The figures certainly plainly showed the .unusual danger of laparotomy and hysterotomy, for the removal of uterine tumors.
Since 1878, owing to the introduction of antiseptic methods of opera tion, a great change has been wrought as regards the value of laparo tomy in myoma of the uterus. Although the successful results of the operation cannot be compared to those obtained in ovariotomy, they nevertheless constitute one of the most marked advances of operative gynecology. A reasonable hope may be entertained that further pro gress may lead to still better results, especially as regards the more dangerous kinds of tumors under consideration.
Although it has been repeatedly shown that statistics are not of very great value, they are nevertheless essential to give us some general and approximate idea of the progress made in the results of operative interfer ence. For this reason it seems proper to here borrow some figures from Bigelow's elaborate compilations. This author collected up to 1883, 573 cases of laparotomy for the removal of uterine fibroids. Of this number 311 recovered and 241 died, a mortality of 41.05 per cent.
In 106 cases the tumors alone were removed (myomotomy in the strict sense), with a mortality of 49.03 per cent. In 229 cases the uterus was also removed (amputatio uteri supra-vaginalis), with a mortality of 41. 04 per cent. As these computations include some of the older cases, the figures given have only a slight value. Nevertheless even they indicate progress.
I have myself endeavored to collect as many cases as possible. Thus I found 359 cases, with 237 recoveries and 122 deaths, a mortality of 33.9 per cent. To this number 245 other cases (by Schroeder, Olshausen, Braun, Tauffer and myself) should be added. Of the above-mentioned 359 cases, 295 were amputations at the internal os, with a mortality 36.2 per cent., and 64 were simple myomotomies, with a mortality of 20.5 per cent.
The results published by individual operators are far more valuable than these general figures. The table on page 268 is the original of Bige low,' supplemented by Hofmeier,' and still later by myself.
Bigelow (1. c.) has collected 279 cases occurring between the years 1878 to 1883, with 244 recoveries, and a mortality of 35 per cent.
All these figures merely show, in a general way, how much progress has been made in this operation. But as regards the advantages of any particular method of operation they show nothing at all, since it was not possible to separate one method from another. To compare myomotomy with ovariotomy is certainly inadmissible.
Ovariotomy is always pretty nearly the same kind of operation, no matter whether there are greater or lesser technical difficulties in the way of its performance. But this is by no means true of the operations for the removal of uterine fibroids.
The following classification may properly be made: 1. The removal of pediculated or broadly attached sub-serous fibroids, simple myomotomy.
2. The removal of tumors that have penetrated more or less deeply into the substance of the uterus, with partial excision of the womb, and with or without opening of the cavity of the uterus, amputatio uteri partialis.
3. The removal of fibroids with excision of the uterus above the vaginal junction, i.e., invariably with opening of the cavity of the uterus, amputa tio uteris supra-vaginalis.
4. The enucleation of fibroids after opening the abdominal cavity, with or without opening of the cavity of the uterus. (Spiegelberg).' Also the enucleation of these growths from within the cavity of the uterus, after incision of the latter as in Caesarean section. (A. Martin.') 5. Enucleation out of the cellular tissue of the pelvis, in those cases where the tumor has developed between the broad ligament, or altogether outside of the peritoneal cavity, as in myoma of the cervix. These opera tions are to be considered quite apart from ordinary enucleations involv ing peritoneal adhesions.
They are very difficult of performance, and offer a correspondingly poor prognosis.
6. Total extirpation of the uterus, as suggested and carried out in some cases of this kind.