[reprint FROM THE DETROIT LANCET, DEC. 1885.] 
Ovariotomy, with the Report of a Case.* 
BY w. P. MANTON, M. D., DETROIT. 
IN 1824, scarcely more than sixty years 
ago, when Richard Bright gave to the 
world the first of his famous papers on ab- 
dominal tumors, the peritoneal cavity was, in 
a pathological sense, unknown. It is true 
that the anatomists and educated men of that 
day were acquainted with the anatomical 
position of the viscera; but the appearance of 
those very organs in disease, and the patho- 
logical changes to which they were suscepti- 
ble, were almost wholly unrecognized. 
Symptoms were often mistaken for the real 
malady, and hence treatment was, in many 
instances, of no avail, and the unfortunate 
too often succumbed to a so-called, incurable 
disease. 
Of all the diseases affecting the abdominal 
and pelvic organs, the pathology of those in- 
volving the ovaries, tubes, and ligaments, 
has, perhaps, remained the longest unknown, 
and consequently the development of 
methods of cure has been retarded. In re- 
gard to ovarian tumors, even so intelligent 
and careful an observer as Bright was led to 
say, “I believe, as far as cure is concerned, 
the malignant ovarian dropsy admits of none, 
unless we may consider excision of the 
*Read before the Detroit Academy of Medicine, 
Nov. io, 1885. tumor in that light; and this must ever be so 
doubtful an operation, surrounded by so 
much darkness, and attended with so much 
danger, that I can only look upon its happy 
event as the fortunate result of a bold and 
hazardous enterprise, which should not tempt 
us to adopt it as a rule of practice.”* 
And yet before this time, and probably 
within the knowledge of Bright, our country- 
man, Ephraim McDowell, had performed and 
published an account of operations of this 
nature; and another, Nathan Smith, of New 
Haven, had imitated his example, with a suc- 
cessful issue (1822). From this time on, 
ovariotomy was done with varying success on 
both sides of the Atlantic; but it was not until 
Clay, of Manchester, England, beginning in 
1842, undertook the operation, that it became 
at all systematized. Since then such men as 
Baker Brown, Wells, Keith, Tait, and others 
have placed the operation on its present 
basis, which even the boldest would not at- 
tempt to deny as most legitimate. 
It is, however, not my purpose to weary 
you with a rehearsal of the history of this 
operation; but I desire to call your attention 
to one or two points, which, although not 
new to you, will bear repeating. 
In the first place, then, who should perform 
operations necessitating the opening up of 
the peritoneal cavity? 
2 
*Clinical Memoirs on Abdominal Tumors, New 
Sydenham edition, i860, p. 142. My answer to this is the specialist. In the 
discussion of a paper read at the late meet- 
ing of the Mississippi Valley Medical Society, 
the reader of the paper said in closing, that 
“he thought it well to send cases to the 
specialist; but if he dies, what then? New 
men must be coming on all the time. He 
taught his students to perform their own 
ovariotomies.”* 
Over against this opinion I set that of the 
best known of our countrymen, both at home 
and abroad, and the striking contrast of the 
words from the man of great experience and 
those just quoted cannot but be obvious. 
“ The observations of others may not agree 
with mine,” says Dr. Thomas, “and many may 
dissent from what I am about to advance, but 
to me it stands forth clearly as an influence 
which has done, and is doing, much to injure 
the position of ovariotomy as a surgical re- 
source. It is this: The operation of ovari- 
otomy is at present in this country performed 
by men inexperienced in the diagnosis and 
treatment of ovarian tumors. The statistics 
of some of the best operators prove that they 
have been progressively successful, as they 
have advanced in experience, and learned to 
avoid the dangers attendant upon the pro- 
cedure, and we must conclude that they who 
operate for the first or second time, must 
damage the array of reported cases, and in- 
3 
*Journal of the American Medical Association, Oct. 
3. 1S85, p. 39°- 4 
crease the rate of mortality. I know full well 
that it may be asked in reference to this 
statement, if inexperienced men never oper- 
ate, where would our supply of new surgeons 
come from ? In reply to this I would remark, 
that if the professional relations of any man 
make it likely that he will be frequently 
called upon to perform this or any other 
operation, he should prepare himself to meet 
the demand upon him; but I cannot think it 
incumbent upou any practitioner, upon whom 
no such demand is likely to be made, to 
undertake so formidable an operation if the 
services of skillful and experienced men be 
attainable for its performance. I sincerely 
believe, as the result of observation, that the 
third influence which I have stated as marring 
the statistics of the subject, is by no means an 
insignificant one, at least in the United States. 
