346 THE PHYSIOLOGY OF REPRODUCTION 



Zweifel and Abel, 1 in describing the after-histories of cases 

 of hysterectomy, stated that, in their experience, when the 

 whole of the uterus was removed, entire atrophy of the ovaries 

 always followed, so that menopause symptoms set in similar 

 to those occurring after ovariotomy. In those cases, however, 

 in which a portion of the uterine mucous membrane was con- 

 served, menstruation continued and there were no menopause 

 symptoms. Consequently, these surgeons have advocated the 

 operation of sub-total hysterectomy wherever possible in pre- 

 ference to complete removal, believing that the functional 

 activity of the ovary is in some way dependent on the presence 

 of the uterus. 



Doran, 2 in tracing the after-histories of sixty cases of sub- 

 total hysterectomy, is disposed to concur with Zweifel and 

 Abel in advising that the uterus should be removed above the 

 cervix. In support of this contention he cites two cases in 

 which menstruation persisted after the removal of the body of 

 the uterus, the cervix being left behind. 



Mandl and Burger, 3 in a monograph dealing with the sub- 

 ject, express the belief that in those cases in which the ovaries 

 are conserved after hysterectomy there is a gradual cessation 

 of function on the part of these organs, resulting from their 

 degeneration. 



Holzbach, 4 on the other hand, states that as a rule the ovaries 

 do not atrophy after hysterectomy, and that, when such de- 

 generation does occur, it is probably due to interference with the 

 nervous connections consequent upon the operation of removal. 



Blair Bell 5 has suggested that menstruation is brought about 

 by an internal secretion of the uterus, while he supposes ovula- 

 tion to depend on the circulation of this secretion, which he 

 calls " uterine." 



1 Zweifel, " Deutsche Gesellschaft fiir Gynakologie in Berlin," Zentral. f. 

 Gynak., No. 21, 1899. Abel, " Dauererfolge der Zweifelschen Myomek- 

 tomie," Arch.f. Gyncik., vol. Ivii., 1899. 



2 Doran, "Sub-total Hysterectomy for Fibroids," Lancet, Part II., 

 November 1905. 



3 Mandl and Burger, Die Biologische Bedeutung der Eierstocke nach 

 Entfernung der Gebdrmutter, Leipzig, 1904. 



4 Holzbach, " Ueber die Function der nach Totalextirpation des Uterus 

 zurtickgelassen Ovarien," Arch.f. Gyndk., vol. Ixxx., 1906. 



5 Blair Bell, loc. tit. 



