THE 
EXTIRPATION OF THE OVARIES 
FOR SOME OF THE 
DISORDERS OF MENSTRUAL LIFE. 
BY 
WILLIAM GOODELL, A.M.,M.D. 
EXTRACTED FROM THE TRANSACTIONS OF THE MEDICAL SOCIETY OF THE STATE 
j, OF PENNSYLVANIA. ~-- 
PHILADELPHIA: 
COLLINS, PRINTER, 705 JAYNE STREET. 
1 879. THE 
EXTIRPATION OF THE OVARIES 
• FOR SOME OF THE 
DISORDERS OF MENSTRUAL LIFE. 
* 
BY 
WILLIAM GOODELL, 
EXTRACTED FROM THE TRANSACTIONS OF THE MEDICAL SOCIETY OF THE STATE 
OF PENNSYLVANIA. 
PHILADELPHIA: 
COLLINS, PRINTER, 705 JAYNE STREET. 
1879. THE EXTIRPATION OF THE OVARIES FOR SOME OF 
THE DISORDERS OF MENSTRUAL LIFE. 
There are certain forms of diseases of women peculiar to the 
menstrual period of life.' These lesions are found either in the re- 
productive organs themselves or outside of them in remote organs, 
but with such monthly exacerbations as show their participation in 
the catamenial excitement. They are always very hard to cure, and 
often prove to be wholly unmanageable until the climacteric has 
become established. 
In this category may be classed fibroid tumors of the womb, 
chronic pelvic peritonitis, chronic ovaritis and ovaralgia, ovarian 
epilepsy, ovarian insanity, and, in short, all those phenomena or 
those lesions which are embraced under the heading of pernicious 
menstruation. 
Fibroid tumors of the womb are fortunately pretty manageable, 
usually the womb like a generous host hospitably entertains them, 
but once in a while an unwelcome one presents itself which arouses 
all the resentment of the womb. If then it stubbornly resist all 
treatment, it slowly but surely destroys life, by the pain which it 
evokes, and the loss of blood which it occasions. What physician 
here present has not seen such cases?-cases in which the patient is 
virtually bed-ridden from her floodings and her sufferings; cases 
which the physician is wholly powerless to remedy; cases in which 
the sufferer looks forward to the climacteric as her only hope. But 
the change of life in these cases is always postponed beyond the 
natural term, oftentimes so much so as to be overtaken by the death 
of the woman. 
Then, again, there are those cases in which, despite all treatment, 
the ovaries remain turgid with blood, acutely neuralgic and sensitive 
to the last degree. A women with such a lesion is usually a bed- 
ridden invalid, racked with pains, and wholly unable to fulfil her 
duties as wife or as mother. Usually she seeks relief in anodynes 
and becomes a confirmed opium-eater. 4 
EXTIRPATION OF THE OVARIES. 
There are, also, many distressing cases of pelvic peritonitis and 
pelvic cellulitis, which cripple a woman past all hope because of 
monthly exasperations. Such cases are unfortunately by no means 
rare, and five years ago I saw a poor woman reduced to skin and 
bone, and finally die, because in spite of all treatment the inflamma- 
tion was rekindled at every monthly period. 
Who has not met with cases of epilepsy which seem to come wholly 
from the sexual organs-cases with an ovarian aura, so to speak? 
The fits begin at puberty, generally last through life, and end in 
impairment of the mind. Often the first convulsion is ushered in 
by the first menstruation, and ever afterwards it is around ovulation 
as a storm-centre that future eclamptic attacks revolve. Such an 
epileptic is the terror of her family and a valueless member of society. 
Generally she dies insane or with an enfeebled mind, and, if she 
marry, she is also too likely to transmit her infirmities to her child- 
ren, either in the same form as her own or in kind. It is, indeed, a 
remarkable fact, as Dr. Parvin has shown in his late inaugural address 
before the American Medical Association, "that of all the maladies 
which proceed from immediate progenitors, or which, having affected 
anterior generations, may be transmitted by a second generation, 
those which are the most certain of continuance, the most inevitable, 
are not those involving structural changes-not cancer nor tubercle, 
for example-but the neuroses, such as hysteria and epilepsy, dis- 
eases that present no appreciable organic alteration." 
Finally, what insane asylum does not hold incurable women, whose 
mental infirmities seem to depend wholly upon the act of ovulation, 
or at least to become greatly exasperated by its recurrence? "Dr. 
