1896 Journal of the American Medical Association (JAMA)  
but I think the operation is even more unjustifiable when performed on a single woman, and should never be resorted to except when it is a choice between castration and death. To remove a young woman's ovaries or womb and then to tell her that she is incapable of marriage physically is a barbarous cruelty. Ethically, in mutilating a virgin in this way, the surgeon may have taken from her all chance of happiness on earth, and even her hope of heaven. Economically, as the world is constructed,
more » ... is constructed, many women have no other prospect in life than marriage. Besides, unless a woman has means, or education, or unusual strength of character, a single life is insupportable. And, I take it, these are not the qualities that are oftenest met with in the gynecologic wards of our hospitals. On the medical side Dr. Lusk puts the case much better than I can. Ovariotomy is not a cure ; it is a makeshift, and in so far is a confession of weakness. Moreover, while aseptic surgery is undoubtedly a great advance on the old methods, it is not difficult to acquire. It is vastly easier to cut out a woman's womb than to make and keep it a healthy organ. And this is precisely the problem that is before gynecology as a science. It must first find out a way to produce a race of women with healthy generative organs, and second, it must learn how to keep all this delicate machinery in order under the immense strain of function put upon it. In many instances I believe the world would be better off if these ambitious young surgeons were put to their books. We need better trained general practitioners, not more men who can perform abdominal surgery successfully. Now gynecology is a brilliant specialty, it offers great rewards in reputation and is money. A great many young men of all grades of intelligence and morals, are rushing into it. Naturally, they look to you as their exemplar, for your success in it has been exceptional. This is why I urge the matter upon your attention. I think your responsibility is very great. Personally, my trust in your good judgment and your heart is absolute, but these are unknown qualities in the young gynecologists who are following in your footsteps. Every day all over the land women are being mutilated at the hands of ambitious young men who are anxious to report to the profession that they can do ovariotomy or hysterectomy. I feel sure that not a few of these helpless victims might be saved present pain and future misery by a word of warning from you. LETTER II. You know that I feel and have felt very strongly on the subject of your letter. The time has been when to express such views as you express would condemn one to charges of "old fogy ism" or ignorance. But ever since the rage for ovariotomy took possession of the medical mind, I have had an invincible repugnance to the castration of women, and have often had hard work to restrain myself when statistics ' ' of 100 cases without a death," "my first year's work in ovariotomy," etc., were read ad nauseam before our Medical Society. I shall never forget the night when one of our "best operators" handed round on a plate the two ovaries of a woman recently castrated : one had a small cystic tumor about the size of an apple, while in the other the cyst was not larger than a marble. The reporter dilated on the physical perfection of the woman, on the fact that she was about to be married, and then told of his successful operation. Just think of it ! And is not this gynecology in its infancy, when to cure a minute cyst or to prevent its growth, the whole womanhood, the whole happiness and all the life of this woman were irretrievably ruined? And yet no one there said one word of disapproval, but all sat and admired the skill of this destroyer of everything that makes a woman's life worth living. A wedding took place here this-spring between a recently castrated girl and a young man who had been engaged to her for a long time. Do you not think that he would rather have married her with one ovary left, even if there were a probability of ill health and suffering? The girl, frombeing slender and young looking, in six months had grown stout and much older and was by no means improved in appearance. This is all but a prelude to saying how much pleased I was at the way you presented your case against the operation. I agree with you that ovariotomy, before or after marriage, ruins a woman in all the essentials of womanhood. It makes of marriage just what you say. Just think of the feeling which a man must have when he marries a mutilated woman ! What does he marry for? There can be no hope and no happiness in such a union ; there is no end to look forward to ; there is nothing which makes marriage perfect and holy. I wish your views could be brought to the inner consciousness of the gynecologists of the country. I wish they could be made to see and feel ; but I fear many of them will think your opinions beyond the domain of science and practice and will pass them by. And then it touches the pockets. Ovariotomies are a source of income ; many have grown rich on them and you strike at the root of a very thriving industry. But you should not drop your task for all this, and the fact that Dr. Kelly sympathizes with your efforts should encourage you to say and to do something to stem the torrent of mutilation. In looking back over the history of surgical progress it is interesting to note the process of evolution which has so gradually brought order out of chaos and from the crude methods of the past evolved the brilliant results which to-day are crowning modern surgery. It is right and just that much credit should be given to antisepsis and yet a large percentage may be justly attributed to improvement of technique and simplicity of procedure. This is an age of brevity. All the world is seeking a more direct route to the point of destination. Unnecessary complications are avoided. To no part of surgery do we find these facts more applicable than in that which relates to the abdominal and pelvic regions. It is unnecessary to state that far too many operations have been performed on the organs in these localities and that many blunders have been necessarily committed. But this great experience has not been without its beneficial lesson; we are approaching simplicity and the outlook for the future is brighter. For many years several intelligent and far-seeing surgeons have intimated that the vaginal route was far superior to the abdominal for many of the operations on the uterus and adnexa. But it has been apparently difficult to abandon the older method for the new and more successful. Vaginal hysterectomy, as a surgical operation, dates back to the early centuries of the Christian era, but it can not be said to have been thoroughly elucidated until the year 1813, when it was performed by M. Langenbeck for cancer. Even then his medical confrères refused to believe that he had performed this operation, and it was not until some years later, when his patient died and a post-mortem was held, that his words were verified. The operation wavered awhile in popular favor and then fell into discredit when Freund, of Breslau, advocated abdominal hysterectomy. The bad success of this again brought the vaginal operation to the front in the year 1878, largely through the advocacy of Czerney, of Heidelberg. Since that period it has been gradually gaining ground, and to-day is rapidly supplanting the abdominal method as a relief for many of the pathologic conditions afflicting the uterus and its appendages. It may be employed : 1. In all cases where we determine to perform double oöphorectomy. 2. In double pyosalpinx or salpingitis. 3. In single oöphoro-salpingitis where we have unyielding, chronic metritis. 4. In severe displacements near the menopause, and all others not yielding to treatment. 5. Tumors of the uterus, interstitial or subperitoneal, not exceeding a child's head in size. 6. In all cases of malignant diseases of the fundus and cervix, when not involving the vaginal or pelvic walls. 7. In small cysts and other growths of one or both ovaries and tubes near the menopause. 8. In all cases of chronic peri-uterine Downloaded From: by a University of Iowa User on 06/08/2015
doi:10.1001/jama.1896.02430580003001a fatcat:5n66swarlneldcnwcwf4kx4ioe