=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. The removal of the uterus has been rendered so safe that even in advanced age it has been employed with success, as the subjoined table shows:-- TABLE OF CASES IN WHICH HYSTERECTOMY WAS PERFORMED ON WOMEN OF SEVENTY YEARS AND UPWARDS. -----------+------+----------------+---------+----------------------- _Reporter._|_Age._| _Nature of |_Result._| _Reference._ | | Operation._ | | -----------+------+----------------+---------+----------------------- Bland- | 73 |Subtotal for | R. |_Trans. Obstet. Soc._, Sutton | | Fibroid 28 lb.| | 1900, xli. 300. Stewart | 70 |Subtotal for | R. |_Australian Med. Gaz._, McKay | | Fibroid 19 lb.| | 1907, 14. Bland- | 83 |Vaginal Hyst. | R. |_Trans. Obstet. Soc._, Sutton | | for Villous | | 1906, xlix. 46. | | disease. | | | | Fig. 15. | | Malcolm | 74 |Total for | R. |_Brit. Med. Journal_, | | Fibroids. | | 1907, ii. 1571. -----------+------+----------------+---------+----------------------- ABDOMINAL MYOMECTOMY _Under this general term it is usual to include operations for the removal, through an abdominal incision, not only of pedunculated subserous fibroids, but also sessile and interstitial (intramural) fibroids of the uterus._ The earliest operations of this kind were performed by Spencer Wells (1863); but little attention was given to this matter until the advantages of abdominal myomectomy were strongly advocated by A. Martin (1880) and Schroeder (1893). The operation has been practised by many surgeons and gynæcologists imbued with conservative ideals in regard to the uterus. In its early days the operation was attended with a very high mortality, but the great improvements in hysterectomy have limited very materially the scope of abdominal myomectomy.