Ovariotomy, in Surgery, the excision of the ovaries. The ovaries in the female are analogous to the testes in the male, and are two oblong flattened bodies (about an inch and a half in length, three-quarters of an inch in width, and nearly half an inch thick in the human subject), situated on either side of the uterus, to which they are connected by ligaments and by the Fallopian tube. The ovary is composed of two well-defined portions, a superficial or 'cortical' portion, and a deep or 'medullary' portion. The whole is enclosed in a tough fibrous coating, which is, however, closely blended with the cortical portion, and cannot be stripped off. It is termed the tunica albuginea. The medullary portion is highly vascular, and of a reddish colour. The cortical portion in the adult ovary contains an enormous number of vesicles, varying greatly in size. These are the Graafian follicles, and contain the ova or germs—the female element of reproduction. Their number is estimated at 30,000. From ten to twenty large and more or less mature vesicles are found near the surface, to which they gradually approach as they become developed. The structure of these ovisacs and their contained ova is somewhat complex, and cannot be described here. More or less coincident with menstruation is the process of ovulation, by which is meant the rupture of the wall of Graafian follicle, and the escape of the contained ovum. On its escape from the ovary the ovum enters the end of the Fallopian tube, by which it is conveyed into the uterus.
The ovary is the subject of several diseased conditions. (1) It is the seat of acute and chronic inflammation. This may arise from injuries during labour, operations in the pelvis, but very frequently is the result of gonorrhoeal infection, spreading from the vagina. Such inflammations cause great organic changes in the structure, often leading to sterility, and they are usually associated with severe pain, frequently so intense as to unfit the subject for all active duty. (2) The ovary is the seat of new growths, which may be of several varieties. Some represent enlargements of one or more Graafian follicles, and attain an enormous size, sometimes weighing 100 lb. or more. They contain fluid which is usually of a viscid, ropy nature, and brownish colour, but sometimes presents other characters. These are known as ovarian cysts. Other tumours are of a more or less solid nature, and contain portions of hair, teeth, bone, &c., and are known as dermoid tumours. Moreover, the ovaries may become the seat of cancerous disease with or without the occurrence of such tumours.
The treatment of ovarian disease by the removal of the offending organ is one of the triumphs of modern surgery. Formerly relief in cystomata was only obtained temporarily by tapping—i.e. withdrawing some of the fluid by means of a trocar and canula. But the tumour almost always filled again, and, though tapping might be repeated time after time, the patient ultimately succumbed. Now the abdominal wall is laid open, the tumour emptied as much as possible of its contents, the collapsed sac drawn through the incision, its neck secured by ligature or otherwise, the mass cut away, the stump returned to the abdomen, and the wound carefully closed by stitches.
Towards the middle of the 19th century the operation was performed by a few surgeons, under the protest of the great majority of the medical profession; now it takes its place as a routine operation, demanded in any suitable case, and performed with results as regards the saving of life and restoration to health, together with an immunity from risk, which can be claimed by no other major operation. The operation for extirpation of ovarian cystoma was first performed by Ephraim M'Dowell of Kentucky in 1809, but was established in England as a regular operation by Charles Clay of Manchester, who operated on his first case in 1842. Clay operated on nearly 400 cases with 69 per cent. of recoveries. Since then the operation has been performed many thousands of times, and the mortality has been reduced to a figure which renders the operation, while always one of the gravest, yet, in competent hands, one of the safest in surgery. To this result the labours in Britain of Spencer Wells, Thomas Keith, and Lawson Tait have mainly contributed. With the best operators the mortality at this moment is probably less than 5 per cent., and some have had series of over 100 cases without a death. This result has been ascribed to various causes, such as the mode of treating the pedicle, or stump, the use of antiseptics, &c., but is probably most due to the experience acquired in dealing with the various complications and difficulties arising in the operation.
Within the last few years the removal of the ovaries and Fallopian tubes for other than cystic disease has come to be recognised as a regular operation, and is now frequently performed. The conditions which are considered as demanding this are: (1) Chronic inflammation in the ovaries or tubes, resulting in the formation of pus, &c. in the latter, or giving rise to intolerable pain and discomfort, and rendering life utterly miserable; (2) cases of fibroid tumour of the uterus, in which life is threatened by the great loss of blood which these tumours often cause. Removal of the ovaries in these cases when possible is usually followed by cessation of growth and shrinking of the tumour, and entire stoppage of serious hemorrhage.
Consult Diagnosis and Treatment of Abdominal Tumours, by Sir Spencer Wells (1885), and Diseases of Women, by Lawson Tait (1885).