the operation hemorrhage may be controlled by an assistant, who compresses with his fingers the vessels on each side of the uterus, or by placing a temporary rubber ligature about the cervix uteri. Hemostasis is effected and the wound in the uterus is closed by layers of continuous or interrupted catgut sutures. Great care should be taken to prevent hemorrhage between the layers of suture, and to insure accurate closure of the incision in the uterus. The temporary ligature about the cervix, or the compression of the vessels of the broad ligaments, should be removed from time to time during the process of suturing and after closure of the uterine wound, in order to determine the position of bleeding points and the efficiency of the hemostasis; and before closing the abdominal incision. the uterine wound should be inspected for several minutes while the woman is in the horizontal position. The abdomen may usually be closed without drain age. CHAPTER XLIII. THE EFFECT OF THE REMOVAL OF THE UTERINE APPENDAGES. REMOVAL of the tube and ovary upon one side has no effect upon menstruation or upon any of the other characteristics of the woman. Removal of the tubes and ovaries upon both sides is followed within forty-eight hours by slight bleeding from the uterus, lasting for one or two days. If the removal of the tubes and ovaries has been complete, menstruation, in the majority of cases, never re appears. In a few cases menstruation appears for one, two, or three periods after the operation, usually in diminished amount, and then ceases for ever. In some other cases there is a period of a few months of amenorrhea, followed by two or three scanty menstrual flows, before the bleeding permanently ceases. These phenomena, it will be observed, are similar to those of the normal menopause. The woman after double salpingo-oophorectomy experiences the nervous and gastro-intestinal disturbances. that so usually accompany the menopause. She, in fact, passes through a premature menopause, the phenomena of which may persist for one or two years. The secondary sexual characteristics of the woman-the voice, the figure, and the growth of hair-are not altered if the appendages are removed during adult life. The case may be different if the appendages are removed in the undeveloped girl, in whom the ovarian influence is essential for complete development. The woman loses none of her feminine attractions. She may, indeed, become better-looking if the operation has relieved chronic suffering. It is said that Gyges, king of Lydia, caused the removal of ovaries from women with a view to prolonging their charms. Double oöphorectomy may be followed by obesity if the woman have a tendency to form fat. The relief of suffering and the consequent improved nutrition favor the development of obesity. There seems to be nothing inherent in the operation to cause it. Many women remain thin after the operation. The emotions of the woman are unaltered by double oöphorectomy, with the exception of some cases in which the sexual desire is destroyed. Sexual desire is dependent upon such a variety of conditions, both within and without the woman, that it is difficult to determine the amount of influence that removal of the ovaries exerts upon this feeling. It is undoubtedly true that sexual desire is sometimes. destroyed by the operation. On the other hand, the sexual desire is very often restored by the operation, which relieves the former dyspareunia, or painful coitus. INDEX. ABDOMEN, binder for, 464 distention of, after celiotomy, 482 drainage of, 465, 468 enlargement of, 21 examination of, 21, 23, 24, 30 exploration of, 473 fluctuation in, 22 protection of contents of, during operation, 474 retentive power of, 97 sterilization of, for operation, 458 operations, dressing of, 463 closing of incision in, 476 of vulvo-vaginal glands, 40, 42 of uterus, malignant, 217 pelvic, treatment of, 494, 497 emansio mensium, 391 Anesthetizer, duties of, 455 Animals, disease of reproductive or- gans in, 17 Anteflexion of uterus, 117 causes, 117, 120 menstruation in, 120 Carcinoma, cachexia of, 190 of cervix, 179 broad ligaments in, 183, 191, 192 diagnosis from lupus, 186 from syphilitic ulceration, 186 peritoneal involvement in, 183 treatment, 191, 193 ureteral involvement in, 183 of Fallopian tubes, 216 of uterus, body of, 214 Catarrh of cervix, 164 Catgut, sterilization of, 462, 463 Reverdin's method, 463 Catheterization, after celiotomy, 480 as cause of cystitis, 423 Celibacy a cause of disease, 20 Celiotomy, 298, 305 abdominal distention after, 482 bowels, after-treatment of, 481 food after, 481 hemorrhage after, 485 urinary secretion after, 481 in laceration of cervix, 150 Cervix, amputation of, 160, 161 in subinvolution of uterus, 212 atresia of, 19 of bladder, 421 |