BATTEY’S OPERATION; 
THREE FATAL CASES, 
WITH 
SOME REMARKS UPON THE INDICATIONS FOR THE OPERATION. 
-BY 
GEORGE J. ENGELMANN, M.D., 
OF ST. LOUIS, MO. 
Reprinted from the American Journal of Obstetrics and Diseases of 
Women and Children, Vol. XI., No. III., July, 1878. 
NEW YORK: 
WILLIAM WOOD & CO., 27 GREAT JONES STREET. 
1878. BATTEY’S OPERATION; 
THREE FATAL CASES, 
WITH 
SOME REMARKS UPON THE INDICATIONS FOR THE OPERATION 
BY / 
/ 
GEORGE J. ENGELMANN, M.D. 
Reprinted from the American Journal of Obstetrics and Diseases of 
Women and Children, Vol. XI., No. III., July, 1878. 
NEW 
WILLIAM WOOD & CO., 27 GREAT JONES STREET. 
1878. BATTEY’S OPERATION; 
THREE FATAL CASES, 
WITH 
SOME REMARKS UPON THE INDICATIONS FOR THE OPERATION. 
BY 
GEORGE J. ENGELMANN, M.D., 
OF ST. LOUIS. 
The removal of the ovaries for the purpose of establishing 
the menopause, either to relieve the hopeless sufferer from 
chronic ovaritis and ovaralgia, and the incurable cases of long- 
continued uterine disease with menstrual exacerbation, or to 
check hemorrhage and limit the growth of uterine fibroids, is 
an operation so recent, so bold, and as yet so uncertain in its 
indications, that we have comparatively few cases on record. 
Some brilliantly successful cases are related, also others in 
which recovery, but not relief from suffering, followed the 
hazardous operation; the fatal cases are rare, perhaps not all 
published. 
It is not pleasant to report one’s failures, but our failures are 
far more instructive than our successes; it is our failures that 
cause us to carefully reconsider the propriety of each step that 4 
Engelmann : Battey's Operation; 
lias been taken, to seek for better methods, and thus achieve 
happier results. 
An analysis of my failures may serve as a warning and as a 
guide to others, and I have undertaken the unpleasant task of 
publishing the details of those three fatal cases as the best service 
I could render this young and promising operation. 
Case I.1—Mrs. S., set. 42 ; in former years unusually strong and 
healthy ; has had four children ; never complained of menstrual 
suffering or irregularity. 
In October, 1875, two years before the operation, she began to 
suffer from nightly attacks of asthma, which, at the time of their 
first appearance, came with great regularity soon after eleven o’clock, 
and lasted, according to their severity, for an hour or more, ending 
with a bronchial cough and expectoration ; during the remainder of 
the night and the entire day the patient was free from the annoying 
symptoms. As the disease progressed, her suffering became con- 
tinuous, the trouble persisting, though in a milder form, throughout 
the entire day, but aggravated by a gastric hystero-neurosis—naust a 
and fulness of the stomach. These symptoms began to increase in 
intensity a few days previous to the appearance of the menstrual 
flow, and continued unabated during the entire period of uterine 
congestion: the nauseated stomach refused all nourishment, while 
cough and asthma precluded sleep; her condition became more bear- 
able as the flow disappeared, but continued throughout the inter- 
menstrual period, again to become more trying at the approach 
of the next catamenia. 
The case had gone from hand to hand, and the pharmacopeia 
had been exhausted by the numerous physicians consulted, without 
affording the patient more than temporary relief by the use of 
narcotics. 
Dr. Otto Greiner, who afterwards referred the case to me, when 
first consulted, found that auscultation and percussion revealed but 
little, notwithstanding the grave pulmonary symptoms; while, upon 
vaginal examination, he discovered an elongated, acutely retroflexed 
uterus, movable and readily straightened by the sound; he intro- 
duced a sponge-tent; the patient soon began to feel more comfortable, 
and in less than twelve hours the annoying cough and the asthma 
completely disappeared. The tent was followed by an intra-uterine 
stem, and as long as this could be borne, without irritating the 
mucosa, the patient was free from the distressing symptoms which 
had so long harassed her; she discontinued her morphine injec- 
tions, left her bed, again relished her food, and slept quietly during 
the night without fear of cough or asthma. The symptoms, as I 
have myself several times observed, would abate soon after the 
1 I have cited this case as an exquisite example of bronchial hystero-neurosis 
in my paper on the hystero-neuroses (Vol. II., Transactions Am. Gynecolog. 
Soc.). Three Fatal Cases. 
5 
introduction ot the stem, to cease entirely within a few hours, but 
upon removal of the intrumenc, the former suffering was sure to 
return in from two to twenty-four hours. The bronchial and 
gastric symptoms responded with the greatest certainty and regular- 
ity to a change in the position of the womb. 
The sensitive condition of the uterus made it necessary to remove 
the stem frequently, until at last Dr. Greiner was obliged to desist 
almost entirely from its use; it was then, in the spring of 1877, that 
I first saw the patient in consultation with him. I found her 
a careworn, haggard woman, mostly confined to her bed, with 
suffering look, emaciated to the last degree, excessively irritable 
and nervous; conditions as described by Dr. G.; both ovaries sensi- 
tive and somewhat enlarged, especially the left. 
We again tried the intra-uterine stems which Dr. Greiner had 
before successfully used. They always afforded relief for a short 
time, but within a day or two, finally within a few hours, the 
patient was forced to remove them on account of the pelvic as well 
as general suffering caused by them. Retroversion pessaries did but 
little good, some proving decidedly injurious ; pressure, even the 
slightest, on the hypertrophied posterior wall of the corpus uteri 
caused intense pain, and a fearful exacerbation of the symptoms, as 
was demonstrated by a glycerine cotton tampon which was intro- 
duced with a view of elevating the fundus. Morphine injections 
were her only relief. 
Medication had been vainly tried ; the causation was evidently 
uterine, but the irritable hyper-sensitive condition of the enlarged 
womb no longer permitted any local application ; removal of the 
uterus and the ovaries, or of the ovaries alone, seemed the only 
remaining means of relief, and the patient was accordingly left in 
my charge. 
I observed her throughout the summer of 1877, seeking to relieve 
the most urgent symptoms. The menstrual exacerbations grew 
more marked ; as the time of the period approached, the urine was 
passed more frequently, the nose began to itch and the nightly 
attacks returned, growing more severe and of longer duration, so as 
to make her suffering continuous when the flow began; nausea 
and asthma were constant, also the bronchial cough with a copious, 
yellow, muco-purulent secretion. This painful condition continued 
throughout the menstrual period and slowly disappeared after the 
cessation of the flow ; then, in the intermenstrual period, came a time 
of comparative comfort; she could sit up, her appetite was fair, 
neither asthma nor bronchitis troubled her; but, dreading the 
intense suffering of the approaching period, she begged for the 
operation which had been suggested to her, well aware of all its 
dangers. 
I determined upon extirpation of the ovaries. Clinical experiment 
had shown the trouble to be uterine in its origin, but it was now 
confined in its fearful intensity to the period of pelvic congestion, 
and this I expected to do away with by establishing the menopause, 6 
Engelmann:■ Battey's Operation; 
thus affording her one continued intermenstrual period, i. e., a con- 
tinued calm. 
Some may urge that at 42 the change of life is so near at hand 
as to obviate the necessity of an operation, but her condition was 
such that she could not continue to suffer for years, not even for 
months, threatening suicide unless relieved. The chances were 
against this mere remnant of a woman, and Dr. Marion Sims, who 
saw the patient in August, although satisfied as to the propriety of 
the operation, thought that there was but little hope for the recovery 
of the patient, on account of her emaciation and extreme debility. 
The patient having been carefully prepared, the operation was 
performed September 2d, 1877, fourteen days after the cessation 
of the menstrual flow, on a clear, cool day following a storm. The 
room, which had been thoroughly cleaned and well aired, was kept 
at a temperature of 75° F. to 80° F. and well saturated with 
moisture; Lister’s antiseptic method was used to its fullest extent, 
carbolized sponges, carbolized spray, carbolized water for hands and 
instruments. 
An incision of inches was made in the linea alba extending 
to within f of an inch of the symphysis ; the wound bled much 
more fi eely than was to have been expected in so cadaverous a sub- 
ject ; some of the vessels were secured by ligatures, others by the 
small bulldog forceps. The abdominal walls were almost completely 
atrophied, and the very vascular peritoneum was readily exposed and 
divided upon the director; some time was lost in checking the persist- 
ent oozing from this membrane; then the very fatty and vascular 
omentum was moved upward, and I introduced two fingers of the left 
hand to explore the pelvis; but as the chloroform could not be pushed 
to complete anesthesia, pulse and respiration having several times 
flagged, the contraction of t he recti muscles was such that I could not 
operate freely, and I was obliged to enlarge the incision to inches; 
several coils of intestines escaped, and after they had been returned 
I Avas obliged to close the way by introducing four fingers of my 
left hand; they were somewhat numbed by the spray, and now 
constricted in the incision by the continued spasmodic contraction 
of the abdominal muscles, so that I was a little annoyed. I readily 
found the enlarged uterine fundus, which had been elevated by an 
assistant with two fingers in the vagina, and passing along the Fallo- 
pian tube, seized the left ovary between thumb and middle finger. 
It was about normal in size, not adherent, and yet I found it diffi- 
cult to move it upward, notwithstanding the assistance rendered 
by pressure from the vagina; still holding the ovary with two 
fingers, I seized it firmly with a strong curved dressing forceps, 
and with difficulty succeeded in dragging it sufficiently into the in- 
cision to tie the mesovarium with a single ligature of heavy braided 
silk; the ovary was then cut away with curved scissors, leaving a 
pedicle of less than half the thickness of a lead pencil; the ligature 
was cut short and dropped. 
The left ovary, which was somewhat larger and also without 
adhesions, was quickly found, and treated in precisely the same way. Three Fatal Cases. 
