nine 3'ears old, she was found bathing with 
 boys, naked, and she said she had frequentl}' had con- 
 nection with older boys. She was sent to various Homes 
 and Schools, but could not be made to mind. At length, 
 at p vears of age, she was sent to the Taunton Insane 
 Asylum, where she remained tour years. Here she was 
 very violent, noisv and destructive, perfectly reckless of 
 personal injur}'', throwing herself headlong down flights 
 of stairs, if an attempt was made to secure her. At the 
 end of four years, she was removed to the Asylum for 
 the Chronic Insane at Worcester. After studying the 
 case for a year, and with the consent of her mother, per- 
 sonal chastisement was tried, at first with good efiect. 
 She went home from Worcester in May, 1880, and 
 behaved admirably for four months. At this time she was 
 sixteen vears old. In October, after a scantv men- 
 
37 
 
 strual flow attended with considerable pain, she began 
 to complain of her head, and appear nervous. After a 
 Tew days, being agitated by the lact that her mother 
 had found she wns studying surreptitiously, contrary to 
 her wishes, she rushed to the second-stor}^ window, and 
 in an instant had jumped from the roof of a veranda, 
 and was found screaming and maniacal on a walk below. 
 She was now sent to Danvers Asylum, with hallucina- 
 tions of sight and hearing. Dr. Goldsmith in reporting 
 her case * says. " Since October 14, 1880, she has been 
 a patient at the Danvers Hospital, where she has en- 
 gaged the sympathy and exhausted the resources of 
 treatment, medical and moral, of every one who has 
 come in contact with her."'" Not to make this account too 
 long, I will say that Dr. Goldsmith decided to try the 
 effect of removing the ovaries, and I did the operation 
 July 20, 1883. Recover}' was rapid. She left the Asy- 
 lum at the end of four weeks, and has since that time, 
 for lour years, been at home perfectly well, living the 
 same life as the other members of the family. She has 
 not menstruated since the operation. A perusal of Dr. 
 Goldsmith's paper, which has been reprinted with the 
 title, " A Case of Moral Insanity."' will well repay 
 the reader. 
 
 Case No. III. Was an utter failure. The patient 
 was a married woman, 27 3'ears old, formerly a school 
 teacher. At about 24 years of age she was married ; 
 within a few weeks unmistakable signs of mental de- 
 rangement appeared ; she attempted suicide b}' drown- 
 ing and was sent to an Asylum. She was a very violent 
 patient. When I saw her she was craz\' and more or 
 less demented. The Superintendent, from whose Asylum 
 she came, said that any operation would be perfectly 
 
 * American Journal of Insanity. October. 18S3. 
 
38 
 
 useless, but her physician was convinced that her excite- 
 ment was more at the menstrual period, and that her 
 insanity was, more or less, connected with the sexual' 
 organs. But the Superintendent was right. She recov- 
 ered rapidly from the removal of the ovaries and tubes, 
 on December 13. 1S83. She was kindly cared for at 
 the McLean Asylum for more than a year, and was 
 neither better nor worse mentally. She destroyed every 
 thing she could, broke windows, and struck her attend- 
 ants, and was demented. She died of Phthisis, in the 
 Worcester Lunatic Hospital, in 1886. never having 
 menstruated since the operation. Her case show^ed how^ 
 unnecessary perfect quiet is after laparotomy, for she 
 had to be tied to the bed and frequently broke all the 
 fastenings, and the straps of the Crosby bed on which 
 she lay, and yet the wound united by the first intention, 
 and she never had hernia. 
 
 Case No. IV. Another perfect failure, as far as 
 relief and cure are concerned. Her s}'mptoms ^\■ere 
 pain and tenderness in the left iliac region ever since 
 she could remember, worse on exertion or on standing. 
 Catamenia regular, painful. Married seventeen years, 
 no children. Appetite poor. Went to the Adams Ner- 
 vine Asylum, and remained five months, came home 
 more ner\ous, weak, and hysterical. Dr. Chamberlain, 
 of Lawrence, found a tender spot and a body in Doug- 
 lass space, that he thought might be a displaced ovary. 
 She stated that her life was a perfect burden, on account 
 of general illness, hyperaesthesia, pain in back, in 
 hands, etc., and she thought that all her symptoms 
 seemed to originate in her side and to the pain that she 
 felt between the umbilicus and the pubes. After etheri- 
 zation, her case reminded me of Case No. I, which had 
 been improved so much at first. Both ovaries were 
 removed on August 24, 1885, but not the whole of both 
 
tubes. Nothing especially remarkable was found on 
 examination of the ovaries. She recovered rapidly, 
 and has suffered nearly all the time since as she did 
 before the operation, on the whole, perhaps, in a milder 
 degree. She menstruates regularh' every 22 days, and 
 menstruation is accompanied by much pain. 
 
 Case No. V. Was another case of hystero-mania 
 with morphia-eating, in a single woman aged 28. The 
 history corresponds somewhat with that given in detail 
 in Case No. I. The ovaries and tubes were removed 
 November 25. 1885. She recovered, and wrote that she 
 was getting well and beginning a •• new life,"' and that 
 the past had been a '■ night-mare." or •■ horrid dream." 
 Her menstruation is irregular, but occurs about ever}^ 
 three weeks. I cannot learn (July, 1887) that she is 
 any better than before the operation. On the whole, I 
 cannot say that my experience with these five cases 
 would lead me to advise removal of the uterine appen- 
 dages for the cure of nervous symptoms and hj'steria, 
 unless the operation were advised by a competent alien- 
 ist. I acted in these cases as an instrument in the hands 
 of others. 
 
CHAPTER VII. 
 
 EXPLORATORY LAPAROTOMIES. 
 
 Case No. I. Was in a lady 62 years old, so large 
 that I could make no decided diagnosis, and in whom 
 respiration could not be carried on in a recumbent 
 position. I had to kneel down and cut upwards while 
 the patient lay on her side. About forty pounds of 
 ascitic fluid was removed, and a soft, friable tumor 
 attached to the sacrum and riffht ilium was found. 
 It was impossible to remove the tumor. The abdomen 
 was thoroughly sponged out and the wound sewn up. 
 The patient recovered rapidly and was much relieved. 
 The ascitic fluid never reaccumulated. About a year 
 afterwards the patient died, and at the autopsy, a soft 
 sarcomatous mass, filling the pelvis and lower abdominal 
 region, was found. 
 
 Case No. II. Was a case of ascites and burst papil- 
 lomatous cyst, attached to the pubes, ischium, and pelvic 
 organs generally. The ascitic fluid reaccumulated, and 
 the patient died about eighteen months later, having 
 steadily refused to be tapped. 
 
 Case No. III. Was a solid adherent tumor, whose 
 attachments and (jrigin were not determined. The 
 patient recovered, but was not benefited nor harmed ; 
 her condition remained about the same. I think she is 
 now dead, but she lived some years. 
 
 Case No. IV. Was a case of large malignant tumors 
 of ovaries, liver, omentum, and intestinal organs gen- 
 erally. The patient recovered, and died in March, 1883, 
 six months after operation. 
 
41 
 
 Case No. V. Was that of a woman 21 3^ears old, 
 with a considerable amount of ascitic fluid and many 
 little thin-walled cysts attached to the peritoneum and 
 intestines ; the pelvis was more or less filled by a friable 
 tumor filling the right side. Its exact attachments were 
 not made out, but it was immovable and was not inter- 
 fered with. The patient recovered, and during the next 
 four years fell into the hands of several surgeons who 
 tapped her. In 1885 she reported herself to Dr. J. 
 Foster Bush as having entirely recovered, and that her 
 tumor had entirely disappeared. If this be true, the 
 growth must have been syphilitic, I think, perhaps of 
 the nature of a gumma. 
 
 Case No. VI. One of abdominal cancer. Recov- 
 ered from the operation and went home, but probably 
 did not live long. 
 
 Case No. VII. Was another case of general ab- 
 dominal cancer with ascites, and was fatal. 
 
 Case No. VIII. On opening the abdomen, ascitic 
 fluid ran out and coagulated fibrin, exactly like the co- 
 agulated fluid of pleurisy after it has been removed 
 from the thorax; this was bailed, scooped, and sponged 
 out. The omentum had become an elongated tumor 
 of a pinkish coral color ; the spleen was in the same 
 condition. There was general cancer. Neither the 
 uterus nor ovaries could be felt ; they seemed to be shut 
 off by a wall of cancer. Nodules were felt in the 
 mesentery. The patient recovered from the operation, 
 and was quite comfortable for a time, but died about 
 seven months later. 
 
 Case No. IX. Was one of tuberculous salpingitis, 
 with cheesy masses extending upwards to the diaphragm 
 6 
 
42 
 
 on both sides, and general tubercular disease of the per- 
 itoneal tissues matting them together. The operation 
 was fatal. The age of the patient was 17 years. 
 
 Case No. X. This case was one of tubercular peri- 
 tonitis with ascites, in a thin, emaciated, feeble, single 
 girl of 21. What looked like the stomach distended 
 with fluid filled the upper portion of the abdominal 
 cavity. This tumor was about ten inches in diameter. 
 Owing to the presence of lymph and adhesions, the liver 
 and spleen could not be felt. Much hanph was lying in 
 masses and flakes upon the abdominal viscera. There 
 were deposits of tubercles sprinkled about on all the 
 abdominal contents seen. The wound healed b}' first 
 intention, but opened spontaneously on the eighteenth 
 day, and gave exit to much clear serum. She went 
 home in good spirits, July 12, 1884. The catamenia, 
 which had been absent since February, 1884, returned 
 in January, 1885, and have been regular since. The 
 wound continued to discharge, but the amount gradually 
 diminished, until in May, 1885, it was very slight. She 
 became fat and strong, and able to do her housework, 
 and gained over thirt}^ pounds in weight. She was 
 married in June, 1885. I saw her in November, 1886. 
 She was strong and well. The wound had contracted to 
 a little sinus, which would admit a probe, and which dis- 
 charged about a drachm or less of pus a day. A won- 
 derful recovery. 
 
 Case No. XI. Was that of a married woman, 46 
 years old. Her abdomen was full of ascitic fluid, and 
 contained a tumor reaching to the ensiform cartilage. 
 She had been tapped five times in four months. When 
 the abdomen was opened, about twenty pounds of ascitic 
 fluid ran out. The parietal peritoneum and that of the 
 bowels, mesentery, and abdominal viscera, was Cf)vered 
 
43 
 
 more or less with cancerous deposits, a few of which 
 were removed for microscopic examination. The left 
 ovary was a tumor about the size of a large football, and 
 was covered with adherent intestines, and with the 
 growths above mentioned. It was impossible to remove 
 the tumor, and the cancerous condition of the peritoneum 
 seemed to preclude complete recovery. Two large 
 india-rubber drainage tubes were put in on either side, 
 and another small one in the pubic region, with the 
 hope of establishing permanent drainage. In the first 
 twelve hours much fluid was discharged, but this grad- 
 ually ceased, and in a few days all the tubes were 
 removed. I have never succeeded in establishing per- 
 manent drainage in ascites by means of tubes, and I 
 never expect to. The track of the tube becomes sur- 
 rounded with lymph, and the only portion of the perito- 
 neal sac drained, is that tubular portion in which the 
 drain lies. Sometimes, as in Case X, nature establishes 
 drainage and cures the patient, but she does this without 
 the aid of tubes. The operation was done on the 3d 
 of January, 1885, and she died six months later. 
 
 Case No. XII. Was that of a little girl ten years 
 old. The abdomen was found filled with hard tumors, 
 thoroughl}- adherent and immovable. The operation 
 was done July 9, 1885, and she died on the 27th of 
 April, 1886, having lived very comfortably most of the 
 time. The growth found its way through the skin of 
 the abdomen about three months before death. 
 
 Case No. XIII. Was one of malignant abdominal 
 tumor. Much more comfortable after Laparotomy. 
 
 Case No. XV. Was one of small adherent tumor 
 attached to the brim of the pelvis on the right side, and 
 to the intestines. It could not be removed. The patient 
 
44 
 
 recovered from the operation, and died in July, 1887, 
 eight months after recovery from the operation. 
 
 Case No. XVL Was another case of malignant 
 tumor of the omentum and peritoneum, in which I tried 
 to establish drainage by means of rubber tubes, but the 
 ascitic fluid accumulated in spite of the tubes. The 
 operation was done November 12, 1886, and was suc- 
 cessful so far as immediate recovery went, but the patient 
 died some months after her return home. 
 
 Case No. XVIII. Had ovariotomy successfully per- 
 formed six years before. The exploratory operation 
 was done in February, 1887, but the tumor of the 
 remaining (left) ovary could not be removed. The 
 operation was fatal. 
 
 Case No. XIX. Was another case of tubercular 
 peritonitis in a fat, healthy-looking girl of 17. The 
 operation was successful. Time enough has not elapsed 
 to decide whether the abdominal exploration will be 
 curative. 
 
CHAPTER VIII. 
 
 LAPAROTOMIES FOR RENAL TUMORS. 
 
 Case No. I. A married woman aged 30, urinary 
 symptoms coming on during pregnancy. In 1878, 
 patient became pregnant, and when quite large, at eight 
 months, noticed gravel in the urine, and suffered from 
 sharp, lancinating pains in region of ureter ; at times, 
 the pain was so severe as to cause her to faint. Her 
 confinement was completed, and in two years she 
 became again pregnant, and was confined of a second 
 child. After one of her attacks of pain, vomiting, 
 cough and general constitutional disturbance, she noticed 
 a swelling in the right hypochondrium and right lumbar 
 region which has increased since. At this time her urine 
 was loaded with pus, and her micturition was very fre- 
 quent. I saw her in April, 1882 ; at that time her urine 
 was chocolate-colored; S. G., 1033; much sediment; 
 reaction acid ; albumen one-half per cent. ; sediment pus, 
 blood, hyalin, and granular casts, and a few fatty casts. 
 Her fasces contained much blood and pus. A tumor, 
 the size of a large cocoanut, occupied the whole of the 
 right hypochondrium, and reached nearly to the spine; 
 it was uniformly firm and tense, but fluctuating and 
 movable as a whole. On April 19, a vertical incision 
 about three inches to the right of the umbilicus was 
 made ; it was about four inches long. I came down upon 
 a dense membrane (the peritoneum) covering the tumor. 
 A director was thrust in and dark, brownish fluid welled 
 up ; a free opening was then made, and about six ounces 
 of inoffensive pus ran out. The kidney was then ex- 
 plored by the finger, and two calculi, one two inches. 
 
46 
 
 and the other half an inch in diameter, were removed. 
 A drainage tube was fastened in, and the wound dressed 
 with carbolized gauze. Vomiting had been one of her 
 symptoms for several months, and was not entirely 
 relieved b}^ opening of the abscess, and the removal of 
 the calculi. The blood and pus in the alvine discharges 
 ceased, and she became much more comfortable, and 
 could lie on the right side ; the abscess was washed out 
 daily, and at times, small stones (one-eighth inch in 
 diameter) and gravel were brought out. On May 2, 
 the urine was pale, clear, with very little sediment, 
 about one-half per cent, of albumen, and contained a 
 few granular casts, pus, and epithelial cells. In about 
 a fortnight she sat up, and eat pretty well, but continued 
 ver}^ weak. The tube was removed on May 14, as it 
 was causing some soreness and the fistula seemed well 
 established. On the i6th, another tube was placed in 
 the wound. She gradually became weaker and weaker, 
 and never really gained much, though the operation 
 relieved her for a time. On May 23d she died. No 
 autopsy was allowed. This patient, with serious disease 
 of the kidneys, was not a good subject for any operation, 
 but to-day, I think I should make the opening in the loin 
 instead of along the outer border of the rectus muscle, 
 for I think the drainage would be better, though I am 
 inclined to think the case was a hopeless one, if any 
 case ought to be considered so. 
 