Sutherland," writes Lawson Tait, "has carefully examined into the 
menstrual history of upwards of five hundred of the inmates of the 
Wakefield Asylum, and has tabulated the following general conclu- 
sions:- 
" That in epileptic insanity the fits are generally increased in num- 
ber, and that the patient frequently becomes excited at the catamenial 
period. That in mania, exacerbations of excitement usually occur 
at the menstrual period, and that a state of intense excitement is 
almost continuous in patients suffering from menorrhagia."1 He 
further states, " that Esquirol and Morel have estimated that de- 
rangements of menstruation form the source of origin of one-sixth 
of the cases of insanity due to physical causes." 
Now when we meet with such cases as the foregoing, and we are 
1 Obstetrical Journal of Great Britain, etc., June, 1873, p. 175. EXTIRPATION OF THE OVARIES. 
5 
constantly doing so, we have hitherto stood by with folded hands, 
dooming the sufferer to hopeless invalidism, or to an untimely end. 
Fortunately, however, there is a remedy which promises much- 
one first proposed by Dr. Battey. This original surgeon reasoned 
that, since these disorders are kept up by the monthly afflux of 
blood, and therefore incurable during menstrual life, the only chance 
of immediate relief lies in the establishment of an artificial meno- 
pause. This change of life he effected by the removal of both ova- 
ries, and he called the operation normal ovariotomy. Fault has, 
however, been found with this name, because the ovaries are some- 
times themselves diseased, and not in a "normal" condition. I have, 
therefore, ventured to resort to the old English word of spaying- 
which, though an inelegant term, as technically defines the character 
of the operation as castration defines the analogous operation in the 
male-and I am glad to find myself upheld in the use of this word 
by so ripe a scholar as Dr. Aveling, of London. 
With these preliminary remarks I wish to give the result of my 
own experience in the removal of the ovaries for diseases not in 
them, but dependent on them. 
Case I.-My first case was that of a maiden lady, aged 33, who 
had for many years been a great sufferer. She was never wholly 
free from pain; but one week before each monthly period this pain 
began to increase, and steadily to grow worse, until it became un- 
bearable. The menstrual flux then appeared, but with no abatement 
of her sufferings. It lasted fully a week, and was always profuse, 
sometimes alarmingly so. Then followed a week of gradual lessen- 
ing of all these distressing symptoms. Thus three weeks out of 
every four were virtually spent by her in bed, and the remaining 
time was not long enough for her to recruit her powers and husband 
her strength for the next encounter with her monthly foe. 
Worn out by loss of blood and by her acute pains, which were 
deemed nervous, she consulted Dr. S. Weir Mitchell. He at once 
discovered an abdominal tumor and asked me to see her. 
The lady was pale, thin, and bloodless, with a face furrowed by 
acute suffering. I found a virginal cervix lodged on the symphysis 
pubis, and a sharply ante-flexed womb imbedded in the hilus of a 
large and kidney-shaped fibroid tumor. Although the sound gave a 
measurement of but three inches, the tumor dipped down to the 
bottom of Douglas's pouch, and reached up to a point two fingers' 
breadth above the navel and to its left. The fibroid was plainly 
subperitoneal, and not amenable to treatment per vaginam. 
Thereafter, Dr. Mitchell and I met frequently and did all that we 
could to alleviate the pain and lessen the bleeding, but without any 6 
EXTIRPATION OF THE OVARIES. 
success whatever. She grew rapidly worse, and it was finally de- 
cided to extirpate the womb. While waiting for the hot weather to 
pass by, I came across a successful case of the same nature cured by 
Trenholme, of Montreal, by the removal of both ovaries; we, there- 
fore, determined to try this operation before resorting to the major 
one, and she gave us no peace until the day was fixed upon. Accord- 
ingly, on October 4,1877, with the aid of Drs. S. Weir Mitchell, John 
Ashhurst, Charles T. Hunter, B. F. Baer, and W. H. Heath, I re- 
moved both ovaries by the vaginal incision. Very trifling was the 
hemorrhage during the operation; no vessel needed tying, and not 
a suture was put into the vaginal wound. The right ovary looked 
healthy, but the left contained a small cyst. 
The immediate effect on the lady was most remarkable. From 
that day, she lost all those pains and aches which had embittered 
her menstrual and intermenstrual life, and they have never returned. 
