The Ethics of Medical Homicide and MutilationO'Malley, Austin
Religion
The Ethics of Medical Homicide and Mutilation
O'Malley, Austin
Medical ethics
When there is pus in the ovary, resection, in the opinion of
gynecologists at present, is not an advisable operation; the ovary
should be removed. Watkins,[189] however, says he resects small
ovarian abscesses in young women with good results. In resection the
blood supply is, as has been said, usually disturbed, and the cause
for the operation is, as a rule, the gonococcus, and both these
circumstances make the prognosis bad. The stitches necessarily used
in resection operations are an additional source of irritation.
Turetta[190] speaks in favor of resection in certain cases. A single
retention cyst may be resected, especially when pedunculated.
Boldt[191] had only one bad result in forty-five resections where a
part of the ovary was saved. If the blood supply after the resection
is evidently to be poor, resection is useless. Skill in surgical
technic has much to do with success in all these cases. When the
uterus is removed because of tumors, even near the time of the
menopause, if one or both ovaries can be left in, this should be
done. In such conservative operations Dickinson found 80 per cent.
of the patients free from nervous disturbance at the time of the
menopause.
[189] _Jour. Amer. Med. Assoc._, January, 1913.
[190] _Il Policlinico_, January 3, 1919.
[191] _Trans. Amer. Gynecol. Soc._, vol. xxxiv, p. 327.
Philadelphia, 1909.
Polak[192] describes an operation for the preservation of the
menstrual function in double suppurative disease of the tubes
and chronic metritis. He maintains that even if only one tube is
infected, both should be removed because this apparently sound
second tube will later, almost as a rule, show infection--probably
by extension from the fundus of the uterus inside. Ordinarily
inflammation of the tubes happens to be bilateral. Owing to the
persistence of the gonococcus in the uterine muscle, surgeons are
inclined to the removal of the whole uterus and both tubes. After
such an operation menstruation ceases, and in the removal of the
uterus the blood supply to the ovary is interfered with so that
the ovaries degenerate. The consequent artificial menopause has
a decidedly injurious effect on the woman's general physical and
mental health. The parts of the uterus permanently infected by
chronic gonorrhea are the cervical region, the fundus and the partes
interstitiales of the Fallopian tubes. Polak advises that in cases
where surgeons usually remove the tubes and the whole uterus they
should instead cure the cervical infection by the cautery and take
out the tubes, but in place of the removal of the whole uterus
they should cut out a wedge including the fundus and the partes
interstitiales of the tubes. This leaves the body of the uterus
and does not injure the circulation to the ovaries. In the last
seventeen cases thus operated upon by him he had success.
[192] _Jour. Amer. Med. Assoc._, December 8, 1917.
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