7 
The pelvic cavity was sponged, and but little blood found in it; 
the omentum was replaced as far as possible, and the wound closed 
with silk sutures; Lister’s dressing was applied and covered with 
a heavy pad of carbolized cotton. 
One and- one-half ounces of chloroform were used during the 
operation, which lasted one hour and ten minutes. 
After condition.- The patient soon rallied from the effects of the 
operation, with a pulse of 94 and a respiration of 28 ; did not vomit 
for the first nine hours ; then nausea, with a slight but irritating 
cough, set in, which readily yielded to a slight increase of the mor- 
phine doses (| grain every three hours subcutaneously). Urine was 
drawn every four to six hours ; morphine continued, and given more 
frequently as pain manifested itself. A few tablespoonfuls of milk 
and gruel was all the nourishment she could be induced to take ; 
the mere sight of broth, beef-tea, milk punch, etc., nauseated her, 
as she had so long depended upon such diet for her sustenance ; a 
little champagne and brandy with ice was well borne, but soon she 
refused everything but soda and toastwater ; milk punch was given 
per rectum. 
Abdominal pain was most severe soon after the operation, then 
gradually disappeared, and on the second and third days she was 
entirely free from it; early on the third day she complained of a 
pain in the lower ribs, while the pain in the back was much less 
than on the first day. 
The pulse rose steadily from 94 to 100 on the second day, 114 
on the fourth, and 120 on the fifth ; as the pulse slowly but steadily 
increased, the respiration decreased in frequency ; 28 to 30 per 
minute on the first day, it was but 22 on the second, 20 on the 
third, 14 to 18 on the fourth, at one time on the fifth day only 10 ; 
the highest temperature was 100.8° F., on the fourth day, ranging 
between 100° and 100.6° at other times. She died on the sixth 
day after the operation from inanition and sheer exhaustion. 
JPost mortem examination, sixteen hours after death: Abdomen 
greatly distended; abdominal wound thoroughly adapted, but not 
united ; intestines distended with gas, their surface scarce reddened, 
showing but faint traces of peritoneal irritation, most distinct in 
the upper part of the abdominal cavity. 
The uterus was normal in position, no longer retroflexed, not 
congested ; its peritoneal covering was somewhat thickened and 
dimmed. No adhesions and no inflammation of the left broad 
ligament; the pedicle appeared as a rounded stump covered by a 
slight deposit of lymph; it had contracted so that the ligature was 
ready to slip off. About the pedicle of the right ovary there were 
some adhesions, in evidence of a slight inflammation in its vicinity ; 
it was still firmly clasped by the ligature. 
The omentum was somewhat injected; there was no fluid in the 
pelvic cavity. Liver, spleen, and kidneys healthy; lungs almost 
normal, no adhesions, somewhat emphysematous, but the bronchi 
free, nowhere enlai’ged, their mucous membrane perhaps a trifle 
thickened; heart small. 
Case II.—Mrs. S., set. 33, healthy and strong in girlhood ; men- 8 
Engelmaistn : Battey's Operation ; 
struation regular and without pain until her eighteenth year, when 
she received a severe blow across the abdomen from a falling sign ; 
this was followed by a burning pain in the right side and constant 
suffering for a considerable time; she became subject to fainting 
spells without loss of consciousness; intense pain preceded and 
followed the menses, and she frequently had a feeling as if some- 
thing were jumping in her stomach ; suffered from globus, etc. 
Married eight years ago, never conceived; after marriage her 
troubles increased ; she was a constant sufferer, especially during 
the last three or four years, from menstrual pain, headaches, pains 
in abdomen, breasts, and throat, generally accompanied by swelling 
of those organs; swelling of the abdomen was frequently followed 
by a watery discharge from the vagina ; she was unable to work 
for months at a time, and often confined to her bed for weeks. 
I first saw the patient in the summer of 1876, with Dr. Hoffmann, 
who had attended her for many years, mainly regarding her nerv- 
ous and hysterical symptoms, but, thinking that he had discovered 
an abdominal tumor, consulted me with a view to operation. 
I found her a bright mulatto, with an exquisite figure and well- 
rounded limbs, nervous and hysterical; left breast enlarged and 
painful, especially the nipple ; the left ovarian region very sensitive, 
even slight pressure upon this part causing abdominal pain, swelling 
of the throat, choking sensation, inability to talk, and gasping for 
breath ; but the most careful bimanual examination revealed but 
indistinct signs of some abnormal resistance in the vicinity of the 
left ovary—this was after a period of intense suffering and watery 
discharge. The uterus was normal in size, acutely anteflexed with 
an eroded os, some endocervicitis; passage of the sound intensely 
painful. 
I made an application to the cervix, and advised astringent injec- 
tions, and iodide with bromide of potash, and valerian. 
The erosions readily healed, and the headache became much less 
constant and annoying; but her general condition grew slowly 
worse until the time of the operation, Feb., 1878, her symptoms, 
varying at times, remained very much the same; eyes pained, most 
in the morning, lids felt heavy and thick, vision was sometimes 
blurred or double; pain in the breasts, mainly the left, was at times 
so severe as to necessitate injections of at least f grain of morphia ; 
frequently felt as if water were moving in her left side ; could not 
stand squarely on both feet, as it caused her pain in the left hip; 
the left anterior superior spine was painful on pressure, the pain 
radiating into the abdomen ; rotation outward and abduction of 
the left leg hurt intensely, and caused pain in the knee; was obliged 
to draw her legs up in order to rest comfortably in bed; often had 
a feeling of contraction, shortening in the muscles of legs, hip, back 
and neck ; could not stoop on account of the faintness and abdominal 
pain it caused, and was obliged to kneel in order to reach anything 
low. Many of these symptoms were aggravated during the period 
of menstrual congestion. 
The catamenia were frequent when I first saw her, coming every 
two, or at most three weeks, either very profuse or lasting scantily Three Fatal Cases. 
9 
for six or eight days; later the flow came at longer intervals, irreg- 
ular, and much less free. 
Coitus was excessively and unbearably painful. 
Memory began to fail; she frequently, even while in bed, com- 
plained of dizziness from which she almost always suffered if on her 
feet; at times seemed but half conscious, her actions beyond her 
control; every four or five months was seized with an epileptic 
attack of several hours’ duration. 
An interesting and puzzling feature of the case was the periodical 
discharge of large quantities of a clear, inodorous, watery fluid, com- 
ing every two or three months, apparently in no connection with 
menstruation, although sometimes preceding the flow. A period of 
great suffering preceded the discharge ; the abdomen would swell, 
and was so much distended, especially in its upper third, under the 
ribs, that she could not fasten even the loosest clothing, and felt 
as if she must bui*st; at the same time complaining of severe pain 
in back and hips; and at these times the resistance in the left side 
was more distinct, evidently a cyst, a thin sack with fluid contents, 
which, however, I could at no time clearly outline; pressure upon 
the tumor gave her the feeling of squeezing a bladder full of water, 
caused intense local pain, sickness of the stomach, a choking sensa- 
tion, and loss of voice; the right ovarian region, which was appar- 
ently free, did not so respond ; the watei’y discharge, lasting several 
days, sometimes came in gushes ; at others, would trickle away for 
hours, but was always very abundant, even so as to saturate the 
bed, and drip through upon the floor; at the same time she would 
pass small quantities of wine-colored urine, and I have myself drawn 
the dark urine from the not distended bladder, while the discharge 
was going on ; this fact, together with the relaxation of the abdomen, 
and the diminution in the size of the tumor which followed the dis- 
charge, tempted me to consider the case as one of hydrosalpinx or 
hydrops tuboeproflaens (Schi’oeder, p. 320, Scanzoni, Vol. II., p. 
75) ; but chemical examination proved the fluid to be nothing but 
hysterical urine. It was perfectly clear, colorless, inodorous ; specific 
gravity varying from 1002 to 1005 ; reaction acid, but scarce per 
ceptible, and upon standing for a length of time, it had the odor of 
decomposing animal matter, and not of fermenting and alkaline 
urine ; upon evaporation, the residue was found to contain oxalate 
of lime, urates, and urea, proving that the fluid could not possibly be 
secreted by a cyst, but must come from the kidneys. 
I once gave jaboi'andi daily for one week, while the fluid seemed 
accumulating and the abdomen was very tense; she took at first an 
infusion of 3 i. to | iv. at a dose, later 3 ij. and 3 iij. to § iv.; this 
relieved somewhat, but was followed by unusual symptoms, unilateral 
sweating; a cold perspiration appeared on the left half of the body, 
and continued eight or ten hours, the right side remaining perfectly 
dry; there was also a trembling of the limbs, and a numbness in 
the left lower arm and in the left side of the trunk. 
Dr. Parvin kindly examined the patient with me, in June, 1877, 
and confirmed the diagnosis of that questionable tumor, which he 
described as a yielding resistance in the left side, a fluctuating tumor 10 
Engelmann : Batteys Operation; 
with indistinct outline, possibly an ascitic fluid; this was at a time 
when she was enlarging. 
Dr. Sims saw her in August, when her abdomen, which, by the 
way, was covered with almost two inches of adipose tissue, was 
more relaxed, and distinctly felt a cyst in the left side, but could not 
fix it; he considered this a typical case for Battey’s operation. 
Nothing seemed to relieve her suffering; tonics, anodynes, rest, 
all gave but temporary relief, while her condition grew steadily 
worse ; the slightest exertion brought about that fearful “ misery ” in 
her left side ; walking up a small flight of stairs was followed by a day’s 
suffering; while in bed, a heavy step on the floor invariably sent a 
thrilling pain through her from the left side upward. Every pos- 
sible means of relief which competent men could suggest had been 
tried in vain, and I determined upon the only course left—the extir- 
pation of the ovaries, which I looked upon as the offending organs, 
most especially the left, which was probably in cystic degeneration ; 
if the cyst should prove to be one of the tube or the broad ligament, 
it was determined to remove both cyst and ovary. 
