Hence this class of tumors will frequently come under the surgeon's knife, even if their true nature has not been discovered. On the other hand, when a clear diagnosis is possible, their removal must generally be urged.
Formerly the majority of operations of this kind were undertaken in consequence of faulty diagnosis, the growths being mistaken for ovarian cysts. The following cases belong in this category : 1. Neugebauer,' who removed a pediculated uterine cysto-sarcoma through the abdominal walls, with a fatal result.
2. Routh' could not complete the operation. The patient died of hemorrhage from the walls of the cyst.
3. Demarquay.' The patient died thirty-six hours after the operation, at which the tumor could be separated from the fundus.
4. Browne.' The operation was not completed. The patient died.
5. Roberts.' The clamp was used. Recovery.
6. Bryant.' The tumor had a pedicle which was clamped. Recovery. 7, 8, 9. Treenholme,' Frankenhauser (Dissert. of Heer). Keith (Lan cet, 1875) operated successfully.
10, 11. Cheever ' and Landi '° lost their ratienta.
The following cases were diagnosticated as cysto-fibromata and then operated upon: 12. Koeberle." Recovery.
13, 14. Keith (loc. cit.) Two successful cases.
15 to 22. Wan" extirpated eight fibro-cysts of the uterus. The opera tion was successful in six cases. There are besides the following cases (coq: Gazette des Hopit., 1869, and Pozzi, loc. cit.): Unfinished operations: Atlee 1849, one successful case.
Baker-Brown 1.860 and 1862, two fatal cases.
Spencer Wells 1864, one case with fatal issue.
Completed and successful operations: Lane 1844, seven cures; Fletcher 1862, Storer 1865, Atlee 1868, E. BOckel 1876, Krassowsky 1876, Hakes 1863, Wells 1863, Koeberl/ 1863, Atlee 1862, Stokes 1863, Oilier 1874, Hegar 1876, James Henry.
I merely mention Spiegelberg's " case in this connection, but do not in clude it in this class, since it relates to a special operation, viz., the enucleation of a cystic myoma from the uterine wall, through the ab dominal cavity.
The final result, attained by the difficult method of comparing statistics, vitiated by the reprehensible custom of repeatedly reporting the same case, is that laparotomy has been performed forty-one times, for fibro cystic uterine tumors, with twenty-two recoveries, i.e., 53.6 per cent. It was impossible to carefully separate those cases in which the tumors were removed alone from those in which the uterus was likewise extirpated. Only seven of the thirty-eight operations could be completed. Only one patient recovered from the effects of the operation. It is certainly re markable that out of the eleven extirpations performed after the diag nosis had been correctly made, only two proved fatal.
From these meagre details it appears nevertheless that the extirpation of cystic myomata by laparotomy, furnishes better results than the same operation when done for non-cystic tumors.
In explanation of this circumstance, it is to be remembered that the former variety of growths are more easily removed, since they are specially connected with the exterior of the uterine wall and are less frequently interstitial.
Under the influence of modern antiseptic methods, still more favorable results have been obtained. What has been already said in connection with fibroids in general, applies with equal force to the cysto-fibromata. It is not necessary to insert separate tables here, showing the detailed results of operations. Grosshoff has collected fourteen cases from the literature of the last few years, with a mortality of only four.