 Case No. II. The case, one of sarcoma of the left 
 kidnev, weighing three and a half pounds, occurred in 
 a man, by occupation a seaman, 29 years old. His 
 symptoms were the discovery of the tumor in the left 
 hypochondrium in August, 1882, emaciation, blood in 
 the urine at times, pain in the back and loss of strength. 
 After considerable study and examination, I decided that 
 
47 
 
 the tumor was renal sarcoma. An incision was made 
 along the course of the left linea semilunaris, and the 
 tissues divided. The empty descending colon was 
 spread out very thin and stretched over the tumor, and 
 was not immediately recognized as such, and was slightly 
 wounded at the very first incision. The opening was 
 sewn up with a continuous silk suture and the operation 
 continued. The incision was carried downward near to 
 the anterior spine of the ilium, and upward through the 
 cartilage of the tenth rib ; this incision was supplemented 
 by another, at right angles, through the oblique and trans- 
 versalis muscles as far as the quadratus. An incision 
 was then made through the posterior layer wall of the 
 peritoneum, and the tumor peeled out of its bed, very 
 much as one would pull out a kidney at an autopsy. 
 The renal vessels and ureter were then secured and tied, 
 and the substance of the kidney cut through on a level 
 with the pelvis. The seat of the tumor was then cleansed, 
 a rubber dra'inage tube passed into the cavity from the 
 loin, and the wound sewed up. Almost no urine was 
 secreted after the operation, and he died November 26, 
 1883, two days after nephrectomy, only eight ounces 
 of urine having been drawn from the bladder in the 
 two days following the operation. At the autopsy, 
 general peritonitis and cloudy swelling of the right 
 kidney were found. 
 
 Case No. III. Was one of large sacculated right 
 kidney full of pus, in a woman 42 years old. I thought 
 the tumor cancerous. The incision was along the course 
 of the linea semilunaris. The ureter was easily isolated 
 and secured in the lower angle of the w^ound. The 
 renal vessels were secured and tied, and the kidney 
 removed. I thought the operation went off very well, 
 but the woman died on the third day with suppression of 
 
48 
 
 urine. The kidney and pus contained therein weighed 
 loj pounds. Onh' three ounces of urine, which was 
 chiefly pus, was drawn from the bladder after the 
 operation. At the autopsy, there was not the least trace 
 of peritonitis, and there had been no hemorrhage. 
 I suppose the death was due to shock and suppression 
 of urine. 
 
CHAPTER IX. 
 
 MISCELLANEOUS LAPAROTOMIES. 
 
 Removal of two immense Lipomas. 
 
 Case No. I. This tumor occurred in a man 38 years 
 old. The tumor was first noticed in March, 1881, 
 though it must have existed long before that date. The 
 tumor filled the abdominal parietes and seemed to fluc- 
 tuate. It had been aspirated many times without any 
 result ; it was fast causing distress and entire inability 
 to work. On October 30; 1881, I made an exploratory 
 incision fifteen inches long. There were slight adhe- 
 sions to the liver. The tumor was about two feet long 
 in its longest diameter, and about a foot long in its 
 shortest. It was covered by peritoneum. I pulled the 
 tumor out of the abdomen until I found that its envelope 
 ran down towards the spinal column, and was then re- 
 flected upon the abdominal parietes, i. e., it was retro- 
 peritoneal. At the lower part there were no adhesions 
 to the bladder, but the tumor seemed to have a central 
 pedicle next to the spinal column, extending from the 
 neighborhood of the cceliac axis downwards along the 
 lumbar vertebras. As it was not known what organs the 
 tumor might contain, and as it was feared that the 
 removal of it might be fatal from shock and heemorrhage, 
 it was decided to replace the mass, and with great diffi- 
 culty it was pushed back under the peritoneum and 
 abdominal muscles and skin, and nearly one hundred 
 sutures were required to close the incision. The patient 
 recovered rapidly, and went home with the wound 
 healed. (This operation was an exploratory incision, 
 
 7 
 
/ 
 
 so 
 
 and shoulci have found its place among the exploratory 
 operators. ) 
 
 Tj^ ^itient went about travelling in' the horse-cars 
 andHgoi^g where he pleased. He walked with consid- 
 er aMepQom fort, wearing a supporting sling which held 
 uj/tne jtumor by straps passing over his shoulders. He 
 becani^ more and more impatient to have another attempt 
 mad^'to remove his burden, and I reluctantly and rather 
 against my better judgment consented to try again. 
 He said, "You know it is neck or nothing this time, 
 doctor." On the 5th of February, 1882, I opened the 
 abdomen by the side of the cicatrix of the former inci- 
 sion, and removed two tumors weighing fifty pounds. 
 They were myxo-lipomas. The incision was about 
 twenty inches long, and a transverse incision four inches 
 long was made on the left side just above the umbilicus. 
 The ascending colon crossed the tumor transversely. 
 The peritoneal capsule of the tumor was more or less 
 torn and ruptured, and the tumor was lifted up with 
 great difficulty, owing to its weight. The ascending 
 colon was separated from the tumor with some difficult}^ 
 and rolled off, after dividing and tying most of its 
 mesentery. The vascular attachments of the tumor 
 were clamped and tied or burnt, from time to time, as 
 was necessary, and the tumor was removed from the 
 abdomen. Another apparently purely myxomatous one 
 now came into sight ; after some hesitation this was 
 removed also ; it occupied the right liypochondriac and 
 lumbar region, the liver being pressed upwards and to 
 the left into the epigastrium. The peritoneal capsule of 
 this tumor was tough and strong ; some of it was removed 
 with the tumor and some of it was left behind. All 
 bleeding points were now secured. Another tumor 
 about ten inclies long was now seen lying on the abdom- 
 inal aorta and pulsating with it. This I decided to let 
 alone. Everything looked as favorable as one could 
 
51 
 
 expect after so severe an operation ; not much blood had 
 been lost, the pulse was 85, and very feeble, but not 
 extremely so. The operation had been thoroughlv an- 
 tiseptic. The intestine which had been pushed off the 
 tumor, or rather from under which the tumor had been 
 withdrawn, was largely deprived of its mesenter}^ and 
 might not be well nourished, but, with this exception, 
 affairs looked as promising as after a severe successful 
 ovariotomy. The patient was put in bed and the foot 
 of the bed w^as elevated. He seemed to do ver}^ well 
 and was conscious and comfortable five hours later, and 
 seemed to be getting along well. He asked for a drink 
 of water, and when it was brought said, " I think I am 
 going," and died. The autopsy was very kindl}" made 
 by Dr. Gannett, who found three tumors of various 
 sizes and the same character as those removed, and no 
 peritonitis. 
 
 Case No. H. Was exacdy like No. I, except that 
 the patient was a female 61 years old. I saw her in 
 1881, and could not believe that the tumor did not con- 
 tain fluid until I had aspirated it in many places without 
 result. It fluctuated and gave a wave on percussion, 
 but it was solid, or at least semi-solid. The operation 
 was similar to the one just described, and the situation 
 of the tumor the same. The patient died soon after the 
 completion of the operation. The tumor weighed 35 
 pounds. The operation was done March 21, 1882. 
 These are the only two fatty tumors within the abdomen 
 that I have ever seen. 
 
 A Case of Pelvic Abscess of long standing communi- 
 cating -with the Rectum. 
 
 The patient was a single w^oman thirty years old. 
 Nineteen months before I saw her, she had been 
 
52 
 
 attacked \A'ith pains in the bowels, abdominal disten- 
 tion, chills and fever, etc., i. e., peritonitis. The date 
 of this illness was January, 1884. The catamenia 
 ceased for fifteen months. On and after March, 1884, 
 she remained at home and seldom went out on ac- 
 count of pain and discomfort in the pubic region. 
 In April, 1884, pus was discharged from the rectum 
 in varying quantities nearly every day. In August, 
 1884, I advised hot vaginal and rectal douches, and 
 these were continued twice a day for six months. She 
 improved and was able to go out, and the catamenia 
 reappeared in April, 1885, and continued for three 
 months. In June, 1885, she began to grow worse and 
 the pus increased in amount. On palpation, a mass of 
 induration was felt in the pubic and iliac regions. On 
 August 29, 1885, the patient was etherized, and the rec- 
 tum dilated. An opening from the rectum into the 
 abscess was found towards the left at a point as high as 
 the finger would reach, and a uterine sound was bent 
 and passed in, and the tip brought up against the 
 abdominal parietes. The tip of the sound was cut 
 down upon and brought out through the anterior abdom- 
 inal parietes at a point in the centre of a triangle, of 
 which the base was a line from the umbilicus to the left 
 anterior spine of the ilium, and the apex the pubes. 
 Considerable offensive grumous pus came from the rec- 
 tum. A rubber drainage tube was passed from the 
 abdominal wound downwards, and out through the rec- 
 tum and anus. To the finger the upper opening seemed 
 to pass through the mesentery or omentum. In the next 
 few days considerable pus was discharged from both 
 openings. For twenty-four hours the discharge from 
 the anterior opening was slightly fascal. At the end of 
 a week the tube was shortened and drawn downwards to 
 allow the upper opening to close, tor fear of establishing 
 a permanent fascal fistula, and the tube protruded from 
 
53 
 
 the rectum. The presence of the tube in the anus 
 became very uncomfortable, and it was removed, the 
 opening in the rectum being daily dilated with the 
 finger. The patient went home September i6. On 
 November 28, 1885, I saw her and she looked much 
 better than at any previous time during my acquaintance 
 with her. She had gained flesh and color. There w^as 
 still some induration in the pelvis, and pus was occa- 
 sionally discharged from the anus. She died of Acute 
 Phthisis in July, 1886. The lungs were filled with 
 tubercles, in some places softened, and at the apex of 
 one was a cavity. The pelvic organs were matted 
 together, so that the outlines of the generative organs 
 were lost. The abscess looked as if it might have 
 been tubercular, perhaps tubercular salpingitis, but 
 neither ovary nor Fallopian tube could be made out, 
 and only by the sense of touch, and by incision, could 
 the body of the uterus be made out. 
 
 Case of Laparotomy for Perityfhlitic Abscess. 
 
 [Reported in the New York Medical Record, Vol. CXIV, page 388.] 
 
 A boy II years old began to have pain in abdomen, 
 January 6, 1886, and on January 9, I opened the abdo- 
 men on a line a couple of inches above and a little 
 behind the anterior spine of the right ilium, about four 
 inches from the umbilicus and six inches from the 
 spinous processes of the vertebras. I came down on the 
 healthy bowel, and felt other coils, behind and below, 
 containing feecal masses, or else enlarged glands, either 
 mesenteric or lumbar. These organs were adherent to 
 one another by a recent plastic process, and on poking 
 about with my finger and carefully separating them, an 
 abscess containing about an ounce or more of offensive 
 (rotten-egg) smelling pus was opened. So far as pos- 
 
54 
 
 sible, I kept the pus out of the peritoneal cavity, and 
 alter empt3ang the abscess, put in a double drainage 
 tube. The abscess continued to discharge for about 
 four weeks. The boy is now stout and strong. 
 
 Cases of Intestinal Obstruction. 
 
 Case No. I. Is a sequel of Case No. 56 of the ovari- 
 otomies, and is reported in the Boston Medical and Sur- 
 gical Journal, Vol. CVII, p. 413. The obstruction was 
 caused by annular stricture of the sigmoid flexure of the 
 rectum. An artificial anus was established at the lower 
 end of the former scar in the pubic region. The patient 
 was very comfortable for nearly a year, and died of 
 general abdominal cancer in November, 1882. 
 
 Case No. II. Was unsuccessful. The obstruction 
 was in the splenic curvature of the colon, and the artifi- 
 cial anus was made in the coecum. The patient was 
 very stout and the weather very hot, the mercury stand- 
 ing at 96° fahrenheit in the shade at the time of the 
 operation. (Case reported in Boston Medical and Sur- 
 gical Journal, Vol. CX, p. 146, February 14, 1884.) 
 
 Case No. III. Was caused by a band from a Meck- 
 el's diverticulum in a young man of 21, \\\iO had had a 
 fascal umbilical fistula from birth. This case is de- 
 scribed in the American Journal of the Medical Sci- 
 ences, Vol. CLXXV, p. 56. Suffice it to say that I did 
 not find the band, that I relieved the obstruction by an 
 artificial anus at the umbilicus, and that the patient died 
 at the end of a week. 
 
 Case No. IV. Has been described in the Ovariotomy 
 Cases, No. CCXXII. 
 
55 
 
 I can only say that if I had known at the time of 
 operating on Case No. Ill, what I know now, the patient 
 would have had a much better chance for recovery. 
 Prof. Fitz's paper has taught me much, and I have oper- 
 ated successfully for the cure of a diverticulum opening 
 at the umbilicus, i. e., the omphalo-mesenteric remains 
 of foetal life. 
 
 La^a7'otomy for Pyosal^inx and a case of Tubo- 
 ovarian Cyst filled with -pus. 
 
 Case No. I. May 21, 1886. A single woman. 22 
 years old, plump and well-nourished, has had much 
 pain in the rectum and vagina since July, 1885. Cata- 
 menia normal. On examination a hard tumor was felt in 
 the left pehdc region the size of an apple, and the 
 tissues between the vagina and rectum were thickened. 
 I operated May 21, 1886. With some difficulty the left 
 ovary was pulled up, and a cyst the size of an orange 
 was tapped and emptied of purulent-looking fluid. The 
 ovary and the tube, which was the size of the thumb 
 and filled with pus, were then removed, and the pedicle 
 tied man}' times on account of bleeding. The right 
 ovary was fixed between the rectum and uterus, and was 
 dislodged with great difficulty. I could not detach the 
 right tube. The right ovary was about the size of a 
 plum, and filled with many abscesses. The disease was 
 probably of gonorrhoeal origin. Drainage was used. 
 Recovery was rapid. A suture was discharged some 
 months later. She is now (Jul}', 1887) well and strong. 
 
 Case No. II. One of suppurating tubo-ovarian cyst, 
 in a woman 44 years old. Operation done December 6, 
 1886. Some ascites. Tumor largely composed of a 
 dilated tube with a communicatincj sacculated ovarv. 
 
56 
 
 About three pounds of offensive pus removed, and the 
 tumor was separated with much violence from the neigh- 
 boring parts. No pedicle could be found. The oper- 
 ation lasted over two hours. Transfusion was employed, 
 20 ounces of warm solution of chloride of sodium being; 
 put into the basilic vein ; this restored the pulse and 
 color. She died, however, about twenty-six hours after 
 the operation. Very possibly, the origin was tubercular 
 pyo-salpinx. 
 
^ted that patients have 
 
 No. 
 
 
 Health since. 
 
 Fibroid seen at 
 Operation. 
 
 Fibn 
 ai< 
 
 6 
 
 F 
 
 Excellent. 
 
 No. 
 
 
 7 
 
 1, 
 
 
 " 
 
 
 8 
 
 '^ 
 
 
 " 
 
 
 9 
 
 S 
 
 " 
 
 
 
 10 
 
 s 
 
 ic 
 
 « 
 
 
 11 
 
 N 
 
 
 
 
 12 
 
 D 
 
 Poor. 
 
 « 
 
 
 13 
 
 F 
 
 
 " 
 
 
 14 
 
 11 
 
 Excellent. 
 
 " 
 
 1 
 
 15 
 
 W 
 
 
 « 
 
 
 16 
 
 Ji 
 
 Excellent. 
 
 " 
 
 
 17 
 
 Ji 
 
 
 
 r 
 
 I 
 
 18 
 
 
 
 
 
 
 
 19 
 
 N 
 
 li 
 
 " 
 
 
 
 20 
 
 D 
 
 " 
 
 1 
 
 21 
 
 F(i 
 
 .. 
 
 
 
 
 
 
 
 - 
 

 Antiseptic 
 
 ovariotomies. ' 
 
 Oar'bolic Acid Spray used. Sixth ovariotomy the first 
 
 antiseptic 
 
 one. "Wlien it is not stated that 
 
 patients have not answered, or have died, it is kno-vvn that they are alive. 
 
 ""• 
 
 DuUi of - 
 Operation. 
 
 ... 
 
 mod of Tumor. 
 
 m.c. ovary. 
 
 «■— "- 
 
 Childrcu before. 
 
 ™'-'— ■ 
 
 Married or Single 
 
 ¥„e!r.' 
 
 .up.„. 
 
 Ligatures lienrd 
 
 Health Bincc. 
 
 Fibroid Been at 
 
 ^SU='' 
 
 Twisted pedicle. 
 
 .O.U,.. 
 
 Drainage. 
 
 AdhcBlons. 
 