The operation was performed February 28th, 1878, four days 
after the cessation of the menstrual flow, but not in the most favor- 
able surroundings. The utmost possible cleanliness was observed 
without resorting to the antiseptic method; a one-per-cent salt 
spray was used to moisten the atmosphere. 
The incision was made at once from the navel to one-half inch 
above the symphysis, through one and one-half to two inches of adipose 
tissue; no bleeding; the peritoneum was readily exposed and incised ; 
the intestines were pushed back and the fundus of the anteflexed uterus 
readily found, but passing from this along the Fallopian tube toward 
the left ovary, which the assistant endeavored to push up, it was 
with difficulty that I found this adherent and degenerated organ 
among the walnut-sized cysts ; it was firmly seized with the forceps, 
but could not be drawn into the incision ; one of the cysts was rup- 
tured and the entire mass, the cystic ovary with a cyst of the par- 
ovarium, was finally tied in the depth of the pelvic cavity with a silk 
ligature which was cut short and dropped. A part of the omentum 
adherent to the ovary was also ligated. The right ovary, also 
adherent and in cystic degeneration, was easily found and tied, 
together with a cyst of the parovarium. 
The pelvis was sponged, omentum replaced, and double silk sutures 
used to close the incision, which was covered Avith a Lister dressing. 
The operation lasted just one hour ; less than two ounces of chloro- 
form were used; patient bore the anesthetic unusually well, did 
not vomit during or after the operation; pulse soft, normal, averaging 
70 during the operation; traction upon the ovary was at once 
followed by a pallor of the face, sinking expression, and a sudden 
slacking of the pulse, Avhich became very feeble, scarce perceptible, 
and only 40 per minute ; as traction Avas diminished, the patient at 
once rallied, the pulse again became stronger and rose to 60, finally 
70. The same symptoms Avere observed to folloAV each traction 
upon the ovary. 
After-condition.—Patient rallied Avell from the operation with Three Fatal Cases. 
11 
her normal pulse of 76 to 80 ; morphine was given subcutaneously ; 
the usual treatment was followed ; the pulse slowly rose and, notwith- 
standing a very comfortable night, symptoms of peritonitis appeared 
on the morning of the second day ; by evening her condition seemed 
critical; pulse 132 ; I gave her 3 b of quinine by subcutaneous injec- 
tion in the course of three hours (chin. 3 i., aq. 3 ij.); marked im- 
provement followed, pulse 120, fuller ; morphine relieved the violent 
quinine tremor; she seemed to rally for some hours, but then steadily 
failed and died two and one-half days after the operation. 
Post-mortem examination, eight hours after death: Abdomen 
considerably distended, incision united; peritoneum and intestines 
scarce reddened; no dulness of the peritoneal covering; no adhesions 
either about the intestines or the abdominal wall, the uterus or 
the pedicles ; no lymph, only a very little of a brownish fluid in the 
pelvic cavity ; slight lymphatic exudation upon the posterior aspect 
of the now straightened uterus ; pedicles in excellent condition, 
rounded and coated with a yellowish lymph; omentum reaching 
very far down and somewhat inflamed. 
Case III.—Mrs. Iv., set. 31 ; was afflicted with caries in childhood; 
first menstruated in her 13th year ; the catamenia continued regu- 
lar and painless, she herself being perfectly healthy. Soon after her 
marriage, in her 23d year, eight years ago, to a vigorous, strong 
man, the first symptoms of uterine trouble appeared, and since then 
her suffering has steadily increased, until, within the last six months, 
she has been totally unfit for work and confined to bed a great part of 
the time ; she has never conceived. Backache and hypogastric 
pain preceding each menstrual flow, and upon the first day of its 
appearance, inaugurated these years of suffering; the flow was at 
some times scanty and at others profuse; occasionally backache and 
exquisite hypogastric pain continued during the three or four days 
of its duration ; later the premenstrual suffering was augmented by 
headaches, which were so intense as to cause her to faint with pain ; 
menstrual hystero-neurosis of the stomach was very marked, the 
distention of the epigastrium not unfrequently terminating in vom- 
iting ; a year ago she suffered so intensely from an intermenstrual 
backache, which left her during the continuance of the flow, that 
she was unable to move from her bed; fainted very easily upon the 
slightest provocation; has had several attacks of pelvic cellulitis. 
During the long period of her suffering has been in the hands of 
quite a number of physicians. 
I saw the patient first in January, 1878, at the request of Dr. 
Summa, then in attendance, and of Dr. Baumgarten, who had been 
consulted in the case; she had just recovered from an attack of 
pelvic inflammation and period of most excruciating menstrual suf- 
fering. I found her a very intelligent lady, considerably emaciated, 
with an appearance of long continued suffering. She had been a 
complete invalid for over six months, unable to undertake even the 
slightest household duties; could, when feeling well, walk but very 
slowly and short distances ; for the past four weeks had been con- 
fined to her bed constantly ; she complained of unceasing backache, 
headache, hypogastric pain, and severe menstrual suffering; in short, 12 
Engelmank : Battey's Operation; 
she was slowly failing, unable much longer to resist the constant 
and increasing pains. 
The abdomen was sensitive, especially so the right hypogastric 
region, while the left, though very tender, was less painful. The 
uterus was normal in size, anteflexed, with an elongated conical cer- 
vix pointing toward the symphysis ; the sound entered readily; the 
right ovary was easily seized between the examining lingers; it was 
excessively sensitive, of the size of a small egg, and of a consistency 
which seemed to indicate a subacute inflammatory enlargement; 
it appeared to be not adherent and movable / the left ovary was 
smaller and less sensitive. Believing the suffering to be due to a 
morbid condition of the ovaries, and that the uterine flexion could 
be entirely neglected, I advised absolute rest, warm applications to 
the hypogastrium, nourishing diet with mild stimulants and tonics; 
later the hot vaginal douche and concentric blisters in the region of 
both ovaries; neither iodide of potash nor quinine were borne by 
the patient. 
Her condition steadily improved, but although she now rested 
well, her appetite was good, and she gained in flesh, her sufferings 
remained the same ; pain in back and sides was continuous, greatly 
increased by motion ; the effort of walking from the bed, three or 
four steps to the rocking chair, was followed by more violent suf- 
fering ; the menstrual period, however, was almost painless. 
Further medication seemed useless; the disease of the ovaries, 
the source and centre of all the troubles, slowly progressed, notwith- 
standing the improvement in her general condition, and no treat- 
ment of any kind could check the advance of this chronic ovaritis ; 
nothing short of a removal of the offending organs promised relief 
to the sufferer ; well aware of the dangers of the operation, she not 
only gladly consented, but even urged its speedy performance. 
Operation.—The most careful preparations having been made, I 
operated March 11th, 1878, five days after the cessation of the 
menstrual flow, observing all the precautions of the antiseptic 
method as taught by Lister. 
Chloroform was first used, but the patient bearing it badly, and 
collapse threatening, ether was resorted to; pulse and respiration at 
once improved, and she was brought fully under the influence of the 
anesthetic. The abdominal incision, which was made fully four 
inches in length, was followed by a copious oozing of blood from the 
•cutaneous vessels, giving some little annoyance; the patient was a 
bleeder ; the flow having been stopped, the peritoneum was incised, 
and with two fingers of my left hand I entered the pelvic cavity, 
touching first the fundus of the uterus. I passed from this along the 
tube in search of the left ovary, but was unable to discover any- 
thing resembling that gland in feel; at the bottom of the pelvic 
cavity, near its left lateral wall, I found a number of small cysts and 
small soft bodies, which partially resembled loops of intestine, con- 
taining gas and feces; the. mass was immovably attached to the 
floor of the pelvis. I next introduced my whole hand, but again 
finding nothing but this soft, nodular mass, I seized a part of it and 
endeavored to pull it up ; it did not yield; I then grasped it with Three Fatal Cases. 
13 
the curved dressing forceps, but did not succeed much better in 
moving it; a temporary ligature of heavy braided silk was applied, 
and the mass seized with a second forceps ; by steady traction upon 
both instruments, it was raised a little and a second ligature placed ; 
a third was found to be necessary, and when finally I endeavored 
to cut the pedicle with the long scissors, in depth of the pelvis, I 
found that at least half of the degenerate ovary remained in place, 
attached to the surrounding tissues. 
The right ovary was then sought, and was found to be equally 
low down and still more immovable than the left; a distinct cyst, as 
large as a hickory nut, was at once ligated, but the mass of the 
degenerated ovary, firmly bound with the broad ligament to the 
sides and base of the pelvis, could not be properly tied and removed, 
and to remove the ovary only in part, would be to leave the opera- 
tion incomplete, and the patient exposed to the same sources of suf- 
fering as before ; nothing could be done in that depth and darkness ; 
the pulse was weakening, no time wms to be lost, and after a brief 
consultation, the abdominal incision was enlarged to two inches 
above the navel, and the pelvic cavity fully exposed; the large nod- 
ular mass was then tied with a double ligature passed through the 
broad ligament, and entirely removed. The left ovary was again 
examined, and as it was found that considerable of the soft reddish 
tissue of the organ had been left, the fourth ligature was applied to it. 
The pelvic cavity was sponged ; the coils of the intestines, much 
reddened, with some lymph here and there upon their peritoneal 
surface, were slowly returned, and the incision closed with silk 
sutures ; the lower angle, through which the ligatures were passed 
out, being left open for drainage purposes. The operation was a very 
trying one, lasting a little over two hours, during which time, not- 
withstanding the use of ether, it twice became necessary to resort 
to artificial respiration. 
After-condition.—The patient rallied fairly from the operation, 
felt comfortably, and did not vomit, but within two hours the con- 
dition changed ; a free flow of blood came from the open lower 
angle of the incision ; the dressing was removed, and applied to the 
abdomen ; the bleeding did not stop until the lips of the wound were 
freely touched with perchloride of iron ; trouble seemed due to the 
cutaneous vessels and capillaries, which bled so freely in the begin- 
ning of the operation ; the hemorrhage was checked for over an 
hour, but then the blood suddenly Avelled up from the depth of the 
cavity; several stitches were cut, and a careful examination made; 
there was no fluid in the cul-de-sac, no dulness in the pelvis, and 
the flow which came, at least partially, from the very vascular peri- 
toneum, was finally stopped by ergot and ice. 
