If the objection be made that the contrast of the results of 305 opera tions with those of 68 can give no exact basis of comparison, I can only say that any series of 68 operations may be taken from my general statis tics of earlier or later times up to 1876, and the ratio of percentage will not be different.
If we except from the four fatal cases, that of fatal hemorrhage on the first day, the mortality falls to only 4.4 per cent. I would not think it striking, however, if some operator should have 100 such cases in succes sion without a death, as the personal expertness of the surgeon and his assistants is a matter of great consideration.
develop in connection with the uterus as often, perhaps, as in connection with any other organ of the body. As regards the variety of growths that may invade its structure, the womb also occupies a front rank. It would be difficult, however, to establish by figures the proof of these statements. Indeed, we lack statistical evidence of an un impeachable kind to guide us in our attempts to accurately establish the relative frequency of all neoplasms. According to the tables published by Gurlt,' embracing 15,880 cases of tumor observed in the Vienna hos pitals, males furnished 29.84 per cent., and females 70.16 per cent. of all cases. This proportion of about seven females to three males is all the more noteworthy, when it is remembered that more men than women (about five to four) were admitted to the Vienna institutions.
The great preponderance of tumors in women is largely due to the frequency of neoplasms of the uterus. In 14,630 If the above cases, in which the nature of the growth was ascertained, 3,521 concerned the womb. (The other female sexual organs, including the mamma, were affected :3,009 times.) C. 0. Weber' has prepared a table of 740 cases of tumor, and according to his figures the uterus occupies only the tenth place as regards frequency of invasion. But Weber based his calculations on cases that came to him for operative relief in a general surgical practice. Moreover, lie admits that uterine cases were rarely admitted to his wards. It will be seen, • therefore, that no inference can be drawn from his figures. And indeed similar objections hold good for most clinical reports which have been published with a view to shed light on the relative frequency of tumors.
While accuracy is thus out of the question, there is certainly no reason to doubt that the uterus is very often invaded by neoplasms.
We have as yet no knowledge regarding the causes of the frequency of uterine tumors. It is true that there is nothing surprising about this phenomenon. We have only to remember the number of different tissues that compose the organ in question, the numerous changes incident to its peculiar functions, (e.g. menstrual congestions, and puerperal evolu tion and involution), and it will appear quite natural that the uterus is more prone to disease than other organs, and especially to the develop ment of tumors.
But beyond such general conceptions concerning the probable etiology of tumors of the uterus, we have not hitherto progressed.
Congenital uterine neoplasms are of extreme rarity. Before puberty. and for some years after its advent, new growths of the womb are likewise of very exceptional occurrence.
This again shows that the prime causative factors must be the recurrence of menstrual congestion, and the more profound structural alterations in cident to childbirths.
The well-known hypothetical views of Cohnheim respecting the origin of tumors, in accordance with which they all start from inclosed germs of embryonal formation, will not be discussed here. It is still an open ques tion whether his inferences receive corroboration or refutation from a consideration of uterine tumors. In the more detailed account of the different kinds of new growths this interesting topic will receive further attention. It may be mentioned in this connection, however, that Cohnheim, in his work on general pathology, frequently refers to the uterus and to the tumors which are apt to grow in it.
A certain number of cases are on record in which uterine neoplasms appear to have developed at a very early age, but in no instance has it been shown that they were really congenital formations.
Uterine tumors may be classified as follows: Neoplasms which start from the proper substance of the womb, and are made up of connective tissue or muscular fibres, or both This group includes: