Does gynecian physiology look to the ovaries for the explanation of menstrual phenomena, and call upon surgery to remove them, in the vain hope of preventing the periodic flux, it finds that the unsacrificed tubes have a function which has certainly been overlooked.
Does the wily tumor, with almost sentient perverseness, defy diagnostic skill, the scalpel lets in the search-light of observation, and the wandering kidney, the cystic kidney, the hydro-nephritic cyst, the renal calculus, the mesenteric sarcoma, the tubercular agglutination, the lithopedion, the stay-liver, the malarial spleen, the pancreatic cancer, are all revealed, and a prognostic prediction saved from a diagnostic defeat.
Does the question arise whether autonomy depends upon uterine persistence, the hysterectomy determines that ovarian life is a separate life, and exists just as certainly as the human face after the mirror which reflected it is shattered.
Does a tuberculous peritonitis invade the abdominal cavity, thickening the delicate lining of that enormous lymph sac, studding intestinal wall and swelling mesenteric glands, surgery gives gynaecology another triumph, and, by its exploratory incision, changes the whole aspect of affairs-a pathological miracle is wrought, and the grave literally robbed of its victim.
But enough! Why multiply examples? Modern gynaecology is a splendid structure, but the hand that holds the torch is the hand that holds the knife.
DISCUSSION.
H.E. BEEBE, M.D.: The subject is certainly one which has been well handled, and I gladly admit my incapacity to add to or justly criticise the paper of my friend Dr. Walton.
To my candid observer it must be plain that progress is stamped upon the doings of everything closing the scenes of the nineteenth century, whatever be the department.
Effective work in all branches of science and art is the basis of success. Specialist are ever in demand.
Positive specific results muse be attained to merit worthy commendation. To-day “fads” are short lived; the twentieth century is to be inaugurated with fewer shams. Perfection is the goal in view.
Surgery is not an exception, and it is impossible to ignore the prominence which gynaecological surgery has everywhere assumed. It is called to accomplish what non-surgical agencies have failed to do-mechanically correct false physiology and pathology.
Abnormalities are to be ameliorated, and cured, if possible, and that too by the most conservative measures. The may be by simple methods or the most expert work.
Effective surgery depends upon knowing when to use it, skill and thoroughness in its performance and efficient after- treatment. Many surgeons are good operators, but are careless in the subsequent attention. To avoid infecting the wound is as important as brilliant operating.
Surgical diseases of women are no small part of the gynaecologist’s practice. Of morbid growths alone, both malignant and benign, affecting the human race, more than 75 per cent. belong to the female organs of generation and are either uterine, ovarian or mammary.
With this fact, and knowing that morbid growths are but a small part of the surgical diseases of women, certainly there is a broad field for surgery in this speciality.
About one-third of all physicians claim to be gynaecologists. To fully ninety-nine-hundredths of this number the teachings of diseases of women have not been thorough and practical. The average gynaecological specialist is capable of doing many of the simpler operations through the natural passages, but it is a great mistake for amateurs who have never done major surgery to attempt operations through artificial openings involving the peritoneum, such as are considered in this paper.
The surgical novices have no business doing this internal major surgery. Few gynaecologists are trained abdominal surgeons; they have not spent enough time in the study of visceral anatomy in the dead-house, nor been in the clinical fields, eye-witnesses “to the scalped to living tissue” by experienced operators. Training and experienced observation are very necessary for so important a work.
To depend upon self-experience alone to learn major surgical gynaecology at the patient’s risk is a responsible matter. Abdominal surgery is a specialty within itself, and needs as much preparation as any specialty.
There are too many laparotomies done and too many untrained operators are doing them to the great detriment of justifiable work. The surgeons lacks acquired knowledge and skill, besides the facilities for doing good work. Seldom, except in emergency, is laparotomy warrantable without a room thoroughly prepared for it.
Skilled abdominal surgeons to-day have a uniform mortality of only about 10 per cent., and a per cent. greater then this usually means incompetency.
The advance made in the field, and so well shown in the paper, has been by experts well trained in antisepsis and the anatomy, physiology and pathology of the female organs of generation.
They knew what to do, when to do it, and how to do it. They knew “the relation of surgery to gynaecology,” and that “the hand that holds the torch is the hand that holds the knife.” .
DR. HANCHETT, of Omaha: I am not here to criticise this noble paper which has been read, but to say “amen” most heartily to it. I make no claim to being a gynaecologist. I treat some cases in my office, as all physicians in general practice, do but I want to say to every general practitioners here that when we have a case of operative surgery in the line of gynaecology we should sent it to a specialist. I have seen in my own city, and many of the western cities of this country, many a life lost by foolish operative surgery on the part of so called gynaecologists who did not understand their business.
Mr. AYERS, M.D., of Rushville, Illinois: I live in a little country town, and we have a few patients of the kind referred to by the last speaker. Ninety-nine out of a hundred of them haven’t got money enough to get out of town. What are you going to do about it? I say do the work the best you can.
PHOERE J.B. WAITE, M.D.: I have enjoyed the paper most heartily. I am frequently in the habit of passing down the bay in New York and observing Liberty enlightening the world-a beautiful statue, to be sure-and I admire the application made in the paper. However much I may admire surgery, I would make the plea for medical treatment in gynaecological practice. The surgeon has come to be prominent in gynaecological practice, and surgeons and physicians are too fond or using the knife. I have seen too many young women, who, have passed under the surgeons knife from whom the ovaries have been removed single women and married women who in my opinion, might have been spared this infliction, because it is a very great infliction.
I have in mind a beautiful young wife who came to me about nine months ago in a very despondent frame of mind, very much distressed over a diagnosis which had been made in her case, and had been told there was no help for her except in the removal of the ovaries. Said I : “You are a stranger to me, but if you were my daughter I would as soon you had your head cut off as to have your ovaries removed.”
She consented to give up the operation and placed herself in my hands. She had been told that she could have no more children, and she was very anxious to become a mother. I took the case, and three months ago she came to me looking bright and happy, and informed me that she was three months pregnant. So much for taking hold o a case medically.
I have also in my mind a young unmarried woman who suffered from dysmenorrhoea, and she passed under this skilled surgeon’s hands; the ovaries were removed, and she did not get better. She grew worse, and to-day she is hopelessly insane. I believe she might have been cured if the Homoeopathic remedies had been carefully studied in her case.
While, as I say, I have great respect for surgery, I have still greater respect for medical treatment.
MARTHA J. RIPLEY, M.D.: I wish to emphasize the remarks made by the last speaker. While agreeing with the very able paper in cases of dire necessity, I should not be true t my convictions as a physician and as a woman if I did not say call a halt on your operations upon women. It is high time that you did so, because to-day many a woman is being operated on in all of our large cities, and in some of our small ones, who needs no operation at all. I could recall case after case of women who are to-day in insane asylums.
My dearest friend went to her grave a week ago from an operation by a skilled gynaecologist. Those operations needed, but beware how you practice them upon women who do not need them. Practice and study your Materia Medica. It is well that some of you do live in small towns where you cannot get skilled surgeons, or I fear there would be very few of your women patients left.
Now, I am looking in the faces of young men who come here and listen to the words of the older surgeons, and I recall what a student of my own said. He came to me and said he was going to perform what I considered quite a difficult operation on a lady. I said to him, “Well, I have got to learn some time, why shouldn’t I begin now?” If you have got to learn upon women, go where those who are your teachers can teach you.
