1911 Encyclopædia Britannica/Ovariotomy

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OVARIOTOMY, the operation for removal of one or of both of the female ovaries (for anatomy see Reproductive System). The progress of modern surgery has been conspicuously successful in this department. From 1701, the date when Houston of Carluke, Lanarkshire, carried out his successful partial extirpation, progress was arrested for some time, although the Hunters (1780) indicated the practicability of the operation. In 1809 Ephraim M'Dowell of Kentucky, inspired by the lectures of John Bell, his teacher in Edinburgh, performed ovariotomy, and, continuing to operate with success, established the possibility of surgical interference. He was followed by others in the United States. The cases brought forward by Lizars of Edinburgh were not sufficiently encouraging; the operation met with great opposition; and it was not until Charles Clay, Spencer Wells, Baker Brown and Thomas Keith began work that the procedure was placed on a firm basis and was regarded as justifiable. Improved methods were introduced, and surgeons vied with one another in trying to obtain good results. Eventually, by the introduction of the antiseptic system of treating wounds, this operation, formerly regarded as one of the most grave and anxious in the domain of surgery, came to be attended with a lower mortality than any other of a major character.

To give an idea of the terrible record associated with the operation in the third quarter of the 19th century, a passage may be quoted from the English translation of the Life of Pasteur: "As it was supposed that the infected air of the hospitals might be the cause of the invariably fatal results of the operation, the Assistance Publique hired an isolated house in the Avenue de Meudon, near Paris, a salubrious spot. In 1863, ten women in succession were sent to that house; the neighbouring inhabitants watched those ten patients entering the house, and a short time afterwards their ten coffins being taken away." But as time went on, the published statistics showed an increasing success in the practice of almost every operator. Spencer Wells states that in his first five years one patient in three died; in his second and third five years one in four; in his fourth five years one in five; in 1876–1877, one in ten. After the introduction of antiseptics (1878–1884) he lost only 10.9% of his operation cases, but this series showing a marked absence of septic complications. These figures have been greatly improved upon in later years, and at the present time the mortahty may be taken at somewhere about 5, 7 or 9%.

Removal of the ovaries is performed when the ovaries are the seat of cystic and other morbid changes; for fibroid tumours of the womb, in which case, by operating, one hastens the menopause and causes the tumours to grow smaller; and in cases where dysmenorrhoea is wearing out and rendering useless the life of the patient less severe treatment having proved ineffectual. Oophorectomy, by which is meant removal of the ovaries with the view of producing a curative effect upon some other part, was introduced in 1872 by Robert Battey of Georgia (1828–1895). The operation is sometimes followed by loss of sexual feeling, and has been said to unsex the patient, hence strong objections have been urged against it. The patient and her friends should clearly understand the object of the operation and the results likely to be gained by it. Lastly, the ovaries are sometimes removed with the hope of checking the progress of inoperable cancer of the breast.

From the time that the operation of ovariotomy was first established as a recognized and lawful surgical procedure, there has been much disputation as to how the pedicle of the ovary, which consists of a fold of peritoneum (the broad ligament) with included blood vessels, should be treated. Some operators were in favour of tying it with strong silk, and bringing the ends of the ligatures outside the abdomen. Others were in favour of having a strong metal clamp upon those structures, or of searing them with the actual cautery, whilst others claimed that the best results were to be obtained by firmly tying the pedicle, cutting the ligatures short, dropping the pedicle into the abdomen and closing the wound. This last method is now almost universally adopted. (E. O.*)