Ovariotomy

“ An incomplete ovariotomy is a very different condition to an enucleation. The cavity left after enucleation closes completely, but when the wall of an ovarian cyst or adenoma is left the tumour gradually grows again, or it may suppurate so profusely that the patient slowly dies exhausted. There are few things sadder in surgery than the slow, miserable ending of an individual who has been subjected to an incomplete ovariotomy. ”

“ The most common causes of death after ovariotomy are septicæmia or septic peritonitis, traumatic or frank peritonitis, shock, exhaustion, and hemorrhage; and it is against these foes that the operator must from the first aim all his efforts. In no other operation does the issue depend so largely on the experience of the surgeon. Every ovariotomist finds that his success grows with the number of his cases. ”

“ Dewees records a successful case of ovariotomy in a woman over sixty-seven; McNutt reports a successful instance in a patient of sixty-seven years and six months; the tumor weighed 60 pounds, and there were extensive adhesions. Maury removed a monocystic ovarian tumor from a woman of seventy-four, his patient recovering. Pippingskold mentions an ovariotomy at eighty. Terrier describes double ovariotomy for fibromata in a woman of seventy-seven. Aron speaks of an operation for pilous dermoid of the ovary in a woman of seventy-five. ”

“ When it is known some days beforehand that the patient will be submitted to this operation, she should be prepared as for ovariotomy. Often it happens that the operation is undertaken after labour has commenced, and in circumstances which make time very precious. Even then the abdomen, pubes, and vulva can be shaved and thoroughly washed with warm soap and water, and lightly rubbed with ether and cotton wool. ”

“ Before leaving this subject, we mention a marvelous operation performed by Billroth on a married woman of twenty-nine, after her sixth pregnancy. This noted operator performed, synchronously, double ovariotomy and resections of portions of the bladder and ileum, for a large medullary carcinomatous growth of the ovary, with surrounding involvement. Menstruation returned three months after the operation, and in fifteen months the patient was in good health in every way, with no apparent danger of recurrence of the disease. ”

“ In fact, the general result of the ovariotomy of the past twenty-five years is “thousands of perishing women have been rescued from death; many more thousands of years of human life, health, enjoyment, and usefulness have been given to the race, and to all future victims of a malady before inevitable in its fatality, consolation, hope, and almost certainty of cure.”
The good influence of this success has, Sir James Paget says, extended to every department of operative surgery, and will always continue to be felt. ”

“ Charles Clay of Manchester, however, more than to all other operators the credit belongs of having placed the operation of ovariotomy on a sure foundation.' Fehr calls him 'the original hero of the operation.' When Clay performed his first operation ovariotomy had been done by Ephraim McDowell (1771-1830) and others in America less than twenty times ”

“ I also added, that peritonitis could only be set up once, whether the sutures included the peritoneum or not. I was for some time after in correspondence with Mr. Wells, but never heard of vivisection in connection with ovariotomy, nor can I perceive any advantage that ovariotomy has received from such experiments. All my operations from first to last have shown the same average amount of success—about 75 per cent. I have never practised nor yet countenanced vivisection. I have given up operating after 400 cases and about 100 deaths.”—Letter of Dr. ”

“ John Bell also has a share of credit in this matter, for in his lectures on surgery at Edinburgh in 1794 he dwelt with much force on the practicability of removing ovarian tumours by operation. It was reserved, however, for a pupil of his, Ephraim M’Dowell, from Virginia, to perform the first modern operation of ovariotomy for disease. He settled in practice in Kentucky in 1795, and in 1809 carried into effect this novel operation upon a middle-aged woman, who survived to complete her seventy-eighth year in 1841. Thus an American had the glory of first boldly starting in the new path. ”

“ When Sir Spencer Wells recorded his first one thousand cases of ovariotomy it was calculated that after deducting the years which the patients who died from the operation would have lived had no operation been done the net result of the thousand cases was an addition of twenty thousand years to human life. One thousand ovariotomies under antiseptic precautions at the present would certainly add at least thirty thousand years to human life. Would not such a guerdon be enough for any man? ”

“ This is more necessary for women who have to get their living by hard work.
COMPLICATIONS OF ABDOMINAL GYNÆCOLOGICAL OPERATIONS
Metrostaxis. After ovariotomy and oöphorectomy, unilateral or bilateral, blood sometimes escapes from the uterus in the course of the first week, and simulates menstruation: it sometimes occurs within forty-eight hours of the operation, and is usually ushered in with a rise of temperature (100°-101°) .
Bed-sores. These sometimes give trouble when operations are performed on elderly or enfeebled patients, especially when they are thin and have incontinence of urine. ”

“ My notebook shows also cases of ovaritis from such imperfect sexual relations as come from the ill-health or the advanced age of the husband, and not a few from immoderate sexual intercourse. Some of the most common causes of chronic ovaritis are emotional in character, such as long engagements, disappointments in love, single life, the reading of corrupt literature, unhappy marriages, nerve-exhaustion, and hysteria. These causes operate by producing circulatory disturbances which keep up a constant congestion of such exacting organs as the ovaries. ”

“ Nature provides these chemical secretions from the Ovaries for the purpose of giving the woman her characteristic physical form and contour, her form, her breasts, her long hair, her broad pelvis, her soft voice, and other secondary sex characteristics; and also of providing for the normal development of the other sex organs. As a proof of this statement, science shows us that if a woman's ovaries are completely removed there is usually a consequent atrophy or "drying up" of the Uterus and the Vagina, and often even of the Vulva. ”

“ There are numerous disorders of the nervous system in women which are dependent directly or indirectly upon a derangement of the pelvic organs. Distant parts of the body are affected pathologically through sympathetic irritation when the primary disease is in the pelvic organs, and direct treatment of the pelvic trouble alone cures these reflex conditions. The very common disorders of pregnancy, the marked physiological changes in women at the beginning of menstruation with puberty, and its cessation with the menopause, are among the first proofs of this assertion that occur. ”