She took stimulants and some little nourishment; did well for the 
first twenty-four hours following the operation, but after that, she 
slowly failed ; pulse steadily increasing in frequency ; death occurred 
on the third day.1 
1 I am under obligation for efficient assistance in the various operations to 
Drs. Hodgen, Baumgarten, Greiner, Engelmann, Sr., Green, Prewitt, Mudd, Nel- 14 
Eng elm ann : Battey's Operation; 
A post-mortem examination was not permitted. 
I have reported these cases in detail, as the operation is so 
recent a one that the unfortunate result, thrice successively 
fatal, must naturally lead us to inquire whether the operation 
was justifiable or not. 
In no instance did I undertake the operation until I had 
myself vainly attempted to afford relief by local and general 
treatment, and unless the patients had for years before been 
under the care of competent physicians, who had been unable 
to stay the steady progress of their agonizing suffering. 
In Case I. the ovaries were removed, to bring about the 
menopause, and thus check the reflex menstrual suffering, which 
had so greatly reduced the patient, and was rapidly hastening 
her end by exhaustion, if it did not lead to suicide. 
Case II. was one of chronic ovaritis, in which the reflex suf- 
fering was intense and continuous, steadily increasing, confining 
the patient to bed, and rendering her, the wife of a working 
man, a helpless invalid, confined to her bed with the prospect 
of still greater trials awaiting her. The ovaries, especially the 
left, which was known to be in cystic degeneration, were also 
directly the seat of much pain. 
Case III. was a typical case of chronic ovaritis and ovaralgia, 
with occasional attacks of cellulitis, in which the suffering was 
mainly confined to the region of the unquestionably diseased 
ovaries, without marked menstrual exacerbation; but this pain 
was such as to confine the patient to her bed, and to torture 
her constantly. It steadily increased, and Battey’s operation 
was performed to remove the offending organs. 
The operation did not prove to be an easy one in either of 
the cases, on account of the tension upon the broad ligaments 
and the adhesions binding down the ovaries. In the first case 
only could the ovaries be pulled up somewhat, partially into the 
incision; in the second, we were obliged to tie in the depth of 
the pelvic cavity; and in the third, the firm adhesion of the 
degenerate ovary with the broad ligament to the floor of the 
pelvis necessitated the exposure of the pelvic cavity, in order 
that it might be possible to complete the operation. 
son, Evers, Schenk, Bierwirth, Kirchner, Hoffmann and Summa, but most 
especially to Dr. John T. Hodgen, for his advice and assistance in the after- 
treatment as well as the operation. Three Fatal Cases. 
15 
In the first case, the patient was a miserable wreck, a hag- 
gard, weak, worn-out woman, with but slight chances of surviv- 
ing the serious operation, for which she prayed as her only 
hope. Death was almost an inevitable result, and it was for 
this reason that Dr. Sims at first differed with me as to the 
propriety of operating; not until he saw the patient in her 
agony did he advise the operation. 
She died of inanition and an inability to overcome the shock 
of the operation. The post-mortem revealed but trifling signs 
of pelvic or peritoneal reaction. 
The second was a bright mulatto, in whom the feeble power of 
resistence characteristic of her color was not increased by years 
of suffering. The fever was not high, peritonitis moderate, the 
pedicle in good condition. 
In the third case, the operation was tedious and severe, and 
the patient weakened by the hemorrhage following, so that she 
succumbed to a comparatively slight reaction. 
Notwithstanding the unfortunate termination, I consider that 
in these three cases the operation was not only justifiable, but 
that it was decidedly indicated and demanded. 
THE INDICATIONS FOR BATTEY’s OPERATION, WITH A SUMMARY 
OF FORTY-ONE CASES OF EXTIRPATION OF THE OVARIES. 
The operation lias now been performed forty-one times, and I 
will but call attention briefly to the practical points brought out 
by an analysis of their more important features, as I have 
endeavored to tabulate them in such a way that comparisons can 
be readily made. 
Table I. contains a list of forty-one cases, five of which 
(marked *) I was obliged to omit in the comparison of indica- 
tions and results, so that Tables II. and III. are based upon an 
analysis of the thirty-six complete cases. 
Number 19 (Sims) could not be utilized, as the operation 
was only attempted, but could not be completed; 39 and 40 
(Hegar) were too recent to permit the statement of a result; 
and I may here say that my knowledge of Hegar’s case is based 
upon occasional references in Hegar’s articles in the Central- 
blattf. Gyndkologie. A detailed account of the cases I could 
not obtain, and hence am not positive as to the correctness of 16 
Engelmann: Batteys Operation; 
TABLE I.—LIST OF CASES. 
Number of Case. 
Operator. 
Locality. 
Number of Op- 
erator’s Case. 
Indications for Operation. 
Abdominal or 
vaginal opera- 
tion. 
One or both 
ovaries re- 
moved. 
Condition of 
ovaries when 
noted. 
Result of Operation. 
1 
Battey 
Georgia 
1 
Amenorrhea, menstrual molimen, convul- 
sions, repeated pelvic cellulitis. 
Persistent ovaralgia (left ovary.) 
Continuous ovaralgia, endometritis, insanity 
threatened. 
Ovaralgia aggravated by menstruation or exer- 
tion. 
Ovaralgia, dysmenorrhea, coccyodynia. 
Constant ovarian pain, ovarian dysmenorrhea, 
insanity threatened. 
Constant ovarian pain, dysmenorrhea. 
Constant ovarian pain, irritable uterus, metri- 
tis, pelvic cellulitis. 
Second operation on Case 5. 
Constant ovarian pain, ovarian dysmenorrhea. 
Atresia vaginae. 
Abdominal. 
Both. 
One. 
Both. 
One. 
One. 
Both. 
Both. 
Both. 
One. 
Both. 
Both. 
Both, right 
only partially 
removed. 
One. 
Cure complete. 
(Temporary relief) not 
improved. 
Cure complete. 
Somewhat improved. 
(Temporary relief) not 
improved. 
Died. 
Cure complete, 
Not improved. 
Not improved. 
Died. 
Cure complete. 
Not improved. 
Cure complete. 
9 
2 
Vaginal. 
Vaginal. 
Vaginal. 
Vaginal. 
Vaginal. 
Vaginal. 
Vaginal. 
Vaginal. 
Vaginal. 
Abdominal. 
Vaginal. 
Abdominal. 
Cystic degen- 
eration. 
3 
3 
\ 
4 
Not entirely 
removed. 
5 
5 
6 
6 
7 
7 
8 
8 
Bound down, 
not entirely 
removed. 
Not entirely 
removed. 
9 
9 
10 
10 
11 
11 
12 
12 
Ovarian and pelvic pain, dysmenorrhea, epi- 
leptic convulsions. 
Dysmenorrhea, menorrhagia, retroflexion and 
hypertrophy of uterus. Uterine treatment 
failed. 
13 
Sims 
New York... 
1 
Cystic. 
14 
2 
Diarrhea, symptoms of fissure ani or of ulcer 
within the sphincter. Intense and ever- 
recurring recto-enteralgia. 
Dysmenorrhea, pain in sacro-pelvic region, 
ovarian pain aggravated by menstruation. 
Dysmenorrhea, pelvic pain, anteflexion, ova- 
rian pain. 
Ovarian pain aggravated during menstruation, 
retroversion. 
Abdominal. 
Vaginal. 
Vaginal. 
Abdominal. 
One. 
One 
One. 
Both. 
Cystic. 
Somewhat improved. 
15 
3 
16 
4 
Cystic. 
Cystic. 
17 
5 
Died. 17 
Three Fatal Cases. 
sacral and pelvic regions, coccyodyma, pho- 
tophobia. 
19* 
7 
Dysmenorrhea, ovarian and pelvic pain, hy- 
pertrophy of posterior wall of uterus, uterus 
Vaginal. 
Operation 
abandoned. 
Bound down. 
Operation abandoned. 
bound down by adhesions. 
20 
Hegar 
Freiburg.... 
1 
Ovaralgia. 
Abdominal. 
Both. 
One cystic,other 
Died. 
slightly changed 
21 
2 
Uterine fibroids. 
Greatly improved. 
Greatly improved. 
Greatly improved. 
22 
3 
Uterine fibroids. 
Both. 
23 
4 
Uterine fibroids. 
Lateral inci 
Both. 
sions directly 
over ovaries. 
24 
Goodell 
Philadelphia. 
1 
Uterine fibroids. 
Vaginal. 
Vaginal. 
Vaginal. 
Abdominal. 
Cure complete. 
Somewhat improved. 
Died. 
25 
2 
Pernicious menstruation. 
26 
3 
Pernicious menstruation. 
Both. 
27 
Thomas 
New York.. . 
1 
Ovaralgia, dysmenorrhea, petit mal. 
Both. 
Cystic. 
Somewhat improved. 
28 
2 
Dysmenorrhea, temporary insanity. 
Attempted by 
One. 
Enlarged. 
Died. 
vaginal, com- 
pleted by ab- 
dominal. 
29 
Trenholm... 
Montreal 
1 
Hemorrhage from uterine fibroids. Intense 
dysmenorrhea from ovarian congestion. 
Abdominal. 
Both. 
Cure complete. 
30 
2 
Chronic ovaritis and ovarian displacement. 
Absence of uterus, amenorrhea, pain on coitus, 
Vaginal. 
Abdominal. 
One. 
Not improved. 
Died. 
31 
Peaslee 
New York... 
1 
Both. 
Cystic. 
hystero-epilepsy. 
Greatly improved. 
Cured (?) 
32 
Sabine 
New York... 
1 
Ovaralgia, dysmenorrhea, inability to step 
with left leg. 
Abdominal. 
One. 
Normal. 
Gilmore .... 
1 
33 
Alabama.... 
Atrophy of uterus, amenorrhea, cerebral 
congestions with convulsions, threatening 
Abdominal. 
Both. 
life. Increasing mental hebetude. 
34 
Pallen 
St. Louis 
1 
Dysmenorrhea and persistent ovaralgia. 
Abdominal. 
Both. 
Right, cystic; 
Died. 
left, dislocated. 
35 
Engelmann.. 
St. Louis.... 
1 
Gastric and bronchial hystero-neurosis, with 
Abdominal. 
Both. 
Slightly en- 
Died. 
intense menstrual exacerbation, retroflex- 
ion, metritis. 
Ovaralgia aggravated by slightest exertion and 
by menstruation, dysmenorrhea, anteflexion, 
larged. 
36 
2 
Abdominal. 
Both. 
Cystic, bound 
down. 
Died. 
epileptiform attacks. 
37 
3 
Ovaralgia, ovarian dysmenorrhea, constant 
pelvic pain, anteflexion. 
Abdominal. 
Both. 
Cystic, firmly 
bound down. 
Died. 
38* 
Koeberle.... 
Strasburg 
1 
Retroversion, constipation, neuroses. 
Abdominal. 
One. 
As regards position 
of uterus, good. 
39 
Hegar 
Freiburg.... 
5 
Uterine fibroid. 
Abdominal. 
Too recent. 
40* 
6 
Perioophoritis, salpingitis, perimetritis. 
Uterine tumor. 
Too reoent. 
41* 
Kaltenbach & 
1 
Abdominal ? 
Both ? 
Died. 
Freund. 18 
Engelmann: Battey's Operation; 
every detail. 38 (Koeberle) does not belong here, as it was an 
accidental extirpation of the ovary, in order to facilitate the 
object of the operation, the fixing of the broad ligament in the 
abdominal incision, in order to straighten a very annoying retro- 
flexion; 41 (Kaltenbach and Freund) I have no history of. 
The most favorable view possible has always been taken in 
giving the results of cases. 
CLASS OF CASES OPERATED ON, AND RESULTS ACHIEVED. 
TABLE II. 
RESULTS. 
INDICATIONS. 
Keflex 
Neuroses. 
Hemor- 
rhage 
Uterine 
Fibroids. 
Malfor- 
mation 
Sexual 
Organs, 
Ovarian 
Dysmen- 
orrhea. 
Ovaritis, 
Ovaralgia, 
etc. 
Total. 
No. 
of 
cas. 
Per 
cent. 
No. 
of 
cas. 
Per 
cent. 
No. 
of 
cas. 
2 
Per 
cent. 
No. 
of 
cas. 
Per 
cent. 
No. 
of 
cas. 
Per 
cent. 
No. 
of 
cas. 
Per 
cent. 
2 
3 
40 
60 
66.7 
2 
40. 
2 
1 
2 
6 
3 
10 
5 
10 
30 
15 
8 
4 
4 
6 
3 
22.8 
11.4 
11.4 
17.2 
8.6 
Somewhat improved... 
1 
50. 
1 
20. 
Survived operation.... 
Died 
1 
1 
50. 
50. 
5 
100 
2 
1 
66.7 
33.3 
3 
3 
60. 
50. 
14 
6 
70 
30 
25 
11 
69.4 
29.6 
Total 
2| o.7 
& 
14.3| 3 
8.6 
6 
16.6 
20 
57.1 
36 
100 
Table II. shows us that in 20 of the 36 cases, which have 
served for this compilation, the operation was performed on 
account of suffering caused by ovaritis and ovaralgia, and in 6 
ovarian dysmenorrhea is given as the indication, so that we 
may say that ovarian disturbance was the cause assigned in 26 
of the cases; uncontrollable hemorrhage and suffering from 
uterine fibroid led to the extirpation of ovaries in 5 cases; mal- 
formation of the sexual organs and menstrual molimina in 3 
cases, and reflex neuroses in two. In 25 cases the ovaries were 
diseased, while in the other 11 they were normal and removed 
only to bring about the menopause. 
The results of the operation, as regards its danger to life, are 
11 deaths, 30.5 per cent, and 25 recoveries, 69.5 per cent; of 
the 25 patients who survived the operation, 16 were improved, 
44.4 per cent of the whole number operated on, while 9 were not 
bettered, 25 per cent; to be more precise, of the 36 cases, Three Fatal Cases. 
19 
£5, 22.2 per cent, were cured; 4, 11.1 per cent, were greatly 
improved, 4 somewhat improved; 6, 16.6 per cent, not im- 
proved, and 3 made worse. 
The success is best and the percentage of death smallest in 
those cases in which both of the normal ovaries were removed 
TABLE III. 
METHODS OF OPERATION AND THEIR RESULTS. 
Ovaries Removed. 
Mode of Operation. 
Incision. 
Total. 
RESULTS. 
Both. 
One. 
Abdominal 
Vaginal 
No. 
of 
Oases 
Per 
cent. 
No. 
of 
Cases 
Per 
cent. 
No. 
of 
Cases 
Per 
cent 
No. 
of 
Cases 
Per 
cent. 
No. 
of 
Cases 
Per 
cent. 
Cured 
29A 
12M 
8 A- 
1 
8i 
5 
26* 
21* 
m 
3 
18f 
8 
22f 
Ilf 
17+ 
Greatly improved 
3 
1 
8| 
4 
4 
Somewhat improved 
2 
9 
16| 
33! 
2 
2 
12! 
37! 
18# 
4 
Not improved 
2 
8 if 
4 
6 
6 
Made worse 
3 
25 
3 
3 
8f 
Survived operation 
Died 
14 
10 
58.4 
41.6 
11 
1 
91f 
8! 
11 
8 
57* 
42* 
14 
3 
82.4 
17.6 
25 
11 
71f 
28f 
Total 
24 
6b. 6 
19 Ism 4 
19 
54.4 
1714.7.9 
36 
100 
to bring about the menopause and to check hemorrhage from 
uterine tumors; we have 5 such cases, all of which were improved 
(2 cured, 3 greatly improved); but one death has occurred, and 
that the case of Kaltenbach and Freund. 
The operation seems to have been followed by a less favor- 
able result in cases of ovaritis and ovaralgia with degeneration 
of the ovaries; 6 deaths, 30 per cent, out of 20 cases; and of 
the Id, 70 per cent who survived; 9, 45 per cent of the 
20 cases, were not improved (3 were made worse, 6 not 
improved) and only 5, 25 per cent, were improved (2 cured, 
one greatly improved, 2 somewhat improved). 
This is the most important class of cases, as it comprises the 
largest number, 20, 55.5 per cent, of all the cases operated on, 
and it is the one in which the operation is most naturally 
indicated, the ovaries themselves being diseased, and the seat 
of suffering. The ill success of the operation in these cases is 
self-evident, if we consider the method of operation resorted to 
in many and the condition of the pelvic organ; an analysis of ' 
these 20 cases will teach a valuable lesson and will lead to 
more successful results in future. 20 
Engelmann : Battey’s Operation; 
In cases in which the operation is performed on account of 
hemorrhage from uterine tumors, menstrual molimina with mal- 
formation of the sexual organs or reflex neurosis, the ovaries are, 
as a rule, neither diseased nor adherent; in the cases now under 
consideration the ovary is always diseased, generally consisting 
of a number of small cysts imbedded in the greatly altered 
stroma; it is bound down by adhesions, if not wholly imbedded 
in the remnants of an old hematocele or of a pelvic cellulitis. 
In each of the 6 fatal cases, 30 per cent, both ovaries were 
removed; in those which are marked cured, both ovaries were 
removed; in the 3 improved, one ovary only was removed in 
two of the cases; the 3 made worse, are all cases of the removal 
of one ovary; and in the 6 cases not improved, only one ovary 
was completely removed; in 4 of them, one ovary only was 
extirpated; and in the other two, the attempt was made to- 
remove both, but did not succeed on account of the adhesions, 
so that parts of one ovary were left in the pelvis. 
The history of the operation in these 20 cases tells us that it 
is often difficult or impossible to remove both ovaries completely, 
and yet that both must be removed to secure success. 
Next comes the operation to relieve the menstrual molimina 
in cases of malformation of the sexual organs; 3 cases, with 
2 cures and 1 death. 
It is hardly necessary to call attention to the comparative suc- 
cess in the cases in which one ovary was removed, and those in 
which both were removed. The extirpation of both ovaries is, 
of course, the more dangerous operation, the percentage of death 
being 38.4 per cent (10 in 26), while in the removal of one ovary, 
it is only 8.3 per cent (1 in 12); but what is the comparative 
success ? All those who survived the removal of both ovaries- 
were improved with the exception of 2, in whom it was 
impossible to remove the glands completely on account of the 
condition of the pelvic viscera, so that practically only one 
ovary was removed; 7, 30.5 per cent, were completely cured; 
3, 13 per cent, greatly improved, 2, 8.7 per cent, somewhat 
improved; while in the cases in which only one ovary was 
removed, we find 7, 58.3 per cent, not improved (3 made 
worse, 4 not improved) and only 4, 33.3 per cent, improved 
(1 cured, 1 greatly improved, and 2 somewhat improved). 
The same comparison may be made between the operations- Three Fatal Cases. 
21 
by the abdominal and those by the vaginal section; the vaginal 
section is evidently somewhat the safer method, but far behind 
the abdominal in its results; 8 of the 19 patients, 42.1 per 
cent, operated on by the abdominal section died, while only 3 
of the IT vaginal sections proved fatal; 11, 58 per cent, of the 
abdominal sections were improved (5 cured, 4 greatly improved, 
2 somewhat improved); not a single patient who survived the 
operation was not improved by it, while the vaginal method 
gives only 5 cases, 29.4 per cent, improved (3 cured [?] and 2 
somewhat improved), but 9, 52.9 per cent, not improved (6 not 
improved and 3 made worse). 
