OVARIAN INSUFFICIENCY 181 



recorded 1 . This method of treatment is only applic- Ovarian 

 able, of course, to patients on whom oophorectomy tfon. SP * 

 has been performed before the menopause. 



In the first place it is well to emphasize the fact 

 that transplantation can only be required in certain 

 cases : in all but those of malignant disease careful 

 operative technique usually enables us to preserve some 

 portion of one or other ovary ; while in malignant 

 disease it is quite clear it would be wrong to transplant 

 any portion of an organ which may contain cancer cells, 

 and, moreover, with malignant disease the woman is 

 usually about or past the physiological menopause. It 

 will be quite evident, then, how restricted is the field 

 in which transplantation can or should be employed, 

 especially when we add to the above statements the 

 information that the ovarian grafts must be autogenous, 

 for in the human subject homogenous grafts almost 

 always perish (fig. 60). 



When a transplantation is carried out, and I rarely 

 practise the procedure except in suppurative salping- 

 oophorectomy, I have found it best to use a wedge- 

 shaped piece, not more than a quarter of an inch in 

 thickness, from which the capsule has been removed. 

 Tuffier, however, buries in the abdominal wall a 

 complete ovary after its removal. The disadvantages 

 attending Tuffier' s procedure are : first, such a large mass 

 of ovarian tissue without raw surfaces cannot be properly 

 vascularized ; second, if it were to be partly vascular- 

 ized pain and swelling might be caused by the ripening 

 Graafian follicles, which would be unable to rupture 

 owing to the encapsulation of the ovary ; and third, 

 the unruptured follicles would form cysts (p. 47). 

 These disadvantages are said to be frequently seen if the 

 whole ovary be implanted. 



If, however, a thin portion of ovary without the tunica 



1 I hope shortly to publish a larger series of cases in my own 

 practice. Excellent summaries of the literature in regard to ovarian _ 

 transplantation have been given by Franklin H. Martin (Surg. Gynecol. 

 andObstet., 1915, vol. xxi, p. 576; Trans. Amer. Gynecol. Soc., 1917, 

 vol. xlii, p. 257). 



