Excerpt from The Use of Traction and Morcellation in the Removal of Fibroids Versus Hysterectomy

From this time I have seldom used the écraseur, but have removed with scissors any growth within the uterine canal which I could reach. I have had no fear of haemorrhage, for this case taught me that it could be controlled in the manner I have described.

In February, 1867, a patient was admitted to the Woman's Hospi tal with a large fibrous tumor imbedded in the greater portion of the anterior wall of the uterus. The tumor encroached on the uterine cavity, but only so far as to give a marked curve to the canal, as nearly the whole was interstitial. The case was under the care of Dr. John G. Perry, then one of the assistant surgeons, who, by my advice, continued the use of sponge-tents for some two months or more. After an absence of several weeks she returned to the hospital in consequence of continued pain from uterine contraction. The 05 was found dilated to some four inches in diameter, with the tumor presenting as a child's head. A broad attachment could now be felt just above the vaginal junction, somewhat less in width than the por tion of tumor occupying the canal, while previous to leaving the hos pital merely a uniform projection existed. June 3d, I operated by passing well up into the canal a large tenaculum, and by steady trac tion drew down or rolled out into the vagina a large portion of the mass. I took out with a pair of scissors a large wedge-shaped por tion, and as the traction had already excited uterine action, I removed piece after piece, as the tumor could be drawn down, until the uterus had been emptied. When the pedicle was divided it was less than half an inch in diameter, and was formed by the capsule covering that portion of the base of the tumor which was nearest to the uterine outlet at the beginning of the operation. The location of the pedicle at this point, I have noticed, has been without. An exception. I have referred to the recorded history of the case, and find that the depth of the uterus was not noted, but my impression is that it was eight inches previous to the operation. The lower portion of the base was felt just within the cervix, and the attachment of the tumor extended from that point to the fundus. The base therefore could not have been less than seven inches in length, with a width of from three to four inches. I purposely commenced the traction as high up as pos sible, and away from the lower portion of the base. I excited museu lar action at the fundus. Where it seems always to be greater than in any other part of the organ. As I rolled out the tumor from above, its separation advanced from this point downward as the uterus con tracted on the diminishing size of its contents. The portions of this tumor weighed together four pounds and a half.

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