The large fibroid tumor also rapidly lessened in size, until, six 
months later, it was no larger than a horse-chestnut. At that size 
it has since remained, but is giving her no trouble whatever. From 
being a bed-ridden invalid she now takes charge of her mother's 
house, and is able to do many other things beside. Last evening, 
Dr. John Ashhurst casually informed me that she and a friend of 
his had, a few days ago, walked four miles into the country after 
wild flowers. Her menses have never returned, but their absence 
has not made any appreciable effect upon her appearance or upon 
her character. She is just the same in these respects as she was 
before the operation. 
In addition to this case I have collected in my work on Gymeco- 
logy,1 eleven others, making twelve in all, in which the operation of 
spaying was performed for fibroid tumor of the womb. Of these, 
three proved fatal, but in each of them the ovaries were removed by 
the more hazardous abdominal incision. In one, operated upon, by 
Hegar, of Freiburg, the tumor grew smaller for five months, and the 
menstrual flux was absent; then a hemorrhage took place, and an 
increase in the growth was observed, but unfortunately the patient 
was soon after lost sight of. In the remaining eight, including my 
own case, convalescence was uninterrupted, the menopause was 
established, the tumor became smaller, and the women were virtu- 
ally cured. 
Now I do not by any manner of means propose the removal of the 
ovaries as the sole means of curing a troublesome fibroid tumor of 
the womb. Whenever one so bulges into the cavity of the womb as 
1 Lessons in Gynaecology, p. 275. EXTIRPATION OF THE OVARIES. 
7 
to be reachable, it ought to be enucleated. In this manner I have 
removed several interstitial fibroid tumors-one of them weighing 
twenty ounces. Then again, we must not forget the incision of the 
capsule, the hypodermic use of ergotine, and other means devised 
for the treatment of these growths. But whenever the tumor is 
irremediable by such means, I believe spaying to be a perfectly 
legitimate operation, and one which will be found very successful. 
Case II-This was an unmarried lady of 27, who had great hem- 
orrhage at her menstrual periods, and exquisite suffering not only 
at these times but for a week before and after. Her physician, my 
friend Dr. C. A. McCall, called me in to see her several times, but I 
was powerless to do any good whatever. Her troubles seemed to 
start from turgid and neuralgic ovaries, for the womb showed no 
lesion whatever, and the pains radiated from each ovarian region. 
She had violent headaches, great emaciation, weighing sixty-seven 
pounds only, and exhibited mental disturbances which threatened 
insanity. I finally recommended the rest cure, but this did her very 
little good, although she was under the skilful supervision of Dr. S. 
Weir Mitchell, and fattened up to eighty-three pounds. It was the 
worst case but one of pernicious menstruation that I have ever seen. 
Finally, after due deliberation, the removal of the ovaries was de- 
cided upon by us and proposed to her. She at once consented, and 
I performed the operation per vaginam, being aided by Dr. McCall 
and by two other medical friends. One stalk was tied with silk, the 
other with gut, which broke, and it was then crushed off with the 
Her recovery was a slow one, being retarded by a small 
pelvic abscess, which burst through the incision, and discharged the 
knot of the silk ligature. Menstruation did not return, and she be- 
came wonderfully better, so much so as to astonish her friends, who 
were all ignorant of the nature of the operation. The secret has 
been well kept; her father, the other members of her family, and the 
servants in the house are to this day unaware of what took place. 
Besides her mother and the physicians present no other soul knows 
that she is without ovaries. Nor is the slightest change of voice, of 
appearance, or of character perceptible. She mingles in society, and 
is just as womanly and as womanish as she was before the opera- 
tion. She has simply reached the climacteric somewhat abruptly; 
as Koeberle calls it. Not long ago, Dr. McCall informed me that 
"she deemed herself perfectly well, and had told him that he need 
never call again as a physician, but as a friend." She has a large 
circle of friends, many of whom have complimented me on the suc- 
cessful issue of my treatment, and have asked questions so hard to 8 
EXTIRPATION OF THE OVARIES. 
parry, that I trust the Recording Angel has dropped a tear over 
each entry of my answers. 
Case III.-This was a married lady, aged 37, and the mother of 
three children, the youngest ten years old. She must have sustained 
some injury from the birth of this last child, for she never conceived 
again and was never well afterwards. Agonizing pelvic pains at first 
ushered in the monthly periods, then kept up for some time after- 
wards and finally never left her. She now became bed-ridden and 
an opium-eater. Early in May, 1878, I was called in to see her by 
her physician, Dr. A. C. Deakyne, who had faithfully attended her 
for two years and had exhausted every means known to medicine. 