 Death tiubscquciit- 
 
 » 
 
 Fob. 27, 1877. 
 
 1. 
 
 Mu„.>ocu,„cy.. 
 
 Left. 
 
 To.. 
 
 No. 
 
 NO. 
 
 Single. 
 
 Long. 
 
 Te.. 
 
 No. 
 
 Excel lent. 
 
 NO. 
 
 NO. 
 
 NO. 
 
 Recovered. 
 
 NO. 
 
 re.. 
 
 Hen,.,,goo.i. 
 
 ' 
 
 Uorch 30, 1878. 
 
 20 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Living iniaST. 
 Has an abdominal 
 
 » 
 
 "Aug. 31,1878. 
 
 - 
 
 
 
 No. 
 
 .b?S». 
 
 
 ™- 
 
 
 
 
 
 
 „ - 
 
 
 
 
 
 
 « 
 
 Sopl. 17, 1818. 
 
 00 
 
 
 
 
 NO. 
 
 
 
 
 Unknown. 
 
 
 
 
 
 
 
 
 
 
 .. 
 
 aept. 20, 1878. 
 
 34 
 
 
 
 TC. 
 
 X.O. 
 
 Odg. 
 
 — 
 
 
 NO. 
 
 
 
 
 
 
 
 
 
 
 " 
 
 Nov. 8, 1878. 
 
 ■-48 
 
 Dnlloculor •• 
 
 
 
 No. 
 
 
 S,„.,e. 
 
 
 
 
 
 
 
 
 Died. 
 
 
 
 after operation. 
 
 
 Doc. 28, 1878. 
 Ifob. IS, 1879. 
 Mnroh 0, 1870. 
 Miiy 11, 1870. 
 Juno 20, 1870. 
 July 10, 1870. 
 Oct. 1, 1870. 
 Nov. 28, 1870. 
 Dec. 21, 1870. 
 
 2J 
 
 Fapllloma. 
 
 Multiloeular cyat. 
 
 Dnilociilar 
 ilult. & dermoid. 
 
 Eieht. 
 Right. 
 Left. 
 
 No. 
 Yc. 
 
 One. 
 
 No. 
 
 
 Biuglo. 
 Single. 
 
 
 -■ 
 
 
 Poor. 
 
 Excellent. 
 
 
 
 
 Died. 
 
 Recovered. 
 
 
 NO. 
 
 Died, Jaly, 1870. 
 Cunoer of lungs 
 
 r/ulou* Only one 
 
 . 
 
 1«. 8,18,0. 
 
 30 
 
 
 Right. 1 
 
 (TwiDB.) 
 
 
 M.„,... 
 
 
 
 
 
 
 
 
 
 
 NO. 
 
 
j^ed that patients have no 
 
 lealth since. 
 
 Good. 
 
 Fibroid seen at 
 Operation. 
 
 ]sro. 
 
 Yes. 
 
 No. 
 
 Yes. 
 
 Fibroid 
 at Opi 
 
 No. 
 
 Tea. 
 
 No. 
 
Antiseptic ovariotomies. Carbolic Ac 
 
 d Spraj used. Sixth 
 
 ovariotomy the first antiseptic one. When it is not stated that patients have not answered, 
 
 or have died, it 
 
 is Imown that they are ahve. 
 
 »„. 
 
 Date of 
 Operation. 
 
 Age. 
 
 K«„,T.„=,. 
 
 Which Ovary. 
 
 — • 
 
 Children before. 
 
 CWldren sincG. 
 
 Married or Single 
 
 SL°.' 
 
 Rupture. 
 
 Llgaturea heard 
 
 Health since. 
 
 Opemiion. 
 
 Fibroid removed 
 ai Operation. 
 
 Twiflled pedicle. 
 
 Rceult. 
 
 Drainage. 
 
 Adhefllona. 
 
 DciKheubecquenl- 
 
 . 
 
 
 - 
 
 Unilocular cyst. 
 
 Broad ligament. 
 
 Tes. 
 
 Four. 
 
 
 M„«ea. 
 
 Short. 
 
 "»• 
 
 No. 
 
 --■ 
 
 No. 
 
 ... 
 
 
 
 Recovered. 
 
 ... 
 
 No. 
 
 
 . 
 
 March 23, 1880. 
 
 3, 
 
 
 Left. 
 
 ... 
 
 Three. 
 
 
 
 Long. 
 
 
 
 
 V... 
 
 
 
 
 
 
 V... 
 
 never appeared 
 
 » 
 
 April 1, 1880. 
 
 ,S 
 
 
 
 Tea. 
 
 ... 
 
 
 Single. 
 
 
 
 
 
 ... 
 
 
 
 
 
 
 
 
 K 
 
 April 17, 1880. 
 
 « 
 
 
 
 ... 
 
 .... 
 
 
 M.„l.. 
 
 S.„l. 
 
 
 
 
 
 .... 
 
 
 
 
 
 
 ■■ 
 
 
 IS 
 
 April 20, 1830. 
 iray 18, 1B80. 
 July 10, 1880. 
 Jnly 15, 1880. 
 
 3. 
 
 Multilocnlar " 
 
 Left. 
 Broad ligament. 
 
 So. 
 
 .... 
 
 
 Shiglo. 
 
 Married. 
 
 Single. 
 
 Long. 
 
 
 
 
 ■• 
 
 
 
 
 
 
 
 ... 
 
 Died, in 1881, of 
 
 . 
 
 Jnly 31, 1880. 
 Aug. 1, 1880. 
 Aug. 21, 1880. 
 Aug. 22, 1880. 
 Sept. 1, 1880. 
 Sept. 2. 1880. 
 Sept. 7, leSO. 
 
 46 
 
 Multiiocular " 
 Dermoid " 
 
 Papilloma 
 
 Right. 
 Right. 
 
 No. 
 
 x™. 
 
 No. 
 
 arrid 
 Single. 
 
 
 
 
 
 Yes. 
 
 
 
 
 Recovered. 
 
 
 No. 
 Yes. 
 
 operatloD. 
 
 Died, four daj'H 
 after operation. 
 
 Died, June, lesi. 
 
 . 
 
 Sept. 23, 1880. 
 
 33 
 
 M„U„.™,„.., 
 
 
 .„. 
 
 Six. 
 
 Girl, 1881. 
 
 „.„,.. 
 
 
 No„.wer.' 
 
 .0..0... 
 
 
 ... 
 
 
 
 
 
 
 
 ITuanotanswercd. 
 
^ted that patients have no 
 
 No. 
 
 49 
 
 [ealth since. 
 
 Good. 
 
 aood. 
 
 esumed to be 
 sood. 
 
 Poor. 
 
 btter than be- 
 Ire, except for 
 -^eart disease. 
 
 Good. 
 
 Fibroid seen at 
 Operation. 
 
 Not known. 
 
 No. 
 
 Yes. 
 
 No. 
 
 Yes. 
 
 No. 
 
 Fibroid ; 
 at Ope 
 
 N 
 

 Antiseptic 
 
 ovariotomies. Carbolic Acid Spray used. Sixth ovariotomy the first 
 
 antiseptic 
 
 one. Wlien it is not stated that 
 
 patients have not answered, or have died, it is known that they are ahve. 
 
 ... 
 
 Operation. 
 
 .... 
 
 KMO.T,,™,. 
 
 m.ho™y. 
 
 Catamenia Bince, 
 
 Children before. 
 
 omm™..™. 
 
 Married or Single 
 
 ¥SL°.' 
 
 Rupture. 
 
 Ligatures heard 
 
 Health Bince. 
 
 Fihrold seen at 
 Operation. 
 
 nl Upcralion. 
 
 Twisted pedicle. 
 
 ■^..t. 
 
 .„,.... 
 
 A....,o... 
 
 '''ram.'.™'' 
 
 38 
 
 Oct. 1, 1880. 
 
 43 
 
 lluUilocular cyai 
 
 Eight. 
 
 
 Not aUBwored. 
 
 
 Single. 
 
 
 Nottnowo. 
 
 Not known. 
 
 Not known. 
 
 «"'"— 
 
 .0. 
 
 ... 
 
 Recovered, 
 
 ... 
 
 Y... 
 
 
 3, 
 
 Oe. CS... 
 
 38 
 
 Unilocular " 
 
 
 Irregular. 
 
 Three. 
 
 
 w... 
 
 
 .„. 
 
 No. 
 
 «... 
 
 .0. 
 
 ■• 
 
 
 
 
 
 
 40 
 
 NOV. .,,880. 
 
 31 
 
 «ul....™o,.. 
 
 : 
 
 Irregular and 
 
 No. 
 
 No. 
 
 Married. 
 
 ■ij " 
 
 
 
 
 
 ,: 
 
 
 
 " 
 
 No. 
 
 
 42 
 
 Deo. 18, 1880. 
 Dec. 21, 18S0. 
 Jau. 6, 1831. 
 Ji.n. . 26, 1881. 
 
 April S, 1881. 
 April 14, 1881. 
 April m, 18S1. 
 April 17, 18S1. 
 
 38 
 
 Multilocular cyat. 
 
 Kigbt. 
 
 Right. 
 Right. 
 
 DiseaeedTiidneyB 
 
 after operalipu, 
 EryBipeliisofface. 
 
 Ulcd of op era Li on. 
 
 Three. 
 
 /SS- 
 
 Single. 
 Single. 
 
 Single. 
 
 3i ■' 
 
 Long. 
 Long, 
 
 ... 
 
 No. 
 
 Poor. 
 foa-,°ex<;elH for 
 
 Good. 
 
 YeB. 
 
 .... 
 
 
 „.„„... 
 
 
 No. 
 
 only pit'iixmt. 
 FiicKil Erj'siiK'laa 
 
 Died, May, ISSl. 
 
1 
 
 yted that 
 
 Datients have n 
 
 ro. 
 
 lealth since. 
 
 Fibroid seen at 
 Operation. 
 
 Fibro 
 atO 
 
 54 
 
 bt good, — fair. 
 
 No. 
 
 
 )5 
 
 Good. 
 
 " 
 
 
 )6 
 
 Poor. 
 
 " 
 
 
 )7 
 
 Good. 
 
 " 
 
 
 )8 
 
 1 
 
 " 
 
 
 9 
 
 i 
 
 « 
 
 
 
 
 i 
 
 " 
 
 
 1 
 
 Poor. 
 
 -« 
 
 
 2 
 
 Good. 
 
 " 
 
 
 3 
 
 " 
 
 " 
 
 
 4 
 
 K 
 
 « 
 
 
 5 
 
 « 
 
 Yes. 
 
 
 6 
 
 " 
 
 No. 
 
 
 7 
 
 
 
 
 8 
 
 
 No. 
 
 
 9 
 
 " 
 
 Yes. 
 
 
Antiseptic ovariotomies. Carbolic Acid Spray used. Sixtl 
 
 ovariotomy the first antiseptic one. When it is not stated that 
 
 )atients liave not answered, 
 
 or have died, it 
 
 is known that they are alive. 
 
 No. 
 
 0?So'n. 
 
 Age. 
 
 K1..o.T™o,. 
 
 ™*-- 
 
 — "• 
 
 Children before. 
 
 --»-• 
 
 Married or Single. 
 
 \SL°! 
 
 Rupture. 
 
 "^■;»:"-' 
 
 Healtli since. 
 
 OpeniiioQ. 
 
 "ro'pV™s.T^ 
 
 Twiatcd pedicle. 
 
 K0.O,.. 
 
 Dminage. 
 
 Aa.o.,0... 
 
 DeatiiBubaoquent- 
 
 . 
 
 May 5, 1881. 
 May 22, 1881. 
 
 3, 
 
 Multilocnlar cyat. 
 
 Rieht. 
 
 .0. 
 
 NO. 
 
 
 
 
 No. 
 
 
 Not good, — fait. 
 Good. 
 
 No. 
 
 
 '. 
 
 
 ....... 
 
 No. 
 
 No. 
 
 Dled, Jan., 1886. 
 
 S. 
 
 May 26,1881. 
 
 42 
 
 
 " 
 
 
 Two. 
 
 
 Married. 
 
 , „ 
 
 
 
 Poor. 
 
 
 
 
 
 
 
 Yo.. 
 
 
 " 
 
 a»= 1,1881. 
 
 " 
 
 UDiloeolar 
 
 L.... 
 
 Ye.. 
 
 
 
 Widow. 
 Married again. 
 
 4i " 
 
 
 
 Good. 
 
 
 ■■ 
 
 
 
 
 
 NO. 
 
 
 . 
 
 
 .2 
 
 CyBt. 
 
 
 No. 
 
 
 
 "SS"' 
 
 S..„. 
 
 
 
 
 
 
 
 
 
 
 
 
 . 
 
 
 81 
 
 
 
 
 
 
 -"«■ 
 
 
 
 " 
 
 
 
 
 
 
 ■' 
 
 
 
 
 .. 
 
 
 1. 
 
 
 
 .... 
 
 NO. 
 
 
 Sfngle. 
 
 4 .. 
 
 ■■ 
 
 
 
 
 
 
 
 
 
 Yo.. 
 
 
 .. 
 
 Juno 30, 18B1. 
 
 88 
 
 a.„o„a. 
 
 
 NO. 
 
 " 
 
 
 W.o„. 
 
 a .. 
 
 
 
 POO,. 
 
 
 
 
 
 ■■ 
 
 
 NO. 
 
 ™i=r°' 
 
 ,. 
 
 Jaly 7, 1881. 
 
 =. 
 
 Unilocular cyst. 
 
 brouU Ugutnent. 
 
 .e.. 
 
 •• 
 
 
 Single. 
 
 8 .. 
 
 
 
 aooa. 
 
 
 
 ■ 
 
 
 
 
 
 
 .3 
 
 July 11, 1891. 
 
 . 
 
 
 .... 
 
 ■• 
 
 
 No,ao..„ea. 
 
 Ma„.a. 
 
 4 .. 
 
 
 
 ■■ 
 
 
 
 
 
 
 
 
 
 „ 
 
 July a-j, 1881. 
 
 „ 
 
 
 Klsbt. 
 
 
 
 
 Bingle. 
 
 8 .. 
 
 ■• 
 
 
 ■■ 
 
 
 
 
 
 
 
 
 
 .,, 
 
 July 27, 1881. 
 
 « 
 
 
 BO.. 
 
 NO. 
 
 
 NO. 
 
 
 21 ■■ 
 
 
 
 
 TO., 
 
 
 
 
 
 
 
 
 .. 
 
 Sept. 1, 1881. 
 
 2. 
 
 Broiid llgamcDt. 
 
 Left. 
 Broad li game at. 
 
 No..a.w„.a. 
 
 
 
 
 21 " 
 
 
 
 
 NO. 
 
 
 " 
 
 
 
 
 ■• 
 
 
 e, 
 
 Sept. 8, 1881. 
 
 28 
 
 Ba™„. ey.. 
 
 .0,.. 
 
 
 
 No. 
 
 
 
 
 
 
 
 
 
 
 SoManto' 
 
 
 
 
 . 
 
 Sept. n, 1881. 
 
 « 
 
 
 
 .„. 
 
 T.eo. 
 
 
 M.„,.a. 
 
 8 .. 
 
 
 
 
 No. 
 
 
 
 
 K.„™.o.. 
 
 
 Y... 
 
 
 00 
 
 Sept. 18, 1881. 
 
 81 
 
 
 
 NO. 
 
 NO. 
 
 ■ 
 
 W.O.. 
 
 3i ■■ 
 
 Tea. 
 
 
 •■ 
 
 Yc». 
 
 ■• 
 
 
 
 
 " 
 
 
 886, of Apoplexy. 
 
ced that patients have not 
 
 No. 
 
 3alth since. | ^^i^roid seen at 
 Operation. 
 
 r, from Pa- 
 ralysis. 
 
 Good. 
 
 No. 
 
 Fibroid rer 
 at Operat 
 
 No. 
 
 )d and poor. 
 
 p was a sinus 
 I upper part of 
 nd, througli 
 jder, and col 
 material was 
 ays passing 
 
 Pair. 
 
 d for a time, 
 hen poor. 
 
 Good. 
 

 Antiseptic 
 
 ovariotomies. Carbolic Acid Spray used. SLxth ovariotomy the first 
 
 antiseptic 
 
 one. When it 
 
 is not stated that 
 
 patients have not answered, 
 
 or have died, it is known that they are aUve. 
 