The success of the operation, when performed by the vagina, 
is very unsatisfactory, and, moreover, the method is unscientific, 
as it is so very difficult, mostly impossible, to determine the 
condition of the ovaries, so that we can say beforehand whether 
the operation can be completed by that route or not. We have 
17 cases of vaginal section, 18, if we add case 19 (Sims), in 
which the operation was attempted by the vagina and abandoned; 
6 of these 18 cases, 33.3 per cent, could not be completed; 2 
were abandoned (19, Sims and 28, Thomas), which was com- 
pleted by the abdominal method, and in 4 others (Battey), it 
was impossible to remove the ovary complete, and the operation 
was left practically unfinished; this uncertainty, to my mind, is 
sufficient to condemn the vaginal method. 
The analysis of the above 36 cases, and the experience 
gained in my own operations, lead me to the following conclu- 
sions with reference to the indications for the operation, and 
some general rules to be observed in its performance: 
INDICATIONS FOE THE OPERATION-. 
The operation is indicated only in certain grave cases of chronic 
uterine or ovarian disease, accompanied by intense suffering 
or uncontrollable reflex symptoms, in which all means of treat- 
ment in the hands of competent physicians have failed, so that 
the unhappy patient must drag out the miserable existence of a 
helpless and constantly suffering invalid, if she does not lose her 
reason or succumb to the tortures of the disease; it may then 
be undertaken, I., in order to establish the menopause; or, II., 
to remove the offending organs, frequently for both purposes. 
I. To establish the menopause, in cases of uterine, ovarian, 22 
Engelmann: Battey''s Operation; 
or reflex suffering dependent upon, or greatly intensified by the 
menstrual congestion. 
(a. Ovaries not Diseased—Normal Ovariotomy Proper.) 
For this purpose the operation is indicated: 
1. By menstrual hystero-neuroses, cerebral, pulmonary, gastric, 
or other reflex symptoms, associated with and dependent upon the 
monthly period of pelvic congestion (14, Sims; 35, Engelmann). 
2. By dangerous hemorrhage, menorrhagia, or suffering 
caused by uterine tumors not suitable for removal (29, Tren- 
holme ; 21, 22, 23, Hegar; 24, Goodell. 
3. By the absence of uterus or vagina, or other malforma- 
tions of the sexual organs, when accompanied by distressing 
menstrual molimina (31, Peaslee ; 11, Battey; 33, Gilmore). 
(b. Ovaries Diseased.) 
4. By ovarian dysmenorrhea and uterine or ovarian suffering 
limited to the catamenia, or greatly increased during the men- 
strual period (12, 25, 28, 34). 
II. To remove the offending organs, when they are the seat 
of constant pain, independent of the monthly flow, although 
generally increased by it; these are cases of chronic ovaritis 
and ovaralgia with pelvic pain, which are marked by the most 
fearful and continued suffering, which is only intensified during 
the catamenia; the ovary itself is always diseased, generally in 
a state of cystic degeneration, and the object of the operation 
is not mainly to establish the menopause, but to remove those 
organs which, by their affection, are causing local suffering, 
and are involving in disturbance the entire nervous system. 
In ovarian hernia the healthy ovary may be removed as the 
offending organ, but this is a class of cases not here to be con- 
sidered (Koeberle, 38). 
I. Operate by the abdominal section; the operation can 
always be completed and the ovaries removed entire, whatever 
be the condition of the pelvic organs; a wider scope is given 
to the fingers and the instruments of the operator than through 
the vaginal incisions, and in the worst cases, when touch fails, 
the eye may help. 
GENERAL RULES GOVERNING THE OPERATIONS. Three Fatal Cases. 
23 
As a rule, the incision is made in the linea alba, but in case 
the ovaries approach the abdominal walls, and can be dis- 
tinctly felt beneath them, the incision may be made at any point 
directly over the ovary; thus in case of hernia or of uterine 
tumors (23, Hegar). The semilunar incision in the side, which 
I would term the direct lateral method, is inferior to the median, 
although in closer proximity to the organ to be reached. 
II. The vaginal operation is admissible only in cases of dis- 
placement upon the vagina (Trenholme, 30). Although the 
ovaries have been frequently and successfully removed by this 
method, which is decidedly less dangerous than the abdominal 
section, it is an uncertainty; almost all those cases in which 
Battey’s operation is indicated, are cases of chronic pelvic suf- 
fering, and disease in which we find a pathological condition 
of those viscera, especially the ovaries, which are generally 
bound down by adhesions. Dr. Sims says: “If we are sure 
that there has been no pelvic inflammation, no cellulitis, no 
hematocele, no adhesion of the ovaries to the neighboring 
parts, then the operation may be performed by the vagina, but 
not otherwise.” 
It seems to me impossible to determine these conditions satis- 
factorily in all cases, and if we remember that bold and skilled 
operators and able diagnosticians, such as Marion Sims and T. 
Gaillard Thomas, have attempted this operation by the vagina 
and have failed, and that its originator, Robert Battey, had, in 
four instances, been unable to remove the ovary entire, and 
was obliged to leave a part of the degenerate and adherent 
organ in the pelvis, thus subjecting the patient to the dangers 
of the operation without affording relief, we cannot but con- 
sider the success of a vaginal operation as a piece of good luck. 
The operator who seeks to remove the ovaries by this method 
must be very positive in his diagnosis, or he must trust in Prov- 
idence for a favorable condition of the pelvic viscera. 
III. Remove both ovaries. The removal of one ovary may 
almost be said to be needlessly subjecting the patient to the 
dangers of the operation, even if that one ovary is the seat of 
pain, and if that one ovary only is diseased; two successful cases 
are known in which complete relief followed the removal of one 
ovary (13, Sims’, 32, Sabine), but generally we find the disease 
recurring in the other ovary, even if temporary amelioration be 24 
Engelmann: Battey s Operation; 
obtained. Dr. Sims justly says that Battey’s operations and 
his own would have presented very different results if they had 
not departed from the theory which Dr. Battey laid down in 
the very beginning, viz., to bring about a change of life by 
extirpating both ovaries. 
In the cases of ovarian hernia, the prolapsed ovary is removed, 
one or both as the case may be, and the incision is made direct- 
ly over the disturbing organ. 
The operation, if properly completed, so that no remnants of 
ovarian tissue are left in the pelvis, is more difficult and more 
dangerous than has been generally represented. However 
great the dangers, experience will lessen them, and sufficiently 
favorable results have already been achieved, so that we may 
look hopefully to Battey’s operation as a last, a desperate, but 
not unpromising resort in those distressing cases of female suf- 
fering dependent upon ovarian disease or menstrual congestion, 
which all treatment has failed to relieve. 
Battey ' 
Battey - 
(?) 
Noeggerath.. 
Thomas ] 
Gilmore 
Sabine 
Yandell and 
McClellan. 
Battey 1 
Peaslee < 
Thomas 1 
Trenholme.. . 
Normal ovariotomy. 
LITER ATTIRE. 
Atlanta Med. and Surg. S 
Jour. 
Read before the Geor-1 
giaMed. Assoc., April, 
1873. 
Atlanta Med. and Surg. 
Jour. 
Atlanta Med. and Surg. 
Jour. 
I Am. Jour, of Obstetrics. 
New York Med. Jour. 
Atlanta Med. and Surg. I 
Jour. 
Am. Jour, of Obstetrics. 
American Practitioner. < 
- Transactions American 
s Gynecological Society. 
Vol. I. 
do. do. 
! 
S 
► 
: do. do. 
i do. do. 
Sept., 1872. 
April, 1873. 
May, 1873, 
p. 67. 
May, 1874, 
p. 155. 
Vol. XX., p. 
181, 1874. 
Sept., 1874. 
Aug., 1875, 
p. 359. 
Oct., 1875. 
June, 1876, 
p. 15. 
p. 340. 
p. 351. 
p. 351-2. 
Normal ovariotomy. 
Report on ovaries removed 
by Dr. T. G. Thomas. 
Normal ovariotomy. 
Normal ovariotomy. 
Battey’s operation. 
On extirpation of the func- 
tionally active ovaries 
for the remedy of other- 
wise incurable diseases. 
Case of solid uterus bi- 
partite. Both ovaries 
removed for the relief 
of epilepsy ascribed to 
ovarian irritation. 
Two cases of removal of 
the ovaries. 
Remarks on Dr. Peaslee’s 
case. Three Fatal Cases. 
25 
Trenholme.. 
(?) 
Trenholme.. 
Stahl 
Battey 
Trenholme.. 
Battey 
Peaslee, Par- 
vin, Goodell, 
Trenholme, 
Noeggerath. 
KoeberlA ... 
Hegar 
Sims 
Hegar 
Budin 
Beigel 
Budin and 
Beigel. 
Hegar1 
Engelmann.. 
Goodell 
A case of excision of both 
ovaries for fibrous tu 
mor of the uterus, and 
a case of excision of the 
left ovary for oophoritis 
and displacement. 
Two cases of ovariotomy 
or spaying. 
Die anticipirte Climax 
durchExtirp.d.Ovar. bei 
Fibromyomen d. Uterus. 
Claim of priority. 
With reference to priority. 
Battey’s operation, remov- 
al of the ovaries. 
Discussion on Battey’s 
operation. 
Gastrotomy in a case of 
retroversion of the ute- 
rus, with extirpation of 
an ovary (does not prop- 
erly belong here). 
Zur Extirpation der Eier- 
stocke. 
Battey’s operation. 
Ueber die Extirpation nor- 
maler und nicht zu um- 
fanglichen Tumoren de- 
generirter Eierstocke. 
Operation de Battey. 
Ueber die Extirpation der 
Ovarien als therapeu- 
tisches Mittel. 
Review. 
Die Castration der Frauen 
The difficulties and dangers 
of Battey’s operation. 
Normal ovariotomy. 
Canada Lancet. 
Abstracted Am. Jour. 
Obstet. 
Richmond aDd Louis- 
ville Med. Jour. 
British Obstet. Jour. 