A more wretched creature I never saw. She was reduced to skin 
and bones, and bore on her face the lines and furrows of the keenest 
anguish. The womb was in its place, and presented no other lesion 
than a slight enlargement. After a careful examination I was forced 
to the conviction that it was a typical case of neuralgic ovaries, with 
nerve-storms radiating from them and breaking upon every other 
organ in the body. It was by far the worst case of pernicious men- 
struation that I have ever seen. Dr. Deakyne himself had come to 
the conclusion that no relief short of spaying would do her good, 
and he had, therefore, called me in. I agreed with him in this 
opinion, and we received the hearty concurrence of the poor woman, 
who was willing to face death in any shape for a promise of relief. 
The operation was performed on May 26, just after she had passed 
through a catamenial tempest of unusual severity. Drs. Deakyne, 
T. M. Drysdale, E. L. Duer, L. A. Dix, and Henry F. Baxter kindly 
helped me on the occasion. There was no difficulty whatever in 
catching the ovaries through the vaginal incision and in removing 
them, but the hemorrhage was freer than usual. Both ovaries 
seemed congested, and one bore a beautiful false corpus luteum. 
For four and twenty hours great relief was experienced and every- 
thing looked promising, but on the next day a slight peritonitis set 
in. It was limited to the pelvic regions, but, having no strength, 
she died on the fourth day. 
While deeply deploring the result, I do not look back upon this 
case with any misgivings as to the propriety of the course pursued, 
for I do not believe that anything short of the extirpation of her 
ovaries would have cured her. But I do not wish to be understood 
as recommending this operation for every case of ovaralgia, for I 
have seen too many cases cured by rest, by a milk-diet, by massage, 
and by electricity. And this is the treatment that I would recom- 
mend as a very efficacious one in the milder forms of this very stub- 
born disease. 9 
Case IV.-This was a married lady, 38 years old, whose brain 
gave way from over-anxiety, and from over-nursing a siek child 
during the summer of 1875. The first token of insanity was night- 
terrors which began to afflict her for two or three days before the 
appearance of her catamenia. These steadily grew worse until I saw 
her in September, 1878. At that time she presented the following 
symptoms: Several days before the appearance of her menses, to 
use the language of her husband, who is a clergyman, "hallucina- 
tions on every subject take complete possession of her, and she be- 
comes so violent as to need locking up." These attacks last during 
the continuance of the menses and for a week afterwards. The re- 
maining part of the inter-menstrual period, which lasts from a week 
to ten days, "she eats and sleeps enormously, like a ploughman," 
and exhibits mere traces of her hallucinations. She has been an in 
mate of several insane asylums without benefit. Two distinguished 
alienists, however, held out hopes to her husband, that with the change 
of life reason would return. Deeply impressed with this opinion, 
and with the conviction that the climacteric could alone cure his 
wife, and having heard of one of my cases of spaying, he brought 
his wife to me, for the sole purpose, if I deemed it best, to bring on 
an artificial menopause. 
I found a congested and an hypertrophied womb measuring 3.5 
inches, and the left ovarian region exquisitely tender; the ovaries, 
however, could not be outlined. These were all the discoverable 
lesions, but in view of the history of the case and of the opinion of 
the two experts, who had had her for several months under their 
charge, I consented to remove her ovaries. 
This was accordingly done by a vaginal incision on November 23d, 
and I was aided in the operation by Dr. Joseph Parrish, Dr. Charles 
II. Thomas, Dr. B. F. Baer, and Dr. Angle. She did not have a single 
bad symptom following the operation, although she twice jumped out 
of bed and had to be forcibly put back and held down. Her pulse 
and temperature never rose above the normal. On the eighth day, 
by dint of a little coaxing, I succeeded in persuading her to let me 
remove a single stitch that had been put in. After that she could 
not be kept in bed without undue violence, and I thought it best, as 
the less of the two evils, to let her get up. No harm whatever 
followed, but I am sorry to say that, although she has not to my 
knowledge menstruated since, her mental condition has not been 
improved. She is now in the skilful hands of Dr. Curwen, who will 
I hope tell us something about her present condition. 
