[176] _Monatschrift f. Geburt. u. Gynä._, 1909, n. 20.
[177] _Zeitschr. f. Geb. u. Gyn._, 1907, vol. lix, n. 1.
[178] _Archiv. f. Gyn._, vol. xcii, n. 2.
In cases of chronic pelvic peritonitis the question comes up frequently whether the womb and both tubes and ovaries should be removed wholly or in part. The text-books decide the question without any heed whatever to the notion of the morality of mutilation as such. They take into account the age of the patient, whether she has children or is desirous of maternity, whether or not she supports herself by manual labor, her temperament and character, and the results attained by men who have tried various methods of operating.
The conservative surgery of the uterus and its adnexa in gonococcal pelvic peritonitis was for many years looked upon with disfavor by surgeons. These conservative operations often failed or later required secondary intervention. Preliminary palliative treatment as now used greatly lessened the number of failures. Operations in peritonic conditions are dangerous because they may let loose encysted bacteria and start up a general septic peritonitis, which may be fatal. By delay and palliative treatment the virulence of the bacteria subsides, except where the woman is reinfected by her husband. In any case the blood-count should have been normal for at least a month and a half before any surgical interference is attempted. Olshausen waited nine months to let nature disinfect the pus.
The removal of a part of a tube is called salpingotomy; the taking out of the whole tube is salpingectomy; the opening up of a shut tube is salpingostomy. The presence of pus in a tube is absolute indication for removal according to the gynecologists at present. Howard Kelly and others have succeeded at times in such cases with conservative surgery, yet such treatment is now deemed obsolete--the dangers and failures seem to overbalance the little good effected. The end of conservative surgery is to try to restore function without pain, to preserve menstruation and ovulation, to put the organs in a condition to make pregnancy possible, and to preserve the internal secretion of the ovaries. The ovaries, so far as the woman's health is concerned, are the most important of her generative organs. If a woman is at the end of her child-bearing age there is no reason to preserve the tubes when they are affected, and conservation is likely to fail; but the ovaries should always be preserved, wholly or in part, when possible.
