FAILURE OR CURE ?

T. Spencer Wells
1891 The Lancet  
To the Editors of THE LANCET. SIRS,-For several years past I have taken some pains to condemn the unnecessary performance of mutilating operations upon women, and have endeavoured to caution the rising generation of medical men against any teaching or example which might tend to lower the standard of surgical ethics and endanger the character of British surgeons. Last month, at the College of Surgeons, I expressed my fear that the operation of oophorotomy has been " performed without due
more » ... without due explanation of the consequences; that advantage has been taken of the susceptible and impressionable condition of women in certain states of health to overstep the bounds of deliberative and consultative practice; that recoveries from the operation have been untruly tabulated as cures of the diseased condition ; and that failures have not all been recorded." On the 7th of this month, after Dr. Playfair's paper on "Removal of the Uterine Appendages in Casesof Functional Neurosis," I read extractsfrolll a paper by Dr. Ross of Toronto on "The Failure of the Removal of the Tubes and Ovaries to relieve Symptoms," in which he says, "Many cures I hear of as cures are not cures "; and in support of that statement I referred to one (among several others "almost as unsatisfactory ") which had been reported as a "practical cure" less than a month after the operation, but has proved to be "a deplorable and disastrous failure." A letter from the operator in this case appears on page 221 of your last number, in which he refers to the original account of the case in the British Gynæcological Journal for 1888, vol. iv., p. 457. The following is this account given at the meeting of the British Gynaecological Society, Dec. 12th, 1888 :-" Mr. Lawson Tait said he had a specimen to show which bore very much upon what had just been said ; he showed the appendages from a lady, thirty-nine years of age, with a very remarkable history. She had been married at the age of seventeen or eighteen, and had two children within twenty months of her marriage. Soon after her second confinement she contracted gonorrhoea from her husband, and she had never known what it was to be well since. She had led a life of single misery for several years. Then she married again, but her health did not improve, and she never became pregnant by her second husband, so that ever since nineteen or twenty she had been absolutely sterile. During the last seven years she had been the patient of a distinguished gynecological baronet, who had, however, failed to relieve her. Ultimately she had been referred to him and he had operated. She had double pyo-salpinx of old standing, and it was very difficult to say which was tube and which was ovary. There were abscesses in both ovaries, and if he had attempted to tap them from the vagina, he would have been obliged to tap several cavities. Instead of doing anything of the kind, he opened the abdomen a month since, and the patient was now practically cured. A case like that was worth a dozen hypothetical imaginations.
doi:10.1016/s0140-6736(02)18555-2 fatcat:mhykf64dm5dnplndffbtyowtua