My impression is, that if the histories of all 
the single operations performed by different 
practitioners in this country were published, 
they would present a lengthy, and by no 
means pleasing exhibit.”* 
It is true that the death rate may, in cer- 
tain instances, have sunk to 8 or even 6 per 
cent., but so slight a mortality occurs only 
in the practice of those who have made ab- 
dominal surgery a long and careful study; 
men who are familiar with every aspect which 
the case may assume, and whom experience 
* Diseases of Women. Fourth Edition, 1878. P. 
740. 5 
and knowledge have fitted to meet any and 
every emergency which may arise. 
The next point to which I desire to call 
your attention is the time in the course of the 
development of the tumor when it is most 
desirable to undertake its removal. An opera- 
tion of such gravity as ovariotomy is naturally 
dreaded by the patient, and consequently 
deferred as long as possible; but it is now an 
almost undisputed fact that the earlier laparo- 
tomy is undertaken the better are the results. 
Dr. Bantock, in an admirable paper on this 
subject, gives his experience in the following 
propositions:* 
1. We should not wait until the patient’s 
general health is impaired—or in other words, 
the principle of such delay is a departure 
from that generally followed in the case of 
other diseases treated surgically. 
2. The presence of the tumor is the cause 
of structural disease in other organs. 
3. Ovarian tumors are liable to a variety of 
accidents, such as rupture, either from injury 
or spontaneously; and twisting of the pedicle; 
to morbid processes, such as inflammation, 
atheromatous degeneration of the blood-ves- 
sels, which, with fatty change in the walls of 
the cysts, leads to hemorrhage into their in- 
ferior, etc. 
4. The existence of adhesions, of degenera- 
tive changes in, and rupture, etc., of the 
tumor greatly interferes with the success of 
the operation. 
* A Plea for Early Ovariotomy, London, 1881. 5. On the contrary, the earlier and simpler 
the operation the greater is the chance ol re- 
covery.” 
“I would urge then,” he says, “with all the 
force which the strongest conviction imparts, 
that ovariotomy should be performed as soon 
as we can be sure of the diagnosis; believing 
as 1 do, that were this rule followed, in only 
a majority of the cases, the success would be 
much greater than we are even now able to 
boast of.” 
All late testimony from operators of note is 
to the effect that “delays are dangerous,” and 
early operation desirable. 
Another point which I wish briefly to men- 
tion is the use of antiseptics. 
To-day, absolute cleanliness in surgery 
means success, where in former times, when 
this was neglected, fatal results were the rule. 
Those who are not in sympathy with Listerism 
insist upon a perfect aseptic condition of sur- 
geon, assistants, instruments, etc. Tait, Keith, 
Bantock, and some other less prominent 
operators, have abandoned not only the spray, 
but also antiseptics in general; but notwith- 
standing the testimony of these eminent men, 
my own experience, gathered during a 
period of some years in this country, and par- 
ticularly abroad, leads me to the conclusion 
that the time has not yet come, if ever it does 
come, when antiseptics, including the spray, 
can be safely abandoned by the majority of 
operators. In advocating these I do 
not lose sight of the fact that they 
6 7 
are often abused and made to mask unclean- 
liness, but this does not d'sprove their useful- 
ness when properly employed as adjuvants to 
other measures. My own preference is for 
carbolic acid, because I have had more ex- 
perience with it than with other antiseptics. 
I think the reports of its injurious effects 
have been greatly exaggerated, for I have 
used it myself, and seen it used in pretty 
strong solution, and up to the present I have 
never known an untoward symptom to super- 
vene. As for its beneficial effects, whether 
or no bacteria can thrive in a five-per-cent, 
carbolic lotion, it certainly has the power of 
destroying the ferment, or pus micrococcus, 
and if no other reason than this could be 
given for its use, it appears to me to be suffi- 
cient to make its continuance a necessity. It 
will not do for us who must of necessity often 
operate in general hospitals, tenement houses, 
and under the most unfavorable conditions, 
to point to such men as Tait, Bantock, or 
Keith, who have abandoned the use of anti- 
septics, and say that as such Nestors in ab- 
dominal surgery have found the spray, etc., 
unnecessary to them, we too can throw it 
aside. Could we have separate wards, or 
hospitals devoted solely to ovarian and ab- 
dominal cases, and kept scrupulously clean, 
with nurses set apart and trained particularly 
for the care of such patients, with operators 
who never see contagious cases, etc., etc., we 
too might dispense with antiseptics and the 
spray. It is, I believe, an established surgical fact, 
that operative cases in the country, where the 
patient is isolated and can get plenty of fresh 
air and sunshine, recover more rapidly than 
in the crowded wards of a city hospital. 
