NORMAL OVARIOTOMY. 
A PAPER READ BEFORE THE 
GEORGIA MEDICAL ASSOCIATION, 
At its Twenty-fourth Annual Session, held in Atlanta, Georgia, 
April 9th, 10th, 11th and 12th, 1873. 
BY 
ROBERT BATTEY, M.D., 
ROME, GEORGIA. 
REPRINTED FROM THE ATLANTA MEDICAL AND SURGICAL JOURNAL. 
ATLANTA, GEORGIA: 
Herald Publishing Company’s Steam Presses. 
1873. NORMAL OVARIOTOMY. 
A PAPER BEAD BEFORE THE 
GEORGIA MEDICAL ASSOCIATION, 
At its Twenty-fourth Annual Session, held in Atlanta, Georgia, 
April 9th, 10th, 11th and 12th, 1873. 
BY 
ROBERT BATTEY, M.D., 
ROME, GEORGIA. 
REPRINTED FROM THE ATLANTA MEDICAL AND SURGICAL JOURNAL. 
ATLANTA, GEORGIA: 
Herald Publishing Company’s Steam Presses. 
1873. The Committee to whom Dr. Battey’s paper was referred by the Georgia 
Medical Association, made the following report: 
“The committee to whom was referred the interesting paper by Dr. Battey, 
on the subject of the “ Removal of the Ovaries,” for the causes therein set forth, 
have not, by reason of limited -time afforded to them, been able to give this im- 
portant subject the thorough and diffusive investigation and discussion to which 
it is justly entitled. They concur, however, in according to the idea, and its 
successful execution by its author, the merits of originality, skill and utility. 
Whether it can be accepted as widely applicable to the relief of suffering from 
these causes, must yet be confided to the cautious and judicious observation and 
experiment of the skillful practitioner; and they would commend the subject to 
the critical interest of the profession, and especially to its brilliant author, for 
additional experiment, and solicit reports from members of this Association on 
the subject at their next annual meeting. 
W. F. WESTMORELAND, 
C. B. NOTTINGHAM, 
J. F. BOZEMAN.” ERRATA. 
Page 8, 17th line,—for “ verified” read vivified. 
Page 12, 14th line,—for “ Miss K, N.” read Miss K. V. 
Same page, 25th line,—for “1867” read 1857. 
Page 20, 2d line from bottom,—for “ appropriate” read approximative. 
Page 24, first foot-note should read Ovarian Tumors, p. ICO. 
Page 26, 13th and 14th lines,—for “destruction” read destructive. 
Same page, 11th line from bottom,—for “ with” read into. 
Page 27, 13tb line from bottom,—for “ beard-like” read head-like. 
Page 31, 15th line—for “corona” read cornua. 
Same page, 3d line from bottom,—for “ curuncular myrtiforms” read cunm- 
culm myrtiformes. 
Same page, 7th line from bottom,—for “ mous veneries” read mans veneris. 
Page 32, 13th line,—for “ corona” read cornua. 
Page3B, 3d and 4th lines,—for “conscientiousness” read consciousness. 
Page 40, 12th line,—for “it” read a stone in the bladder. 
Same page, 18th line,—for “immovable" read irremovable. 
Same page, 14th line from bottom,—for “ miraculously” read marvelously. 
Page 42, 22d line,—for “me” read no. NORMAL OYARIOTOMY. 
Since our last convocation, in the city of Columbus, I have 
felt it to be my duty to enter the domain of surgery, and carve 
out for myself a new pathway through consecrated ground, upon 
which the foot of man has not dared wittingly to tread. I doubt 
not it is known to you all that I have invaded the hidden recesses 
of the female organism and snatched from its appointed seat a 
glandular body, whose mysterious and wonderful functions are 
of the highest interest to the human race,—nay, an organ en- 
dowed with functions, the integrity of which determines the very 
existence of the race itself. Eor having done this, I trust I shall 
not be assassinated, neither in my carriage at home, nor in this 
hall, nor yet upon the streets of your orderly city. Those of 
you, my brethren, who know me personally, I hope will scarcely 
need the assurance that I have not taken this step forward with- 
out mature and deliberate thought. Whatever may be your 
opinions of the wisdom of my course, I trust you will see in it 
evidences of a heart not devoid of human sympathy—of a mind 
not shirking professional labor—of a hand not fearing to lift 
itself when duty calls. 
However pure may have been the motives actuating me,— 
however cogent may have appeared, to my own mind, the rea- 
sons which have impelled me,—I must of necessity stand before 
the bar of the medical world, and submit myself to its just 
judgment. It becomes me, too, to appear before you, my breth- 
ren and my peers, to answer for myself. 
And first, for the facts. These have already been spread before 
the profession through the pages of the Atlanta Medical and 
Surgical Journal, which has an extended circulation among the 
members of this body, as well as in the profession generally of 
this and the surrounding States. These facts have likewise been 
published in pamphlet form, and widely distributed to the med- 
ical press and medical men, both in this country and in Europe. 4 
Normal Ovariotomy. 
This statement of facts has probably been read by the great 
majority of the members present, and I will gladly save you the 
infliction of a rehearsal of the pamphlet, which I now present 
you as the basis of the remarks I have to make. 
Allow me here to correct an error which has inadvertently 
crept into my report, in stating the age of my patient, Miss 
Julia. She was twenty-three years old when she first came 
under my professional charge, and was thirty at the time of the 
operation. 
In continuation of the history of my case from the publica- 
tion of the pamphlet down to the present, we shall not consume 
much time. 
HISTORY CONTINUED. 
Thirty-fourth Day.—She feels fullness about the head and 
pain in the back, which reminded her of the premonition of 
one of her old attacks. She was pnt under the influence of 
bromide potassium, and the nervous symptoms soon passed off. 
Forty-second Day.—Complains again of pain in the left iliac 
fossa, and had metrostaxis. 
Forty-third Day.—Pain relieved by blister; metrostaxis con- 
tinues. 
Forty-fourth Day.—Uterine flow has ceased. 
January 1,1873.—5 he has had a uterine flow for four days, 
without headache or any material nervous disturbance. This is 
the third attack of metrostaxis since the operation. 
January 24.—Complains a little of soreness and pain in the 
left iliac region. 
February I.—Metrostaxis for one day. 
February s.—Complained a little on yesterday and to-day of 
headache and pain in the back; ordered a purgative and bro- 
mide, which soon relieved the symptoms. 
February 7.—Nervous symptoms are all gone. She is fatten- 
ing up decidedly, and rapidly gaining strength. She is ten 'pounds 
heavier than ever before in her life. She has several times walked 
a mile, spent the day visiting, and walked home again in the 
afternoou. She appears bright and cheerful and happy, and 
says her nervous attacks are trivial in comparison to those suf- 
fered previous to the operation. She has passed the winter 
without cough or any chest symptoms, and without rheumatism, 
except some trivial aching in the wrist and elbow. Normal Ovariotomy. 
5 
February 15.—Attacked with bilious dysentery, ushered in by 
rigor and fever, and attended with a very free metrostaxis—freer 
than she has ever experienced before. The metrostaxis contin- 
tinued for sixty hours, and the dysentery for several days. 
March 22.—She is visiting her friends from house to house, 
attends her church regularly upon the Sabbath, and shops upon 
the street. She walks a mile with ease. 
As far as I am able to discover, she has lost nothing of value 
whatever in consequence of the operation; and the patient herself, 
who was duly informed, prior to the operation, of all its possible 
consequences, assures me that in no respect does she find her- 
self different from her former self, excepting in the absence of 
her previous sufferings, and the wonderful improvement in her 
health and spirits. 
Having removed by incision the ovaries of my patient, I very 
naturally felt that I had done an ovariotomy; but when I at- 
tempted a comparison with the recognized operation of our 
friends, the ovariotomists, I found at once striking differences, 
both in the thing done and the purpose of its execution. It 
seemed to me well, under the circumstances, to recognize at 
once these differences, by adopting a new and distinguishing 
appellation. Reflecting a little upon the matter, it appeared to 
me that it was I who had really and truly done an ovariotomy, 
rather than Dr. Ephraim McDowell, as I understand the rule, or 
law, or principle, which governs medical nomenclature in such 
cases. My proceeding, therefore, seemed to me to be an ovarioto- 
my, according to an established law, rule, or principle. By this custom, 
law, rule, or principle, I felt that my operation was regular ova- 
riotomy, and McDowell’s irregular. As my proceeding removed 
the organ prior to its degeneracy by disease, it seemed to me 
an ovariotomy which related to rudiments or elements. And more- 
over, if it- be possible to say that an operation of such nature is 
in any sense square, then mine is the square ovariotomy. But 
all this was a little too complex. I desired, if possible, to express 
my thought on the point in a single word, and, referring the 
matter to Webster, I readily selected the word normal as express- 
ing the qualificationsfirst, “ according to a square or rule;” 
second, “ regular,—according to an established law, rule, or 
principle;” and third, “relating to rudiments or elements.” 
April 7.—Condition the same. 6 
Normal Ovariotomy. 
Of course, I could not conceive that an operation for the re- 
moval of the normal ovaries could in any sense be a natural 
ovariotomy. 
In considering the propriety of the operation of normal ova- 
riotomy in the case recited, it will be pertinent to inquire: 
1. Was there rational ground for the belief that the change 
of life would cure my patient of her sore malady? 
2. Was there rational ground for the belief that removal of 
the ovaries would bring about the change of life? 
3. Was it justifiable to effect a cure at the sacrifice of her 
ovaries ? 
To the first of these questions, as it seems to me, there can 
be but one answer. My patient was suffering with the perturb- 
ing influences of an unrelieved menstrual molimen. The change 
of life is understood to include both the cessation of the menses' 
and the cessation of the menstrual impulse. The removal of 
the menstrual molimen—the exciting cause of the perturba- 
tion—would logically remove the effect with the cause. Upon 
this point allow me to quote a single authority. Dr. Tilt says: 
“With respect, however, to women who had been suffering 
for many years from intractable chronic affections that had 
baffled our best efforts to bring about recovery, the results of 
cessation are in general eminently satisfactory. We are, most 
of us, in the habit of telling our patients that they will be cer- 
tainly cured by the change of life; and although this promise 
is often given to keep up the patient’s hope, rather than as the 
result of a well-grounded prognosis, still it is surprising how 
frequently the prophecy proves true. This remark particularly 
applies to ovarian congestion and subacute inflammation, and to 
most chronic diseases of the womb. 
“I have notes of some forty patients, who were for many 
years before the menopause confined to the bed or the sofa by 
chronic uterine inflammation, who made marvelous recoveries 
very soon after the change was effected, and who are once more 
actively engaged in those pleasures and duties of society from 
which they had been divorced for ten or fifteen years. Out of 
many similar cases, in which recovery was not thus rapid and 
perfect, I can not call to my recollection a single instance in 
which great improvement was not obtained, I have also ascer- 
tained from twenty-six women, who had ceased to menstruate, Normal Ovariotomy. 
