[Reprinted from the American Journal of Obstetrics and Diseases of 
Women and Children, Vol. XXYIL, No. 2, 1893.] 
THE ETHICAL SIDE OF THE OPERATION OF OOPHORECTOMY. 
HOWARD A. KELLY, M.D., 
BY 
Baltimore, Md. 
I consider it a privilege to be able to present to the profes- 
sion the following terse, crystallized, earnest declaration, from a 
purely ethical standpoint, criticising all operations which inter- 
fere with the procreative functions of a woman. 
Since receiving this letter I have been again travelling in mind 
over that much-discussed ground kept so constantly before us 
in the journals of eight and ten years back. 
I think the only causes for which we now remove ovaries 
and tubes apparently normal or capable of extruding, and trans- 
mitting an ovum to the uterus, are: 
2. Certain cases of insanity, associated with marked menstrual 
exacerbations, or distinctly menstrual in type ; 
1; Menstrual insanity; 
8. Menstrual epilepsy ; 
4. Osteomalacia; 
5. Extreme dysmenorrhea rebellious to every other mode of 
treatment in wery rare instances ; and, 
6. Occasionally to check the growth of myomata. 
All gynecologists will not assent to the fifth heading, but I 
still insist that there are cases justifying its place in the list. 
My correspondent, as will be seen, takes a radical view of the 
whole matter—“nothing short of impending death justifies the 
operation.” Ido not now propose to discuss the pros and cons 
of this important question, or to reply in future to any criticisms 
directed against this remarkable letter. I simply present it with 
the additional comment that, as surgeons in the constant presence 
of a suffering patient, perhaps we tend at times, under stress of 
sympathy, to prevent the ethical side of the argument being 
represented in its due proportions. 
The operation here spoken of wTas performed ten years ago 
for retroflexion, hydrosalpinx, and pelvic perifonitis. 
1892. 
My Dear Dr. Kelly :—Mrs. A. tells me that in your special- 2 KELLY : THE ETHICAL SIDE OF THE OPERATION OF OOPHORECTOMY. 
ty of surgery you are criticised for “ tmsexing women.” Will 
you permit me, as a husband and as a priest, to give you my 
opinion of that for which yon are criticised. 
While ovariotomy does not destroy sexual desire nor the plea- 
sure of cohabitation, yet the removal of the organs of mother- 
hood causes a serious obstacle to the affections due a wife. For 
in depriving a woman of the possibility of children there is 
taken from the home the unifying power of parental love. And 
no high-sonled affection can be sustained by mere sexual }Dlea- 
sure where the hope of children is taken away; and every 
Christian husband who understands God’s chief purpose in 
marriage—namely, reproduction of species—cannot justify mar- 
riage as merely the means of sexual gratification. As a husband 
I believe that neither life-long helplessness nor anything short 
of impending death justifies ovariotomy, if, with the diseased 
organ or organs remaining, there could be the remotest reason- 
able hope of children. For the- woman, pain of body is prefer- 
able to the anguish of soul attendant upon the destruction of the 
hope of becoming a mother. And as a man I should, in my 
present light, conscientiously decline to marry the best of wo- 
men from whom had been taken the sacred fountain of mother 
hood. As a priest I believe that the absence of that function 
excludes the right of marriage, and, if performed after mar- 
riage, its absence takes away the right of sexual cohabitation, ex- 
cept where that act is needful to prevent mental impurity or the 
sins of adultery or fornication. 
Since the diseased state of the ovaries taken from Mrs. A. be- 
fore marriage ratified your prognosis, and you were wise in hav- 
ing my consent to both operations, and the assurance of mutual 
agreement between the betrothed that the second operation, in 
which the remaining ovary was removed, was based upon the 
fact that Mrs. A. would be better fitted for a life of usefulness 
as a clergyman’s wife, your operating in this instance was ab- 
solutely without reproach in the operation of ovariotomy upon 
my wife. And you are at liberty to use this letter wherever it 
may tend to justify yourself and the special surgical skill with 
which God has endowed you, with but such limitation as your 
honor as a Christian gentleman and physician places upon you in 
protection of Mrs. A. from unpleasant publicity as to the fact 
of ovariotomy having been performed upon her. Believe me, 
with profound respect, etc.