354 SURGERY 



Ovariotomy during pregnancy has likewise a most astonishing 

 record, since Williams in his book reports 142 cases collected by 

 Orgler, with only a mortality of 2.77 %. 



In 1902, in one London hospital there were 40 ovariotomies, with 



1 death, or 2.5 % mortality, as contrasted with 100 % mortality 

 about 1870. Thus in a quarter of a century the mortality has been 

 reduced in one of the most formidable operations in surgery from 

 71 % to 6 %, and in exceptional series of cases even to 2.5 % mortality. 

 It may be of interest to show the progress which surgery has made 

 during the century in reference to the operation of ovariotomy, 

 from 1809 to 1904. 



In America McDowell 1809, and later, 12 cases; mortality, 66% 



N. Smith 1821, 1 0% 



A. G. Smith 1823, 1 0% 



Several operators 1855, 21 70% 



In America 1857, 97 34% 



In England 1857, 123 43 % 



In Germany ....1857, 47 77% 



Hofmeier 1903, 200 4.5% 



Hofmeier 1903, last, 115 1.74% 



From the above table it appears that during the first quarter 

 of the nineteenth century, according to the combined reports of 

 McDowell and N. and A. G. Smith, the mortality in 14 cases of ova- 

 riotomy was 57 %. The combined English and American returns 

 for 1855 and 1857 give an average mortality of 48%. The most 

 recent figures are by Hofmeier, for 1903, who returns a mortality of 

 1.74%. If the earlier mortality prevailed at the present time, 

 Hofmeier would have had 180 deaths in a total of 315 cases, instead 

 of 11, which actually occurred. 



Hysterectomy, or removal of the entire uterus, with or without the 

 ovaries and tubes, affords a most striking illustration of the recent 

 development of surgery. Hysterectomy shows brilliant results when 

 performed for malignant disease; but the result of the operation 

 when performed for malignant disease is the darkest chapter in the 

 present status of surgery. Bigelow collected, in 1884, 359 cases of 

 hysterectomy for fibroids of the uterus, with a mortality of 58%. 

 Kelly reports, in 1898, 100 cases of hysterectomy, including extirpa- 

 tion of the ovaries and tubes, with a mortality of only 4 %. Pryor 

 has investigated the subject of the mortality of abdominal hysterec- 

 tomy for myofibroma of the uterus, and states that it is not over 



2 %, while in fibrocysts of the uterus, it is much higher, reaching at 

 least 10%, and states that this great increase in mortality is due 

 to "coexisting cardiac lesions, which so often accompany fibrocystic 

 disease." Pryor also states that his mortality of hysterectomy in 

 pus cases is about 3 %. Noble reports 58 cases of pyosalpinx and 

 abscess of the ovary, in which he performs hysterectomy with re- 

 moval of the appendages, and the immediate mortality was not 