7 
that they were no longer troubled by habitual leucorrhcea, and 
doubtless many suffer for years from unrecognized uterine affec- 
tions, which are at least completely cured by the change of life. 
Prolapsus of the womb was cured in three cases; thirty-five 
women no longer suffered from uterine deviations, though they 
still existed; in four cases, varicose veins had gone down; in 
twenty-four, piles had disappeared; and in eight other cases, 
they had ceased to bleed. Fifty-three women spoke of the 
great additional strength obtained, and of the abatement of 
their liability to dyspepsia. Ganglionic affections then often lose 
their gravity, and become less frequent; and the same remark 
applies to almost all cerebrospinal affections, even to the most 
formidable—for Esquirol has seen many women remain mani- 
acal so long as menstruation lasted, who immediately and spon- 
taneously recovered after the menopause.”* 
Who is there among you, my brethren, who, having had some 
years of observation, can not recall few or more cases to cor- 
roborate these observations of Dr. Tilt ? 
If the ovular theory of menstruation is to be accepted as an 
ultimate fact, the answer to my second question becomes as 
easy and as logical as the first. If the menstrual nisus be sim- 
ply the result of ovulation, then the cessation of ovulation, the 
cause, necessitates the cessation of the effect of that cause, 
whether this cessation occur by reason of atrophy of . the ova- 
ries by age or their removal by the knife. It seems to me, there- 
fore, that the question to be considered is, Are there reasonable 
grounds for the acceptance of the ovular theory of menstruation ? 
I do not propose to undertake the discussion of this theory. 
I will not consume your time and weary your patience with the 
unnecessary details, but shall content myself by citing such au- 
thoritative opinions as are to be found upon my own shelves, 
and which, I shall contend, fully warrant me in accepting the 
theory as an ultimate fact so far as my duties to my patient are 
concerned. 
Upon the subject of menstruation, Dr. Charles West uses the 
following language: 
The ovaries are the grand organs of sexual activity in the 
female; and during the whole time that sexual life continues, 
they are employed in bringing ova to maturity, and then in ex- 
• Change of Life. Philadelphia, 1871. p. 20. 8 
Normal Ovariotomy. 
trading them at certain periods when they have attained a state 
of fitness for further development, if subjected to the fecund- 
ating influence of the semen. Accompanying this internal pro- 
cess, the consequence and the evidence of the local congestion 
which attends it, we observe a periodical discharge of blood, 
constituting menstruation.”* 
Dr. Meigs says: 
“I adopt the notion that the act of menstruation, rigorously 
construed, consists in the periodical maturation and deposit of 
an ovulum—of which act the flowing of the menstrual blood is 
but the outward and visible sign.”t 
“ In fact, it appears that each menstrual nisus may be regarded 
as an abortive effort at reproduction, and the elimination of the 
discharge itself, simply as the necessary disposal of a certain 
amount of blood, which, had conception taken place, would 
have been devoted to the support and maturation of the verified 
ovum; or, to use the words of Dr. Power, * a woman menstru- 
ates because she does not conceiveand it has been happily 
said, by Dr. Tyler Smith, that menstruation may be considered 
as the first act of human parturition; it is, as it were, the par- 
turition of the ovule, while labor is the parturition of the ma- 
tured ovum.”^ 
Montgomery says: 
Tyler Smith says “ the cause of menstruation must be referred 
to the ovaria. We may look, then, to the ovaria for the exciting 
cause of menstruation, and this function is evidently subsidiary 
to that of ovulatioh.Ӥ 
“Menstruation, therefore, strictly interpreted, is ovulation, 
and the sanguineous discharge, that is vulgarly considered as 
the principal point, is far less principal than the ovarian ovula- 
tion—of which, indeed, it is only the outward mark or symp- 
tom. The true doctrine was that of a local plethora, or, in other 
words, a state of periodical hypersemia of the reproductive 
organs; and now that doctrine is not only established, but is 
made plain to the understanding—for the periodical paroxysm 
Dr. Meigs says: 
* Lectures on the Diseases of Women. Philadelphia, 1857. p. !20. 
t Woman and Her Diseases. Philadelphia, 1854. p. 419. 
{ Signs and Symptoms of Pregnancy. Philadelphia, 1857. p. 387. 
§ Lectures on Obstetrics. New York, 1858. Normal Ovariotomy.. 
9 
of stromatic force, that hurriedly concludes the ripening of the 
most perfect oya, establishes the affluxion that fills the capilla- 
ries of the reproductive organs, and engorges them, or renders 
them hypersemic to the point of causing the monthly hemor- 
rhage by which the hypersemia is removed, leaving behind it no 
trace of indisposition. 
“When Percival Pott, the illustrious surgeon, removed the 
ovaria of his patient, under an operation for hernia, he took 
away with them the power of menstruation. There are numer- 
ous examples of females who did never menstruate, owing to 
the absence of the ovaries. 
“Patients suffering with chronical maladies, attended with 
protracted amenorrhoea, exhibit, in the ovarian stroma, no ves- 
tiges of the Graafian vesicles. I lately examined the ovaria of 
a girl who died after some eighteen months of severe chronical 
ailments, during which she did not menstruate. Those ailments 
had no primary connection at all with any state of the reproduc- 
tive organs; yet, upon carefully examining the ovarian stroma 
of both the ovaries, it was found to be a compact, whitish tis- 
sue, very similar to that which we observe in women long past 
the change of life. No trace of the ovarian vesicle existed in 
either of them. It is generally so.”* 
Scanzoni says: 
“ Under the name of menstruation, we commonly understand 
a series of phenomena manifested in the female organism, and 
having for its first cause the periodic ovulation, which takes 
place in a Graafian vesicle.”t 
“ What, pray, are these organs ? They are the ovaries—the 
essential and only organs of generation, strictly so-called, in the 
female. The development of the ovaries occurs at the period 
of puberty, and then it is that their physiological action com- 
mences. At this time you will observe, on the surface of these 
bodies, the Graafian vesicle—this latter containing the ovule, 
which, I have told you, escapes ordinarily with the menstrual 
blood. As these ovules on the surface become matured, the 
ovary itself forms the center of a sanguineous afflux, a veritable 
Bedford says: 
* Obstetrics: The Science and the Art. Philadelphia, pp. 146, 152, 156, 167. 
f The Diseases of the Sexual Organs of Women. New York. Fourth Amer- 
ican Edition, p. 314. 10 
Normal Ovariotomy. 
congestion, in which the fallopian tubes and uterus participate. 
This congestion results in the escape of mucus and of blood, 
which pass from the uterus through the os tincse into the vagina, 
and thence externally; and this is menstruation.”* 
Bennett says: 
“ The researches to which I refer prove, in the most satisfac- 
tory and conclusive manner, that menstruation is intimately con- 
nected with the evolution from the ovary of matured ova, which 
takes place periodically in the virgin as well as in the married 
female. In the human female the maturation and evolution of 
ova occur at frequent intervals, and are remarked by the exu- 
dation from the uterine cavitv of a greater or less quantity of 
blood.” t 
Tilt says: 
“Nevertheless, as we positively know that the ovaries rule 
supreme over menstruation, and that they cause many diseases 
of women during the period of woman’s greatest reproductive 
energy, it is fair to suppose that they aggravate and delay the 
cure of the most common uterine diseases, when ovarian irrita- 
tion is no longer relieved by an habitual menstrual flow.”t 
Our own Sims says : 
“It must be admitted, however, that menstruation is a sign 
of ovulation, the one taking place ■when the other begins, and 
ceasing when it stops.Ӥ 
Thomas says : 
“ That the discharge of blood, which occurring at monthly 
periods constitutes menstruation, is a true hemorrhage depend- 
ent upon the process of ovulation, is now regarded as a settled 
fact by most progressive physiologists. In accordance with a 
law of nature, which we recognize in its effects, but can not 
explain, once in every twenty-eight days, one or more ovules in 
each ovary burst their envelopes, and, entering the fallopian 
tubes, pass downward to the uterus. This eruption of ovules 
proGluces in the ovaries congestion and nervous exaltation, 
which continue until the process is completed.” 11 
Byford says: 
* Diseases of Women and Children. New York, 1856. p. 233 
f Bennett on the Uterus. Philadelphia, 1860. p. 51. 
X Change of Life. Philadelphia, 1871. p. 273. 
§ Clinical Notes on Uterine Surgery. New York, 1866. p. 40. 
II Diseases of Women. Philadelphia, 1869. p. 493. Normal Ovariotomy. 
11 
“ Several conditions are necessary to the healthy performance 
of menstruation,— 
“1. The ovaria must be present, and sufficiently healthy to 
produce ova. 
“2. The uterus must be sufficiently perfect, anatomically and 
physiologically, to be the medium of this elimination. 
“ 3. A certain, but not as yet very well-defined, state of the 
blood and nervous system. 
“I do not think that these are all the conditions necessary 
to perfect menstruation; they are the obvious and undoubted ones. 
The physiological chain of circumstances that give rise to men- 
struation may be given thus; The organs concerned being fully 
developed, the blood and nervous system matured to a certain 
degree, an ovum is produced, and during the time it is being 
matured and cast off from the ovary, all the organs of genera- 
tion are intensely congested by the increased energy of the cap- 
illary circulation; the congestion and stress of blood upon the 
delicate capillaries of the mucous membrane of the uterus be- 
come so great that the walls of some of these vessels are rup- 
tured, and an effusion of blood takes place in the cavity of the 
uterus, which, finding its way out of the vagina, is called men- 
struation. If ovulation does not take place, the congestion does not 
occur, and in the absence of the congestion, there is no effusion.”* 
Need I say more on this point? Was there rational ground 
for the belief that removal of the ovaries would bring about the 
change of life ? Judge ye. ' 
I can not, however, leave this branch of the subject without 
calling your attention to certain facts and observations which 
might seem to you to somewhat obscure the clear and convinc- 
ing evidences of ovular menstruation, and I shall endeavor to 
satisfy you, if I may be able to do so, that it is an obscurity 
only in seeming, not in reality. 
I quote, briefly, from Dr. Atlee’s recent work upon “ Ovarian 
Tumors,” at page 35 and onward: 
“ Case IY.— * * * April 17th, 1854,1 operated on Mrs. 
J. 0., of Baltimore, * * * removing both ovaries. She was 
thirty-five years old; had first menstruated at the age of twelve 
years, was married at the age of eighteen, and had six children, 
the youngest being four years old. * * * She nursed all 
* Medical and Surgical Treatment of Women. Philadelphia, 1867. p. <57. 12 
Normal Ovariotomy. 
her children, and while nursing she menstruated regularly, com- 
mencing at the expiration of five months after parturition. She 
continued to be very regular after the birth of her last child, 
up to the period of the operation. * * * After the opera- 
tion, the same evening, the menses appeared, and continued the 
usual number of days. For several years Mrs. C. wrote to me 
on every anniversaiy of the day of the operation, always assu- 
ring me that menstruation was perfectly regular. Being on a 
visit to Baltimore, in December, 1866,1 saw her, and she in- 
formed me that she had menstruated as regularly as ever up to 
May, 1864, when the menses ceased for one year, and again re- 
turned in May, 1865, for the last time.” 