 No. 
 
 OpSi?on. 
 
 Age. 
 
 Kind of Tuinor. 
 
 Which Ovary. 
 
 Catameuia aince. 
 
 Children before 
 
 »-»-'• 
 
 Married or Single 
 
 InoWon". 
 
 Bnptnre. 
 
 Llgat 
 
 .™he„d 
 
 Health since. 
 
 Fibroid seen at 
 
 ".'.%V=?- 
 
 T„i..edp 
 
 e:;,^ 
 
 .e..,.. 
 
 Il„..ge. 
 
 AdhcBlona. 
 
 Deftth subecqnent- 
 
 ™ 
 
 Sept. 27, 1881. 
 
 00 
 
 Multllocular cyst 
 
 Loft. 
 
 -■ 
 
 Hve. 
 
 NO. 
 
 Married. 
 
 
 NO. 
 
 
 NO. 
 
 ''°"s,?r^- 
 
 NO. 
 
 NO. 
 
 No 
 
 
 Ueeo.e,.d. 
 
 NO. 
 
 No. 
 
 
 71 
 
 0.. .1.81. 
 
 « 
 
 „ „ 
 
 
 Ym, until 1882, 
 
 Eight. 
 
 
 
 7 .. 
 
 
 
 ■■ 
 
 Good. 
 
 
 
 
 
 
 
 Te.. 
 
 
 n 
 
 Oct. 6, 18SX. 
 
 
 .„™. .. 
 
 Right. 
 
 .... 
 
 .o. 
 
 • 
 
 ^i.o.. 
 
 
 
 
 
 
 
 
 
 
 
 
 No. 
 
 Bladdor opened at 
 operaliOD, sewed 
 
 .. 
 
 Oct. 24, 1S81. 
 
 Nov. 19. 1881. 
 Dec. 1, 1831. 
 
 Jw). 30, 1882. 
 
 Murcli 20, 1882. 
 
 April 3, 1882. 
 April 4, 1882. 
 
 
 "LeftOvary. 
 MulUlocular cyst. 
 
 Kife'ht Ovary. 
 
 Right. 
 
 ^otU. 
 Right. 
 
 Right. 
 
 
 Two. 
 
 One. 
 One. 
 
 Two. 
 
 Single. 
 
 Single'. 
 Single. 
 
 Bingle. 
 
 3i " 
 
 Long. 
 
 Long. 
 
 No. 
 No. 
 
 
 
 fromupperpartof 
 wound, through 
 
 Blw;iyB passing. 
 
 
 
 " 
 
 
 three duj'8. 
 
 
 No. 
 
 Nuclena, a hair 
 Irom cy.l. 
 
d that patients have 
 
 Good. 
 
 Died. 
 
 Good. 
 
 Poor. 
 
 Good. 
 
 Fibroid seen at 
 Operation. 
 
 Yes. 
 
 No. 
 
 Fibi 
 at 
 
Antiseptic ovariotomies. 
 
 Carbolic Acid Spray used. Sixth 
 
 ovariotomy the fii-st antiseptic one. Wlieu it is not stated that patients have not answered, or have died, it 
 
 is Imown that they are alive. 
 
 No. 
 
 Oporulion. 
 
 Age. 
 
 ™~- 
 
 ™— ■ 
 
 Catamenia since. 
 
 Children before. 
 
 Children since. 
 
 Married or SiDi,'le. 
 
 SI".' 
 
 -'■"- 
 
 Ligatures heard 
 
 H.,..,„.. 
 
 Operation. 
 
 "St:=J' 
 
 Twifltcd pedicle. 
 
 n...u. 
 
 Drainage. 
 
 Adhesions. 
 
 Death euhsequeiii- 
 lyt^DatoJ,«d 
 
 .3 
 
 April 10, 1S82. 
 April 12, 1832. 
 April 19, 1682. 
 April 20, 1832. 
 April 22, 1882. 
 April 22, 1882. 
 April 23, 1882. 
 April 20, 1882. 
 Sray 5, 1882. 
 May 13, 1882. 
 Juno 6, 1882. 
 
 June 22, 1882. 
 
 32 
 
 Dermoid 
 
 UultUocular 
 Cy8t. 
 
 Cyst. 
 Multilocular 
 
 Unilocular 
 
 cyst. 
 
 Kight. 
 
 Broad ligament. 
 Right. 
 
 Bight. 
 
 Broad ligament. 
 
 night. 
 
 Left. 
 
 operation. 
 
 One. 
 
 Three. 
 Ko. 
 
 XiDc, mid seven 
 miscarriages. 
 
 No. 
 Has not answered 
 
 Two. 
 bVC 'Sfl! giri.' 
 
 Stagle. 
 
 Single. 
 Married. 
 
 Single. 
 Married. 
 
 Single. 
 
 3 inches. 
 Long. 
 
 Long. 
 
 Long. 
 44 inches. 
 
 Yea. 
 
 ■• 
 
 Died. 
 Good. 
 
 Poor. 
 
 ... 
 
 No. 
 
 No. ■ 
 
 " 
 
 Died, April 20. 
 Recovered. 
 
 Ve.. 
 
 TCB. 
 
 ?if.:Ly^:.s!. 
 
j^ted that patients have i 
 
 Health since. 
 
 ain in left side. 
 
 Good. 
 
 ood, I suppose. 
 
 Good. 
 
 Poor. 
 
 Good. 
 
 Died. 
 
 Good. 
 
 Poor. 
 
 Good. 
 
 Fibroid seen at 
 Operation. 
 
 No. 
 
 Yes. 
 
 No. 
 
 Yes. 
 
 No. 
 
 Fibro 
 at 01 
 
Antisep 
 
 tic ovariotomies. Carbolic Acid Spray used. Sixth ovariotomy the first antiseptic one. WTien it is not stated that patients have not answered, or have died, it is known that they are alive. 
 
 KJnd of Tumor. 
 
 'in°Slon°' 
 
iaith since. 
 
 Good. 
 
 d that patients have not 
 
 Fair. 
 
 Good. 
 
 Fibroid seen at Fibroid re 
 Operation. at Opera 
 
 No. 
 
 Yes. 
 
 No. 
 
 Yea. 
 
 No. 
 
 No. 
 
 Yes. 
 
 ] « 
 
 No. 
 
Antiseptic ovariotomies. Carbolic Acid Spray used. Sixtli 
 
 ovariotomy tlie first antiseptic one. "When it is not stated tliat patients have not answered, or have died, it 
 
 is known that they are aUve. 
 
 Ho. 
 
 Operalion. 
 
 ... 
 
 KiDd of Tumor. 
 
 "WTiich Ovnry. 
 
 — •• 
 
 Children before. 
 
 OhUaren.,.ee. 
 
 Married or Single. 
 
 Length of 
 Incision. 
 
 Rupture. 
 
 Ligatures Jicard 
 
 HeaUh.,ne.. 
 
 Operalion. 
 
 Fibroid removed 
 at Operation. 
 
 Twisted pedicle. 
 
 Result. 
 
 Drainage. 
 
 Adhesions. 
 
 Death subsequent- 
 
 .. 
 
 Nov. 23, 18S2. 
 Dec. 30, 1832. 
 
 . 
 
 Uultlloculnr cyst. 
 Faplltoma. 
 Unilocular cyet. 
 
 StultUocular " 
 
 Right. 
 
 Right. 
 
 No. 
 Yc. 
 
 One. 
 No. 
 
 No. 
 
 Single. 
 Single. 
 
 " 
 Long. 
 
 
 NO. 
 
 Good. 
 
 
 No. 
 
 
 Recovered. 
 
 
 Yea, slight. 
 Yea. 
 
 Operated on again 
 
 .» 
 
 Jan. 8, 1883. 
 Jan. 20, 1833. 
 Jon. 31, 1883. 
 
 April 4, 1883. 
 May 2, 1883. 
 
 . 
 
 Dermoid " 
 Multilocular " 
 
 Cyal of left 
 broad ligomcDt. 
 
 Both. 
 Right. 
 
 Right. 
 
 Left. 
 Right. 
 
 Left. 
 
 Yc.onco.IOmo.. 
 ntler operatioD. 
 
 Ye.. 
 No. 
 
 Several. 
 One. 
 
 One. 
 
 Three. 
 
 
 Married. 
 Single. 
 
 Single. 
 
 Shor.. 
 
 Ycfl. 
 
 •■ 
 
 " 
 
 YC9. 
 
 No. 
 TcB. 
 No. 
 
 
 
 Died after opera 
 topping, 5 weclia 
 
 Recovered. 
 
 
 Yes. 
 
 Died, May, 1884. 
 

 iated that 
 
 patients have n 
 
 No. 
 
 1 
 
 Health since. 
 
 Fibroid seen at 
 Operation. 
 
 Fibrolc 
 atOj 
 
 134 
 
 Good. 
 
 No. 
 
 
 135 
 
 •' 
 
 " 
 
 
 [136 
 
 " 
 
 " 
 
 
 137 
 
 '■ 
 
 " 
 
 
 138 
 
 " 
 
 " 
 
 
 . 139 
 
 " 
 
 " 
 
 
 140 
 
 ■ 
 
 " 
 
 
 141 
 
 " 
 
 " 
 
 
 142 
 
 " 
 
 " 
 
 
 143 
 
 ( 
 
 Yes. 
 
 
 144 
 
 ( «< 
 
 No. 
 
 
 145 
 
 <: 
 
 " 
 
 
 146 
 
 ^ood, till 1884. 
 
 " 
 
 
 147 
 
 ^ Good. 
 
 " 
 
 
 14--> 
 
 I 
 
 " 
 
 
 149 
 
 1 « 
 
 " 
 
 
 
 
 
 

 Antiseptic 
 
 ovariotomies. 
 
 Carbolic Acid Spray used, Sist 
 
 1 ovariotomy the first antiseptic 
 
 one. When it is not stated that 
 
 patients have not ans-vvered, or have died, it is known that they are ahve. 
 
 No. 
 
 Operation. 
 
 Age. 
 
 — — 
 
 Which Ovary. 
 
 CatameDia elnco. 
 
 Children before. 
 
 Childrea since. 
 
 Married or Sioglo 
 
 ¥„&.' 
 
 Rupture. 
 
 Ligatures heard 
 
 Hea,...,oee. 
 
 OperatioD. 
 
 at Operation. 
 
 T-...p.,.o. 
 
 Result. 
 
 Drainage. 
 
 .d...,.a.. 
 
 Death sub sequent- 
 
 1138 
 
 May 17, 1883. 
 May 30, 1363. 
 
 July 3, 18B3. 
 July 12, 1833. 
 July 20, 1883. 
 Aug. 1, 1883. 
 Aug. 4, 1883. 
 Ocl. 10, 1883. 
 Oct. 12, 1863. 
 Oct. £5, 1883. 
 Nov. 15, 1883. 
 
 20 
 
 UullUoonLr cy.t 
 
 Papilloma. 
 D.rmold oj«l. 
 
 I'aiiilloma * 
 Multllocular cy.l. 
 
 Right. 
 Right. 
 
 Tea. 
 
 YcB. 
 
 One. 
 Two. 
 
 Two. 
 
 DurlDg growth of 
 cyst, she was prog- 
 wan produced, 
 
 One. 
 No. 
 Three. 
 
 One. Girl. 
 Aug., 1886. 
 
 Easy labors. 
 Both girls'. 
 
 Dec.riSM. 
 
 Both girls! 
 
 Single. 
 
 Married. 
 
 Married?!)ec.,'S4. 
 Married. 
 
 Single. 
 Widow. 
 
 Long. 
 Short, 
 
 Long. 
 
 Short. 
 
 ■' 
 
 Y-ea. 
 
 Not heard from. 
 
 No. 
 
 Ye8. Oct., 1885. 
 Knot on pedicle 
 
 Good. 
 
 Ym. 
 
 No. 
 
 
 Recovered. 
 
 
 No. 
 Yes. 
 
 Died, Sept., ]86e, 
 of Cousumption. 
 
 U, 
 
 Dec. 3, 1883. 
 
 s. 
 
 
 Left brond liga- 
 Rleht. 
 
 ..,™..3,o.„. 
 
 No. 
 
 Eight. 
 
 
 Single. 
 Widow. 
 
 
 .0.. 
 
 
 
 
 
 
 
 
 No. 
 
 
A 
 
 ated that patients have 
 
 
 No. 
 
 Health since. 
 
 Fibroid seen at 
 Operation. 
 
 Fib 
 at 
 
 150 
 
 Good. 
 
 No. 
 
 
 151 
 
 " 
 
 
 
 152 
 
 
 " 
 
 
 153 
 
 " 
 
 " 
 
 
 154 
 
 " 
 
 " 
 
 
 155 
 
 " 
 
 " 
 
 
 156 
 
 " 
 
 Yes. 
 
 
 157 
 
 
 No. 
 
 
 158 
 
 " 
 
 " 
 
 1 
 
 159 
 
 ood, except cys- 
 titis. 
 
 " 
 
 
 100 
 
 Good. 
 
 " 
 
 
 101 
 
 Fair. 
 
 Yes, 
 
 
 102 
 
 Good. 
 
 No, 
 
 
 103 
 
 i 
 
 «' 
 
 i 
 
 10+ 
 
 'Good till 1885. 
 
 " 
 
 i 
 
 165 
 
 
 
 
 
 
 
 
Antiseptic ovariotomies. Carbolic Acid Spray used. Sixth ovariotomy tlie first antiseptic one. "When it is not stated that patients have not answered, or have died, it is known that they are aHve. 
 
 .. 
 
 Date of 
 OperatioD. 
 
 Age. 
 
 151 
 
 Jan. 10, 1884. 
 Joii. 28, 1894. 
 
 25 
 
 1. 
 
 Feb. 20, 18S4. 
 
 38 
 
 .8 
 
 March 8, 1884. 
 
 88 
 
 1« 
 
 March 34, 1884. 
 
 ei 
 
 1. 
 
 April 2, 1884, 
 
 « 
 
 ,m 
 
 JU.. 7,1881. 
 
 81 
 
 1,.,8 
 
 
 . 
 
 101 
 
 Juno 14. 1884. 
 
 82 
 
 1. 
 
 
 4, 
 
 1. 
 
 July 2, 18*1. 
 
 4= 
 
 inl 
 
 July S, 1884. 
 
 SO 
 
 
 No. No. 
 
jited that patients have 
 
 No. 
 
 Sealth Bince. 
 
 Fibroid seen at Fibre 
 Operation. ^ at ( 
 
 Igg 'ot very good. | No. 
 
 Good. 
 
 171 
 
 173 
 
 oor. Cousfh. 
 
 175 
 
 Good. 
 
 177 
 
 178 
 
 179 
 
 181 
 
 Yes. I 
 

 Antiseptic ovariotomies. Carbolic Acid Spray used. Sixth ovariotomy the iirst antiseptic 
 
 one. Wlien it is not 
 
 stated that patients have not answered, or have died, it is known that they are alive. 
 
 .0. 
 
 Date of 
 Operation. 
 
 Afo. 
 
 K,o..,Tu.o.. 
 
 W.e.O„,y. 
 
 C.o„e....„. 
 
 ChUdren before. 
 
 Children since. 
 
 Married or Single 
 
 ¥.S;.' 
 
 Rupture. 
 
 Ligatures lieard 
 
 H„,t..iu.e. 
 
 Operation. 
 
 at Operation. 
 
 Twisted pedicle. 
 
 Kcult. 
 
 D,a.a... 
 
 Ad...iou.. 
 
 Death Bubaeq^ient- 
 
 ™ 
 
 July 12, 1H84. 
 
 3. 
 
 MuU„oou,„oy.. 
 
 BO.. 
 
 DnUlMjy,^1885. 
 
 NO. 
 
 NO. 
 
 —■ 
 
 -"'■ 
 
 No. 
 
 No. 
 
 Not very good. 
 
 No. 
 
 NO. 
 
 NO. 
 
 Recovered. 
 
 .0. 
 
 NO. 
 
 
 ,0, 
 
 July 10, 1884. 
 
 « 
 
 Cancer of right 
 
 Right. 
 
 1,,.. 
 
 ■■ 
 
 Died. 
 
 Single. 
 