As to the spray, I am in full sympathy with 
my friend Mr. W. A. Meredith, assistant to 
Sir Spencer Wells, and himself a surgeon to 
the Samaritan Hospital in London, where so 
much has been done for the advancement of 
abdominal and ovarian surgery. “ I still 
consider it,” he says, “an essential part of 
the antiseptic method, believing that its use 
enables us to dispense with drainage in many 
cases, where, but for this safeguard, such pro- 
cedure would be deemed advisable, even 
aftfer an operation in other respects strictly 
antiseptic.”* 
In the foregoing paper I have attempted 
to show: 
1. That the inexperienced and general 
practitioner should not attempt operations 
involving an opening into the peritoneal cav- 
ity, as the death-rate from the operation is 
thereby increased, and the operation brought 
into disrepute. Whereas, the success of the 
specialist in this line of practice has reduced 
the mortality from a maximum to a minimum 
percentage, as proved by statistics. 
2. That the universal testimony of experts 
is to the effect that the sooner an operation 
8 
* Fifty Cases of Completed Ovariotomy, etc. Re- 
print from British Medical Journal, August 9, 1884. is undertaken after the diagnosis of an ovar- 
ian tumor has been made, the better are the 
chances for the patient’s recovery. 
3. That, although certain foreign special- 
ists, operating under the most favorable con- 
ditions may do away with the spray and anti- 
septics, the majority of operators, who labor 
at a disadvantage, cannot, in justice to their 
patients, abandon either. 
In my own opinion, the careful following 
out of Listerism, in combination with cleanli- 
ness, good surgery, and strict attention to 
details, will, in the not distant future, place 
the results of ovariotomy in America on a 
level with those now obtained in foreign 
countries. 
At the close of the first year of my private 
practice in this city, I am fortunate enough 
at the very start to be able to give the results 
of one case of ovarian cyst upon which I have 
operated. 
Helena R., a small, lightly-built blonde, 22 
years of age, was referred to me by Dr. C. P. 
Frank, of this city. She had been more or 
less an invalid for two years, but no swelling 
of the abdomen had been noticed until ten 
months previous to my seeing her. Since 
then she had filled up so rapidly as to neces- 
sitate tapping, which operation had been per- 
formed twice, and nine and seven quarts of 
fluid, respectively, withdrawn. 
When I first saw her, two months after the 
last tapping, she was again much distended, 
suffered much from dyspnoea and cough, and 
9 had the extremely emaciated, cachectic look 
so common in ovarian cases. 
At this time the girth at the umbilicus was 
forty inches, and the distance from ensiform 
cartilage to the symphysis, sixteen inches. A 
diagnosis of multilocular ovarian cyst of the 
right side with parietal adhesions was made. 
On May 26, 1885, Dr. Frank kindly ad- 
ministering the anaesthetic, assisted by Dr. 
W. R Chittick, I operated in the presence of 
Drs. Geo. P. Andrews, and Geo. Dufheld, at 
St. Mary’s hospital. 
The operation presented no particular dif- 
ficulties. The tumor was extensively ad- 
herent to the abdominal parietes, and also to 
the omentum, and on account of its solid 
constituents necessitated the enlargement of 
the abdominal wound from three to five 
inches. The pedicle was rather long and 
thin and sprang from the left side of the 
uterus, instead of the right as supposed. 
The opposite ovary was normal. Scarcely 
an ounce of blood was lost during the opera- 
tion. China silk was used both in tying the 
pedicle, and closing the external wound. 
The patient reacted well from the opera- 
tion, and during the whole course of con- 
valescence suffered little or no pain, although 
on three occasions twenty drops of Tr. opii 
were given per rectum to alleviate restless- 
ness. 
The catheter was used for three or four 
days, after which the patient was able to void 
her urine. 
10 Four times the temperature went up to 
ioo°, twice as the result of a movement of 
the bowels on the 16th and 18th days. The 
estimated average temperature for the whole 
period of nineteen days was scarcely above 
normal. 
The patient sat up on the thirteenth day, 
and was discharged cured on the nineteenth 
day. 
Since then she has been in perfect health, 
and has gained something like forty pounds 
in weight. 
Menstruation returned the second month 
after the operation, and has continued regular 
and in normal amount ever since. 
The tumor removed with its contents 
weighed 27 pounds. 
83 Lafayette Ave. 
11