“ Case Y.— * * * April 25th, 1855,1 removed both ova- 
ries from Miss K. N., of Baltimore. * * * She was nine- 
teen years old; she first menstruated before her thirteenth year 
of age, and was regular afterward. * * * Six months after 
the operation I saw the patient in Baltimore, where she had 
just issued her wedding cards. She had no red menstruation 
since the operation, but she experienced the usual sensations 
in her head and back at regular monthly intervals, accompanied 
with white discharge at those times. She married, made a visit 
to Europe, and after her return I learned through her mother 
that the monthly discharge continued, and that the sexual feel- 
ings were normal.” 
“ Case Yl. * * * October 16th, 1867,1 extirpated the 
left ovary of Mrs. J. C. * * * She was twenty-seven years 
old; had been married four years, but had not conceived. After 
slight irregularity in menstruation, she had first noticed the 
tumor in May, 1857. * * * The right ovary was examined 
and pronounced healthy. 
“ July Bth, 1861, Mrs. 0. called to see me, having an ovarian 
tumor in the right side, which had existed for about six weeks, 
and was rapidly enlarging. Menstruation was regular. Octo- 
ber 16th, 1864, she called again, and reported herself perfectly 
regular ever since. November 11th, 1864,1 removed the right 
ovary. * * * The left side of the uterus was examined at 
the time, and found to be perfectly truncated, being short of 
every kind of appendage.” 
Her physician writes Dr. Atlee on December Bth, 1870: 
“ She informed me that from the time of the first operation Normal Ovariotomy. 
13 
up to the second, she menstruated regularly; since the last op- 
eration she has been regular, and is to-day. In fact, she is at 
this time menstruating. When I say regular, 1 mean, of course, 
that in its fullest sense; she is regular as to time, guantity, quality, 
etc., and free from any abnormal symptoms.” 
“Case Yll.—Both ovaries removed,—one in 1846, by Dr. 
Charles Clay, of Manchester, England, the other by myself, in 
1861; menstruation always regular.' * * * During the whole 
of the above period, notwithstanding one ovary had been extir- 
pated, and the other ovary was extensively diseased, menstrua- 
tion not only returned regularly, but conception took place, 
gestation was matured in spite of repeated tappings, and a liv- 
ing, healthy child born! And yet more, menstruation contin- 
ued to recur regularly afterward, as she writes from Wisconsin, 
October 24th, 1863 : ‘Courses all right every month 7” 
On the 23d September, 1865, Dr. H. R. Storer, of Boston, 
operated upon Sarah A. Colcord, of Malden, unmarried, aged 
forty-seven, and removed the uterus as well as both ovaries. Dr. 
Storer says: 
“ I now (November 9th) made the first vaginal examination 
since the operation, and found the cervix reduced to a mere 
nodule, button-shaped,, and much smaller than I expected to 
find. From the date of the operation until October 11th, eight- 
een days subsequently, and twenty-six days after the last appear- 
ance of the catamenia, there was no discharge whatever from 
the vagina. There now ocurred a sanguineous effusion, attended 
&y feelings of lassitude, backache, etc., lasting thirty hours, and 
being an evident attempt at the reestablishment of menstrua- 
tion,—a very curious circumstance, and of great physiological 
interest, when it is recollected that the uterus and both ovaries 
had been removed. The ensuing period has been passed with- 
out its recurrence.”* 
From Peaslee’s new work on “ Ovarion Tumors,” page 527, I 
quote another case of Dr. H. R. Storer’s : 
Mrs.(Durham, aged forty-three years, the mother of six chil- 
dren. Menstruation had been regular down to within two 
months, and was now suppressed, as was supposed, by preg- 
nancy. The symptoms became urgent, and November 20,1867, 
* American Journal of Medical Science, January, 1866. p. 119. Normal Ovariotomy. 
both ovaries were removed. In the present instance, the menses 
had been absent for two months, and yet reappeared subse- 
quently to the operation, although the ovaries had both been 
removed, and the major part of the fallopian tubes also.” 
In the American Journal of Medical Science, for January, 1868, 
page 81, Dr. Storer says: 
“ I removed both ovaries, a year since, from a patient in 
Brookline, Mrs. Mathews. In this case I deviated from the 
usual method of dealing with the pedicle, in that I did not 
divide the pedicle, as is usually done, but carefully dissected 
away the fallopian tubes, throughout their whole length, from 
the surrounding masses, preserving them intact, and then closed 
the peritoneal wounds along their entire course by metallic 
wires. * * * The ovaries were entirely removed, and yet 
the patient has had during the supervening period, quite regu- 
larly, a sanguineous discharge, without evidence of uterine dis- 
ease, and which haemostatics, generally and locally applied, 
have failed to check or prevent.” 
Dr. Peaslee cites from his own practice and others, twelve or 
thirteen other cases, in most of which the sanguineous discharge 
occurred but once or twice, and goes on to remark : “Unques- 
tionably, therefore, a sanguineous flow occurs 'per vaginam, in 
exceptional cases, after double ovariotomy; this obtaining only 
once or several times, at regular or irregular intervals, and very 
soon or a considerable length of time after the operation. But 
can such a flow be appropriately termed menstruation? 
“ If, for the moment, we set aside all the generally received 
ideas of menstruation as depending on ovulation, I suppose no 
one would accept as menstruation the flow which occurs but 
once, and in the first week after the operation, or indeed at any 
point of time thereafter. Such a hemorrhage is a mere uterine 
epistaxis, or metrostaxis, as Mr. Wells has appropriately named 
it, and may arise from the body of the uterus alone, or the cer- 
vical canal, or both, at the same time. 
“ Thus we have in literature six cases of apparent menstrua- 
tion after double ovariotomy. Was it really such? 
“ If we define menstruation to be the sanguineous flow which 
is produced by ovulation, or which merely accompanies the ovu- 
lation, of course the term is here inapplicable, since, in the 
absence of the ovaries, ovulation is impossible. But there is Normal Ovariotomy. 
15 
no proof, nor any probability, that ovulation produces true 
menstruation. Certainly, ovulation and even parturition occurs 
in some women who have never menstruated. Menstruation is, 
therefore, an accidental and an incidental, rather than an essen- 
tial function, and it has no apaiogue in most of the lower ani- 
mals. In itself considered, it is merely a flow of blood at stated 
periods from the interior of the uterus, irrespective of its con- 
nections or causation. But, in its scientific acceptation, it has 
always been restricted to the flow from the cavity of the uterus 
and the fallopian tubes, which returns once a month to a health}’-, 
non-pregmant woman of the child-bearing age. More recently, 
it has been found also that ovulation occurs especially, but not 
exclusively, at the same time ; and physiologists are, therefore, 
obliged to associate this idea also with menstruation, as the 
before-mentioned characteristics always have been, and w-e must 
have some term to express precisely these ideas, and no more 
nor less. We must, therefore, cease to use the term in this 
sense, and substitute another, or retain it in this sense alone. 
In other words, if an exceptional uterine flow, in circumstances 
such that ovulation is impossible, be called menstruation, the 
same term must not be applied to the flow which physiologically 
accompanies ovulation. No one, I suppose, proposes to relin- 
quish the term in the latter circumstances; it must, therefore, 
not be applied in the former, but a new term must be used, and 
metrostaxis is unobjectionable. Metrostaxis may occur at any 
time, and does occur under very diverse circumstances, from 
any part of the uterine cavity, or the cervical canal, in a con- 
gested state of the internal vessels of the non-pregnant uterus; 
and may occur from the cervical canal alone even during preg- 
nancy, or after the removal of the ovaries and all of the uterus 
except the cervix, as in Koeberle’s case.* The flow may also, 
though very rarely, become quite regular, as we have just seen 
in cases in which both ovaries have been removed. But all this 
is mere metrostaxis, and not menstruation, and can not be cited to 
disprove any theory of the causation of true menstruation; and 
no such theory, therefore, need here be discussed. 
“ Thus double ovariotomy, as a rule, is not followed by any 
* And even after removal of ovaries and nteius, except a email segment of the 
cervix, as in the case before cited, of Sarah A. Colcord. 16 
Normal Ovariotomy. 
loss of the special characteristics of woman,—the only decided 
physiological change being a final cessation of menstruation, as 
loell as of ovulation.” 
“Even when both ovaries are diseased, the menses may appear 
without any apparent derangement; and this may be accounted 
for on the supposition, that in the diseased ovary there may still 
exist Graafian vesicles in a normal condition. The removal of 
one ovary does not necessarily prevent ovulation nor impregna- 
tion,—provided the remaining ovary, though diseased, contains 
Graafian vesicles in a healthy condition. And what is more 
remarkable, as a physiological fact, the removal of both ovaria 
is sometimes followed by a regular red discharge, even for years, 
and until it is arrested at the usual climacteric period. Perhaps 
this may be the result of a habit, or habitual molimen, just as a 
eunuch, whose testicles have not been removed until puberty 
has been established, may have both erection and the ejacula- 
tion of a fluid.” 
Dr. Atlee reasons this point as follows : 
In the New York Journal of Medicine, for 1844, is to be found 
“ a remarkable case in the practice of Dr. LeConte, of Georgia, 
in which a negress seventy years of age, in whom the menses had 
been absent more than twenty years, was treated by thunder 
and lightning from the Almighty’s battery, one charge from 
which brought on the menstrual flow, which continued regu- 
larly for the two succeeding years.”* 
In the London Lancet (reprint) of 1861, page 190, is reported 
the case of a widow lady, aged seventy-four: “ She has had for 
the last six months a periodical hemorrhage from the uterus, 
returning every three weeks or so, the discharge exactly resem- 
bling, she says, what it was when she was young. She com- 
plains of nothing but gradually increasing weakness. Has long- 
standing heart disease.” 
In the same connection, Dr. 0. N. Eoyle, P.E.C.S., reports 
three other analogous cases: “ One in private practice, who 
during the last year of her life was the subject of a regular 
periodical discharge, resembling in appearance the catamenial 
secretion of her youth. She died a few months since, in her 
sixty-seventh year, of anasarca, the result of long-continued dis- 
* Journal Gynaecological Society, September, 1872. p. 238. Normal Ovariotomy. 