Deutsche med. Wochen- 
schrift. Berlin. 
British Obstet. Jour. 
British Obstet. Jour. 
Trans. American Gyne- 
cological Soc., Yob II 
do. do. 
Gaz. Med. de Strasbourg. 
Centralblatt f. Gyn. 
British Med. Jour 
Centralblatt f. Gyn. 
Le Progres Medical. 
Wiener Med. Wochen- 
schrift. 
Centralblatt fur Gyn. 
Volkmann’s Samml. klin. 
Vortrage, 136-38, 
Transact. Am. Medical 
Assoc. 
Am. Journ. of Obstet. 
(Pro. Phila. Obst. Soc.) 
July, 1876. 
Oct., 1876. 
Sept. 1876, 
p. 241. 
Oct. 1876. 
Dec., 1876, 
No. 60. 
March, 1877. 
May, 1877. 
May, 1877. 
do. 
No. 3, 1877. 
pp. 73, 297, 
1877. 
Dec. 1877. 
Jan. 1878, 
p. 25. 
Feb.’78. No.8 
Feb., 1878, 
Nos. 7 and 8. 
March, 1878, 
No. 8. 
Issued May 
22d, 1878. 
June, 1878. 
July, 1878. 
EXTIRPATION OF THE HEALTHY OVARY FOR OVARIAN HERNIA, 
NOT VAGINAL. 
Englisch, Jo- 
seph. 
Meadows.... 
McCluer 
Ovarian hernia, compila- 
tion of 38 cases. In one 
case (Pott’s) both ova- 
ries removed. 
Hernia of the ovary. 
Remarks on ovarian phys 
iology and pathology. 
(Successful operation by 
Mr. Lawson, Aug., 1861.) 
Case of ovarian hernia, 
successful operation. 
Med. Jahrbiicher,Vienna 
Biennial Retrospect of 
Med. Surg. of the New 
Sydenham Soc., 1872. 
Am. Journ. Obst. 
Am. Journ. Obst. 
1871. 
1872-3. 
Aug. 1873, 
p. 233. 
Feb., 1874, 
p. 613. 
1 This, the latest and most complete article on the subject, reached me when 
my paper had already gone to press, too late to make more than this short 
mention of it. Battey’s Operation; 
A BRIEF SUMMARY 
O F 
RESULTS ACHIEVED IN THE FORTY-SEVEN 
CASES SO FAR REPORTED. 
BY 
CtEO. J. ENGELMANN, M.D., 
CONSULTING SURGEON TO THE ST. LOUIS FEMALE HOSPITAL, FELLOW OF THE AMERICAN 
GYNAECOLOGICAL SOCIETY; FELLOW OF THE LONDON OBSTETRICAL SOCIETY, 
OF THE LONDON PATHOLOGICAL SOCIETY, ETC. 
\Reprinted from the St. Louis Medical and Surgical Journal, August, 1878. 
SAINT LOUIS: 
GEO. O. RUMBOLD&CO., PRINTERS AND PUBLISHERS. 
1 87 8. BATTEY’S OPERATION; 
A BRIEF SUMMARY 
O F 
RESULTS ACHIEVED IN THE FORTY-SEVEN CASES SO FAR 
REPORTED. 
BY 
GEO. J. ENGELM ANN, M. D., 
OF ST. LOUIS. 
Since the publication of my paper on this operation in the 
July number of the American Journal of Obstetrics, “ Battey’s Op- 
eration : Three Fatal Cases, with Some Remarks upon the Indi- 
cations for the Operation,” I have received reports of six addi- 
tional cases, making forty-seven in all, together with more com- 
plete notes upon some of those already tabulated, and I now wish 
to give a brief summary of the results of Battey’s Operation, as 
they appear in the forty-three cases of which I have full notes; 
at the same time, (Table I.a), will supplement the list of cases given 
in my previous paper, which contained but 41. The histories of 
cases 39, 40 and 41, have been completed, and six new cases 
added, so that I have now 47 recorded. Ol these 47 eases, 43 only 
could be utilized for an analysis oi all the points to be eliminated 
in Tables II. a and III. a; these tables are identical with Tables 
II and III of the previous paper; the former, however, are based 
upon a comparison of 43 cases, while in the latter we have only 
36. Case 19, Sims, is omitted, as the operation, begun per vagi- 
num was abandoned, it being impossible to remove the adherent 
ovaries; 38, Kceberl6, can not be classed as one of Batte3’’s Oper- 
ations, and 43 and 44, Hegar, are too recent to permit a state- 
ment of the result to be given as yet. 30 
Engelmann : Battey’s Operation j 
No. of 
Ca.se. 
Operator. 
Locality. 
N umber 
of Opera- 
tor’s case 
Indication of Operation, 
aUUuiumal 
or Vaginal 
Operation. 
One or 
both Ovaries 
removed. 
Condition ol 
Ovaries when 
noted. 
Result of Operation. 
39 
Hegar .... 
Freiburg 
5 
Large, rapidly growing uterine fi- 
broniyoma. 
Abdominal 
1 a t e r al, 
direct 
over ovar’s 
Both. 
At first improved, later growth of 
tumor, hemorrhage pain, fever. 
4» 
6 
Perioophoritis, salpingitis, perime- 
tritis, retrofllexio, dysmenorrhoea,... 
Abdominal 
Both. 
Cystic 
Cured, menopause , 
41 
Kaltenbach 
Abdominal 
Both. 
Died 
42 
Freund .... 
1 
Abdominal 
Baih. 
Died 
43 
Hegar 
Freiburg 
- 
Oopho itis. salpingitis, dysmenor- 
rhtea, antiflexion .' 
Abdominal 
direct iat’1 
method. 
Both. 
l oo recent, apparently improving.:.. 
44 
8 
Dysmenorrhoea, ova algia 
Abdominal 
Both. 
Too recent, pain disappeared at once. 
4A 
9 
Uterine fibromyoma of rapid growth 
mennorrhagia. pain 
Abdominal 
Both. 
4<; 
Martin . .. 
Berlin... 
1 
Uterine fibromyoma, menorrhagia, 
metrorrhagia 
Abdominal 
Both. 
Normal 
Greatly improved ; menopause ; tu- 
mor decreasing. 
47 
2 
Subserous uterine fibroids; dysmen- 
orrhoea. pain, epileptic attacks. ... 
Abdominal 
* 
Both. 
Normal 
Greatly improved,; menopause ; tu- 
mor decreasing. 
* Kedus abdomimw of one side cut transversely to reach the ovary. 
* 
SUPPLEMENT TO TABLE I. 
TABLE I. a. 
CONTINUED LIST OF CASES. A Brief Summary of Results. 
31 
Omitting these four cases from the list of 47, 43 are left for 
the compilation of Tables II. a ami Til. a. 
TABLE II. a. 
CLASS OF CASES OPERATED AND RESULTS ACHIEVED. 
Results. 
Rell 
r<)s 
INDICATIONS. 
>x Sen- 
ses. 
11 e m o rr- 
hage Ute- 
rinei* ibr’d 
Malforma 
ti >n Sex- 
lalOrgai 
J v a r i a i 
Dyonen- 
orrhoea. 
Ovaritis, 
ivaralgia 
If-. 
Total. 
* 
No. 
t'erCt 
No. It'erCt 
No. 
Pe. C. 
.So. 
t'erCt 
no. ,1'erOt 
No. 
I’er Ct. 
‘2 
(j.i. (>; 
.33.33 
. .3. 1.14.28 
. .9. 
..29.93, 
G. eatlvImpro - 
5 . 45 4 
1 4 76 
a 
. .13.95. 
Somewhat Im- 
proved 
1 
. ..r) ). 
. 1.. .9:09 
. i 
. 18.63 
.2. |..9.52 
. .0 
11 62t 
Made Worse . 
. . .3. 
(> 98 
Survived Op- 
e i at ion 
1 
..50.. 
.8. . 1.79.72 
*; 
.66.69 
. .5).. 
17. .71 4i 
. .29 
..67.44. 
I ied 
1 
. V* 
.27.27 
. .1. 
.33.33 
. .5 ). . 
. .6. .28.77 
. .14 
..32.55. 
To nl 
2 1 
..4.65 
.11. 1.25.5. 
8. .31 
. .6.91 
. .6. 
.41.95 1 
.21. ; .48.83 
. .43 
. 100 
Table II. a shows the various affections which have served as 
indications for this operation and the results which have been 
achieved. 
In twenty one of the 43 cases the operation was performed on 
account of suffering due to ovaritis and ovaralgia, and in six on 
account of ovarian d}Tsmenorrhoea, so that ovarian disturbance 
served as the indication in twenty-seven of the cases ; next in fre- 
quency. suffering and uncontrollable hemorrhage, due to uter- 
ine fibroids and fibromyomata, led to the extirpation of the ova- 
ries (11 cases)—a simpler operation than hysterotomy; malfor- 
mation of the sexual organs and menstrual molimina in three 
cases, and reflex neuroses in two. 
In 27 cases the ovaries were diseased, while in the other 16 
they were normal, and removed only to bring about the meno- 
pause. 
The results of the operation, as regards the danger to life, 
are 14 deaths, 32.5 per cent., and 29 recoveries, 67.4 per cent.; 
somewhat less favorable than it appeared in the previous anal- 
ysis of 36 cases, which gave a mortality of 31.5 per cent, with 
69.5 per cent, recovered. 
Of the twenty-nine patients who survived the operation, 20 
were improved, 46.5 per cent, of the whole number operated on, 
while 9 wem not bettered, 20.9 per cent.; to be more precise, 9 
were cured, 20.9 per cent., 6, 13.9per cent.'were greatly improved; 32 
Engelmann : Battey’s Operation; 
5, 11.6 per cent, somewhat improved ; 6, 13.9 per cent, not im- 
proved, and 3, 6.9 per cent, made worse. 