 .oo. 
 
 
 
 
 
 
 
 
 Died 0.3d day. 
 
 ■■ 
 
 Ye«. 
 
 
 ■OS 
 
 Aug. 18,1884. 
 
 .8 
 
 .u,.„ooo,„oy.. 
 
 
 NO. 
 
 .,.. 
 
 
 M„.e.. 
 
 S..„. 
 
 
 
 
 eood. 
 
 
 
 
 aeeovered. 
 
 
 NO. 
 
 
 ... 
 
 
 . 
 
 
 
 
 
 ■■ 
 
 
 
 ■■ 
 
 
 
 
 '■ 
 
 
 
 
 
 
 
 n. 
 
 Bepl. 11, 1884. 
 Ocl. e, 1884. 
 Nov. S, 1884. 
 
 28 
 
 
 Right. 
 
 Left. 
 
 Left broad liga- 
 
 .... 
 
 No. 
 Thtoo. 
 
 One. Boy. 
 
 W.O.. 
 
 Short. 
 
 NO. 
 
 
 
 
 
 ■■ 
 
 
 " 
 
 
 NO. 
 
 
 174 
 
 Nov. 27, 1884. 
 
 27 
 
 
 ..,.. 
 
 " 
 
 No. 
 
 
 SiOfle. 
 
 
 
 
 ^ 
 
 oor. Cough. 
 
 
 " 
 
 
 
 
 
 
 .:. 
 
 Doo. 3, 1884. 
 
 87 
 
 Unilocular " 
 
 
 NO. 
 
 
 ■' 
 
 M„.ie.,. 
 
 
 1-0.. 
 
 
 
 aood. 
 
 
 
 
 
 
 Te.. 
 
 
 m 
 
 
 42 
 
 Paiwlloinu. 
 
 130.. 
 
 
 ..0. 
 
 
 ..o... 
 
 Me.„„. 
 
 NO. 
 
 
 
 
 
 
 
 
 ■■ 
 
 
 
 "' 
 
 
 4. 
 
 MuU„oeu,.,.y... 
 
 ..,.. 
 
 .... 
 
 NO. 
 
 
 ilarried. 
 
 
 
 
 
 
 
 
 
 " 
 
 
 
 178 
 
 Dec. 13, 1884. 
 
 3, 
 
 Uuilocular " 
 I'aiiUlomii. 
 
 hroad lignmcut. 
 
 NO. 
 
 Six. 
 One. 
 
 
 
 Short. 
 
 
 , 
 
 
 
 
 
 
 
 Ve.. 
 
 
Antiseptic ovariotomies. Carbolic Acid Spray used. Sixth ovariotomy the fii-st antiseptic one. "When it is not stated that patients have not answered, or have died, it is known that they are alive. 
 
 Children before. 
 
 Married or Single. 
 
 Fibroid removec 
 
 
ed that patients have not 
 
 Good. 
 
 Good. 
 
 Fibroid seen at 
 Operation. 
 
 No. 
 
 Fibroid re 
 at Open 
 
 No. 
 
 Yes 
 
 Yes. 
 
 Yes. 
 
 No. 
 
 No. 
 
 Yes. 
 
 Yes. 
 
 No. 
 
 No. 
 
Antiseptic' 
 
 ovariotomies. Carholio Acid Spray used. Sixth ovariotomy the first 
 
 antiseptic 
 
 3ne. Wlien it is not stated that 
 
 patients have not answered, or have died, it is known that they are ahve. 
 
 Ho. 
 
 Date of 
 Operation. 
 
 Age. 
 
 Kind of Tumor. 
 
 Which Ovary. 
 
 Cntamenia since. 
 
 Children before. 
 
 Children aince. 
 
 Married or Single. 
 
 Length of 
 InclBion. 
 
 Rupture. 
 
 Ligatures heard 
 from. 
 
 Health Bhice. 
 
 Operation. 
 
 at Operation. 
 
 Twiated pedicle. 
 
 Result. 
 
 Drahiage. 
 
 Adhesions. 
 
 Death Bubsequcnt. 
 
 ly. Dale and 
 
 cauae of. 
 
 IBS 
 
 May 4, 1885. 
 
 39 
 
 MaUilocuIsr cyst. 
 
 Left. 
 
 No. 
 
 No. 
 
 No. 
 
 Bhrgle. 
 
 Short. 
 
 No. 
 
 No. 
 
 G-ood for srx 
 weeka. Died of 
 
 No. 
 
 No. 
 
 No. 
 
 Eecovered. 
 
 NO. 
 
 NO. 
 
 Died of general 
 abdominal canter 
 and alao obatruc- 
 tiouin region of 
 pancreas.- Cancer 
 in Scar.— October 
 16, 18S5. 
 
 .« 
 
 May 6, 1885. 
 
 38 
 
 
 
 To.. 
 
 
 " 
 
 
 
 Tea. 
 
 
 Good. 
 
 
 
 
 
 ■■ 
 
 
 » 
 
 May 11, 1885. 
 
 35 
 
 Multiloculor cyal 
 and fibroid of 
 
 Both. 
 
 Five time., .light, 
 and decreasing. 
 
 
 
 Married. 
 
 Long. 
 
 Ko. 
 
 
 
 .es. 
 
 Yoi. 
 
 
 
 Yes. 
 
 Yea. 
 
 
 » 
 
 June 2, 1885. 
 
 5, 
 
 Unilocular cyet. 
 
 Le«. 
 
 No. 
 
 Three. 
 
 ■ 
 
 
 Short. 
 
 
 
 Now another ab- 
 dominal tumor. 
 
 No. 
 
 No. 
 
 " 
 
 " 
 
 . NO. 
 
 No. 
 
 
 « 
 
 Juno 2, 1885. 
 
 45 
 
 Uultllocular cyata 
 
 Both. 
 
 
 Two. 
 
 
 
 " 
 
 
 
 Good, 
 
 
 
 " 
 
 
 
 Yea. 
 
 
 an 
 
 June 6, 1885. 
 June 13, 1885. 
 June 20, 1885. 
 
 35 
 
 Multllocular cyal 
 and fibroid of 
 
 Eight. 
 
 Yes. 
 
 T«». 
 No. 
 
 
 Single. 
 
 
 " 
 
 
 
 Yes. 
 
 Yes. 
 
 
 " 
 
 
 No. 
 
 
 .oa 
 
 July 2, 1885. 
 
 44 
 
 Multllocular cyst. 
 
 Right. 
 
 
 One. 
 
 
 Married. 
 
 Medium. 
 
 •• 
 
 
 
 NO. 
 
 NO. 
 
 Yes. 
 
 
 Ves. 
 
 Yes. 
 
 
 207 
 
 July 15, 1»85. 
 
 ", 
 
 and fibroid of 
 
 Left. 
 
 Irregular. 
 
 
 
 
 Short. 
 
 
 __ 
 
 
 Yes. 
 
 Yes. 
 
 No. 
 
 
 No. 
 
 No. 
 
 
 .» 
 
 July 17, 1885. 
 July 22, 1885. 
 Sept. 7, 1885. 
 
 40 
 
 nbro-cyst, right. 
 Mult, cyet, left. 
 
 Multllocular cyats 
 Papilloma. 
 
 
 
 No. 
 No. 
 
 
 
 Long. 
 
 Short. 
 
 Long. 
 Bladder wounded 
 
 YCB. 
 
 
 
 ■ No. 
 
 
 
 
 
 Yea. 
 
 A remarkable 
 
 211 
 
 Sept. 14, 1885. 
 
 40 
 
 Multllocular cyet 
 
 Left. 
 
 
 Two. 
 
 
 
 Long. 
 
 
 
 
 
 
 
 
 NO. 
 
 
 
 2,2 
 
 Sept. 30, 1885. 
 
 23 
 
 Papilloma. Left 
 broad ligament. 
 
 
 Ves. 
 
 NO. 
 
 
 Single. 
 
 Short. 
 
 
 
 
 
 
 
 
 
 NO. 
 
 Died.Feb. 7,18BC, 
 
 213 
 
 Oct. 5, 1885. 
 
 03 
 
 Multllocular cyet 
 
 
 ' No. 
 
 Two. 
 
 
 Married. 
 
 " 
 
 
 
 
 
 
 Yea. 
 
 
 
 Yes. 
 
 probably of Can- 
 
cl that patients have 
 
 lalth since. 
 
 Good. 
 
 Good 
 
 Seatli from 
 inal obstruc- 
 tion. 
 
 Good. 
 
 Fibroid seen at Mb 
 Operation. at 
 
 No. 
 
Antiseptic ovariotomies. Carbolic Acid Spray used. Sistli 
 
 ovariotomy the first antiseptic one. Wlien it is not stated that patients have not answered, or have died, it 
 
 is known that they are aUve. 
 
 .„. 
 
 o?2il. i^«- 
 
 Kl.a.,T„„o.. 
 
 Which Ovary. 
 
 Catamenia since. 
 
 Children before. 
 
 Children since. 
 
 Married or Single. 
 
 Length of 
 Incisioo. 
 
 RuptDve. 
 
 Ligatures beard 
 
 Hi-alth since. 
 
 Fibroid seen at 
 Operation. 
 
 Fibroid removed 
 at Operation. 
 
 Twisted pedicle." 
 
 .e»l.. 
 
 Drainage. 
 
 Adhesions. 
 
 Death Bubecquent- 
 
 =u 
 
 Oct. S, 1SB5. 
 
 18 
 
 dermoid cyst. 
 
 Lcrt. 
 
 No. 
 
 - 
 No. 
 
 No. 
 
 Single. 
 
 Long. 
 
 NO. 
 
 No. 
 
 Poor. Died. 
 
 NO. 
 
 No. 
 
 
 Recovered. 
 
 Yes. 
 
 Tea. 
 
 
 .. 
 
 Oct. 23, 1885. 
 
 33 
 
 MuUiJocular " 
 
 Both. 
 
 .,ca. 
 
 
 
 
 Short. 
 
 
 
 
 
 " 
 
 " 
 
 Died ou 5th day. 
 
 NO. 
 
 No. 
 
 
 ., 
 
 Oct. H, 1885. 
 
 10 
 
 jDilociilfLV " 
 
 Kitrht 
 broad ligumeut. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 217 
 
 Oct. 17, 1885. 
 
 30 
 
 MuItilocnlajcyBte 
 
 Both. 
 
 .0. 
 
 Three. 
 
 
 Married. 
 
 Long. 
 
 
 
 Good. 
 
 
 
 
 Recovered. 
 
 Tea. 
 
 Tea. 
 
 
 .S 
 
 Oct. 22, 1885. 
 
 30 
 
 cyfli. 
 
 Right. 
 
 Tea. 
 
 So. 
 
 ' Girl'.' 
 
 .. 
 
 Short. 
 
 
 
 
 
 ■■ 
 
 
 
 NO. 
 
 NO. 
 
 
 ™ 
 
 
 20 
 
 „ .. 
 
 
 
 One. 
 
 NO. 
 
 - 
 
 
 
 
 
 
 
 
 
 
 Yea. 
 
 
 .0 
 
 Nov. 0, 1885. 
 
 3. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ■■ 
 
 
 
 NO. 
 
 
 221 
 
 Nov. 23, 1885. 
 
 38 
 
 Dermoid cyst. 
 Muliilocular. 
 
 
 
 No. 
 
 
 Single. 
 
 Long. 
 
 yes. 
 
 
 
 
 
 
 
 
 
 
 222 
 
 Deo. 11, 1885. 
 
 61 
 
 Multilocular cyBt. 
 
 LC. 
 
 No. 
 
 Ten. 
 
 
 Married. 
 
 " 
 
 No. 
 
 
 Good 
 till dcnth Erom 
 
 
 
 
 
 
 Tea. 
 
 Died, March 22, 
 
 1886, of Intestuial 
 Obstruction. 
 Strangulallon 
 
 through adhesions 
 
 223 
 
 Dec. 0, 1885. 
 
 « 
 
 Unilocular " 
 
 Right 
 broad ligament. 
 
 Te.. 
 
 Fonr. 
 
 
 
 Short. 
 
 
 
 Oood. 
 
 
 
 
 
 
 No. 
 
 
 225 
 
 JaD. 0, 18S0. 
 JttD. 14, 18S0. 
 
 38 
 
 Roil 11(1 -c'l led 
 Sareoinii. 
 
 Right 
 hroad ligament. 
 
 Right. 
 
 Died. 
 
 No. 
 
 ■ 
 
 Single. 
 
 Long. 
 
 
 
 
 
 
 
 ie<. 
 
 
 
 
 220 
 
 
 61 
 
 Multilocular cyel 
 
 " 
 
 No. 
 
 T.O. 
 
 
 Married. 
 
 Short. 
 
 
 
 
 
 
 
 Recovered. 
 
 
 Yea. 
 
 
 « 
 
 Jno. 10, laSG. 
 
 33 
 
 M„,.„„c„l„c>..t 
 
 .ct. 
 
 
 Four. 
 
 
 „ I „ 
 
 
 
 
 
 
 
 .. 
 
 " 
 
 ■■ 
 
 
 =28 
 
 Jiiii. 27, 1880. 
 
 35 
 
 „ ,. 
 
 Right. 
 
 
 
 °°'F°S'e!'*"- 
 
 
 
 
 
 ■■ 
 
 " 
 
 
 
 
 
 
 220 
 
 Jnn. 28, 1880. 
 
 62 
 
 twiated pi>dlclc. 
 
 Left. 
 
 Died. 
 
 No. 
 
 t 
 
 
 
 
 
 
 Yes. 
 Cyat dark oruu- 
 berry or purple 
 
 Died. 
 
 
 
 In ArticuIoWortis 
 at time of 
 operation. 
 
stated that patients 
 
 _. ,^, . Fibroid seen i 
 
 Health since. I Operation. 
 
 No. 
 
 Good. 
 
 Tea. 
 
 Poor. 
 
 No. 
 
 Good. 
 
Antiseptic ovariotomies. Carbolic Acid Spray used. Sixth ovariotomy the ;flrst 
 
 antiseptic one. Wlien it is not stated that 
 
 patients have not answered, or have died, it is known that they are alive. 
 
 .0. 
 
 Date of 
 Operation. 
 
 Age. 
 
 Kind of Tumor. 
 
 Wliicb Ovary. 
 
 Catamcnia Biitcc. 
 
 Children before. 
 
 Children since. 
 
 M„riedo,S,ogie. 
 
 Length of 
 IdcIbiou. 
 
 Rupture. 
 
 Ligatures Iieard 
 
 Healtli .Inoe. 
 
 OperatiOD. 
 
 at Operation. 
 
 Twisted pedicle. 
 
 Keeoit. 
 
 Drainage. 
 
 AdlieBtona. 
 
 DeatliBubBequent. 
 ly. Date and 
 
 «0 
 
 Feb. 1, 1886. 
 
 2e 
 
 "STvarle.. 
 
 Both. 
 
 Ha.ootaiiBwereci. 
 
 One. Miscarriage. 
 
 
 M„.ed. 
 
 Short. 
 
 
 
 
 No. 
 
 No. 
 
 No. 
 
 Recovered. 
 
 Y'o.. 
 
 Yee. 
 
 
 231 
 
 Feb. 8, ISS6. 
 
 Another operation 
 
 March 5, 1887. 
 
 Dr. Utley. 
 
 . 
 
 Mullilocular cyst, 
 with perJtoniliB. 
 
 Left. 
 
 Yes. 
 
 No. 
 
 .0. 
 
 Widow. 
 
 
 No. 
 
 No. 
 
 POO. 
 
 
 
 Tee. 
 
 
 No. 
 
 
 
 233 
 
 Feb. 13, 1886. 
 Feb. 15, 1886. 
 
 48 
 
 Mnltllocnlnr cyat. 
 
 Right. 
 
 No. 
 
 Two. 
 
 " 
 
 Single. 
 
 Long. 
 
 " 
 
 
 
 
 
 No. 
 
 
 
 No. 
 
 J 
 
 234 
 
 Feb. 10, 1886. 
 
 24 
 
 Papilloiua. 
 
 
 Yos. 
 
 Four. 
 No. 
 
 
 
 
 Short. 
 
 : 
 
 
 
 
 
 
 
 
 No. 
 
 H 
 
 23. 
 