Now, although this case was a failure, I cannot but think that the 
EXTIRPATION OF THE OVARIES. 10 
principles which governed my conduct are sound ones, and should I 
meet with a case of insanity limited to the catamenial periods, I 
should not hesitate to remove the ovaries. So impressed, indeed, 
am I with the soundness of these views, that it is my intention in 
the course of a few days to remove the ovaries from an epileptic 
young lady, whose first fit began at her first menstruation, and whose 
present fits pivot around the monthly flux as a centre. 
How shall the operation of spaying be performed? By the abdo- 
minal incision the ovaries can always be removed; by the vaginal 
one, very generally. Each operation has its advocates, but I am a 
warm upholder of the latter, because it is the safer. I have, else- 
where,' collected and tabulated fifty-one cases of spaying, with fifteen 
deaths. Ju thirty-one cases the abdominal incision was employed, 
and was followed by eleven deaths; while, out of twenty cases in 
which the ovaries were removed through a vaginal incision, only four 
died. This smaller rate of mortality is attributable to the greatly 
lessened exposure of the peritoneum, and to the dependent drainage 
opening. By this operation, however, the ovaries cannot always be 
caught and removed. They may be carried up by a large fibroid 
tumor and lie beyond the reach of the finger. Or they may be, as 
Sims2 and Thomas3 found them, so bound down by firm adhesions 
as not to be dislodged. In my four cases, I had no difficulty what- 
ever in reaching the ovaries and of removing them per vaginam. So 
impressed, indeed, am I with the greater safety of this mode of 
operation, that I shall always attempt it. Should it fail, the abdo- 
men can afterwards be opened, and the abandoned vaginal incision 
be utilized, if needful, as a drainage opening. The abdominal 
operation should be performed under the spray, and every detail of 
Lister's should be scrupulously carried out. Of the great value of 
antiseptic surgery in cases needing the exposure of the peritoneal 
cavity there can be no question whatever. The wonderful successes 
of Keith and Thornton amply prove it. Not quite three w'eeks ago 
1 removed, from a lady sent to me by Dr. A. H. Sheaffer, of Lewis- 
town, a large fibro-cystic tumor of the womb through an incision 
extending from near the ensiform cartilage to the symphysis pubis, 
and needing twenty-three sutures to close. The tumor had no stalk, 
but, springing directly from the womb, had to be enucleated from 
its peritoneal capsule. Yet, thanks to the spray, the patient re- 
covered without a single bad symptom, and with less constitutional 
EXTIRPATION OF THE OVARIES. 
1 Goodell's Lessons in Gynaecology, p. 277. 
2 Transactions American Gynaecological Society, vol. i. p- 352. 
8 British Medical Journal, December, 1877. EXTIRPATION OF THE OVARIES. 
11 
disturbance than that which usually follows the removal of a small 
surface growth like an adipose tumor.1 
In the vaginal operation I have not yet tried the spray, but I 
intend to do so, although Sims found that the constringing action 
of the carbolic acid incommodiously narrowed the calibre of the 
vagina. 
If the abdominal incision be performed, the incision should extend 
from near the navel to a point as low down as is compatible with 
the safety of the bladder, and then each stalk should be tied with 
gut and dropped within the cavity. In the vaginal operation, the 
patient should be placed on her back and not on her side. I am 
satisfied that it was the lateral posture that helped to kill my third 
patient, for as soon as the peritoneum was opened the air rushed 
out and in during every inspiration and expiration-an untoward 
circumstance which cannot happen in the dorsal posture. A duck- 
bill speculum is introduced, and the perineum pulled downwards. 
The post-cervical mucous membrane is next caught up by a uterine 
tenaculum, and it and the under-lying peritoneum snipped open for 
about one inch, with a pair of scissors, of which I have found Kiich- 
enmeister's to be the best. The index finger of the left hand is then 
passed in, the womb pushed down from above by the right hand, 
and each ovary brought down to the incision by the finger, hooked 
into the sling made by the oviduct. The ovary is now seized by a 
fenestrated forceps and brought into the vagina. The stalk is trans- 
fixed by passing a needle, armed with a double gut thread, between 
the ovarian ligament and the oviduct, and each half securely tied. 