17 
ease of the heart and liver. The two other patients were union 
cases. One died last year in the infirmary here, to which lam 
surgeon, at the good old age of ninety-three, in a perfect state 
of health up to the day of her death, with this exception (the 
catamenia), save an obscure fluctuation which she occasionally 
complained of in the abdomen, at the bifurcation of the aorta, 
a few months previous. The third party is still living, and in 
her sixty-seventh year. For the last fifteen months she had 
ascites, and during that period I have had occasion to tap her 
six times. Since the first tapping, however, she has never expe- 
rienced any return of her monthly sickness, -which regularly 
occurred three months previously.” 
Bear with me while I cite from my own practice another case 
which, I can not but think, has an important bearing upon this 
question. 
Some years ago 1 was summoned to visit Mrs. S., a lady of 
sixty years. As she entered her parlor, and extended the hand 
to me in her usual cordial manner, she remarked: 
“Doctor, I know that you will think me an old fool to send 
for you! But I must tell you. lam not sick; I never enjoyed 
better health in my life. I have neither pain nor ache any- 
where ; I have good appetite, good digestion, and sleep well; I 
never was stronger; I run up and down stairs all day long, and 
attend regularly to my own household affairs. I changed life 
at forty-five; had some little trouble, but not very much, and 
have had good health ever since. But of late I have become 
regular again just like I was when a girl. I feared it might not be 
quite right, and thought I would like to talk with you about it.” 
“I think you did well, Madam, to send for me. Tell me, how 
long has this been ?” 
“Nearly a year, Doctor.” 
“How often do you come so?” 
“ I am perfectly regular, Doctor, like I used to be.” 
“And bow long does it last, and how about the quantity?” 
“ Why, four or five days, Doctor; and just like it used to be.” 
“ Does it weaken you at all?” 
“ No,—not a bit.” 
“Is the discharge offensive?” 
“ Not at ail.” 18 
Normal Ovariotomy. 
“Yon perceive nothing wrong about you at all, excepting this 
return of the menses ?” 
“ No,—nothing.” 
“ Well, Madam, I shall not laugh at you for calling me. I 
think you were right in asking advice; but I do not think it 
quite right for you to resume your youthful functions again in 
this way. I fear something is wrong, and I must see, I must 
know, what it is.” 
“Very well, Doctor, as you think best.” 
A careful exploration of this case revealed a hard, somewhat 
nodular uterus, firmly tied down to the neighboring organs, but 
with no breach of continuity in its mucous surfaces that I could 
detect. There was no ulcer; there was no fungus, no polypus, 
no fibroid. In less than a year her family followed her to the 
church-yard—because of carcinoma uteri. 
Upon the question of menstruation: After listening to her 
recital in the parlor, as I have described it, how easily could I 
have written down the case in the precise language of Dr. Atlee’s 
correspondent: 
“In fact, she is at this time menstruating. When I say reg- 
ular, I mean, of course, that in its fullest sense; she is regular 
as to time, quantity and quality, etc., and free from any abnor- 
mal symptoms.” 
Is this menstruation? Shall a woman of seventy, of eighty, 
mayhap of ninety-three years, having long passed the meno- 
pause, go through a sort of senile puberty, and take a new leas© 
of menstrual life? If we should hold firmly the doctrine that 
the initiatory impulse of the menses proceeds from the ovaries, 
does it necessarily follow that the outward sign of this function 
must cease at once upon the withdrawal of its moving cause ? 
Is it matter of great surprise that, in exceptional cases, the sign 
should recur once, twice, or even many times ? 
What is the teaching of nature on this point ? How is it at 
the climacteric ? Do we not all know that a more or less pro- 
longed interval usually occurs between the commencing irregu- 
larity and the final cessation—called by Tilt the “ dodging 
time ” ? Indeed, does not nature generally abhor any sudden 
and violent change in her economy ? 
May we not draw a lesson, too, from mechanics ? What of a 
body moving responsively to a propelling force ? If the force Normal ovariotomy. 
19 
be suddenly withdrawn, do we expect the moving body to come 
instantly to a state of rest ? Do we not know that it continues 
its motion for a time, in spite of the counter forces of friction 
and atmospheric resistance, by reason of the acquired momen- 
tum ? And is there no analogue to momentum in the forces 
which move the nervous mass in man ? If we suddenly decap- 
itate an animal, do we expect to see the evidences of animal 
life instantly and wholly to disappear ? Does anybody doubt 
for a moment that, in the higher order of animals, the great 
encephalic organs preside absolutely over the phenomena of 
life? Does anybody doubt that the decapitated animal is vir- 
tually dead ? 
How is it with traumatic epilepsy from depressed portion of 
skull? Suppose a length of time has elapsed, and the convul- 
sive habit has been fully established. We now apply the tre- 
phine and remove the offending cause; are we greatly surprised 
if the effect (i. e., the epilepsy) should fail to disappear at once? 
How about eclampsia ? Do we not all know how much easier it 
is to control the first paroxysm than the second, and the second 
than the third ? Is there not something like momentum in this ? 
Does not hysteria, too, acquire increasing momentum under the 
influence of the same continued cause ? 
Take the case before us. We have seen that while this patient 
had formerly no menstrual flow from the uterus, speedily after 
the removal of the ovaries, a flow appears; and this, too, recurs 
several times subsequently, at irregular intervals—sometimes 
with abnormal nervous manifestations, sometimes without them. 
Is this menstruation ? Shall we say that the presence of the 
ovaries caused the amenorrhoea, and their removal cured it, and 
established true menstruation ? May not the moving force of ovu- 
lation, continued through ten, fifteen, or even twenty years, com- 
municate to the nervous mass a momentum which shall continue 
to manifest itself, in exceptional cases, long after the ovaric 
force is withdrawn ? 
What say you then, my brethren? Will the removal of the 
ovaries determine the change of life? 
I must crave your indulgence for having detained you so long 
upon this branch of the subject. I have purposely abstained 
from entering into the details of the physiology of menstrua- 
tion, which could but weary your patience. I have refrained 20 
Normal Ovariotomy. 
from the production of the very numerous authorities outside 
my own meagre library, and yet I have greatly desired that 
your convictions should be wdiolly unclouded upon this point. 
If I have not effected the change of life by my interposition, 
then I have done nothing—worse than nothing—and it is in 
vain that I stand before you to-day. I am persuaded in my 
own mind that there is not one of you, my brethren, who will 
be disposed to take issue with me here, and I proceed, there- 
fore, to consider the final question : 
Was it justifiable to effect a cure at the sacrifice of the ovaries? 
In the absence of any accumulated array of facts, it has been 
generally believed that the removal of the ovaries involved (a) 
danger to life; (b) loss of procreative power; (c) loss of the 
aphrodisiacal sense ; (d) loss of menstrual molimen ; (e) loss of 
the outward fejainine graces—including mammary atrophy, 
change of voice, growth of beard, etc. 
The fact that no surgical operation (however trivial in its 
nature), involving the use of the knife, is without danger to life, 
can not be too deeply impressed upon our minds. I shall not 
contend for a moment that the operation in question is free of 
danger; but I shall endeavor to satisfy you, by authorities, and 
by the results of observation and analogy, that the danger is 
not out of proportion to the severity of the malady, upon the 
one hand, nor the magnitude of the results upon the other. 
The danger to life is of a three-fold character; First, that 
attending the simple incision, which is common to all opera- 
tions, and which is trivial in importance, and therefore need 
not detain us here; secondly, the dangers attendant upon the 
opening of the peritoneal cavity; and thirdly, those consequent 
upon the removal of the ovaries. 
The opening of the peritoneal cavity is certainly no new pro- 
ceeding. There are very many instances already upon record 
where this has been done for various purposes, to say nothing 
of the long array of cases of operations for hernia and the 
modern ovariotomies. But to form a fair .estimate of its dan- 
gers, we must divest the simple operation itself of all the com- 
plicating procedures of which it has been only the prelude. 
This, happily, we may do, in an appropriate way, by drawing 
our inferences from the exploratory incision for diagnosis in 
ovarian tumor. Normal Ovariotomy. 
21 
After drawing a proper distinction between this procedure 
and an unfinished attempt at ovariotomy, in which more or less 
violence has been done to the abdominal contents, Dr. Peaslee 
remarks: 
“ Still less dangerous, however, is the making a short incision 
* * * the express purpose of introducing the finger, or 
the steel sound, to ascertain the character of the tumor and the 
presence or absence of adhesions,—provided, always, that the 
patient’s general health is not too much depressed. Of Dr, 
W. L. Atlee’s two hundred and twenty-two collected cases, 
twenty-five were cases in which explorative incisions merely 
were made, and all these recovered. Dr. F. Bird stated, before 
the Medico-Chirurgical Society, November 12th, 1850, that he 
had made such incisions in between forty and fifty cases with- 
out any injurious consequences ensuing.”* 
I may remark, in passing, that I have had but one such case 
in my practice, in which I passed my fingers freely about in the 
cavity and down into the pelvis for the purposes of diagnosis. 
I had no reason, at any time, to regard the life of my patient 
in a particle of immediate danger. 
While, as far as I am informed, there is no controversy upon 
the point of originality in the operation of normal ovariotomy, 
as I have defined it, there are a number of instances of more 
or less authenticity upon record in which the healthy ovaries 
have been successfully extirpated, or are supposed to have been 
removed. These cases, however, with exception of the one 
already cited from Percival Pott, are too vague and apocryphal 
to be here considered. They may be found in Dr. Peaslee’s 
work, at page 226. 
Allusion is also made in Appleton's Journal, of September 21, 
1872, to the same operation, practiced among the Skopts, a reli- 
gious sect in Boumania, as a religious rite, as circumcision is 
among the Jews. It appears that a fatal case had aroused the 
authorities to take cognizance of their doings; and as they are 
represented to have long practiced this rite, it would seem that 
it had been attended, probably, with no great degree of fatality, 
or attention would have been earlier drawn to the subject. 
In the absence of statistics to guide us to a judgment of the 
* Ovarian Tumors: Peaslee. p. 177. 22 
Normal Ovariotomy. 
fatality likely to ensue from normal ovariotomy, we can only 
approximate it by analogy. 
It is a familiar fact that a like operation has been in practice, 
from time immemorial, upon the domestic animals. It is well 
known that the danger therefrom is exceedingly small; and this 
without any special care or nursing. 
Of the statistics of ovariotomy, it is generally conceded that 
the rate of mortality, in the hands of experienced operators, is 
steadily decreasing. Upon this point Peaslee says : 
“ Ovariotomy, in well-selected cases, is not comparatively a 
dangerous operation, ninety per cent, recovering, probably, in the 
hands of experienced operators. Over eighty per cent, have 
actually been saved of cases not selected for their promising 
features, but taken as they came under the operator’s notice, 
who rejected none which seemed to afford any chance of recov- 
ery from the operation.”* 
He likewise quotes Spencer Wells’ opinion to similar purport: 
That short incisions through the abdominal parieties,—that the 
removal of a simple, unilocular cyst, and the absence of adhe- 
sions,—are all circumstances which materially diminish the mor- 
tality of ovariotomy, we would naturally expect; and such is 
the experience of operators and the dictum of the authorities. 
