Mortality. In order to give some idea of the great improvement which has taken place in the operation of abdominal hysterectomy for fibroids in London the following figures will be found of great interest.
In the year 1896 the results of abdominal hysterectomy for fibroids in the hospitals of London may be inferred from the following table:—
| St. Bartholomew’s | 7 | with | 3 | deaths |
| St. Thomas’s | 5 | " | 2 | " |
| St. George’s | 1 | " | 0 | " |
| Middlesex | 6 | " | 1 | " |
| University College | 3 | " | 0 | " |
| Samaritan | 17 | " | 4 | " |
| Soho (for women) | 1 | " | 0 | " |
| Chelsea Hospital for Women | 9 | " | 1 | " |
| 49 | " | 11 | " |
In these hospitals and the New Hospital for Women the returns in 1906 are as follow:—
| St. Bartholomew’s | 26 | with | 4 | deaths |
| St. Thomas’s | 40 | " | 2 | " |
| St. George’s | 8 | " | 0 | " |
| Middlesex | 50 | " | 0 | " |
| University College | 21 | " | 1 | " |
| Samaritan | 37 | " | 2 | " |
| Soho (for women) | 60 | " | 1 | " |
| Chelsea (for women) | 80 | " | 1 | " |
| New (for women) | 26 | " | 0 | " |
| 348 | " | 11 | " |
Fig. 15. Villous Disease of the Uterus. The uterus is shown in sagittal section. The cavity is dilated and occupied by a villous tumour growing from its posterior wall. Successfully removed from a multipara aged 83. Full size.
The returns during 1906 and 1907 from my service at the Chelsea Hospital for Women and the Middlesex Hospital, as verified by the Registrars, were 101 abdominal hysterectomies for fibroids; all the patients recovered. Of these 101 operations, 7 were total and the remainder subtotal hysterectomy.
The risks of abdominal hysterectomy. The dangers of hysterectomy are those common to cœliotomy, such as sepsis, peritonitis, shock, and the risks of the anæsthetic. There are certain special dangers, such as hæmorrhage; injury to the vesical segments of the ureters, and especially the bladder; injury to the intestines, especially the rectum; acute intestinal obstruction; thrombosis and pulmonary embolism. These risks and dangers are considered fully in their relation to all forms of abdominal gynæcological operations in a special chapter (see Chap. XI).
Among the rarer forms of death after hysterectomy may be mentioned acute perforation of the stomach or the small intestine, cerebral hæmorrhage, lobar pneumonia, thrombosis of the right auricle, embolism of the femoral artery ending in gangrene of the leg, suppression of urine, and acute mania. These are fatal conditions which follow any major operation in surgery, and have no special connexion with hysterectomy.