[186] _Jour. Obstet. and Gynecol. of Brit. Empire_, March and April, 1910.
[187] _Trans. Amer. Gyn. Soc._, vol. xxxvi, p. 324.
[188] Norris, _Gonorrhea in Women_, p. 289.
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.
[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.