Have we not in normal ovariotomy yet more favorable con- 
ditions than these; and may we not reasonably expect a yet 
greater reduction of mortality than has been attained, or is even 
attainable, in the ordinary operation of ovariotomy? If the 
opinion recently expressed by Dr. Marion Sims—that the mass 
of all the deaths from ovariotomy is caused by septicaemia, con- 
sequent upon the decomposition of bloody serum poured out 
within the cavity—shall prove to be correct, it is evident that 
the danger from this source is materially lessened in normal 
ovariotomy. 
The loss of possible power to perpetuate the species is undeniable. 
But let me ask, Of what value is this function to a single lady 
of thirty, all her life an invalid, and hopelessly incurable except- 
ing by the change of life, which itself implies the loss of this 
function? Indeed, we need not rest the case here; for there is 
abundant authority for the assertion that my patient, by reason 
* Ovarian Tumors, p. 339. Normal Ovariotomy. 
23 
of her endometritis and amenorrhoea, was, in all probability, 
already sterile. 
“An abnormal shape of the cervix has been pointed out by 
Dr. Sims as a frequent cause of infecundity. * * " My own 
experience leads me to the conclusion that, excepting endometri- 
tis, this is the most common of all the causes,” etc. “ Endome- 
tritis, whether it be cervical or corporeal, fills the uterine canal 
with a thick, tenacious mucus, which often prevents the entrance 
of seminal fluid.”* 
Thomas says; 
Byford says 
“ Amenorrhoea is the least frequent of menstrual deviations 
as the effect of inflammation in the cervix uteri; but this inflam- 
mation is frequently the cause of scanty menstruation. It is 
curious to notice the manner in which this scantiness occurs. 
It seems to come on after the inflammation has lasted for a con- 
siderable time, and is almost always associated with sterility.”t 
In a paper read before the Obstetrical Society of Berlin, by 
Dr. Carl Mayer,upon the morbid conditions which give rise to 
sterility in women, in speaking of chronic endometritis as one of 
the conditions, he characterizes it as one of the most obstinate 
varieties of uterine disease, and asserts that he “ never saiu a 
woman laboring under it become pregnant.” 
I venture the opinion, based upon my own limited observa- 
tion, that conception coexisting with amenorrhoea from any 
cause, of fifteen years’ duration, is very exceptional in its occur- 
rence. I have never known such an instance. I doubt whether 
any medical gentleman who hears me can recall one such case 
under his own observation. And yet I do not for a moment 
doubt that such exceptional case might occur, and has occurred; 
I only contend that they are exceptional—very exceptional—and 
do not vitiate the rule that long-standing amenorrhoea, from 
any cause, is eminently productive of sterility. 
It has been generally supposed that the removal of the ovaries 
would be attended, necessarily, with loss of the aphrodisiac sense. 
This, however, appears not to be the result, certainly not the 
uniform result. 
* Diseases of Women, p. 509. 
f Medical and Surgical Treatment ot Women, p. 160. 
| American Journal of Medical Science, January, 1859. p. 269. 24 
Normal Ovariotomy. 
In the case of Miss K. Y., of Baltimore, previously cited upon 
another point, and in which both ovaries were removed, Dr. 
Atlee remarks : “ She married, made a visit to Europe, and after 
her return I learned through her mother that the sexual feelings 
were normal 
Upon this point Dr. Peaslee* says: “ Thus double ovariotomy, 
as a rule, is not followed by any loss of the special character- 
istics of woman; the only decided physiological change being 
a final cessation of menstruation as well as ovulation. Three 
of my own patients, married and highly educated ladies, after 
recovery again became splendid examples of womanhood, en- 
joying the most perfect health, and retaining all their former 
attributes of mind as well as of body, and with undiminished 
sensory capacities in their matrimonial relations''' 
On the 18th of March, 1871, Dr. Meadows,! in the Hospital 
for Women, London, removed both ovaries, the patient recover- 
ing without a bad symptom. She was seen again on Ist August, 
when “ she stated that she continued to menstruate quite regu- 
larly, and has sexual desire as much as ever." 
Mr. Spencer Wells! mentions a case of double ovariotomy, in 
his practice, where the patient, after recovery, not only retained 
her sexual powers, but in an exaggerated degree, and “ actually 
became aggressive in her demeanor.” 
My friend, Prof. John T, Darby, of South Carolina, informs 
me, in a private letter, that he is assured by a patient from whom 
he removed the uterus and both ovaries, that she enjoys the 
approaches of her husband as much as ever. 
The loss of the menstrual molimen is the condition of cure, it is 
the rolling off of a burden; in no sense can it be considered a 
calamity. 
Of the loss of outward feminine graces—of mammary atrophy, 
change of voice, growth of beard, etc., it may be said that such 
occurrences after double ovariotomy are exceptional, and not 
the rule. An observation of Dr. Peaslee upon this point has 
already been quoted, and he further remarks: “It has also 
been asserted that women from whom both ovaries have been 
removed undergo a decided physiological change, they becoming 
•* Medical and Surgical Treatment of Women, p. 160. 
f London Lancet. Eeprint June, 1872. p. 324. 
t American Journal of Obstetrics, Mar, 1872. p. 131. Normal Ovariotomy. 
25 
thin, their features more masculine, the voice harsh, the breasts 
atrophied, and sometimes a well-developed beard resulting from 
the operation. In Mr. Potts’ case, already cited, the first-men- 
tioned two of the preceding changes occurred; in a case reported 
by Dr. A. Reeves Jackson, the voice became harsher and more 
masculine, but otherwise no change was discernible; and Dr. 
W. L. Atlee found one of his patients, after double ovariotomy, 
with a “shaved beard.” This was, however, fourteen years 
after the operation; and the change probably occurred during 
the previous three years, the patient passing from forty-seven to 
fifty years of age, since Dr. Atlee makes no mention of the 
change as having occurred when he visited her at the age of 
forty-seven. I have seen a well-developed beard in three in- 
stances in women who had cystic disease of the ovary, and 
should accept such a fact as a ground of suspicion that both 
ovaries are affected. 
“ But on the other hand, it should be stated that the same 
changes which have been mentioned above have been observed 
in women, especially when somewhat advanced in life, who have 
never been suspected of ovarian disease of any form. 
“ The cases I have just detailed must also be regarded as 
exceptional. In three of my first six cases, both ovaries were 
removed, and neither of the patients has lost any of her femi- 
nine attributes up to the present time, so far as indicated by 
external appearances. The time which has elapsed since the 
three operations is twenty-one, sixteen and nine years. I have 
since had six successful cases of double ovariotomy, in neither 
of which has any change in the physical appearance occurred; 
but the time with these has only been from six to two years. 
Nor do Dr. Clay and Mr. Wells, with their extensive experience, 
mention any instances of the occurrence of such changes. 
“ It can not, therefore, be stated, as a general proposition, that 
the removal of the ovaries produce a change in the physical 
organization of woman, so as to make her more masculine in 
appearance, voice and form; though such changes sometimes 
follow double ovariotomy, as well as attend the progress of ova- 
rian disease in cases not submitted to that operation, but they 
also occur independently of any suspected ovarian lesion.” 
Do I hear some one exclaim with indignant surprise, “ What! 
Ovariotomy for amenorrhoea!” 26 
Normal Ovariotomy. 
Ovariotomy for amenorrhcea ? By no means! I beg not to 
be so misunderstood; I make no such proposition. When I 
reflect that the menopause is but a sort of physiological amen- 
orrhoea, so to speak, how could I propose to cure one amenorrhcea 
by substituting another amenorrhcea? I trust I shall not be 
accused of the heresy similia similibus, etc. What Ido propose 
is this : Ovariotomy to determine the change of life; and the change 
of life for any grave disease which is incurable without it, and 
which is curable with it. 
But it may be asked, What necessity is there for surgical inter- 
ference in these cases ? I answer, it is necessary because the 
pathological conditions for which the remedy is proposed are: 
First, destruction of human life; second, destruction of human 
health; third, destruction of human reason; fourth, destruction of 
human happiness; and fifth, incurable by the recognized resources of 
our art. 
Who that has stood by the bedside of his unconscious patient 
and witnessed the distended veins, the throbbing arteries, the 
suffused, darkened countenance, and perchance the violent con- 
tortions of obstinately recurring convulsions, and has not felt 
that the human organism before him was engaged in a fearful 
conflict ? Can it be that the brain, the lungs, the heart, and 
other vital organs, stand by as idle spectators while the battle 
fiercely rages ? Nay, are not the heart, the brain, and the spinal 
marrow already actively engaged in the contest ? and shall they 
all, and always, come off the field unscathed ? 
When we consider for a moment the intricate system of tele- 
graphic intercommunication by which nature connects all the 
various forces of her grand army with one composite whole, 
and by which she rallies one, or all, at her pleasure, upon the 
point of attack, is it a wonder that the brain, the heart, the 
lungs, or, indeed, any other organ, should suffer irreparable 
damage? 
If, after many such conflicts, we should find apoplexy, cerebral 
softening or mania, need we be surprised ? If, under the stress 
of labor it has to undergo, the heart becomes dilated or hyper- 
trophied ; if the endocardium or pericardium inflame; if the 
valves break down, and are no longer able to perform their ap- 
pointed office, are we filled with wonder ? If we find the lungs Normal Ovariotomy. 
27 
suffering pneumonia, pulmonary apoplexy, or tubercular deposit, 
do we raise our hands in astonishment ? 
Suppose we find a patient whose history shows these repeated 
vascular conflicts—as for instance my first cited case, Miss Mary 
M.—must we search industriously for a long-forgotten rheumatic 
pain in some distant joint to explain her broken-down heart ? 
But we have not time to comment at length upon this subject. 
I shall read you brief statements of a few cases, and hurry 
onward. 
Before the Obstetrical Society of Philadelphia, Dr. B. G. Cur- 
tin read the following history: C. W., a stout, robust, middle- 
aged Irish woman, was admitted August 28th, 1866, to the in- 
sane department of the Philadelphia Hospital, laboring under 
an attack of acute mania, brought on by intemperance. After 
her admission, in a lucid interval, she informed Dr. Curtin that 
she had never menstruated, but that periodically she had pains 
in the head and back, with all the other symptoms usually ac- 
companying the performance of this function, and attributed her 
mental condition, in a measure, to the absence of the flow. She had 
been married and living with her husband for ten years, and 
had never conceived. The maniacal symptoms returned, and she 
died, very suddenly, three days after her admission. 
“On post-mortem examination no abnormal condition of the 
brain could be discovered; the immediate cause of death was 
an extensive pidmonary apoplexy. The external sexual organs 
were normal, the uterns undersized, but with all its appendages 
complete. On both fallopian tubes, about midway between 
their extremities, were beard-like prominences. On laying them 
open two calcareous nodules were found, each about the size of 
a pea, and completely obstructing the calibre of the tubes, 
which, above these points, were dilated and distended by fluid. 
