_ A. Martin' collated 50 new cases, only 7 of which, or 14 per cent, terminated fatally. Miinnel's and Martin's operations amount altogether to 66, with a mortality of 12 per cent. It is interesting to note that, ac.
cording to Martin's investigations, out of 12 cases in which enucleation was performed after the tumor had partially escaped into the vagina, three were fatal. The mortality thus amounted to 25 per cent. in these cases.
On the other hand, those cases operated on before the tumor had escap ed from the os uteri showed a mortality of 12i per cent.
Pozzi ' gives very carefully prepared statistics of 64 enucleations with 16 deaths, or 25 per cent.
To these contradictory statistics I now subjoin the cases collected by myself, including those of West, because his cases show so high a rate of mortality, and because I shall, by including them, avoid the error to which the exclusive publication of favorable cases leads. I have not been ahle to consult the original report 9f West's cases, in all instances. I have either excluded the cases of all other observers which I could not find in the original, or have referred to the author's papers. I have not intro duced cases of partial enucleation which lead to a cure by gangrene of the tumor, because they will be separately considered.
On the other hand, enucleations which were begun but not completed have been included in the following list. The distinction between enucle ations which were intentionally partial, and those in which accidental cir cumstances led to an interruption of the operation, is not observed in the majority of the reports.
The following are the favorable cases among those collected by West: Amussat, 2; Maisonneuve, 2; Grimsdale, Teale, each 1; Atlee, 7.
I have also found the following cases which resulted favorably: Routh,' 7; Hegar,' 7; Demarquay,' 3; Matthews Duncan,' 3; Hutchinson,' 12; Hutchinson,' 9, in which the capsule was perforated by means of the actual cautery; the same,' four incomplete records; Guyon,' 5; By ford," Whiteford," Boye," each 1 case; Marion Sims," 8; Meadows," 1; Hall Davis," 2; A. Martin," 4; Ruge," John Scott," Scott," Bourgeois," Fleischer,' Giommi,' R. Barnes,' Chroback,' Mannel,' Retzius,' (each one case); Jordan,' Frankenhauser,' Gusserow,' (each 2 cases); C.
Braun," (6 cases.) The enucleations with a favorable result, collected by myself from the literature of the subject, thus amount to 103. We should remark that one of Frankenhfiuser's favorable cases died, a year after the operation, from obliteration of the vena cava, said by Frankenhauser to hare de pended upon morbid processes in the uterus.
The following cases resulted fatally: Atlee, 5; Berard, Baker-Brown, (each 2 cases); Maisonneuve, Boyer, Simpson, West (each 1 case); (quoted by West); Velpeau," 2, (one of which was an unfinished operation); Routh, (Zoe. cit) 2; Hegar, Demarquay (The. cit) each one; Hutchinson, (loe. ea) 6, in which the capsule was split with the knife; 6 in which it was opened with the hot iron, and 2 unfinished operations. Guyon, (loc. cit.) 9; Sy mington Brown," 1 (incomplete); Marion Sims (lee. cit.) 5 (3 of them un finished). Gusserow, 2 (not published and both unfinished). Total number of fatal cases 51. The total number of operations amounts to 154, with a fatal issue in 51 cases, i.e., in 33.1 per cent.
The cause of death was usually pymmia or septicremia, produced by gan grene of retained portions of the tumors. In other cases death resulted, sometimes after weeks or months, from thrombosis, embolism, peritonitis or hemorrhage. 15 unfinished enucleations, with 9 deaths, are included in the above tables. In 29 cases the operation was done at different sittings, the intervals between which varied. Eight of these cases were fatal.
It could be easily shown that improvements in technique, and a more careful selection of cases suitable for operation, have led to better results even up to the year 1877. But the introduction of antiseptic precautions has worked almost a revolution in this, as in so many other operations.
Thus, for example, Lomer" has collected 130 cases embracing the period from 1873 to 1883. Of this number 18 died and 112 recovered, i.e., a mortality of 16 per cent. A few of the cases collected by him are con tained in the above references, which extend up to 1877. The progress from a mortality of 33 per cent. to one of 16 per cent. is a decidedly re markable one.