Clinical Lecture on Uterine Myoma
L. Tait · BMJ · 1889
WITHIN the last few weeks a remarkable group of cases of this disease has been brought under your notice in which many of its strange phases have been peculiarly emphasised, and you have seen me carry out a variety of proceedings for its treatment.The interest of these cases has been greatly enhanced by a paper which you may have read, which you all ought to read, in the columns of the JOITRANAL.It is from the pen of no mean authority, Dr. Thomas Keith, a man who has exercised great influ- ence in the progress of abdominal surgery, and in whose steps, until lately, I was proud to tread.Some strange change seems of late to have come over him, and now all is disagreement where formerly all was concord.1The chief cause of difference between Dr. Keith and others, in- cluding myself, has arisen on the disease we are now discussing.I have already told you how its treatment by removal of the uterine appendages arose, how completely successful it has been, and in a few days a volume will appear in which my cases are re- corded in detail, showingfor this operationthe insignificant mortality of 1.23 per cent. in 262 consecutive cases.The permanent and oom- plete efficacy of this method of treatment has been established by evidence beyond all cavil; in fact, it stands unrivalled in the history of modern surgery.There are, however, some cases, how large the proportion we do not yet exactly know, for which it is unsuiited for various reasons, and these cases fall under the category requiring hysterectomy.The details of this latter operatioin I shall lay before you by-and- by; sufficient for my present purpose to saythat in the perfection of its detail Dr. Keith acquired and deserved, with one unfortunate qualification, much credit.But it is more than clear that Dr.Keith did not succeed satisfactorily with the less formidable operation, removal of the uterine appendages.He has confessed as much, and he certainly has never ventured on any detailed publication of his experiences.But Dr. Keith brought down the mortality ofhysterectomy, as I shall tell you, to within justifiable limits, that is, about 10 per cent., and at that we have nearly all arrived, perhaps some of us have improved upon it, but you will at once see that as this is a remanet mortality, it is really not so bad as it looks; it is the mortality of the residuum of the cases, those which cannot be dealt with by removal of the appendages, which must always be a more satisfactory operation.I for one do not despair of seeing hysterectomy with a mortality as low as ovariotomy, though there are certain essential details-mainly the difficulty of dealing with the pedicle by the intra-peritoneal method-which stand sadly in the way.We had all settled down to a consensus of opinion upon the main lines of treatment when there arose in Paris a strong advocacy for the treatment of this disease by a plan known as electrolysis, and it is this which has set us all by the ears.Keith gives a ghastly account of the electrolytic treatment of uterine tumours by Simpson,2 and he has the 1 Atn indication of the change is given in Dr. Keith's first paragraph, where clearly a fault of memory exists.He says that it so happened that he was the las-t of the Edinburgh medlical apprentices who had a regular indenture.Dr. Kteitlh's indentures must liave been executed somewhere about the year 1844, before I was born, and I am sure that indentures were not unknowin when I was a student from 1860 to 1865.According to general belief among the studlenits, based on the statements of the alleged apprenltices, at least two of the University professors took indentured pupils with fees of three hundred guineas.I know of one executed in 186;2.