The ovaries were marked with numerous cicatrices of ruptured 
Graafian vesicles, one apparently being only three weeks old. No 
evidences of pelvic peritonitis. 
“Dr. ’Win. Pepper remarked that cretaceous nodules appeared 
to him to be the remains of old blood-clots, which had originally 
formed in the fallopian tubes.” 
Are there no signs of the fatal conflict in this case ? 
At the same meeting Dr. Harris, of Philadelphia, read a paper 
in which he states : “ I met in New York a woman, of twenty-six 28 
Normal Ovariotomy. 
years of age, having her heart so frightfully diseased that she was 
not only a great sufferer, but looked upon by physicians as a 
living curiosity, whose affection resulted from rheumatic inflam- 
mation 'produced hy her having bathed her genitals in cold ivater at 
the age of thirteen, under the impression that the menstrual flow 
was a bleeding from some accidental injury, her mother having 
never warned her of the event, nor instructed her as to what 
she should do upon its appearance.” 
Might not a careful investigation find marks of the conflict here? 
In St. George’s Hospital, London,* was admitted May 30th, 
1872, J. C., a girl aged eighteen ; “ her family was healthy; she 
was single and had never seen any catamenial discharge; but for 
three months before admission she had, from time to time, suf- 
fered pain at the lower part of the back and between the shoul- 
ders. During these attacks of pain she had bleeding from the 
nose and gums, which lasted about a iveek, and then ceased, returning 
again after the interval of one month. For two or three weeks 
before she came to the hospital she had great irritability of her 
skin, to relieve which she had recourse to scratching, but this 
gave rise to immediate bruising of the parts. For four months 
past she had complained of pain in the left side, accompanied 
with difficulty of breathing, cough and spitting of blood. She 
had never had rheumatic fever; but about four years ago she suf- 
fered from chorea. 
“On admission she was very amende, the lips and conjunc- 
tiva being almost bloodless. She suffered from shortness of 
breath, and had frequent bleedings from the nose, mouth and 
skin. She said she had never menstruated. There -were hem- 
orrhagic spots on the tongue, inside the lips, and on the gums. 
Some of the spots on the tongue were as large as half a split 
pea, and the tip was so covered with ecchymoses that it had the 
resemblance of a strawberry. The lips were cracked, and on 
the inner side were numerous ecchymosed spots. The surface 
of the chest was more or less marked with these hemorrhages, 
but here some of the spots could be picked off; at the places 
where scratching had been practiced there were distinct bruises. 
On the legs and thighs the spots had more the character of the 
hemorrhages seen in purpura. In many places the blood seemed 
* Lancet, New York, November, 1872. p. 593. Normal Ovariotomy. 
to have actually exuded from the skin, as they could readily be 
lifted off; but there was no evidence that mechanical means had 
been employed to produce them. For four or five days she had 
suffered from epistaxis. On examining the chest, a loud mitral 
murmur, most marked at the apex, was heard, the heart’s action 
being very irregular and rapid. The lungs were resonant, and 
air freely entered; but the breathing was rapid and labored, 
even after slight exertion. There was troublesome cough, and 
occasionally the patient spat blood. There was no vaginal 
orifice; the small cavity representing the canal of the vagina 
ended in a cul-de-sac, and was not deep enough to hold a tea- 
spoonful of fluid. The urethra was in the middle of this cavity. 
The labia majora were well-formed, but small, and there was 
an ordinary amount of pubic hair. The space between the rec- 
tum and the urethra measured about half an inch. On passing 
the finger into the rectum, no uterus could be discovered ; and 
when a catheter was introduced into the bladder, it could be 
distinctly felt through the anterior wall of the rectum. Numerous 
ecchymoses were present on the inner side of the labia majora. 
The patient continued to improve until 11th 
June, when the breathing became much embarrassed, and ac- 
companied with severe palpitation of the heart, cough and spit- 
ting of blood; death taking place at 3p. m., consciousness re- 
maining till the last. 
“Autopsy : Body well nourished; limbs and trunk covered with 
ecchymoses. Mammae fairly developed, but nipples small. On 
opening the thorax the pleurae were found to be spotted with 
ecchymoses. The lungs were cedematous, and gorged with hlood. 
The pericardial cavity contained a small quantity of light, red 
fluid, but the walls were dotted with hemorrhagic spots, espe- 
cially the visceral wall. The endocardium at the upper part of 
the left ventricle was thickened and opaque. The aortic valves 
were th ick, 'puckered and inefficient, the mitral valve thickened, and so 
contracted that the orifice would only admit the tip of the little finger. 
The muscular walls of the right ventricle and left auricle much hyper- 
trophied. The liver, spleen, and kidneys did not present any 
abnormal appearance. The ovaries ivere very well developed and 
congested, and contained a recent false corpus luteum. The uterus 
was absent, (evidently congenitally,) only a small nodule of 30 
Normal Ovariotomy. 
fibrous tissue being found in the folds of the peritoneum, be- 
tween the rectum and the bladder.” 
Surely, we have the mortal wounds of the recent conflict here. 
At the annual session of 1872, in Columbia, of the South 
Carolina State Medical Association,* Dr. T. G. Simmons, of 
Charleston, relates the history of a “Case of Atresia Vaginae ; 
Death from Tetanus at Menstrual Period, with Account of Post- 
Mortem Appearances.” M. E., a negress, primipara, was deliv- 
ered by craniotomy and evisceration on the sth of May, 1869. 
Atresia vaginae followed, and in December of the same year an 
unsuccessful attempt was made to reestablish the vaginal canal 
on account of her suffering with symptoms of retained menstrual 
discharge. Dr. Simmons says : “ The patient continued under 
my care suffering intensely at each recurring menstrual period, 
but never showing any appearance of an acccmulation. I re- 
sorted to various anodyne and anti-spasmodic agents for her 
relief.” November 19th, 1870, another attempt was fruitlessly 
made to remedy the difficulty. On the 14th July, 1871, says 
Dr. Simmons, “ I saw her, and found her suffering intensely with 
pains in back and limbs, also some rigidity in recti-abdominales, 
pains and rigidity in masseters. These I deemed to be hysteri- 
cal phenomena. * * * The next morning, found 
she had passed an uneasy night, but had slept at intervals. 
The tetanic symptoms well marked, but the paroxysms not very 
violent or frequent. Patient does not present any wound, nor 
is she aware of any. * * * (27th July.) I saw 
her again in the evening; found her much worse ; the remedies 
now seemed of no avail to relieve her of the pain or relax the 
severity of the spasms. Jaws tightly locked, but still able to 
swallow fluids; opisthotonos. She remained in this state of 
fearful suffering until the morning of the 30th, when death 
closed the dreadful tragedy, sixteen days from its commence- 
ment. * * * Autopsy, fourteen hours after death: 
Some degree of emaciation ; rigor mortis well established ; ab- 
dominal organs presented a healthy appearance; the uterus 
small and bound down, anteflexed and laterally displaced to the 
left by strong bands of cicatrical tissue; the left ovary pro- 
lapsed and ihe fallopian tube adherent to the uterus, extending 
* Transactions South Carolina Medical Association, 1872. p. SG. Normal Ovariotomy. 
down over that organ; and the fimbriated extremity firmly 
attached to and opening into the vagina on left side, about one 
and a half inches from the uterus, and at point of opening made 
at time of operation. The vagina occluded by dense fibrous 
structure for one and a half inches, the cicatrix being continu- 
ous in structure with uterus and inseparable from it. The right 
ovary and fallopian tube presented nothing worthy of note. 
There were no recent corpora-lutea apparent on either ovary. 
The seat of attachment of the fallopian tube 
at its entrance into the vagina was stained dark-red from recent 
sanguineous discharge through it. * * * The left 
ovary was hound down to the uterus hy broad bands of adhesions: 
length of uterus two and a quarter inches ; width at widest part 
one and three quarter inches. The uterine canal was obliterated, 
except at either corona; no trace of cavity or os to be found. 
The fallopian tubes, on both sides, obliterated from uterus to 
ovary, but patent from fimbrise to ovary. The fimbriated ex- 
tremity of right fallopian tube presented no appearance of recent 
discharge, nor were there any appearances of hemotocele to be 
found. The pelvis was contracted antero-posteriorly to two 
and a half inches.” 
Dr. T. E. Brown, of Baltimore, reports in the October (1872) 
number of the American Journal of Medical Science, p. 575, a 
“Case of Abnormal Structure of the Female Genital Organs.” 
“ I was called some three months ago to a lady, nineteen years 
of age. " * * Four days previous to the patient’s 
death she had quite a profuse bleeding at the nose, lasting 
about forty-eight hours, and concluding with a sort of nasal 
catarrh, which, taken with the facts that she had never mens- 
truated, and that the nose bleedings were frequent in their 
recurrence, induced an examination, post-mortem, of the inter- 
nal organs of generation. " * * 
“ The vulva was natural in formation and appearance, with 
the mous veneries and external surface of labia majora well 
covered with hair; no clitoris could be perceived. The vagina, 
which was a simple cul-de-sac, about two inches long, was dis- 
sected out without encountering the crura clitoridis. It was 
destitute of rugm, hymen, curuncular myrtiforms, and had no 
communication with the os uteri. The bladder and rectum were 
firmly adherent to each other, instead of being separated by an 32 
Normal Ovariotomy. 
uterus, for which we hunted in vain. The bond of adhesion 
between the bladder and rectum was the broad ligament, occu- 
pying its usual position, of a crescent shape; and imbedded in 
either horn of this crescent, near the summit, about one and a 
half inches internal to and on a line with the iliac fossae, was a 
nodular body, dense in structure, of the size of an apricot ker- 
nel, to which were attached a perfect ovary, fallopian tube, and 
round ligament. The parts adjacent to the ovaries wTere greatly 
congested, evidently connected with a recent ovulation; and an incision 
into one of the ovaries showed several corpora lutea, with their 
corresponding cicatrices, on the outer surface. 
“ I am of opinion that the nodular bodies referred to were 
what would correspond to the superior corona of the uterus, and 
the non-striated muscular fibre, found by Dr. Tiffany in a small 
section, confirms my impression of its being uterine tissue. The 
mamma were unusually well developed, and the symmetry 
of the patient’s figure wrell illustrated the vigor of her previous 
health, and her powers of endurance in sickness.” 
In a private letter, Dr. Brown writes me : “ Her physique was 
a model of anatomical symmetry and female beauty; breasts 
well developed, as were also the external organs of generation. 