The happy result obtained in the first five cases in which both 
ovaries were removed to bring about tbe menopause and check 
hemorrhage from uterine tumors—all successful—has been some- 
what marred by more recent records, three deaths occurring 
among the 11 patients operated on, 27.2 per cent., a mortality 
still somewhat below that found under other indications, and I 
would especially remark, that those who survived were all im- 
proved; 2 cured, 18 per cent.; 5 greatly improved, 45.4 per cent, 
and one only at first somewhat improved, and soon relapsing into 
the old condition. 
In cases of ovaritis and ovaralgia with degeneration of the 
ovaries, we find a mortality of 28 per cent.; but of the 15 who 
survived this operation only 6 were improved, 28.5 per cent, of 
the 21 cases, while 9 were not improved 42.8 per cent. I may at 
once add that this unfavorable result is due to the extirpation of 
only one ovary, or to the incomplete removal of both in some of 
the earlier operations by the vaginal method. 
Three of the six cases of ovarian dysmenorrhoeawere relieved, 
three proved fatal. 
In the three cases in which the operation was performed to 
relieve the menstrual molimina, in malformations of the sexual 
organs, we have two cures and one death. 
TABLE III. a. 
Ovaries removed. 
MODE OF OPERATION . 
Incision. 
TOTAL. 
Results. 
Both. 
One. 
Abdominal 
Vaginal. 
No. 
I'er Ct. 
No. 
I'er Ct. 
No. 
Per CT. 
.So. 
Per CT. 
No. 
'er ( i 
Cured 
8 
25.8 
1 
8.3 
0 
23. 
3 
17.(14 
9 
2 • 93 
5 
1(5.1 
1 
8.3 
(5 
23. 
13.95 
Somewhat improved. 
:j 
iUi 
2 
1(5. (i 
3 
11.3 
2 
11.71 
11 (52 
2 
4 
;>:{. 3 
(> 
35.2! 
(5 
1.1.95 
8 
*24 <> 
3 
Survived Operation... 
IF 
58. 
U 
91.15 
io 
f)/ 
14 
82.3. 
.44 
Died 
18 
41.9 
i 
8t3 
11 
42.3 
3 
17. (54 
14 
8*2.5T» 
Total 
31 
7-'. 
12 
28. 
2G 
(50.4(5 
17 
39^>3 
43 
UK). 
METHODS OF OPERATION AND TIIEIR RESULTS 
The increase in the number of cases lias made a slight change 
in the mortality as occurring in those operations in which both 
ovaries were removed, (Tab. III. a); the per centage of deaths as A Brief Summary of Results. 
33 
obtained from the 36 cases of Tab. Ill, was 38.4 per cent.; ten of 
the 26 in which both ovaries were extirpated, while we have in 
the 43 cases, as shown by Tab. III. a, a mortality of 41.9 per 
cent.—13 of the 31 cases; 5,16.1 per cent, were improved ; 3,9.6 
per cent, somewhat improved ; fortunately no additional cases 
are recorded of the removal of only one ovary, so that the per 
eentage is unchanged; 1 in 12 died, 8.3 per cent.; 58.0 percent, 
however, are not improved, and only 33.0 per cent, are im- 
proved to 51.5 percent, improved by removal of both. 
The correct tendency of the later methods of operation is also 
shown by-the fact that the recent operations were all performed 
by the abdominal section. 
The percentage of deaths remains the same, 42.3 per cent, 
of the abdomnial and only 17.6 per cent, of the partially incom- 
plete vaginal sections proved fatal, but 57.5 per cent, of the ab- 
dominal sections were improved to 29.4 per cent, of those oper- 
ated on by the vaginal method. 
There are several points of a more general interest in the 
histories of the cases operated on by myself, to which I would 
again call attention, although they have been referred to in the 
previous paper. {Am. Journal Obst., July, 1878, pp. 465,466.) 
The unilateral sweating, in case II, which I had occasionally 
observed, was on the affected side, the left, in which the patient 
located all her sufferingand where the degeneration of the ovary 
bad progressed farthest. 
This is perfectly analogous with the the case of a gentleman I 
have recently seen ; he is lamed on one leg, in consequence of an 
infantile paralysis, and occasionally, not at all times, exertion 
will produce unilateral sweating on that side of the face corres- 
ponding to the paralyzed extremity. 
In case If, the repeated use of jaborandi, continued for almost 
a week, caused a decided increase of the symptoms; the right 
side remaining dry while profuse, cold perspiration invariably 
appeared on the entire affected left side. 
I remark this, because Drs. Ringer and Bury, in their article 
on “The Effect of Pilocarpine (the Alkaloid of Jaborandi) on 
two cases of Unilateral Sweating,”* cite two cases, in most 
both of which the first injection of pilocarpine caused the most 
profuse sweating on the normal side, while further experi- 
* Practitioner, Dec., 1876—ref. American Journal of Medical Science, 
April, 1877. 34 
Engelmann : Battey’s Operation-, 
ment showed that the injection would sometimes be followed by 
more profuse sweating on the one side, sometimes on the other; 
one of the patients, in whom they could not determine the cause 
of the affection, was cured by the use of the Jaborandi, while 
in the other, an apoplectic, the adnormity was somewhat lessened, 
but not controlled. . 
The collapse which followed traction on the ovary, I first ob- 
served in case II, in a very marked degree, the pulse becoming so 
slow and feeble, respiration flagging, that chloroform was stopped 
and we were somewhat alarmed about the patient, until it was 
observed that as the traction was diminished she at once rallied, 
and that the same symptoms followed each traction on the 
ovary. In case III the phenomenon was not quite so marked. 
The same symptoms have recently been several times observed 
by Dr. J. T. Ilodgen, in operating for varicocele, whilst tighten- 
ing the ligature; the appearances, at first, until their recurrence 
demonstrated the cause, were such that the anaesthetic was 
stopped and respiration stimulated. 
These facts, once known and thoroughly understood, may save 
the operator some annoyance. 
I have adopted the just suggestion of Marion Sims, and have 
spoken of the operation as Baitey’s Operation, because the 
difficulty which Sims refers to of finding a name sufficiently dis- 
tinctive and characteristic of this .operation, has not yet been 
remedied, and we, moreover, owe the operation to Battey. 
term, Normal Ovariotomy, is inapplicable, as it is in rare 
instances only that the ovaries are found to be in a normal con- 
dition in cases in which the operation is indicated; some have in- 
appropriately spoken of it as Spaying, (extirpation of healthy 
ovaries,) and recently Hegar terms it The Castration of Women, 
less correct even than his predecessors in the choice of names, 
unless we allow a liberal deviation from the ordinary signification 
of the word castration. 
It is ovariotomy proper, and Ovariotomy it should be called, 
were not that term now, by long continued usage, given to the 
operation for the extirpation of ovarian tumors; since this, the 
only distinctly correct term, analogous to ihat used for the re- 
moval of other organs, has already been adopted for a totally dif- 
ferent operation, although upon the same gland,let this new oper 
ation be known the name of its author. 
There seems to be no dispute as to who this is, but there cor- A Brief Summary of Results. 
35 
tainly is a disposition to evade an open acknowledgment. 
1 do not propose to enter upon any unnecessary arguments, 
as a plain statement of the tacts in the case will allow every 
unprejudiced mind, to judge to whom the honor is due. 
Prof. Hegar, of Freiburg, seems inclined to claim the opera- 
tion, because he had once peribrmed it a short time previous to 
Battey’s first case, but the patient died, and with her the opera- 
tion was buried—like the unsuccessiul cases of others, this 
one was not published, nor did Hegar operate again until four 
years later, and not until Battey, Thomas, Gilmore, SabinO, Yan- 
dell and McClellan, Peaslee and Trenholmehad given their expe- 
rience to the world, and the operation had been discussed in 
many of the County and State Medical Societies ol America; 
not until then did Hegar issue his first publication (Stahl, Die 
anticipirte Climax, Deutsche Men. Wochenschrift, No. 50, Berlin, 
Dec. 1876) and make known his first two cases in which he suc- 
cess! tilly removed the ovaries to control hemorrhage resulting 
from uterine fibroids; even in this adaptation of the operation 
was he anticipated b}’ Trenholme, ot Montreal, both in time of 
operation and of publication. 
Resume. 
DATE 
| opk’tok. 
| REMARKS. 
July 27, 
1872 Hegar’s.. 
. First case ovaries removed for ovaralgia, patient died. 
Aug. 17, 
1872 Battey’s.. 
First case ovaries removed to relieve menstrual molimina; 
convulsions, repeated attacks of pelvic cellulitis—suc- 
cessful . 
Sept. 
1872 Battey ’... 
First publication. 
Dec, 
187(5 Hegar’s.. 
. First publication. 
Jan. 
187(5 Trenholme First successfully removed the ovaries to check the oiher- 
wise uncontrollable hemorrhage due to uterine tumors. 
July 
1876 Trenholme First published his case. 
Aug. 
1876 Hegar 
. First successfully removed ovaries to check hemorrhage due 
to uterine fibroids. 
Dec. 
1876 Hegar 
. First published his two cases. 
LITERATURE.—SUPPLEMENTARY. 
Budin and 
Beigeg, .... 
Martin, .... 
Hkoah 
Kngklmann 
(LJodecl , .. 
Kngelmans 
> Review, 
Zur Ovariot'irnie 
Die Castration die Frauen. 
Ttie Difficulties »nd Dan- 
gers of Battey’s Operati on... 
A Case of Spaying for Fib- 
roi l Tumor of the Womb.... 
i,Battey’s Operation : Three 
Fatal Cases, with Sopie lie- 
marks upon the Indications 
for the operation, 
1 
Centralblatt fur Gyn | 
Berliner Klinische. 
Wochenschrift 
Volkmann's Sammelung 
Klin. Vortreege, 136-138 
Tram. Am. Med. Association 
Am Journal of Med. Sciences 
American Journal of Obstetrics i 
March, 1878, 
No. 8. 
April, 1878. 
Nos. l.i St 18. 
Maj’ 22, 187S 
Head, June, 
1878. 
July, 1878. 
July, 1878.