A Contribution to the History 
of Ovariotomy on the 
Insane. ; 
BY 
W. P. MANTON, M.D., 
DETBOIT, MICH. 
REPRINT FROM TRANSACTIONS, 
1889. A CONTRIBUTION 
TO THE 
HISTORY OF OVARIOTOMY ON THE INSANE. 
BY 
W. P. MAKTON, M.D., 
DETROIT, MICHIGAN. 
Visiting Physician to the Woman's Hospital, Detroit; Consulting Gynecologist to the Eastern Asylum; 
President of the Detroit Gynecological Society; Fellow of the British Gynecological Society, etc. 
REPRINTED FROM THE TRANSACTIONS OF 
THE AMERICAN ASSOCIATION OF OBSTETRICIANS AND GYNECOLOGISTS, 
SEPTEMBER, 1889. 
PHILADELPHIA: 
WM. J. DORNAN, PRINTER. 
1889. A CONTRIBUTION TO THE HISTORY OF 
OVARIOTOMY ONgTIE INSANE. 
By W. P. MANTON, M.D., 
DETROIT, MICHIGAN. 
Of late the subject of insanity following surgical operations has 
been brought so repeatedly to the attention of the profession that 
this condition which, eighteen months ago, would have been con- 
sidered as of rare occurrence, is now recognized in the light of 
accumulated evidence as a comparatively frequent sequela of chi- 
rurgical practice. 
Mr. C. T. Dent, in an admirable paper,1 mentions three ways by 
which surgical operations may produce psychical disturbance: 1. 
By anticipation. 2. By the actual operation, which may cause pain, 
afford relief, entail shock, etc. 3. By the after-effects. " These," 
he says, " like the actual operation, may act by producing pain or 
giving relief, or by setting up septic mischief." He then goes on to 
say that 
"A still more important factor in producing physical disturbance is mental 
reaction. The relaxation of control previously exercised, the loosening, as it 
were, of the mental tension, or the physical disturbance resulting from the 
removal of a diseased part, which had led to much mental contemplation 
and called up unduly the subjective qualities of human nature, are all factors 
which, to say the least, must be taken into account more or less in successful 
after-treatment. The sea may calm down after the storm has disturbed it, 
but once in a way wreckage will be seen floating on its surface." 
This writer, while not denying that natural or inherited mental 
instability may be found in the history of some of these cases, 
believes that in the majority of instances this is not so. My own 
limited experience does not agree with this, for in the few cases 
1 Journal of Mental Science, April, 1889, p. 1. 4 
MANTON, 
which have come under my personal observation there has been a 
distinct history of a neurosis. 
Without entering farther into the discussion of this very interest- 
ing subject, which belongs to psychiatry and not to gynecology, I 
desire to present for your consideration a case which is not only 
remarkable, but unique. As will be noticed farther on, the cause 
of insanity in the subject of this record is put down to a trifling 
operation; some months later a capital operation is performed with 
complete restoration of the mental balance, but this soon gives place 
to a condition resembling the first state, differing from it only in 
degree. 
Miss A. M., German-American, single, aged thirty-four, a dressmaker by 
occupation, was admitted to the Eastern Michigan Asylum December 27, 
1888. On the mother's side the family history is good, but the father is 
reported to have been a heavy drinker, and to have died in his forty-fifth 
year. 
The patient is a small blond, weighing seventy pounds. For several years 
she is said to have been delicate, and for eight or ten years nervous. In 
February, 1888, she suffered from abdominal dropsy, and her family physi- 
cian reports also having found a tumor simulating the spleen. There was like- 
wise an enlargement of the uterus, or a tumor near it. Eleven quarts of a 
light-colored fluid were aspirated from the abdomen at this time. Following 
this she suffered much pain, and about a month after the operation con- 
tracted a low form of fever, from which she passed into a state of acute 
mania, frothing at the mouth, barking and snapping at her friends, so that 
she was thought to be affected with hydrophobia. When she regained her 
strength sufficiently to go about she became indecent in her language, 
untidy in her habits, and inclined to assault those about her. 
On admission to the asylum she was extremely feeble and emaciated, and 
much depressed mentally, having delusions of apprehension. For a time 
there was a slow improvement in her general condition, but she never be- 
came strong or had good health. At times she would be very noisy; at 
others quiet and indifferent, paying no attention when spoken to. One dis- 
tressing peculiarity in the case was her tendency to fasten onto some sentence 
and repeat it over and over in a monotonous voice from hour to hour, ending 
each period with a "Huh." Her appetite was capricious, and sometimes 
excessive, which may have given rise to her most frequent formula, "A piece 
of bread and butter, please, huh? " or, " Give me a drink of water, please, 
huh?" 
