The last fact to mention is that one patient, from whom a submucous fibroid had been enucleated from the cavity of the uterus (hysterotomy), died four years later from cancer arising in the body of the uterus (see p. 51).
Olshausen has recently considered this question, and indicates that the chief objection to the abdominal enucleation of uterine fibroids is its high mortality.
He furnishes a table of 563 cases, collected from twelve operators, including himself; of these 59 patients died, representing a mortality of 10.5 per cent. Olshausen, in the years 1900-5, performed enucleation on 124 patients with 14 deaths. Eight of the patients subsequently came under notice with recrudescence of fibroids. Christopher Martin has performed abdominal myomectomy 73 times with 1 death.
The question of myomectomy, when fibroids complicate pregnancy and labour, or give trouble after labour, is considered in detail on p. 78.
REFERENCES TO REPORTS OF HYSTERECTOMY PERFORMED FOR FIBROIDS IN MALFORMED UTERI
BLAND-SUTTON, J. Fibroids in a Unicorn Uterus. _Clin. Journ._, Lond., 1901-2, xix. 1.
BLAND-SUTTON, J. Case of Fibroids in both halves of a Bicornate Uterus. _Proc. R. Soc. of Medicine_, 1908. Obstet. and Gyn. Sect., ii. 95.
CZERWENKA. Uterus bicornis unicollis, &c. _Centralbl. f. Gyn._, Leipz., 1900, xxiv. 207.
DORAN, A. The Removal of a Fibroid from a Uterus Unicornis in a Parous Subject. _Brit. Med. Journ._, 1899, i. 1389.
GOW, W. J. Cystic Intraligamentous Myoma with Double Uterus. _Trans. Obstet. Soc._, Lond. (1898), 1899, xl. 134.
HEINRICIUS. Ein Fall von Myoma im rudimentaren Uterus bicornis unicollis. _Monatschr. f. Geburts. u. Gyn._, Berl., 1900, xii. 419.
KAMANN. Uterus bicornis unicollis with a Myoma in the Left Horn; Subtotal Extirpation of the Left Horn. _Centralbl. f. Gyn._, 1905, xxix. 795.
MARTIN C. The Ingleby Lectures. On the Dangers and Treatment of Myoma of the Uterus. _Lancet_, 1908, ii. 1682.
OLSHAUSEN, R. In Veits’ _Handbuch der Gynäkologie_, Wiesbaden, 1907, Bd. ii, p. 607.
ROUTH, A. Fibroid of One-horned Uterus. _Trans. Obstet. Soc._, 1888, xxix. 2 and 57, with a good drawing.
ON THE RELATIVE VALUE OF TOTAL AND SUBTOTAL HYSTERECTOMY
The great success which followed the use of the short ligature in ovariotomy induced several surgeons to apply the same principle to the cervical pedicle when removing the uterus for fibroids. The result was dismal failure. Matters improved somewhat after Koeberlé introduced the serre-nœud, and this continued the safest method until 1892. In the meantime antisepsis had begun to take effect in pelvic surgery, and attempts were made by Bardenheuer (1881), Polk, and other surgeons to avoid the dangerous difficulties connected with the treatment of the stump by removing the cervix as well as the uterus (total hysterectomy), and they attained an encouraging measure of success. Nevertheless, other surgeons (Goffe, Milton, Heywood Smith, and Stimson) felt that the enucleation of the cervix was not always necessary, and sought to find a way of avoiding it. The credit of solving this difficulty fell to Baer of Philadelphia (1892), for he showed that it is dangerous to constrict the neck of the uterus with ligatures, it is only necessary to secure the arteries.