Owing to the condition of her intellectual faculties, her previous 
history could not be accurately obtained. Enough, however, 
was found out to satisfy me that there was an abnormality as to 
her menstrual sickness, which had been taking place for some 
time in the form of epistaxis, two of which hemorrhages ocurred 
during the time of my treatment of the case, with the usual in- 
terval of about four weeks, at which times all the symptoms of 
the disease (afterwards diagnosed to be cerebal meningitis) 
were more pronounced. She voided daily a gallon or gallon 
and a half of normal urine ; later on, involuntarily drenching 
her bed and clothing several times during the day. These, and 
other symptoms, simply corroborative as to the character of the 
malady, terminated in profound coma, which continued up to 
her death. As I have said before, I regard this case as being 
cerebral meningitis, which, very probably, was associated with 
some cerebritis, and that the disease ivas the result of suppressed 
uterine menstruation acting upon a mind already much concerned 
and excited upon the subject of some possible defect existing Normal Ovariotomy. 
33 
in the organization of her generative apparatus, together with 
the relation of such defect to her matrimonial prospects.” 
Dr. Byford* says : “ The debility, the imperfect or perverted 
hsematosis or the nervous energy, seldom becomes so great as to 
be the immediate cause of death. This, however, sometimes 
does occur, and ice should indulge a false security to suppose that 
our patient could not thus die. I think I have seen more than one 
instance of death thus resulting. * * * As very 
correctly stated by Dr. Bennett, such an unnatural condition of 
the nervous system and Rood is engendered hy the disease as to destroy 
the capacity of the patient to resist or ward off the attacks of the 
acute diseases to which she may he exposed, or the chronic ones for 
which site may inherit a strong predisposition 
What say you then, my brethren, may a woman die because of 
unrelieved menstrual molimen ? 
I shall not detain you with any authorities or argument to 
show that this condition is destructive of human health. I have 
shown that it may be destructive of life; ergo, it may be destruc- 
tive of health. But I appeal, confidently, to the individual ob- 
servation of each one of you for the proofs of this proposition. 
It is destructive of human reason. I shall detain you with but 
a single authority upon this point, that of Prof. Fordyce Barkert 
who says: “Now, appreciating these phenomena, which are 
physiological in most women, you will be prepared to believe 
that a pathological condition of these organs, and an impair- 
ment or arrest of their functions, may be a cause of great dis- 
turbance of the circulating and nervous systems, and may result 
in absolute derangement of the cerebral functions. Although 
these are scarcely referred to by the systematic writers on female 
diseases, yet every one who has had much clinical experience 
in these diseases must have seen their results more or less fre- 
quently. Every insane hospital probably contains more or less 
of such cases, and the special writers on mental diseases furnish 
numerous illustrations of this fact.” 
“ Of cases of insanity which were induced by amenorrhcea, (I 
say so because the cure of the amenorrhcea was followed by an 
entire disappearance of the insanity,) I have seen two,” which 
he goes on to relate, and also the history of a third case which 
* Medical and Surgical Treatment of Women, p. 174. 
f Journal of the Gynaecological Society, May, 1872. Normal Ovariotomy. 
ended fatally. “The autopsy absolutely revealed nothing to 
explain the cause of death. The ovaries were normal as to size 
and structure, but somewhat congested, and on one teas the most 
marked and beautiful specimen of recently ruptured Graafian vesicle 
that I have ever seen, while the uterus was less than half the 
size of the virgin uterus. Its cavity did not contain one drop of 
blood, but its lining membrane had numerous points of ecchy- 
mosis.” 
It is also destructive of human happiness. Think you, my 
brother, when you have felt the pulse, eased the bodily pain, 
cooled the burning fever, arrested the paroxysm, that you have 
done all that our noble profession exacts at your hands? Have 
you nothing to do as to the precious pearl which the human 
casket is but formed to enclose ? Is the heart and the soul of 
your patient no concern of yours ? We can not forget that some 
of the brilliant exploits of surgery have chiefly for their object 
the happiness of mankind, in the removal of unsightly deform- 
ities. Have you no care for woman’s happiness ? Within the 
boundaries of an adjoining State, but a few years ago, there 
lived and labored an obscure practitioner of our beneficent art, 
eking out a livelihood for himself and family, his fertile brain 
and kindly heart the solace and hope of his humble patrons. 
Noiv he is gone forth to receive the homage of the medical 
world, and to inscribe his name so high upon the pinnacle of fame 
that remote generations of man may see and read it. 
Do you ask me why all this homage—why all these honors ? 
I answer you, his attentive ear ivas open to the cry of human misery. 
He entered the hut of a lonely prisoner, an outcast from society, 
an object of disgust and abhorrence to her town family and 
friends; nay more, an object of loathing to herself, because of 
the stench of her incontinent urine. She was not sick, she needed 
no medicine, and yet his ear was open to her cry. In meditation 
deep, his busy brain scintillating with brilliant thought, he 
stooped him down, as did his Lord and Master, and with his 
finger wrote upon the ground. And lifting himself up he said 
unto her, “Woman where are those thine accusers? hath no man 
condemned thee ?’ She said, ‘No man, Lordand he said unto 
her, ‘ Neither do I condemn thee.’ ” And, in imitation of his 
Divine Archetype, he removed her shame, and taking her by the 
hand he led her forth, and restored her to the world and to Normal Ovariotomy. 
35 
happiness; and to-day the voice of woman, reverberating from 
peak to peak, echoes the name of Sims all around the habitable 
globe! 
Again, it is incurable by the recognized resources of the art. 
Allow me to quote you a few authorities upon this point. Prof. 
Thomas* says : “ The prognosis of chronic inflammation of the 
uterine body is ohuays grave with reference to cure. Even if the 
case is not of very serious character, and has lasted only a short 
time, the possibility of rapid recovery is doubtful, while, if it 
has continued for a number of years, it ivill often prove incurable. 
In most cases a certain amount of amelior- 
ation may be effected even when they are of long standing ; in 
a certain number treated early, cure may unquestionably be ac- 
complished ; while in a great many nothing whatever, either in the 
way of cure or relief., can be obtained, and the patient, after 
passing from physician to physician, settles down into a careful 
mode of life, resolved to cease treatment and bear as best she 
may an evil which she has learned to regard as incurable.” 
Prof. Thomas also goes on to remark that the prognosis is 
unfavorable “ when the case is of long standing; the nervous 
system is involved; patient not near the menopause.” 
Speaking to the same point, Scanzonit says : “ Unfortunately, 
the favorable time for the radical cure is ordinarily past, and we 
may esteem ourselves fortunate if we can but moderate some- 
what the hypersecretion of the uterine mucous membrane, and 
moderate its consequences. As for ourselves, we do not re- 
member a single case where we have been able completely to cure 
an abundant uterine leucorrhoea of several years’ standing. We 
have already said that the severer forms of this malady may 
become dangerous to the general organism; and many women,whom 
we have been called upon to treat, had to attribute to the neg- 
lect of the disease a bodily and mental debility, which they 
would keep for the rest of their days, or hysterical attacks, 
which deprive them of all enjoyment of life.” 
Dr. ByfordJ says : “We should temperately encourage our 
patient, if we can conscientiously do so, and if our judgment 
will not allow us to do so, we should express, temperately and 
* Diseases of Women, p. 255. 
f Diseases of Women, p. 202. 
| Medical and Surgical Treatment of Women, p. 172. 36 
Normal Ovariotomy. 
cautiously, an unfavorable prognosis; and hope should never he 
extinguished until the pxdient is moribund. Too many good reasons 
will suggest themselves for the last course to require any argu- 
ment in support of it. What I have said of a guarded prog- 
nosis, and the necessity of not giving a sweeping and absolute 
opinion, seems to me peculiarly applicable to the disease of 
which I am now treating. Physicians have not all been con- 
vinced of the propriety of treating uterine diseases with the 
speculum ; a large number are entirely, and conscientiously, 
opposed to it. They are made so, undoubtedly, by the failure 
of local treatment to fulfill the hope originated by its most ar- 
dent advocates. It does not do what they are told it will do; it 
certainly does not in all cases. The only grave error, I think, 
committed by that benefactor of mankind, Dr. Bennett, in his 
work on the unimpregnated uterus, is that his book leads his 
readers to believe that he scarcely, if ever, fails to cure his cases. 
This is the impression made upon most physicians who read his 
book. However true it may be, with reference to the practice 
of so able a master, I think it would be an unjustifiable expec- 
tation on the part of the profession at large. From what I have 
heard and read of the opposition of medical men to local treat- 
ment in uterine disease, I think this unrealized expectation of 
success from local treatment, is one of the main causes of it. 
Upon trial, medical practitioners become disappointed with the 
results as they were led to expect them, and abandon the plan 
as a failure. While I cannot coincide with Dr. Bennett as to 
the almost universal success of local treatment for uterine in- 
flammation, I am of the opinion that it is greatly superior to 
any other with which lam acquainted. Prognosis must depend 
for its reliability, to some extent at least, upon a correct and 
complete diagnosis of the whole condition of the patient.” 
Are cases of chronic corporeal endometritis, accompanied by amen- 
orrhoea of fifteen years' duration, easily cured ? Are they generally 
curable ? Are they curable at all ? 
Does somebody object that the ovaries are normal, and we must 
not sacrifice a healthy organ for the sake of a diseased one ? 
Is a part greater than the whole ? Is the integrity of one organ 
superior to that of the whole body ? Must the erratic function 
of the ovary be allowed to subvert the functions of the entire 
organism ? But this principle has been settled upon the highest Normal Ovariotomy. 
37 
possible authority, and for more than eighteen centuries. 
“ Wherefore if thy hand or thy foot offend thee, cut them off, 
and cast them from thee ; it is better for thee to enter into life 
halt or maimed, rather than having two hands or two feet, to be 
cast into everlasting fire.” 
Is it objected that normal ovariotomy is a reproach to gyn- 
aecology? I answer in the language of an honored teacher, 
Prof. S. D. Gross, of Philadelphia: “As long as the human 
body is liable to accidents, and as long as nature is incapable of 
arresting, by her own efforts, the various morbid processes 
which she herself institutes, so long will practitioners be com- 
pelled to invoke the aid, and, I may add, the blessings of oper- 
ative surgery. Is it a disgrace to amputate a leg for a morti- 
fication of the foot, to extirpate a testicle that has been de- 
stroyed by cystic disease, to divide the stricture in strangulation 
of the bowel, to extract a stone from the bladder ? * * 
Surely no one will doubt that in these, and a hundred other in- 
stances, our object can be attained only by an operation. 
Medicine, under such circumstances, however judiciously ad- 
ministered, is not only utterly futile, but is always ready to avail 
itself of the aid of surgery. Its empire is temporarily sus- 
pended, and it only resumes its legitimate function after the use 
of the knife.” 
A similar charge has been brought against an operation of 
which Dr. LeFebre, of Belgium, says : “ Ovariotomy is a 'pre- 
cious conquest for modern surgery, and must not be abandoned.” 
