DEVELOPMENT IN NINETEENTH CENTURY 355 



quite 2 %, and 36 cases of removal of the appendages without hys- 

 terectomy, with a mortality of 5%. Richardson, of Boston, had a 

 mortality of 3% in 111 cases during the past two years; and Polk, 

 of New York, has had a long series of cases with equally brilliant 

 results. Webster reports 65 hysterectomies for infective disease of 

 the uterus and appendages, with a mortality of 1.07%. With such 

 an array of statistics before us in hysterectomy, which may be con- 

 sidered the keystone of the arch, there is no more forcible illustration 

 of the steady advance of surgery than the improvement in this 

 operation. In regard to vaginal hysterectomy, statistics are likewise 

 brilliant ; thus Pryor has collected 228 cases of vaginal hysterectomy 

 for non-malignant disease, with one death. Webster reports 40 

 cases of vaginal hysterectomy for malignant disease of the uterus, 

 with no death from the operation itself. No mention is made of the 

 percentage of permanent cures in these cases. 



Hysterectomy for the cure of cancer furnishes the most discouraging 

 and melancholy statistics of any modern operation. In this case it is 

 not so much the fault of the technic as it is the disease which calls 

 for the operation. Cancer is most fatal in the uterus; but the time 

 will soon come when early operations will effect a far greater per- 

 centage of recovery. Cancer of the cervix and body of the uterus is 

 most fatal, yet the faintest glimmer of dawn is upon the horizon, 

 and the results of hysterectomy for the permanent cure of cancer are 

 beginning to show signs of improvement. In the history of every 

 great operation the mortality is high at first; but as technic im- 

 proves and early and radical operations are resorted to, the result 

 will be different. Ovariotomy passed through just such a crisis, and 

 it is certain that hysterectomy for cancer will show better results in 

 the future and if so it will be the greatest triumph of surgery. The 

 statistics of hysterectomy for cancer are subject to the widest varia- 

 tion. Penrose states that his results have been most discouraging, 

 as he has only two or three patients who have permanently recovered. 

 Penrose also criticises the report of 20 % of cures for cancer of the 

 uterus at the Johns Hopkins Hospital, and claims that "after due 

 deduction and thorough sifting of their figures, 5 % of cures comes 

 nearer the actual truth." The mortality of the operation itself for the 

 cure of cancer has a favorable showing in contrast to the results of 

 permanent cure. Thus Pryor, in 1901, reports 98 cases of hysterec- 

 tomy for cancer of the uterus with a primary mortality of about 11 %. 

 In a very careful and thorough research of the literature of the sub- 

 ject, I find that abdominal hysterectomy for cancer has an immediate 

 mortality of nearly 20%, if the cases from all available operators 

 are taken, and that the immediate mortality for vaginal hysterectomy 

 for cancer has been as high as 16 %, and by some operators reduced 

 to almost zero. 