 March 30, 18S6. 
 April 1, 1886. 
 
 25 
 
 Mu'ltilouiilnr cynt. 
 
 
 
 
 
 
 Single. 
 
 Long. 
 Short. 
 
 
 No. 
 
 
 ., 
 
 
 
 
 
 
 ! 
 
 23. 
 
 April 5, 1886. 
 
 3, 
 
 
 
 
 Two. 
 
 
 
 
 
 •■ 
 
 
 
 
 
 Ye.. 
 
 
 
 
 
 230 
 
 April 29, 1886. 
 
 4a 
 
 Papillomii. 
 
 BO.. 
 
 Died. 
 
 No. 
 
 
 
 Single. 
 
 Long. 
 
 
 
 
 
 
 NO. 
 
 Died. 
 
 
 Yoe. 
 
 Died. ObBtructed 
 
 240 
 
 242 
 
 April 22, 1886. 
 May 22, 1880. 
 
 42 
 26 
 
 MulLilotuliir cyst. 
 Dermoid " 
 Multiloeulur " 
 
 Elghl. 
 
 Yes. 
 
 No. 
 One. 
 
 
 
 Married. 
 Single. 
 
 Short. 
 
 
 
 
 
 ■■ 
 
 
 Recovered, 
 
 
 Cancer (?) of 
 removed. 
 
 Yee. 
 
 
 m 
 
 June 7, 1886. 
 
 3, 
 
 
 Right. 
 
 
 Two. 
 
 
 
 
 
 
 
 
 Yea. 
 
 " 
 
 
 
 
 
 
 2« 
 
 June 8, 1886. 
 
 23 
 
 
 
 No. 
 
 
 
 
 Long. 
 
 .o...iee. 
 
 
 Poor. 
 
 No. 
 
 " 
 
 
 
 
 Yes. 
 
 
 «. 
 
 Juno 9, 1886. 
 
 22 
 
 "°o"Sf°om«Dl'l 
 
 Loft. 
 
 Y... 
 
 Tbreo. 
 
 ■■ 
 
 
 
 No. 
 
 Yc». 
 
 aood. 
 
 
 
 
 •■ 
 
 " 
 
 
 
AiStated that patients 
 
 No. 
 
 Health since. Kbroid see 
 [ Operatic 
 
 J Presumed to be 
 ^ good. 
 
 Good. 
 
 No. 
 
 Yes. 
 
 No. 
 
 Fair. 
 
 Good. 
 
 Tes. 
 
 No. 
 
 258 
 
Antiseptic ovariotomies. Cavbolie Acid Spray used. Sixtli ovariotomy the fii-st antiseptic one. When it is not stated that patients have not answered, or have died, it is known that they are alive. 
 
 ' 
 
 Dato of 
 OperoUoD. 
 
 Age. 
 
 Kind of Tumor. 
 
 Wliich Ovary. 
 
 Catamenia since. 
 
 Chiidren before. 
 
 Children since. 
 
 Married or Single. 
 
 ^S£^' 
 
 Rupture. 
 
 Ligatures heard 
 
 Healihelnce. 
 
 Operation. 
 
 Fibroid removed 
 at Operation. 
 
 Twisted pedicle. 
 
 Reault. 
 
 Drainage. 
 
 Adhesiona. 
 
 Death HubBcquent. 
 
 ly. Date aud 
 
 cause of. 
 
 246 
 
 July 7, 1886. 
 
 43 
 
 Multilocular oyst. 
 
 Right. 
 
 [asQotauBWcred. 
 
 TOO. 
 
 No. 
 
 Married. 
 
 Long. 
 
 No. 
 
 NO. 
 
 Presumed to be 
 good. 
 
 No. 
 
 No. 
 
 NO. 
 
 Recovered. 
 
 Yee. 
 
 .e.. 
 
 
 M7 
 
 July 8, 1886. 
 July 8, 1886. 
 July 27, 1886. 
 Sept. 4, 1886. 
 
 56 
 
 Jnilocular " 
 Uulliloculor " 
 
 Eight. 
 
 No. 
 
 No. 
 
 
 Binglo. 
 Widow. 
 Singio. 
 
 Short. 
 
 
 
 Good. 
 
 Tea. 
 No. 
 
 
 Tea. 
 
 „ , 
 
 NO. 
 
 No. 
 
 
 251 
 
 Oct. 9, 1886. 
 
 48 
 
 
 ront of Bladder. 
 
 Died of Tetanus. 
 
 Two. 
 
 
 Married. 
 
 ■• 
 
 
 
 
 
 
 
 Died on 5th day, 
 of Tetanua. 
 
 
 
 
 252 
 
 Oct. 16, 1886. 
 
 6. 
 
 Uoilocular " 
 1114 lbs. 
 
 Left. 
 
 NO. 
 
 No. 
 
 
 
 Single. 
 
 
 
 
 Fair. 
 
 
 " 
 
 " 
 
 Recovered. 
 
 
 .e.. 
 
 Died, April, 18B7. 
 
 .3 
 
 Hoy. 10, 1880. 
 
 43 
 
 Mulliloculnr cyst, 
 dermoid, 
 gelatinouB. 
 
 
 Not heard from. 
 
 
 
 
 
 Long. 
 
 
 
 Good. 
 
 Tea. 
 
 
 Ve.. 
 
 
 
 
 
 254 
 
 Nov. 20, 1886. 
 
 15 
 
 Mulliloculnr cyat. 
 
 
 
 
 
 
 Shoru 
 
 
 
 ■■ 
 
 Ho. 
 
 
 
 
 
 NO. 
 
 
 25a 
 
 
 31 
 
 Broad lieonaeiit. 
 
 Neither. 
 
 YCB. 
 
 
 
 
 Married. 
 
 
 
 
 " 
 
 
 
 No. 
 
 
 
 
 
 266 
 257 
 
 Jan. 10, 1887. 
 Jau. 18, 1887. 
 
 22 
 
 ilultiloculur cyst. 
 Miiltilocular cyats 
 Multilocular cyat. 
 
 Both. 
 
 Died. 
 
 One. 
 
 
 
 Single. 
 
 Long. 
 
 Short. 
 Long. 
 
 
 
 
 
 
 
 Died. 
 
 
 Yes. 
 
 
 25, 
 
 Fob. 3, 1887. 
 
 37 
 
 
 
 Yea. 
 
 ■• 
 
 
 ■• 
 
 Married. 
 
 Short. 
 
 
 
 
 
 
 
 
 
 ■• 
 
 
 200 
 
 Fob. 9, 1887. 
 FoK 17, 1887. 
 
 30 
 
 
 " removed. ^ 
 Both. 
 
 No. 
 
 No. 
 
 
 Widow. 
 Married. 
 
 Long. 
 
 
 
 
 
 
 
 : 
 
 Yea. 
 
 Yea. 
 No. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ied that jiatients have not 
 
 alth since. 
 
 Good. 
 
 Filii-oicl seen at 
 Operation. 
 
 No. 
 
 Fibroid rei 
 at Opera 
 

 Viitiseptic 
 
 OYaviotoniies. Carbolic Acid Spray used. Sixth ovai-iotomy the first 
 
 antiseptic one. When it is not stated that patients have not answered, or have died, it is known that they are ahve. 
 
 Date of- 
 Operatiou. 
 
 Aso. 
 
 Kind of Tumor. 
 
 Which Ovary. 
 
 «.„.„..„». 
 
 Children before. Children since. 
 
 Married or Single. 
 
 Sli^!' 
 
 Rupture. 
 
 Ligdtiires heard 
 
 1 r'l -1 1 
 Health .iuce. | "i™„il'„„. 
 
 at Operutiou. 
 
 TwHted pedicle. 
 
 Result. 
 
 Drainage. 
 
 .dhCOU.. 
 
 Death subsequent- 
 ly.^^DiUe^^and 
 
 62 
 
 Fob. 10, 1887. 
 
 80 
 
 M„lU,ocu,«r.y.,. 
 
 Left, 
 
 and Hterus also 
 
 removed. 
 
 K.. 
 
 No. ; No. 
 
 Single. 
 
 Long. 
 
 No. 
 
 NO. 
 
 Good. 
 
 No. 
 
 'no. 
 
 Ye.. 
 
 Kecovered. 
 
 Ye.. 
 
 Y... 
 
 
 es 
 
 Feb. 23, 1S87. 
 
 « 
 
 Jnllocular " 
 
 T.eft 
 broad ligament. 
 
 
 Two. 
 
 
 Married. 
 
 Shorl. 
 
 
 
 " 
 
 ■■ 
 
 
 NO. 
 
 
 No. 
 
 No. 
 
 
 « 
 
 Feb. 25, 1887. 
 
 57 
 
 MuUilocularcysU 
 
 B..„. 
 
 
 r-our. 
 
 
 
 Long. 
 
 
 
 
 
 
 
 
 Died. 
 
 Ye.. 
 
 Ye.. 
 
 
 » 
 
 Feb. 26, 1837. 
 
 23 
 
 Unilocular cyst. 
 
 Loa. 
 
 Died. 
 
 Three. 
 
 
 
 Short. 
 
 
 
 
 
 
 
 
 
 No. 
 
 
 
 6. 
 
 Feb. 27, 1887. 
 
 61 
 
 
 " 
 
 No. 
 
 S.. 
 
 
 
 Long. 
 
 
 
 " 
 
 
 
 
 
 Keeovered. 
 
 
 
 
 «, 
 
 March 28, 1887. 
 
 48 
 
 Oermoid " 
 
 Kighl. 
 
 ■• 
 
 TWO. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 6, 
 
 March 30, 1887. 
 
 55 
 
 Multilocular " 
 
 Left. 
 
 
 P„„r. 
 
 
 
 
 
 
 
 
 
 
 
 Died. 
 
 Ye.. 
 
 
 
 ., 
 
 April 11, 1887. 
 
 40 
 
 
 B„U.. 
 
 
 NO. 
 
 
 Binfle. 
 
 Short. 
 
 
 
 
 
 
 
 
 Recovered. 
 
 No. 
 
 
 
 7. 
 
 April 14, 1887. 
 
 23 
 
 
 left. 
 
 re.. 
 
 
 
 Married. 
 
 
 
 
 ., 
 
 
 
 
 
 
 
 No. 
 
 
 " 
 
 April 18, 18S7. 
 
 0. 
 
 Multiloeulart^yHtH 
 
 broad ligament. 
 
 «„. 
 
 Five. 
 
 
 Widow. 
 
 
 
 
 
 
 
 
 
 
 ■■ 
 
 Yes. 
 
 
 » 
 
 April 1«, 18S7. 
 
 44 
 
 Mnitiiccuiarcyst. 
 
 Right. 
 
 Ye.. 
 
 Three. 
 
 
 Married. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 U 
 
 May 2, 1887. 
 
 " 
 
 
 
 N„U,e.,,Hro,„. 
 
 one. 
 
 
 
 
 
 
 
 " 
 
 
 
 
 
 
 
 
 m 
 
 May 5, 18S7. 
 
 53 
 
 
 Left. 
 
 No. 
 
 No. 
 
 
 Single. 
 
 ■■ 
 
 ■■ 
 
 
 
 
 
 
 
 
 
 No. 
 
 
 2!? 
 
 Slay 10, 1897. 
 May 11, 1887. 
 May 12, 1887. 
 
 : 
 
 "' •" ; 
 
 Rigbl. 
 
 No. 
 
 one. 
 
 
 Married. 
 
 
 
 
 
 
 
 
 
 •■ <?) 
 
 Yc. 
 No. 
 
 Ye.. 
 No. 
 Ye.. 
 
 Died, 18th day, of 
 Pulmonary 
 Embolism. 
 
 .a 
 
 May 16, 18S7. 
 
 33 
 
 Multilocular " 
 
 L.«. 
 
 To.. 
 
 NO. 
 
 
 Single. 
 
 
 
 
 
 
 " 
 
 
 
 
 
 
 After nearly four 
 
 270 
 
 May 20, 18S7. 
 
 28 
 
 
 Right. 
 
 
 One. 
 
 
 Married. 
 
 
 
 
 
 
 
 
 
 " (?) 
 
 
 
 pulec and temper- 
 cntly of iudlgea- 
 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 280 
 
 J„„a 8,™t. 
 
 53 
 
 Colloid tiimorB. 
 
 IJoth. 
 
 No. 
 
 Eight. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 No. 
 
 tion. 
 
 281 
 
 June 30, 1857. 
 
 35 
 
 Multilocular cyst 
 
 
 Ye.. 
 
 NO. 
 
 Single. 
 
 
 
 
 " 
 
 
 
 
 
 
 
 
 
 282 
 
 July 7, 1887. 
 
 45 
 
 Papilloma. 
 
 
 
 Three. 
 
 Married. 
 
 
 
 
 
 
 
 
 
 
 .. 
 
 Ym. 
 
 
 
 
 
 
 
 
 1 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
's by Laparotomy 
 
 No. 
 
 Pd 
 
 Adhesions. 
 
 No. 
 
 Tes. 
 
 No. 
 
 Tes. 
 
 No. 
 
 Tes. 
 
 and 
 
 No. 
 

 
 
 
 
 
 
 Hysterectomies and 
 
 removal of 
 
 Uterine Tumors 
 
 )y Laparotomy. 
 
 
 
 
 
 
 Ko. 
 
 Ago. 
 
 Date. 
 
 Kind of Tumor. 
 
 Catamenia since. 
 
 Children befo 
 
 re. Married or Single. 
 
 Ine,.,on. 
 
 Rupture. 
 
 Treatment of Pedicle. 
 
 AdlieBione. 
 
 Health. 
 
 Cauae of Death. 
 
 Draiu age- 
 
 Wei.^ht of 
 
 Result. 
 
 Remarks. 
 
 ' 
 
 40 
 
 April 
 Moy 
 
 S, 1881. 
 n, 1882. 
 
 Myon.«. 
 Fibro-cyat and botb ovaries 
 
 Died. 
 
 No. 
 
 Single. 
 
 Long. 
 
 Unltnown. 
 
 Intra-peritoneal. Tied and 
 cauterized. 
 
 Intra-peritoneal. Tied aud burnt. 
 
 No. 
 
 Good. 
 
 Debility. 
 
 No. 
 
 U Iba. 
 
 Recovered. 
 Died. 
 
 
 = 
 
 .. 
 
 April 
 
 11,1833. 
 
 Two-horocd uteruB filled with 
 bloody fluid. 
 
 No. 
 
 ■■ 
 
 
 " 
 
 No. 
 
 Estra-peritoneal. Tied with 
 Bilk aud kept oulaide. 
 
 No. 
 
 Good. 
 
 
 
 
 neeovered. 
 
 
 ^ 
 
 « 
 
 April 
 
 24, 1883. 
 
 Fibro.n.yo.a. 
 
 Died. 
 
 six. 
 
 
 " 
 
 
 Extra-peritoneal. Clamp. 
 
 Tee. 
 
 Died. 
 
 septicemia. 
 
 
 
 Died. 
 
 
 
 44 
 
 Oct. 
 Nov. 
 
 3, 1883. 
 
 
 
 No. 
 
 j Single. 
 
 I 
 
 Married. 
 
 
 
 Intra-peritoneal. Tied. 
 Intra-peritoneal. 
 
 " 
 
 
 Shock 
 
 " 
 
 8 lbs. 
 
 
 
 : 
 
 52 
 
 June 
 
 12, 188). 
 23, 1884. 
 
 Fibroid. 
 
 „ 
 
 
 
 
 Yea. 
 No. 
 
 Extra-peritoneal. Ktcberle'e 
 eerre-ncuud. 
 
 Intra-peritoneal. Tied. 
 
 No. 
 
 Good. 
 
 
 
 2S " 
 
 Recovered. 
 
 
 ■' 
 
 . 
 
 Aug. 
 
 0, 1884. 
 
 Fibro-myoma. 
 
 Died. 
 
 
 Single. 
 
 
 
 Extra-periConeal. Koeberle's 
 
 
 Died. 
 
 Septieiemia. 
 
 
 71 lbs. 
 
 Bled. 
 
 
 ,. 
 
 . 
 
 B.O. 
 
 6,1884. 
 
 Fibre -myoraatoiie cyst. 
 
 Yes. 
 
 
 
 
 ■■ 
 
 Intra-peritoneal. Tied and burut. 
 
