Three hundred and eighty-four laparotomies for various diseases : with tables showing the results of the operations and the subsequent history of the patients. A resumé of the writer's experience in abdominal surgery during the last fifteen years / By John Homans.

Homans, John, 1836-1903

Date:: 1887

Credit: Three hundred and eighty-four laparotomies for various diseases : with tables showing the results of the operations and the subsequent history of the patients. A resumé of the writer's experience in abdominal surgery during the last fifteen years / By John Homans. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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$In regard to hysterectomy, my success has not been great. ]Mv cases of removal of uterine fibroid tumors number twenty-seven, with seventeen recoveries and ten deaths. I perform the operation much better than I did years ago, and my later cases have nearly all recovered, but still I am not fond of it and always rather shrink from it. I never do it unless the patient seems in danger of her life from heemorrhage. mechanical pressure, or ex- haustion, or else suffers such pain that life is not worth living. I do not know which is the better way of man- aging the stump, whether intra or extra-peritoneally : I am pretty sure, however, that with me the extra-peritoneal is safer, although I cannot say that a more skillful opera- tor might not make the intra-peritoneal method safe and reliable. Encouraged by the recovery of a patient after hyster- ectomy for fibro-myoma in which the stump had been left in the abdomen, I treated the next case intra-perito- neally, with fatal result. The autopsy showed that the stump was the cause of a quite limited peritonitis, and that if it had been left outside the patient would appar- ently have been relieved of the source of blood-poison- ing, and might have recovered. I use a wire ecraseur, either Koeberle's or a longer one, for I find that for the compression of the pedicle Koeberle's screw is not long enough, and one must have se\eral of Koeberle's serre- nceuds or else an instrument with a longer screw, and the latter seems to me simpler. I have used drainage several times after removal of fibroid tumors, but it is usuall}- unnecessary. When the clamp and pin come away, there is usually some fluid in the cavity where the stump was, and this has often a very offensive odor like that of a sewer, but it seems of no consequence, as the patient's temperature and pulse are nearly normal. I suppose there is a septic-putrescence and a non-septic- putrescence ; but at the first glance one would suppose$