THE TESTICLE AND THE OVARY 377 



surgeons have advocated the operation of sub-total hysterectomy 

 wherever possible in preference to complete removal, believing that 

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

 presence of the uterus. 



Doran, 1 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. In a later paper 2 he mentions four cases in which both 

 ovaries were removed and the menopause was neither immediate nor 

 complete. He records forty additional cases of sub-total hysterec- 

 tomy, with after-histories, making a hundred in all. 



Mandl and Biirger, 3 in a monograph dealing with the subject, 

 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 degeneration 

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

 connections consequent upon the operation of removal. 



Graves 5 states that after hysterectomy vasomotor disturbances 

 ensue with approximately equal frequency whether the ovaries be 

 retained in situ, totally oblated, or transplanted. Retention of 

 ovarian tissue after removal of the uterus is said to be of little or no 

 physiological value and may even be productive of serious trouble 

 to the patient owing to the formation of cysts or adhesions. 



Blair Bell 6 once suggested that menstruation was brought about 

 by an internal secretion of the uterus, while he supposed ovulation 

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

 " uterine." 



Bond" has put forward the view that the ovarian secretion is 

 influenced by a saline secretion from the anoestrous uterus, the two, 

 however, acting antagonistically to one another, so that the prevention 

 of the uterine secretion by hysterectomy favours the hypertrophy of 



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

 1905. 



- Doran, "Sub-total Hysterectomy for Fibromyoma Uteri," Proc. Roy. Soc. 

 Med., (February) 1911 ; Lancet, vol. clxxx., (14th Jan.) 1911. 



3 Mandl and Burger, Die Biologische Bedeutung der Eierstocke nach Entfernung 

 der Gebarmutter, Leipzig, 1904. 



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

 zuriickgelassenen Ovarien," Arch.f. (tt/nak., vol. Ixxx., 1906. 



5 Graves, " Retention of Ovarian Tissue after Hysterectomy," Surg., Gynec. 

 and Obstet., vol. xxv., 1917. 



Blair Bell, loc. cit. But cf. The Sex Complex, London, 1916. 

 7 Bond, "Some Points in Uterine and Ovarian Physiology and Pathology 

 in Rabbits," lint. Med. Jour., Part II., July 1906. 