 .e.. 
 
 Good. 
 
 
 " 
 
 3i " 
 
 Recovered. 
 
 
 . 
 
 60 
 
 Fob. 
 Fab. 
 April 
 
 June 
 July 
 
 5, 1885. 
 
 14, 1885. 
 20, 1885. 
 
 15, 1885. 
 
 Fibro-myoma. 
 
 Myoma. 
 
 Fibro-myoma. 
 
 Fibroid. Ovuriea uystlc also. 
 
 Fibroid and un ovury cyalic. 
 
 Fibroid. 
 
 Died. 
 
 Irregular. 
 Tea. 
 
 Ono. 
 
 Married. 
 
 Single. 
 Married. 
 
 Single. 
 Married. 
 
 Short. 
 Long. 
 
 
 Extra-peritoueal. Kosberie'a 
 Berre-uojud. 
 
 Intra-peritoneal. Ligature and 
 WMitery. 
 
 Extra-pcritoneiil. KiDbcrlc'i) 
 Intra-peritoneal, Tied. 
 
 Extra-peritoneal. Kceberle's 
 aerre-utcud. 
 
 No. 
 
 Died. 
 Good. 
 
 nasmorrhnge. 
 
 Tea. 
 
 No. 
 
 Tea. 
 
 i 
 
 8 ■■ 
 Small. 
 
 4 
 
 Died. 
 
 
s by Laj^arotomy 
 
 Ko. 
 
 IK 
 
 lis, 
 
 Yes. 
 
 No. 
 
 Ko. 
 
 Ilk, 
 
 Yes. 
 
 No. 
 

 
 
 
 
 
 
 Hysterectomies and 
 
 removal of Uterine Tumors 
 
 by Laparotomy- 
 
 
 
 
 
 
 Ko. 
 
 Age. 
 
 Dale. 
 
 K..„,T™o,. 
 
 Catanieiiia since. 
 
 Children before. 
 
 Miirpcd or Single. 
 
 ineieion. 
 
 Rupture. 
 
 Treatment of Pedicle. 
 
 Adheeloue. 
 
 Health. 
 
 Cause of Death. 
 
 Drainage. 
 
 Weight of 
 
 Result. 
 
 Remarks. 
 
 . 
 
 !» 
 
 Sept. 18 
 
 1885. 
 
 llyxo -fibroma. 
 
 No. 
 
 .0. 
 
 Siogle. 
 
 - 
 
 NO. 
 
 Exlra.peritoueal. Kiuberle's 
 serre-nieud. 
 
 NO. 
 
 Oood. 
 
 
 No. 
 
 .... 
 
 Recovered. 
 
 
 IS 
 
 45 
 
 Feb. 22 
 
 «8.. 
 
 Fibro-myomn. 
 
 
 
 
 
 l^ied. 
 
 Extra-peritoneal. 
 
 
 Excellent. 
 
 PeritoniliB. Ulceration 
 
 of the ccceal valve, 
 pelvic abscees. 
 Death, 27th day. 
 
 
 fl iDChee of 
 uterine 
 cavity. 
 
 IG lbs. 
 
 Died. 
 
 
 20 
 
 48 
 
 Oct. 6 
 
 1886. 
 
 Fibro-mysoma. 
 
 So. 
 
 Sli. 
 
 Married. 
 
 
 No. 
 
 
 Tea. 
 
 Excellent. 
 
 No peritonitis. Death 
 
 
 
 Recovered. 
 
 
 . 
 
 . 
 
 Jau. 11 
 
 188. 
 
 ibro-myoraa. 
 
 "" 
 
 Ooe. 
 
 
 
 Died. 
 
 
 No. 
 
 Died. 
 
 logical shock, ap- 
 parently. 
 
 
 6 
 
 Died. 
 
 
 . 
 
 4, 
 
 ,„. 22 
 
 1887. 
 
 
 No. 
 
 
 Single. 
 
 
 No. 
 
 Estra-peritonenl, including a 
 piece of tbe bladder. 
 
 " 
 
 Good. 
 
 
 
 =... 
 
 .ee.„red. 
 
 A portion of bladder was 
 included in serre-nomd 
 
 . 
 
 ,2 
 
 ... , 
 
 18S,. 
 
 .„™...™. 
 
 
 One. 
 
 Widow. 
 
 
 
 Extra-peritoncjil, tied with silk, 
 and held outside with a pin. 
 
 Tei. 
 
 
 
 Tea. 
 
 Incorpora- 
 ted with left 
 
 ovary. 
 
 
 Ventral hernia cured at 
 
 « 
 
 
 Fob. 12 
 
 1887. 
 
 Fibro-myoma. 
 
 
 Three. 
 
 Morrled. 
 
 
 
 Extra-peritoueal, 
 
 No. 
 
 
 
 No. 
 
 7.h.. 
 
 
 
 . 
 
 ™ 
 
 ... :. 
 
 1887. 
 
 Ulerua incorporated in an 
 Ovariuii Tumor. 
 
 •■ 
 
 No. 
 
 Single. 
 
 
 ■• 
 
 Extra-peritoneal, lied with eilii, 
 
 .e.. 
 
 
 
 Tes. 
 
 Inosrpora- 
 
 teri with left 
 
 ovary. 
 
 
 Twisted pedicle. 
 
 » 
 
 3» 
 
 March 18 
 
 1887. 
 
 »"-™»; 
 
 
 
 ■■ 
 
 
 
 Extra -peritoneal. Pelvic portion 
 of Tumor loft behind. 
 
 
 
 Obatmction of ureters 
 by wire. 
 
 NO. 
 
 .lbs. 
 
 Died. 
 
 
 2, 
 
 48 
 
 April 29 
 
 1887, 
 
 
 No. 
 
 
 
 
 ■• 
 
 Extra.peritoneal. 
 
 No. 
 
 
 
 
 
 Recovered. 
 
 
Qe and Ovarian Tumo] 
 
 R E M A ] 
 
 s. Xo Autopsy. 
 
 icer removed. 
 
 lis of Tumor Isrought outside and held t 
 
 plum removed. Died some years later. 
 
 3 Omentum for Diagnosis. 
 
 topsy. 
 
 lit Ovary. 
 

 
 
 Laparotomies. 
 
 Attempted and Partial Removal of Uterine and Ovarian Tumors 
 
 
 "ko. 
 
 Dale. 
 
 Age. 
 
 Caiiae of OperaUon. 
 
 Result. . 
 
 R E M A R 
 
 K e . 
 
 ' 
 
 FBb. 3, 18S0. 
 
 a, 
 
 ABciU'S and Sarcoinatous Ovaries. 
 
 Died. 
 
 
 Died on the 10th day. Dlaeascd Kidneys and probably Peritoniiia. No Autopsy. 
 
 
 2 
 
 Juno U, 1881. 
 
 " 
 
 Sarcoma of Omentum, Srcnoutery and Pelvic OrganB, 
 
 
 
 B,.o,.oe..oa....™. AW13...o,Bacep.,o.Ca„e„„„ovo.. 
 
 
 = 
 
 July 13, ISSl. 
 
 50 
 
 Utor]in;Fihro.cyat, 
 
 
 
 Cyst emptied and wails sewed up and dropped back. 
 
 . 
 
 f 
 
 * 
 
 xov. .:,«a,. 
 
 33 
 
 
 
 
 Cyst emptied. lOJ lbs. solid matter removed. Cyst walls and wu 
 
 lis of Tumor brought outside and held by 
 
 Steel Sound. 
 
 :> 
 
 Dbc. 29, I»81. 
 
 30 
 
 
 Recovered 
 
 
 Cyst emptied. 14 lbs. fluid removed. Another Fibroid size of a 
 
 )lum removed. Died some years later. 
 
 
 » 
 
 Feb. 10, 1882. 
 
 5. 
 
 Solid Sarcoma or Cancer of IFterue, Ovaries, Bowels, and Pelvic com.iHa. 
 
 Died. 
 
 
 S,.oe..o...a.,.ao.o„,.«o.ope.„o„. 
 
 
 
 
 May 6, 1882. 
 
 .2 
 
 Attcitcs and Cyelic Tumor in Pelvia. 
 
 
 
 Cysta (small) punctured. Uterus involved in Tumor. 
 
 
 » 
 
 Aue- ^. 1882. 
 
 3, 
 
 Adherent Ovurian Cyst. 
 
 
 
 Nothing removed. 
 
 
 « 
 
 SEpl. 11, 1882. 
 
 62 
 
 Fibro-cystof Uterus. 
 
 
 
 Portion of Tumor (7 lbs.) removed. 
 
 
 ,0 
 
 S.P1. 21,1882. 
 
 62 
 
 Adherent Ovarian Tumors. 
 
 
 
 Ascitic and Ovarian fluid removed and a portion of Cysts. 
 
 
 " 
 
 Nov. 15, 1882. 
 
 20 
 
 Cancer of OvaricB and Peritoneal OryaEs. 
 
 
 
 One Ovary removed ; and Ascitic fluid and a portion of Caneeroua Omentum for Diagnosis. 
 
 
 ,. 
 
 April 21, 1883. 
 
 30 
 
 Aecitea and General Abdominal Cancer. 
 
 
 
 Probably growth originally, Papilloma of Ovaries. 
 
 
 13 
 
 May 21, 1883. 
 
 38 
 
 Fibroid of Uterus, and Tumor of both Broad Ligaments and Uterui^. 
 
 
 
 Cysts and fluid removed, partially. 
 
 
 „ 
 
 July 10, 1883. 
 
 « 
 
 Tumor filled with pus, adherent to Bowels, small and large, and Pelvis. 
 
 
 
 Probably a Salpingitis. Died in Convulsions in 34 hours. No Autopsy. 
 
 
 U 
 
 Nov. 27, 1883. 
 
 48 
 
 Cystic Fibro-myoraa and Ovari.tn. 
 
 
 
 P.„,a,„,oova,„l..e™.aa. 10 ...„.»„.. 
 
 
 u 
 
 Oct. IS, 1881. 
 
 6. 
 
 General Abdominal Cancer. Originally, perhaps. Ovarian. 
 
 
 
 Tweuly-tive pounds of fluid removed. ' 
 
 
 " 
 
 May 7, 1886. 
 
 « 
 
 Uterua tilled and covered with Fibro -myomatous Tumoru. 
 
 
 
 A sebaceous mass removed, and probably more or less of the Right Ovaiy. 
 
 
3d to sMn. 
 
 , of Cancer of liver and uterus. 
 
 L885. 
 
 It pui-ulent discharge in 1887. 
 
 R E 
 
 ther disorders. 
 
 R E 
 
 moved in 1S77, on account of cj-sti 
 
 ied soon afterward. 
 
 n adult foJtus removed. Specimei 
 
Laparotomies for Ovarian Cysts, stltclied to sldn. 
 
 No. 
 
 pa... 
 
 Age. 
 
 Cuuee of Operation. 
 
 Kbsult. 
 
 
 REMARKS. 
 
 
 1 
 4 
 
 July 18, 1883. 
 March i, 1884. 
 Aug. la, 1884. 
 Oct. 6, 1884. 
 
 as 
 
 AdhercDt cyet, origin probitbly ovariuii, inseparable. 
 
 Tumor puocliirctl. Oviirian, probably. 
 
 Turaor probably ovariau, or of broad liBiuncut, aud tubercular. Peritonitie. 
 
 Cyat of riflit broad ligameiit. 
 
 Recovered. 
 
 Tumor stitched to skin, and drained. Died subsequently, of Cancer ol 
 Tumor stitched to sldn, and drained. Died of Phthisis, 1885. 
 
 ,.e.an.U,.e™,. 
 
 
 6 
 
 June 12, 1885. 
 
 3, 
 
 Multiloculur ovarian cyst, — adherent. 
 
 
 Cyst stitched to skin, and drained. Well, except forsliglit purulent dis 
 
 
 
 T 
 
 May 25, 1880. 
 
 41 
 
 CysiH of botli ovarieg. Left, ndhe'rent aod inseparable. 
 
 
 Cyst stitched to skin, and drained. Perfectly well in 188T. 
 
 
 
 ' 
 
 June 3, 1880. 
 
 40C?) 
 
 Jliihilocnlar ovarian adherent cyet, with thick walls. 
 
 
 Cyst stitched to skin, and drained. Perfectly well in 18S7. 
 
 
 
 
 
 
 
 
 Lai^ar 
 
 otomies for Cysts complicated with otlier disorders. . 
 
 
 
 
 
 No. 
 
 Date. 
 
 Age. 
 
 Cause of Operation. 
 
 Resuit. 
 
 R E M A R 
 
 K S . 
 
 
 
 - 
 
 July 3 
 
 is™. 
 
 45 
 
 Uterine fibro-cyst. 
 
 Died. 
 
 Walls of cyst stitched to skin. Both ovaries had been removed in 1877, on account of cys 
 
 —■ 
 
 
 
 
 2 
 
 Oct. n 
 
 1882. 
 
 . 
 
 Uterine fibro-myomatous cyst, and ovarian cyst. 
 
 
 Ovarian Tumor removed. Uterine cyst stitched to akin. 
 
 
 
 
 
 3 
 
 Aug. 1 
 
 1883. 
 
 42 
 
 Tumor probably ovarian, but exact nature unknown. Alraosl eulid. 
 
 Recovered. 
 
 .o™„...e. .0 ..o, an,, .™,„e.. ..e,. .„„», .u... .oou a«e™a,a. 
 
 
 
 
 
 ^ 
 
 Sept. 20 
 
 1883. 
 
 A.OU, 
 
 Bomi-solid Tumor attached to bladder and all neighboring organs. 
 Probably ovarian, originally. 
 
 Died. 
 
 Tumor stitched to skin, and drained. 
 
 
 
 
 
 „ 
 
 March 
 June 
 
 , 1880. 
 
 35 
 
 Cyst of extra-uterine prcgniincy, seven years old. 
 
 
 Cyat Btitclicd lo skin, and drained. Ali Ibe skeleton of au adult fuTtus removed. Specim 
 Cyat Btitclied to skin, aud drained. Died of shock and Peritonitis. 
 
 u in Warren 
 
 Museum of H 
 
 arvard College. 
 
 9 
 
 ' 
 
 April 
 
 ,188,. 
 
 45 
 
 Adherent Tubo-oviirian cyst. Fibro-myomii. Hydro -salpinx. 
 
 
 Cyst stitched to skin, aud drained. Died of Acute Peritonitis. 
 
 
 
 
 
jsy, the Tumors were found to be ir 
 
 lominal tappings. 
 
 R E 3J 
 
 me, better than for many years. M 
 
 jvable. 
 
 Vent home well and strong 
 
Exploratory Laparotomies. 
 
 KO. 
 
 Pntc of 
 OiieralioD. 
 
 Ago. 
 
 Cause of Operation. 
 
 Result. 
 
 - 
 
 E M A R K S . 
 
 
 , 
 
 Dec. 12, 1S7S. 
 
 02 
 
 
 Iteeoverea. 
 
 T,.ea.c„o.nev.„eeu„ea.S.ea..ayoa,.«o.vard.. 
 
 
 
 = 
 
 Feb. 22, 1881. 
 
 48 
 
 Papillomntous adherent Tumors and ascites. 
 
 
 Died eight months later, September 9, 1SS2. At the autopsy, the Tumors were found t 
 
 bo irremovable. 
 
 
 3 
 
 Aug. 18, 18S1. 
 
 80 
 
 Solid sarcoma, probsibly not cystic. So adherent as to be immovaljje, and 
 originally, ovurJLm. tiome ascites. 
 
 
 Died a year or two later. 
 
 
 
 ' 
 
 Sept. 22, 1S81. 
 
 21 
 
 Ascites, and pelvic Tumor, immovable. 
 
 
 Tumor is said to have disappeared in ISSiJ, after many abdominal tappings. 
 
 
 
 ^ 
 
 Sept. 20, 1S82. 
 
 8, 
 
 Ascites, and general abdominat Cancer. 
 
 
 Died, March 19, 1883, six months after Laparotomy. 
 
 
 
 « 
 
 May a, 1883. 
 
 84 
 
 ABcites, and general abdominal Cancer. 
 
 
 l.t.ou.M.o.avo.,eaa.ou.,.„o„ou...,a..,. 
 