The ovary is then removed, the ligatures cut off at the knot, and 
the stumps returned into the pelvic cavity. In order to hinder the 
chance of the protrusion of a bowel-loop I have in three instances 
closed the vaginal opening with one suture-and that either of silver 
of of gut. But in the case with the incision left unclosed, no pro- 
trusion took place. The hemorrhage during the operation was in 
1 In further proof of the advantages of an antiseptic treatment, let me add 
that on May 31st, nine days after reading this paper, I removed under the 
spray, a colloid polycyst of right ovary, weighing forty-five pounds. 
Although there were many adhesions, Dr. J. E. Bauman, of Telford, 
Montgomery Co., whose patient the lady was, wrote me that she recovered 
promptly "without a ripple of trouble." Again, on June 15th, I removed, 
with every antiseptic precaution, a very large polycyst from patient of Drs. 
R. Horner and J. M. Radebaugh. The parietal and omental adhesions were 
so numerous and strong, and so much oozing followed their rupture, that a 
glass drainage tube was put in. It, however, proved wholly needless, for 
the temperature after the second day never reached 100°, and the recovery 
was without a drawback. 12 
EXTIRPATION OF THE OVARIES. 
only one of my cases quite free, but it was venous and needed no 
ligature. 
There is one drawback to this operation. For some reason the 
removal of both ovaries does not always bring about the cessation 
of the menses. From a careful collection of all the published cases 
of double ovariotomy occurring during menstrual life, I find that, 
out of 132 cases, there were 15 in which regular monthly fluxes kept 
on, and 9 in which such fluxes were either irregular or lessened 
in amount. The cause of this unexpected continuance of the menses 
has been attributed by Koeberle to a portion of ovarian stroma un- 
wittingly left behind, but I think it is often owing to the existence 
of a third or accessory ovary. Kocks found a third ovary attached 
to a womb removed by him for cancer.1 The specimen was exhibited 
at the Medical Congress held last year at Cassel, and verified by 
Dr. A. R. Simpson, who happened to be present.2 Puech has col- 
lected several such cases.3 Winckel lighted upon one such case, and 
has given a beautiful wood-cut of it.4 While the lamented Beigel, 
in 350 post-mortem examinations, found 8 women with a third or 
accessory ovary, containing true ovarian stroma.5 These accessory 
ovaries range in size from a hemp-seed to that of a cherry, and are 
usually attached by a slender stalk. They very generally lie on the 
boundary line separating the peritoneum from the serous covering 
of the ovary. Beigel found three attached to one ovary, and Wal- 
deyer as many as six. "On microscopic examination they were 
found to consist of normal oVarian tissues, and to contain Graafian 
follicles in every degree of development, as well as relics of corpora 
lutea, and follicles which had dwindled without rupturing. The 
author concludes that both conception and also the pathological 
changes of normal ovaries may originate in these bodies. They may 
also have a bearing on the recurrence of menstruation after the com- 
plete removal of the ovaries." I cannot but think that this is the 
explanation of Atlee's two remarkable cases, in which, one ovary 
having been removed, the other became so diseased as to need 
repeated tappings, and yet each woman not only menstruated, but 
gave birth to a child.6 
1 Centralblatt fur Chirurgie, No. 49, p. 839. 
2 Edinburgh Medical Journal, January, 1879, p. 512. 
3 Annales de Gynecologic, January, 1879, p. 74. 
4 Die Pathologic der weiblichen Sexual-Organe ; Leipzig, erste Lieferung, 
Tafel xxxiv. 
5 Obstetrical Journal of Great Britain, July, 1877, p. 286, from Wiener 
Medizinische Wochenschrift, May 26, 1877. 