“ The pelvic measurements are normal, and the external sexual organs are fairly normal in most respects, though somewhat small. At a period ten years subsequent to the date of this history, further examination, under anesthetics, by a gynecologist, showed no traces of ovary on one side. The general conformation of the body is feminine. But with arms, palms up, extended in front of her with inner sides of hands touching, she cannot bring the inner sides of forearms together, as nearly every woman can, showing that the feminine angle of arm is lost. ”

“ Roth has revived the old view that one ovary provides the germs for the male offspring, the other those for the female offspring. He believes further that in the process of cohabitation the mechanical impressions and stimuli received by one-half of the external genital organs, reinforced by contact with and pulling on the pubic hair, are transmitted through the pudic nerve and the hypogastric plexus to the corresponding half of the vagina and the uterus, to the Fallopian tube of that side and to the corresponding ovary. ”

“ The processes that occur in the ovary at the time of the ripening and rupture of the graafian follicle, and the resulting tension of the follicular wall, induce by stimulation of the ovarian nerves an increased sensibility of the central zones, and produce in a menstruating female a condition of increased sexual excitability, so that slight stimuli will give rise to a powerful orgasm more readily than would otherwise be the case, when the reflex irritability of the centre is less pronounced and the sexual impulse is consequently less intense. ”

“ In girls, those definite signs, menstruation and the growth of the breasts, before the age of ten, mean premature awakening of the ovaries and a concomitant co-reaction of the other endocrines, creating the ensemble of maturity.
In females, the primary stimulus, the initial spark of femininity, must originate in the ovary. There are other forms of precocity in the female, dependent upon stimulations of other glands, but these forms are masculinisms, a masculinization of the personality, and not a true awakening of the feminine constitution. ”

“ These outward signs are combined with certain internal changes, affecting especially the ovaries and the uterus, that are described under the terms of ovulation and menstruation.
Ovulation.—The ovaries produce ova that are retained in cavities termed ovisacs (Graafian follicles) , which are scattered throughout the ovary. Sometimes an ovisac contains more than one ovum, but usually each ovisac contains but one. When the ovary becomes functionally active, some of the ovisacs in the deeper part of the organ increase in size and develop toward the surface. ”

“ Patient presents nothing remarkable in external appearance. She is gracefully formed, but the muscular system is not strongly developed. Pelvis is, in all respects, that of a female, but the arms and legs are decidedly large and of masculine form. Ladies’ shoes do not fit her, but, being opposed to exciting attention, she forces her feet into female shoes, and they are, therefore, much deformed. Genitals normally developed, and present no other abnormality than descent of the uterus, with hypertrophy of the vaginal portion. ”

“ According to Hensen, the direct stimulation of the sexual impulse proceeds by way of the dorsal nerve of the (penis or) clitoris; he assumes, however, that certain states of the reproductive glands are able to induce an increase in the irritability of the centres connected with the aforesaid nerves. In women it certainly appears that particular states of the ovary have a stimulating or inhibiting influence respectively on sexual excitement, so that we might ascribe to the ovaries the rôle of a regulator of the sexual impulse. ”

“ It seems probable also that chronic ovaritis may occur as the result of celibacy or sterility. The unceasing menstrual congestions of the virgin or the sterile woman, which, as has already been pointed out, seem to predispose the woman to fibroid changes in the uterus, seem likewise to develop the growth of connective tissue in the ovary. ”

“ The cause of cirrhosis of the ovaries is unknown, though it may be associated with cirrhotic liver. The change is met with in women between 20 and 40 years of age, the ovaries being in a shrunken, hard, wrinkled condition. Under ovarian neuralgia are grouped indefinite painful symptoms occurring frequently in neurotic and alcoholic subjects, and often worse during menstruation. The treatment, whether local or operative, is usually unsatisfactory. The ovary is frequently the seat of tumours, dermoids and cysts. Cysts may be simple, unilocular or multilocular, and may attain an enormous size. ”

“ This contraction is effected by stimulation of the fine nerves, called vaso-motor, that are distributed to these muscular fibres, and which are derived from the sympathetic ganglia, that form part of that same ganglionic system from which the nerves of the ovaries and other viscera are supplied. The utero-ovarian blood-vessels derive their nerves from the hypogastric plexus, which, formed by branches from both sympathetic ganglia and spinal cord, is the exclusive source of the innervation of the uterus and ovaries. ”

“ When, however, the ovary is completely prolapsed, lying in the bottom of Douglas’s pouch, between the posterior wall of the vagina and the rectum, well-marked symptoms usually arise.
The woman suffers pain whenever she is in the erect position. The pain is increased by walking, probably because the ovary is squeezed between the cervix and the sacrum. Coitus sometimes causes intense pain. Defecation causes pain. The pain begins with the movements of the bowels, and often lasts for one or two hours afterward. ”

“ Diseases of the Ovaries and Parovarium.—The ovaries undergo striking changes at puberty, and again at the menopause, after which there is a gradual shrinkage. One or both may be absent or malformed, or they are subject to displacements, being either undescended, contained in a hernia or prolapsed. Either of these conditions, if a source of pain, may necessitate their removal. The ovary is also subject to haemorrhage or apoplexy. Acute inflammations (oöphorites) are constantly associated with salpingitis or other septic conditions of the genital tract or with an attack of mumps. ”

“ When one ovary is displaced, it is usually the left one, because the left ovary, as explained under the heading of Ovaritis, is the one more liable to disease. When both ovaries are displaced, the left one will be the lower and the more easily reached, because the left round ligament is the longer and the left side of Douglas's pouch the deeper. ”