Chest complications in abdominal disease : a study in diagnosis : the first Hunterian lecture of the Hunterian Society session 1901-2 / by J. Mitchell Bruce, M.A., L.L.D., M.D., F.R.C.P.

  • Bruce, J. Mitchell (John Mitchell), 1846-1929
Date:
1902
Catalogue details

Licence: In copyright

Credit: Chest complications in abdominal disease : a study in diagnosis : the first Hunterian lecture of the Hunterian Society session 1901-2 / by J. Mitchell Bruce, M.A., L.L.D., M.D., F.R.C.P. Source: Wellcome Collection.

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    vaginal hysterectomy; it is desirable in many cases to remove the whole cervix, but it is not necessary to do this as a routine procedure. The reasons for these opinions must be considered in some detail. It is, I believe, admitted by most writers that the ideal method of dealing with fibroids requiring removal by coeliotomy is to remove them either by ligature or by enucleation, and in certain circumstances by actually opening the uterine cavity, extracting the tumour, and then suturing the incision as after a Ceesarean section, an operation to which I applied the term hysterotomy. In actual practice this ideal operation of removing the tumours and leaving the uterus and ovaries intact can only be carried out in a small proportion of cases, prob¬ ably in less than 10 per cent., and it is fair to state that enucleation and hysterotomy are often more troublesome and serious operations than hysterectomy, also the pre¬ servation of the uterus is not always an advantage to the patient. When a woman is submitted to hysterectomy for fibroids we can assure her that the tumours will not recur, but after a myomectomy or enucleation in a woman in the reproductive period of life we cannot give her this assurance, for she may have in her uterus many (C seedling ” or what I prefer to call “ latent fibroids,” and one or several of these may grow into formidable tumours. My rule of practice in this matter may be summarised thus : A young woman contemplating marriage, or a married voman anxious for an offspring, may, if her tumour be single and admits of myomectomy or enucleation, have nei uterus spared. Although I have carried out these measures on many occasions I only know of five patients who have subsequently borne children. It is, however, a matter of greater interest to me to re ate that in several instances of pregnancy complicated wit tumours, and in which the signs were very urgent,