 
 
 
 Aug. 0, 1888. 
 
 00 
 
 Ascites, and general abdominal Cancer. 
 
 Died. 
 
 In three days, died of Peritonitis. 
 
 
 
 . 
 
 March 22, 1881. 
 
 .0 
 
 Ascites, and general abdominal Cancer. 
 
 Recovered. 
 
 Blea about ..™„n... MO. 
 
 
 
 « 
 
 Juno 13, 1884. 
 
 " 
 
 Tubercular salpingitis and cheesy deposits in abdomen, of tubular and 
 tubercular origin. 
 
 B,0U. 
 
 Death from Peritonitis, on third day. 
 
 
 
 ,0 
 
 Juno 1!), 1884. 
 
 21 
 
 Tubercular peritonitis. 
 
 liccovered. 
 
 Fat and well in 1SS6. Married. Has gained thirty pounds. 
 
 
 
 " 
 
 Jan. 8. 1885. 
 
 40 
 
 Canoo..,„na.„o„,„a,v,.ee.. A.eH0.an..„a,ua.e. 
 
 
 Death, six months later. 
 
 
 
 12 
 
 July 0, 1885. 
 
 10 
 
 Canterous abdominal Tumor, of unknown origin. 
 
 
 Died, May 1, 1880, nine months after Laparotomy. 
 
 " 
 
 
 
 
 
 
 
 
 
 H 
 
 Nov. 20, 1885 
 
 
 Cancer of omentum, probably. Ascites. 
 
 " 
 
 Iticd of Pneumonia, March 13, 1SS6. Health, up to that time, better than for many year 
 
 . Much benefited by operation. 
 
 . 
 
 „ 
 
 Feb. 10, 1886 
 
 
 Enbirged uterus, and apparent Tumor in left iliac region. 
 
 
 Ko™.ova..Tu„o,.oun.. 
 
 
 
 U 
 
 KOV. 2,18Se 
 
 05 
 
 Tumor in right iliac region. 
 
 
 Tumor involving and including small intestine, — not removable. 
 
 
 
 ,« 
 
 Nov. 13, 1880 
 
 5. 
 
 General abdominal Cancer. 
 
 
 Drainage. A.e,..e «u. renrovo. D,e. .ou.o „ou.b. later. 
 
 
 
 - 
 
 Feb. 10, 1S&7 
 
 08 
 
 — ■>— ■ 
 
 
 Went home well. Not since heard from. 
 
 
 
 n 
 
 Feb. 22, 1887 
 
 55 
 
 Abdominal Tumor. 
 
 Septic PeritonittB. 
 
 Ovariotomy, si.^i years before. 
 
 
 
 10 
 
 April 30, 1887 
 
 17 
 
 AscitCB. Tubercular peritonitis. Ovary and tube removed for diagnosis. 
 
 Kc covered. 
 
 Drainage. Prof. FiTZ reported the disease tubercular. Went home well and strong. 
 
 
 
 I 
 
ge : — Three cures. 
 
 r. Her monthly sickness has been 
 
 lylum about 1S71. The resources of 
 
 7 lost than before operation. 
 
 tter to have removed the uterus. 
 t of the abdomen. Subsequently 
 
 r December 20, 1886, and patient's 
 
 One cure. Four, 
 
 manent Improvement, thovigh the ] 
 
 Goldsmith in American Journal o 
 
 lum, of Phthisis, 1886. 
 
 Dre operation. Catamenia painful. 
 
 before operation. 
 
Jan. 21, 18811. 
 
 Five cases of removal of Uterine Appendages for the cure of Uterine Haemorrhage : — Three ciires. One no improvement. One death. 
 
 myoma and McnBtnial Insanity. 
 
 Profuse Bleeding from Fibro-myooia. 
 
 Profuae Bleeding from Fibro-myoma. 
 
 Catamcnia since. 
 
 T'lowing slightly 
 
 roucb of the 
 
 ceased 
 
 Flowed for five 
 weeks. Now cat- 
 
 Exceesive Flowing 
 
 RPHiilt Recovery 
 
 Perfect recovery. 
 
 appeared, and the 
 paticDt is happy 
 and overjoyed at 
 
 No improvement. 
 
 Recov'd from 
 
 ■ REMARK 
 
 laller. Her monthly siclineBs hne been lees than before opernlion, but a r 
 
 leaking of blood till June, 
 
 111 Worcester iDsane Asylum about 1S71. The resources of the town where she lived had teen exhausted in attempts to restrain and control her during her menstrual periodg. 
 
 It would have been better to have removed the uterus. The tumor was a large, wet, spongy fibro-myoma, and t 
 pulled out of the abdomen. Subsequently the tumor was stuffed back. 
 
 Tumor somewhat larger December 20, 1S88, and patient's condit 
 
 r the tumor had beefl 
 
 
 
 
 Five cases of removal of Uterine Appendages for IN'ervons Disorders. One enre. 
 
 Four, no great hnprovement. 
 
 Ho. 
 
 Date. 
 
 Age. 
 
 Cause of Operation. 
 
 Catamcuia since. 
 
 Result. 
 
 DeatL. 
 
 UBMA.KS. 
 
 > 
 
 
 . 
 
 Hysteromania. 
 
 No. 
 
 Much improve- 
 
 Recovered. 
 
 I think there is do permanent improvement 
 
 though the patient states that there is. 
 
 ' 
 
 July 20, 1S83. 
 
 1» 
 
 Moral Insanity, Operation done at Danvers Insane Asylum. 
 
 
 Complete relief. 
 Perfectly well. 
 
 
 Case reported by Dr. Goldsmith in Ameri 
 
 an Journal of Insanity, October, 1SB3. 
 
 ' 
 
 ... .3,^3. 
 
 . 
 
 Mania. {Chronic.) 
 
 
 No improvement 
 
 
 B,.a.Wo„e.,„A.„..,o.P....,.,18 
 
 ,. 
 
 • 
 
 AUB. M, 1885. 
 
 35 
 
 Severe pain in left ovarian region, causing nenous symptoms. 
 
 Tes. Regular. 
 
 No great improve- 
 
 
 About the same as before operation. Cata 
 
 uenia painful. 
 
 ^ 
 
 Sov. 25, 188S. 
 
 
 Pain, Nervous Excitement, and Hystero-Epilepay. 
 
 Yes. 
 
 No great improve- 
 
 
 The same condition as before operation. 
 
 
nors. — Two immense 
 
 R E M A R 
 
 and the abdominal wound, extending n 
 
 laining behind. Cases reported in " Boi 
 
 . Case reported in '• Boston Medical ar 
 
 REM 
 
 vom-out, feeble woman. Stones remov 
 
 •nal," Vol. ex, p. 73. Suppression of u 
 
 edical and Surgical Journal." 
 

 
 
 Lapai'otomy 
 
 for other purj^oses than the removal of Abdommal Tumors. — Two immense fatty Timiors. 
 
 
 No. 
 
 .a.o. 
 
 CouBCOf operation. 
 
 -""■ 
 
 REMARKS. 
 
 ^ 
 
 Oct. 30, 1881. 
 
 Iinracnae Lipoma. Ketro -peritoneal. Patient, 
 
 exploratory. 
 
 man aged 38. Operation 
 
 
 Recovered. 
 
 The Tumor was found to be broadly attached behind the peritoneum 
 
 and the abdominal wound, extending nearly from the Eiisiform cartiinge lo the Pubea, was 
 
 o»ca„p. 
 
 " 
 
 Feb. 5, 1882. 
 
 Same patient, who desired to Iry the oper 
 
 lion aan last resort. 
 
 
 Died. 
 
 Tumors removed weighed GQ pouude. More myxomatous tumors re 
 
 laining behind. Cases reported in " Boston Medical and Surgical Journal," Vol. cviii, pp. 3 
 
 and 241. 
 
 
 Wnreh 21. 1882. 
 
 Patient, ii woman with a fluctualhig Tumor from 
 wlicu uBpira(«d. Aged 
 
 whieli notliing would run 
 
 
 
 Tumor removed, a rayxo-llpoma weighhig 35 pouuds, retro -peritonea 
 
 Case reported in " Boston Medical and Surgical Journal," Vol. cviii, pp. 35 and 241. 
 
 
 
 
 
 
 
 
 
 
 
 Renal Tumors. 
 
 
 
 
 
 
 
 
 No. 
 
 B.O. 
 
 Sex. 
 
 Cause of Operation. 
 
 Result. 
 
 REMARKS. 
 
 
 
 
 
 
 
 
 
 Recovery from the 
 
 
 
 
 
 
 
 
 
 
 April 10. 1882. 
 
 Female. 
 
 
 
 itbacees of right Ividney. Age 
 
 
 
 Deatrone month 
 
 A case of calculous nephritis of long standing, in a wom-o 
 
 
 
 
 
 I outer bordc 
 
 rof right reel 
 
 
 ^ 
 
 Nov. 23, 1883. 
 
 Malo. 
 
 
 Sareo 
 
 ma of left Kidney. Aged 29. 
 
 
 
 Died. 
 
 Case reported in " Boston Medical and Surgical Journal," 
 
 Vol. ex, p. 73, SupprcBBion of urine and peritoi 
 
 ..,.. 
 
 
 
 
 
 
 ' 
 
 Aug. 1, 1884. 
 
 Female. 
 
 Large e 
 
 icculiited Kidney 
 
 right) lllled with pus. Tumor 
 Aged 42. 
 
 weiglictl 
 
 2 pounds. 
 
 
 Suppression of urine. Case reported in " Boston M.dical 
 
 uid Surgical Journal." 
 
 
 
 
 
 
 t 
 
strnction. 
 
 Very comfortable for nearly a y 
 
 Patient very stont. Weather ve 
 
 Great relief for a week. Case <^ 
 
 Described in text. 
 
 Abscess. 
 
 1887. 
 
 )yaries and Tubes. 
 
 R E M A 
 
 t tube could not be distinsuished. Man 
 
 3e and uterus distinguishable. 
 
 Abscess. 
 
 R E 
 
 f passing an india-rubber drainage-tube 
 

 
 
 
 
 Laparotomy on account of 
 
 Intestinal obstruction. 
 
 
 
 K 
 
 Date. 
 
 Age. 
 
 Sox. 
 
 Cause of Operation. 
 
 T,.l.e„.. 
 
 Be.„,.. 
 
 REMARKS. 
 
 
 B., ..... 
 
 « 
 
 Female. 
 
 IntCBlmftl olistniction, ciinacd by Cancer of the df 
 months after ovariotomy. 
 
 euding colon, aeven 
 
 AniBcial anue in pubic region. 
 
 Recovered. 
 
 Very corafortnble for nearly a year. Died of general abdon 
 
 inal Cancer, November, 1 
 
 .. 
 
 
 July 10, lSS-2. 
 
 
 
 Inteslinal ol.atri.cliou, cauaed l.y Cancer of the dt^t 
 splenic region. 
 
 ending colon, in the 
 
 Artificial anus in creciil region. 
 
 Died. 
 
 Patient very stout. Weather very hot. 
 
 . 
 
 
 
 ..... .,,»«. 
 
 . 
 
 Male. 
 
 Inleetiual obstnicliou, cauaed by a baud from a JIo 
 
 .1W,„„,.1U,. 
 
 Artlficiiil anus in umbiliciil region. 
 
 
 Great relief for a week. Case described by Prof. FlTZ, in t 
 
 lie "American Journal of 
 
 l.e>...,S*,..,..V0,.el„.p.». 
 
 
 April 3, ISSa. 
 
 61 
 
 .e..,e, 
 
 Intcatinal obstruction, cansed by strangulation of tiit 
 the cicatrix of ovariotomy. 
 
 intesUne at the site of 
 
 Artificial anus at site of old cicatrbc. 
 
 
 Described in text. 
 
 
 
 
 
 
 
 
 
 Laj^arotomy 
 
 on account 
 
 of Peri-typlilitic Abscess. 
 
 
 .S„. 
 
 Bale. 
 
 Cauaeof Operation, 
 
 
 Treatment. 
 
 Result. 
 
 REMARKS. 
 
 ' 
 
 Jan 
 
 11, IS.. 
 
 Peri-typhlitic abHcesa and 
 
 peritonitis. 
 
 Lap 
 
 arotomy in right iliolumbar region. 
 
 Recovered. 
 
 Well and hearty in 1887. 
 
 
 Laparotomy for Pyosalpinx and Suppuration in Ovaries and Tubes. 
 
 1.0. 
 
 Ba,„. 
 
 Ago. 
 
 Cause of Oper.illon. 
 
 Keault. 
 
 REMARKS. 
 
 ' 
 
 May 21, 3380. 
 Doc. 0. 1886. 
 
 22 
 
 Double pyo-aalpiux and abscesHca iu both ovaries (gonorHxcal]. 
 Suppurating tubo-ovarian cyst, with general old pelvic peritonitis. 
 
 Died. 
 
 Both ovaries filled with absceeaea, and adherent. The right tube could not be diatinguiebed. Many ligatureB or rather many knots. Ligature discharged seveu months later. 
 Pelvic organs presaed together, and only right Fallopian tube and uterua distinguishable. 
 
 
 
 
 
 
 
 
 Laparotomy for long-standing Pehdc Abscess. 
 
 
 
 
 
 
 
 
 So. 
 
 Date. 
 
 A.e. 
 
 Sex. 
 
 OaufiQ of Operation. 
 
 Result. 
 
 B.MAKKS. 
 
 ^ 
 
 Aug. 20, 1885. 
 
 ,0 
 
 Female. 
 
 Pelvic Abscess f 
 
 
 s probably tubercular. 
 
 Recovered. 
 
 Improved by operation, -which consisted of paasing an India 
 
 •rubber drainage-tube from the pnbic regi 
 July 0, 18B0. 
 
 n through pelvis and rec 
 
 urn, and o 
 
 ut through the a 
 
 
 f general tu 
 
 bcrculoslfl 
 
 I 
 
matures heard 
 from. 
 
 e., prior to 1877 
 
 Health eince. Fib 
 

 
 
 
 
 
 Ovariotomies before the adoption of Listerism: — 
 
 i. e., prior 
 
 to 1877. 
 
 
 
 
 • 
 
 
 
 So. 
 
 Date. 
 
 Age. 
 
 Kind of Tumor. 
 
 Wblcb Ovnry. 
 
 CatamenJa since. 
 
 Children before. 
 
 Children alnce. 
 
 tiiui,'le. 
 
 O.SL. 
 
 Rupture. 
 
 Ligaturea heard 
 
 Health since. 
 
 ™„,..o„. 
 
 Fibroid removed. 
 
 Twisted pedicle. 
 
 Geault. 
 
 Drainage. 
 
 Adhesions. 
 
 1 
 
 ,8«. 
 
 30 (?) 
 
 Multilobular cysts. 
 
 Both. 
 
 
 K„. 
 
 
 Slhglo. 
 
 .oog. 
 
 
 
 
 No. 
 
 No. 
 
 No. 
 
 Died. 
 
 No. 
 
 Yes. 
 
 ^ 
 
 April 24, 1873. 
 
 « 
 
 Multiloeular cyal. 
 
 Eight. 
 
 
 
 
 ■• 
 
 
 
 
 
 
 ■■ 
 
 
 
 
 
 3 
 
 Feb. 17. 1874. 
 
 . 
 
 Papillorna. 
 
 Both. 
 
 
 
 
 Married. 
 
 
 
 
 
 
 ■■ 
 
 
 
 ■■ 
 
 ■■ 
 
 ' 
 
 Feb. 18, 1874. 
 
 43 
 
 M„U„„»,„.,.. 
 
 Right. 
 
 
 
 
 
 
 
 
 
 
 
 
 » 
 
 ■■ 
 
 
 .» 
 
 May 18, 1875. 
 
 
 Unilocular " 
 
 ..t. 
 
 
 Yes. 
 
 
 
 Short. 
 
 
 
 
 
 
 
 
 
 No. 
 
 Only one of the above cases, the last, was at all promising. I think I could easily cure a similar 
 
1- 
 
Hoaana 
 
 H75 
 
 COLUMBIA UNIVERSITY LIBRARIES ihsi sixi 
 
 RD540H75C.1 
 
 Three i- , c -: ,- : ; , ^, , riparotomi 
 
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