And Sir Wm. Ferguson, nearing the close of a long life made 
brilliant by his surgical researches and practice, standing upon 
the very pinnacle of British surgery, his whitened locks encir- 
cling an honored brow, says of it: “ The proceeding is a well- 
established fact, which ranks among the best and safest efforts in 
surgery to save human life." 
Do I hear some little soul whisper, “An innocent woman suf- 
fers that a doctor may gain notoriety ?” There are, I fear, even 
in our own professional household, narrow minds which, like the 
frightened ostrich of the plain, hide their diminutive heads be- 
neath a scanty covering of envy and prejudice, where they can 
see nothing but their own gaudy plumage, and vainly imagine 
themselves safe from the shafts of Achilles; narrow minds, 
whose obscured vision finds little within the great temple of 38 
Atlanta Medical and Surgical Journal. 
science, in which we worship, besides the gilded horns of the 
altar and the glittering cornice and panel work; narrow minds, 
whose meagre ken is incapable of appreciating the nobler con- 
scientiousness of duty discharged for duty’s sake. 
In retrospecting the ground we have gone over, you perceive 
I have proposed for your acceptation a new operation in sur- 
gery, which I believe to be original with myself in its concep- 
tion, original in its elaboration, and original in its successful 
execution. I have related to you the history of the case up to 
the present time. I have endeavored to show you that the 
change of life was a reasonable remedy for the morbid condi- 
tions present in the case ; that it was reasonable to expect that 
the removal of the ovaries would determine the change of life. 
I have asked you to hold fast to your faith in the ovular theory 
of menstruation, notwithstanding some anomalous results of 
double ovariotomy. 
While admitting, for myself, the danger to life from the exe- 
cution of normal ovariotomy, I have asked you to admit, upon 
the other hand, that this danger is not great, and that it is not 
out of proportion either to the severity of the malady upon the 
one hand, or the magnitude of the results upon the other. I 
have admitted that sterility necessarily followed the operation, 
but I have also asked you to admit that, in all human proba- 
bility, it also preceded the operation, and is not to be charged 
as one of its consequences. 
I have denied that the operation involves loss of the aphro- 
disiac sense. I have shown you that, in numerous instances, 
after double ovariotomy, it was retained in full vigor; and I 
now challenge you to show one instance of its loss. 
I have admitted the exceptional loss of the feminine graces, 
and I ask you also to admit that such results, after double ova- 
riotomy, are exceptional, very exceptional, and do not invalidate 
the general rule that there is no such loss. I have endeavored 
to satisfy you that an unrelieved menstrual molimen is destruc- 
tive to life; that it is eminently destructive of health and hap- 
piness ; and that the condition is often incurable by the recog- 
nized resources of our art. 
And now it but but remains to inquire, What is Our Duty? 
Heartily do I adopt and commend to you, my brethren, the Normal Ovariotomy. 
sentiment of Dr. Charles West,* an opponent of ovariotomy: 
“ One remark I can not refrain from making on the grievous in- 
jury that is done both to the advance of medical knowledge and 
to the standing of our profession with the public, by the practice 
of treating some of these questions as though they were ques- 
tions of moral right or ivrong. It would seem, from what has 
sometimes been said on the subject, almost as if ovariotomy 
could not be defended save from some sinister end, nor its ex- 
pediency be doubted except from a moral obliquity rendered 
excusable only by hopeless dullness. Belief in each other’s 
integrity of purpose seems to me essential to our eliciting truth 
by discussion; and I see no reason why lam to suspect another 
of being less mindful of our common duty to humanity because 
he tries to relieve suffering, or to prolong life, by some means 
in which 1 have not the same confidence. 
“ Your duty and mine is, not to sit down in apathetic indif- 
ference, doing nothing, trying nothing, for a patient’s cure, 
because her disease is one which hitherto has proved almost 
invariably mortal; but rather, patiently, carefully, with much 
mistrust of our own powers, much watchful scrutiny of our own 
motives, to apply ourselves to the trial of every means by which 
suffering may be mitigated or life prolonged. To this our com- 
mon humanity prompts, our obligations as medical men compel 
us. It is to misinterpret both, very grievously, if we not merely 
content ourselves with doing nothing, but take shelter under 
noisy censure of the conduct, and uncharitable construction of 
the motives, of those who read their duty differently.” 
In the rapid strides which gynaecology has taken of late 
years, we may indulge the hope that the field for normal ova- 
riotomy will become still narrower than now, but in the mean- 
time what are we to do for these hopeless invalids? Are they 
to be allowed to suffer on year after year without hope, except 
in the interposition of nature at the climacteric? 
Suppose a patient of middle age come to you with a stone in 
his bladder, undermining his health and destroying his hap- 
piness; will you look at your life-tables and say to him; “Sir, 
you must be patient; you must drink freely of the diuretic teas 
and of the mineral waters ; perchance they may diminish some- 
* Lectures on Diseases of Women, p. 441. 40 
Normal Ovariotomy. 
what the size of your stone; and if they do not do this, they 
will, at all events, render you more comfortable, and enable you 
to bear sufferings which you can not remove by medicines. 
Nothing but the knife can cure you, and really I can not cut you; 
you might die, and besides it might render you impotent, so 
that you could not become the father of a family. Such things 
have happened, and who knows but it might happen to you ? 
See here!—here is the life-table of general averages ; your rea- 
sonable expectation is ten, fifteen, perchance twenty, years; 
then nature, herself, will relieve you of all your sufferings. Sir, 
you must really be patient and hope for the best.” 
Do you thus read your duty ? Is it any more dangerous to 
life than an unrelieved menstrual nisus; any more destructive 
to human health; to human happiness ? 
But there is a class of cases of which West says, “ They are 
completely beyond the reach of remedyof which Hodge says, 
“ Disappointment must often ensue, as the causes of amenor- 
rhoea are frequently immovableof which Byford says, “ In 
all cases of absence of the ovaria or uterus, we could not expect 
to do good by any treatmentof which Thomas says, “ If the 
uterus be absent, all that can be done will be to abstract a suf- 
ficient. amount of blood from the arm, by venesection if nec- 
essary, to relieve the urgent symptoms attending each epoch.” 
Does our duty to these resolve itself into a mere meditation 
upon the wonderful powers of endurance with which our Creator 
has so miraculously endowed woman ? And what of those who, 
though having a uterus, are yet partakers alike with the others 
in the same sufferings, the same despair, the same death ? 
Is it enough that we follow the injunction of old Thomas 
Eainalde, as laid down in his W’oman’s Book, “ To instruct and 
comfort the party, not only refreshing her with good meat and 
drink, but also with sweet words, giving her good hope of a final 
deliverance, encouraging and enstomaching her to patience and 
tolerance, etc.” Shall we give her some doses of camphor, of 
musk, of valerian, of assafoetida ? “ Things that to hear them 
told, have made me tremble;” things of which she has already 
taken gallons, and for years; things, the very name of which is 
a stench in her nostrils to this day! Shall we take some ounces 
of blood from the arm with our thumb lancet ? Nature has been Normal Ovariotomy. 
41 
bleeding her scores and scores of times, and all to no purpose, 
save to ward off for the time impending death. 
Am I told of the restorative powers of the mountain air, of 
cheerful society, of travel, of the mineral waters ? As well des- 
cant to the famishing ditcher in the bogs of Ireland of the 
toothsome delicacies of Delmonico’s or the Trois Freres; as 
well remind the hapless traveler, with mangled limb crushing 
beneath the ponderous train, of the soothing influences of music, 
and of the gentle evening zephyr. 
In all this large and learned and grave assembly, am I alone 
in my experience, when, after years of study, of patient inves- 
tigation and earnest labor, I am forced to say to my discouraged 
patient; “It is enough ; I have faithfully studied and labored 
your case; I have exhausted the materia medica; I have tried 
every expedient; for you there is no balm in Gilead; hence- 
forth you can only look to the change of life for remedy.” Can 
it be that after years of such sad experience, I have come up 
here to learn, at last, a ready solution for so difficult a problem 
in the old and familiar resources of our art? Happy indeed 
would be the day; thrice happy the man who should thus return 
to his suffering, hopeless patient, joyfully shouting—Eureka! 
Eureka! 
Go with me to the chamber of a solitary invalid, worn down 
to a shadow by her long years of painful suffering, heart-sick 
with hope deferred. See her as she sits in her solitude of des- 
pair—the winding-sheet of her own living sepulture gathered 
about her—anxiously peering into the dark, unknown future, and 
impatiently waiting to catch, if possible, a glimpse of the fleet- 
footed, ghastly messenger, bearing the sand-glass and the scythe 
—her last, her only friend[! 
Go with me to the family fireside; see her now around the 
cheerful hearthstone, the sunny smile of contentment and hope 
replacing the gloomy clouds of despair. See with what interest 
and zeal she engages in the duties and the pleasures fitting to 
her age and sex. Already are the deep furrows' and angular 
prominences being smoothed and rounded by adipose deposits ; 
already is she attaining somewhat of the beauty and grace 
which the promise of her girlhood had foreshadowed. She feels 
that she is now anchored in a secure harbor, from which she 
can look back with composure upon the many fearful storms 42 
Normal Ovariotomy. 
through which she has passed, and which she may no longer 
dread. And though she can not claim for the future the rewards 
of maternity, she is thankful that she escapes its perils and its 
cares. Failing in other objects of her womanly love and devo- 
tion, she finds in her church, and in the great cause of humanity, 
ample scope for all her heart’s desires. 
Look upon this picture, and then upon this, and tell me, my 
brethren, which do you elect ? 
Do I address some who, though rejecting my proposal for 
remedy, have nothing effective to offer instead; some who, 
“ laden with years, furrowed with the routine of long experience, 
to whom a certain unvarying regimen has become as a part of 
their nature, still entertain the belief that the school in which 
they were taught, and the maxims therein imbibed, embody the 
principles of a system—the type of perfection—not to be dis- 
turbed by additions and improvements, so denominated, and 
from which nothing can be safely or advantageously removed?” 
To such I would respectfully say, in the language of England’s 
great dramatist: 
“Tell me not, Friar, that thou hearest of this, 
Unless thou tell me how I may prevent it. 
If in thy wisdom, thou canst give me help, 
Do thou but call my resolution wise, 
And with this knife I’ll help it presently. 
Therefore, out of thy long experienced time, 
Give me some present counsel; or behold ! 
’Twist my extremes and me this bloody knife 
Shall play the umpire ; arbitrating that 
Which the commission of thy years and art 
Could to no issue of true honor bring. 
Be not so long to speak; I long to die, 
If what thou speak’st speak not of remedy 
What say you then, my brethren ? If we believe in our hearts 
that the change of life will cure these direful maladies, ought 
we still to content ourselves with sweet and honeyed words, en- 
couraging and. enstomaching to patience and resignation? 
Ought we not rather to bring down the clenched fist in manly 
determination of purpose, exclaiming, by the eternal powers 
let the change of life come—Now ! now !