6 Ovarian Tumors, pp. 38 and 39. EXTIRPATION OF THE OVARIES. 
13 
Does the extirpation of both ovaries, after puberty has been estab- 
lished, unsex a woman ? Further than the inevitable induction of 
sterility, and the probable absence of menstruation, the deprivation 
of both ovaries no more unsexes a woman, than castration after 
puberty unsexes a man. In the one the ability to inseminate is lost; 
in the other, the capability of being inseminated; but in both the 
sexual feelings remain pretty much the same. The physical and 
psychological influence of the ovaries upon woman has been greatly 
over-rated. In the popular mind, a woman without ovaries is no 
woman. Even Virchow has gone so far as to say that "on these 
two organs depend all the specific properties of her. body and her 
mind, all her nutrition and her nervous sensibility, the delicacy and 
roundness of her figure, and in fact all other womanly characteris- 
tics."1 Koeberle, who had the large experience of eighteen cases of 
double ovariotomy, has written so fully on this subject that I cannot 
do better than to quote him at length.2 "They go so far," he says, 
"as to assert that castration, which takes from man his muscular 
vigor, the deepness of his voice, and the growth of his beard, has 
precisely the opposite effect upon woman. The truth is, that the 
absence of the ovaries causes in general simply the same changes 
which attend the menopause; but these changes are not always so 
marked, and they never so wholly modify the body and mind as has 
been asserted. As regards cases of congenital deficiency of the 
ovaries attested by autopsy, I'uech has collected a sufficient number 
to warrant the following conclusions: 'The absence of the ovaries 
does not necessarily entail the absence of the characteristics of 
puberty. At the usual time, the mens veneris becomes covered 
with hair, the pelvic basin enlarges, the haunches spread, the limbs 
grow plump, and the breasts develop, as if menstruation was about 
to be established. Further, absence of the sexual impulse, and in- 
difference to persons of the other sex are by no means inherent to 
this anomaly. The rebutting testimony brought forward by Pears 
and Lancereaux are based upon exceptional cases, explainable by 
their surroundings and by their physical sufferings. Contrary facts 
are far more numerous, and amply show that sexual desire does not 
necessarily depend upon the normal development of the ovaries. 
This position is still further strengthened by the fact that sexual 
desire is present in women who have passed the change of life, and 
that some young girls long before the age of puberty are addicted 
1 Maladies des Ovaires, par E. Koeberle; Extrait du Nouveau Dictionnaire 
de Medecine et de Chirurgie Pratiques, tome xxv. p. 487. 
1 Ibid. 14 
EXTIRPATION OF THE OVARIES. 
to masturbation. The plain inference therefore is, that the sexual 
appetite is, up to a certain point, independent of the capability of 
procreation, and can fully exist even when the sexual glands are 
absent.' In my own experience, the extirpation of both ovaries 
causes no marked change in the general condition of those who 
have been operated upon. They are women who may be considered 
as having abruptly reached the climacteric. Their instincts and 
affections remain the same; their sexual organs continue excitable, 
and their breasts do not wither up. These women do not grow fat 
unless there is a previous tendency to stoutness. Abnormal growths 
of hair do not take place, and the tone and quality of their voices 
are not changed."1 
In confirmation of these views Battey notes, in his cases of spay- 
ing, the persistence of aphrodisiac power. Nor in any of them was 
" there a loss of the womanly graces, but, on the contrary, the patient 
gains flesh and becomes more attractive."2 Analogous opinions are 
expressed by Hegar3 and by Wells. The latter, indeed, reports the 
case of a teacher of singing, who wrote to him three months after 
the operation: "My voice is stronger; I can sing the upper notes 
with greater facility than formerly. I can sing from A up to C 
natural."4 Peaslee writes: "Double ovariotomy as a rule is not 
followed by any loss of the special characteristics of woman; the 
only decided physiological change being a final cessation of men- 
struation, as well as of ovulation. Three of my own patients, married 
and highly educated ladies, after recovery, again became splendid 
examples of womanhood, enjoying the most perfect health, and re- 
taining all their former attributes of mind, as well as of body, and 
with undiminished sensory capacities in their matrimonial rela- 
tions."5 Atlee reports a case of double ovariotomy, in which mar- 
riage took place after the operation, as "the sexual feelings were 
normal."6 Six months after an analogous operation, Verneuil found 
his patient with well-developed breasts and decidedly fatter. " She, 
in fact, seemed far more of a woman than before the operation."7 
These opinions are amply confirmed by the history of my own 
patients, who are not conscious of any physical or psychological 
changes whatever. 
1 Loc. cit. 
2 Transactions American Gynaecological Society, 1876, p. 119. 
3 Castration der Frauen, von A. Hegar. 
1 Diseases of Ovaries, New York, 1873, p. 448. 
5 Diseases of the Ovary, p. 530. 
6 Ovarian Tumors, p 35. 
7 Annales de Gynecologic, Aout, 1877, p. 146. EXTIRPATION OF THE OVARIES. 
15 
The operation of spaying is yet in its infancy, and time is needed 
to develop its resources- But I cannot help feeling that in care- 
fully selected cases, it will prove the sole means for curing many 
mental and physical disorders of menstrual life, which have hitherto 
baffled our science, and are a standing opprobrium to our profession.