On January 1, 1889, it was noted that her feet were much swollen the 
night before, and that her upper eyelids were puffy in the morning. It was 
thought that she was failing fast, her general condition being precarious. I 
saw the patient at the request of Dr. Henry M. Hurd, Medical Superin- 
tendent, and examined her under ether. She was then quite feeble and HISTORY OF OVARIOTOMY ON THE INSANE. 
5 
much emaciated. The abdomen was slightly distended by a kidney-shaped 
tumor, the hilus of which pointed downward. The growth was movable in 
all directions, but especially upward. It was hard, somewhat nodulated, but 
fluctuation was not to be obtained. The history of the case, and the general 
physical signs, led me to suggest that possibly the tumor might be a floating 
cystic kidney. I was not able, however, positively to exclude ovarian cyst. 
At my suggestion the patient was put on a tonic treatment and kept in bed 
a portion of the time. The result was most gratifying : she gained in flesh 
and improved in every way. It was a question in our minds whether the 
presence of the abdominal tumor was not responsible for all or a part of the 
mental condition ; and it was decided that while the removal of the growth 
might have little or no effect on the disordered mind, there could be no doubt 
that in a general way such operative treatment would be productive of good. 
I therefore undertook the operation May 26th, kindly assisted by Drs. Burr, 
Morse, and Lansing, of the asylum staff; Dr. Rouse, of East Saginaw, the 
patient's family physician, also being present. On opening the abdomen it 
became at once evident that the tumor was ovarian, and attached below by 
a long thin pedicle, to the left side of the uterus. It was also fixed above to 
the diaphragm by a second pedicle (adhesion-band), which was thinner and 
more vascular than the true pedicle. There were no other adhesions. The 
growth was thus guyed, as it were, above and below, which permitted con- 
siderable motion, particularly upward, as the pedicle was somewhat longer 
than the adhesion. The right ovary was found to be greatly enlarged and 
cystic, hence also was removed. The weight of the tumor was five pounds. 
Convalescence from the operation was speedy and uninteresting. The mental 
phenomena presented were, however, remarkable. It was as if the clouds 
had broken away after a storm, leaving the whole body illuminated by the 
awakening intellect. She apologized for all the trouble she had caused, 
and, to the nurse, expressed much concern in regard to her personal appear- 
ance. During the succeeding few days her mind was perfectly clear and her 
conversation rational. She greatly enjoyed talking with the nurse, and seemed 
to remember much that she had done since her admission to the asylum. 
June 2d, her mind became somewhat dull and clouded, and she remained 
with closed eyes most of the day. From this time on to the 25th of the 
month her mental condition varied, but she did not lapse to her former state. 
On June 25th she was allowed to return to her home, as she had several 
times expressed a desire to do so, and it was thought that the change might 
be of benefit. The journey was a short one, but the patient was very restless 
and impatient to reach her destination. Her expectations were not, however, 
realized : once home, she continued restless-walked about the house, notic- 
ing the changes in furniture, etc.-and expressed her disappointment, as 
things did not look natural. She asked for medicines, such as she had had 
at the asylum, and wanted to go back. 
About four o'clock the next morning, after a very restless night, most of 
which was spent in walking about the room, the patient suddenly rushed 
from the house, clad only in her night clothes, and, before those who were 
following her could interfere, sprang into the well. She was immediately 6 
HISTORY OF OVARIOTOMY ON THE INSANE. 
rescued from her perilous position, rendering herself as much assistance as 
she could. An hour later she again repeated the performance, and was 
again rescued. The patient's friends had by this time concluded that the 
asylum was the best place for their charge, and she was accordingly returned, 
having been absent somewhat less than twenty-four hours. Her condition 
since that time has been one of slow mental retrogression toward her former 
state. Her attendant tells me that she is not as bad as she was before the 
operation, and she certainly has improved greatly in her physical health. 
The present indications seem to point to ultimate recovery. 
As throwing some light on the etiology of the mental symptoms, it may 
be mentioned that the patient's urine had been examined during her early 
stay in the asylum, and a small amount of albumin, but no casts, discovered. 
This was the condition of a specimen examined the morning of the operation. 
June 5th, the specific gravity was 1020, and there was a heavy deposit of 
phosphates, some pus, and a trace of albumin. 
June 22d, the specific gravity was 1016, the amount of albumin consider- 
ably increased, while pus, epithelium, uric acid, calcium oxalate crystals, and 
hyaline casts were present in the sediment. Subsequent examination of the 
urine gave essentially the same results.1 
I am much indebted to Dr. Christian for these urinary analyses, and to 
Dr. C. B. Burr, medical superintendent, for notes of the case. 
1 Since the above was written a sister of the patient has been admitted to the 
asylum, suffering from melancholia.