Ovariotomy; is it - or is it not - an operation justifiable upon the common principles of surgery? Are - or are not - capital operations in surgery justifiable to the extent generally practised? / [Sir James Young Simpson].

Simpson, James Young, 1811-1870

Date:: 1846

Credit: Ovariotomy; is it - or is it not - an operation justifiable upon the common principles of surgery? Are - or are not - capital operations in surgery justifiable to the extent generally practised? / [Sir James Young Simpson]. Source: Wellcome Collection.

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$sols existing internally. Probably it will be found that a surgeon would more rarely require to repeat ovariotomy, in consequence of the remaining ovary subsequently becoming diseased, than he now requires to repeat lithotomy, in consequence of a second or a third stone forming after a time in the bladder. 4. Ovarian disease (it is averred) does not produce such dangerous and urgent symptoms as to demand an operation.—Dr Simpson said that he had already advert¬ ed sufficiently to the dangerous and ultimately fatal tendency of the common multilocular dropsy of the ovary. He had at present charge of one case, where an enormous ovarian tumour produced occasional most intense suffering, in the form of severe abdominal pains and spasms resembling the agonies of labour. In many cases where it had reached a large size, it more or less incapacitated the patient, by its simple weight and volume, from following the ordinary duties belonging to her station; and, if poor, threw her upon the bounty and charity of others. In most it was, after a time, liable to be attended with local attacks of irrita¬ tion and inflammation, fever, &c., or produced dyspnoea, difficult progression, &c. Dr S. doubted if, in many cases operated upon, of aneurism or necrosis, or ulcers, &c., supposed to demand amputation, &c., the suffering or the incapa¬ city from the duties of life, were greater than in a large proportion of ovarian cases. But, argue the surgeons, we operate early in aneurisms, &c., because they continue to increase,—the same is true of ovarian tumours; because the aneurismal swelling is, after a time, liable to affect the structure of neighbour¬ ing parts, and render late operative interference less successful,—the same is true of ovarian tumours; because with the aneurismal disease the constitution will sympathise and become debilitated,—the same is true of the ovarian tumour; because the aneurism may burst and endanger life,—the same is true of ovarian tumours. Dr Simpson had, two years ago, seen one burst into the peritoneum, and prove fatal; its parietes were eroded by small internal ulcerations at several points, and at last had given way. Any argument urging haste in the one case, would, he feared, equally apply to the other. On the contrary, would proper palliative treatment applied to local aneurisms not stay their progress, and make them as chronic, if not more so, in their course, than multilocular turn ours \ Mr Fer- gusson has lately stated that he has watched one case of axillary aneurism <e for se¬ veral years” without it increasing. And aneurisms sometimes are, at last, spon¬ taneously cured; much oftener, Dr'S. believed, than ovarian dropsies. Take ano¬ ther case that happened in the Hospital practice this morning. A man applies with stricture, and symptoms of stricture only. On passing a small bougie, a stone is struck in the bladder, and the patient is forthwith advised to submit his life to all the perils and consequences of lithotomy, though he has no suffering traceable to the calculus. Would it be justifiable to advise a patient with an ova¬ rian dropsy, giving her no trouble, to submit in the same way to ovariotomy ? Dr S. most assuredly thought it would be utterly unwarrantable. And the pal¬ liative treatment for urinary deposits and calculus was, (it must further be re¬ collected,) now far more advanced than the palliative treatment of ovarian drop¬ sy. A calculus of this kind would not likely increase so rapidly as to destroy the patient in five or ten years. An ovarian tumour very likely would do so. And sometimes, as in this case, an urinary calculus does not really give rise to such uneasiness as to demand any very active palliative treatment. Do we not sometimes see calculi in the bladder after death, which have never given rise to any marked symptoms during life? Again, does not the operation for the obliteration of the varicose veins of a limb sometimes prove speedily fatal, and yet the disease itself is one easily palliated by rest and bandages. Besides, tins recognized legitimate surgical operation for varicose enlargement was not only dangerous to life, but, he feared, useless in its effects. In most cases, at least, the disease was as bad again in a few months as it was before surgical interfer¬ ence was adopted. Did we not sometimes see surgeons amputate the limb, when it was merely the seat of simple and benign, but untractable ulceration ? And ulceration might be a very serious inconvenience to a labouring man; but$