Ernest Rumley Dawson.

The causation of sex in man; a new theory of sex based on clinical materials together with chapters on forecasting or predicting the sex of the unborn child and on the determination or production of either sex at will online

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when doing hysteropexy, the normal ovary being removed
to facilitate reposition of the uterus.

Mr. Alban Doran 1 states he had " more than once de-
tected ovarian tissue in the ovarian ligament close to the
uterus and far from the anatomical ovary," so that though
the anatomical ovary be removed, some ovarian tissue is
still left behind in the pedicle stump.

1 " Trans. Obstet. Soc.," vol. xlvi., 1904, p. 102.


If the pedicle be long, owing to stretching and dragging
out of the ovarian ligament by a tumour, we cannot say how
far along it ovarian tissue extends, and so we are quite likely
to leave some ovarian tissue in it when we divide it to re-
move the tumour; if the pedicle be short, as Doran 1 says,
" the operator rightly dreads slipping of the ligature, and
so is apt to make it too long and leave a piece of ovary

Dr. J. Halliday Groom 121 confirms this: he says, "it is
often difficult to state for certain that the whole of the ovary
has been removed; a small portion may be left in the

In cases of ovariotomy performed during pregnancy,
Dr. W. Walter* says

" the closer to the uterine wall the pedicle was ligatured, the greater
the chance of irritation (of the uterus) resulting in miscarriage,
hence the pedicle was secured as far from the uterine wall as safety

Here we see a reason why ovarian tissue is sometimes left
behind in the pedicle, and a case published by Baldwin 4
proves it. The patient was pregnant. She had two
ovarian cysts, which

" had become adherent, but the tumours were distinct, and each
had quite a long pedicle. Owing to the known fact of her pregnancy,
care was taken to avoid any manipulation of the uterus."

The tumours were removed.

She has had two other children since the operation, but
the sex is not given.

It is evident that some ovarian tissue was not removed, for
though both ovarian tumours were removed, she became
pregnant twice after the operation, and I maintain that those
children were of the same sex if the ovarian tissue was
left on one side only; had some been left on both sides, then
it is possible she had children of both sexes that is, either
pigeon-paired twins, or else male and female children at

1 Doran, " Journal of Obstetrics and Gynaecology," vol. ii., 1902, p. 7.

2 Halliday Groom in " Allbutt and Playf air's Gynaecology," p. 343.

3 Dr. W. Walter, " Journal of Obstetrics and Gynaecology, " January
1903, vol. iii. p. 93-

4 Baldwin, op. cit., vol. iii., March 1903, p. 264.


different times after the double or bilateral ovariotomy
had been performed.

In the following case, reported by Dr. R. Stansbury Sutton, 1
the patient had an ovarian tumour on each side. Double
ovariotomy was performed, i.e. both ovarian tumours were

" This operation was done on October 20, 1892. On June 10, 1894,
the patient gave birth to a male child. Again, on February 25, 1896,
she was delivered of a male child."

Therefore a portion of an ovary must have been left
behind in the abdomen, and of whichever ovary it was
(I maintain it was a portion of the right ovary) the fact
remains, that that portion of ovary " bred true," that is,
it yielded two boys, not first a boy and then a girl. This
surely cannot be looked upon as a coincidence.

In another case, Dr. Balding, after ovariotomy by Spencer
Wells (whether bilateral, or which side is not mentioned),
delivered a patient of male triplets not two boys and a
girl, note. That is, the ovary not removed yielded three
children, all the same sex. I contend that either only the
left ovary was removed, or, if both were supposed to be
taken away, a piece of the right ovary was allowed to remain.

Here it will be well to call attention to a paper by Dr.
J. H. Dauber* who therein shows conclusively the reason
why patches of ovarian tissue are often to be found in the
ovarian ligament, and also he suggests sometimes in the
ovario-pelvic ligament. It is due to traction on the ovaries,
during development, by the muscle fibres in the ovarian

Besides being situated in these ligaments, there is very
strong reason to believe ovarian tissue is sometimes to be
found in between the layers of the broad ligaments, and
unconnected with the ovarian ligaments, or ovary.

Dr. Dauber 3 corroborates thus :

" It is generally believed either that accessory ovaries, or addi-
tional patches of ovarian tissue, like accessory thyroids in the neck,
may exist in the broad ligaments " ;

1 Dr. R. S. Sutton, " Geneva Gynaecological Congress," September 1896;
and " Trans- American Gynaecological Society," 1896, p. 105.

2 Dr. J. H. Dauber, " Lancet," Jan. 28, 1905, p. 224.

3 Loc. oil.




and a case reported by Baldwin^ proves this conclusively :

" On July 15, 1893, both ovaries and tubes were removed. No
adhesions were encountered. Sixteen months later, in November
1894, careful examination revealed a small mass of tissue to the left
of the uterus. When this was pressed upon, a sensation was ex-
perienced similar to that caused by pressure upon an ovary."

The abdomen was again opened :

" This mass of tissue, which was between the layers of the left
broad ligament, and apparently just below the remains of the
ovarian ligament, was identified and removed. It was about the size
and shape of a small Lima bean, and presented all the characteristics
of ordinary ovarian tissue. No other ovarian tissue could be found
at any other point, and the abdomen was closed. Menstruation
continued, however, showing that some ovarian tissue still remained

Let it be noted that both ovaries are definitely stated
to have been removed, yet ovarian tissue was found and
removed from between the layers of the left broad ligament ;
but in spite even of this, " some ovarian tissue still re-
mained," as evidenced by the return of menstruation.

I have therefore now enumerated three possible anatomical
sites in which ovarian tissue may sometimes be found in-
dependently of the true ovary, and therefore the removal
of the whole ovary or the whole of an ovarian tumour,
on both sides, does not invariably prevent a subsequent

And now we must consider the possibility of a super-
numerary ovary.

An extra or third true ovary, having the size, shape,
and activity of the normal organ separated from it,
and in association with a third Fallopian tube, is quite

Accessory ovaries, however, do occur, but not with the
frequency which Beigel claimed for them.

They are, Dr. J. W. Ballantyne z says, "probably con-
stricted portions of the normal organs which have been
separated at an early period in the development"; they

1 Baldwin, " American Journal of Obstetrics," December 1902, quoted
in " Journal of Obstetrics and Gynaecology," vol. iii., March 1903, p. 265.

2 Ballantyne, " Allbutt and Playf air's System of Gynaecology," 1906,
pp. 130, 131.



occur, he says, in " 2 to 3 per cent, of post-mortem examina-
tions." In rare cases, " the ovary has been found divided
into two nearly equal parts by such a constriction."

Sir J. Bland-Sutton l has always denied the existence of a
true third ovary. He admits of ovaries so deeply fissured
that a " portion of the gland is almost isolated," and the
ovary " seems to consist of two parts united by a narrow

Hence it must be possible for an ovarian tumour -to
develop in one part and not the other, and by its weight
and traction to gradually elongate this isthmus, so that,
when operated on, the isthmus between the two isolated
parts is divided by scissors instead of the true ovarian
ligament, and therefore a piece of ovary proper is left
behind, though the whole ovarian tumour is claimed to
be removed.

A case reported by Dr. Galabin 2 is very corroborative.
Two portions of the ovary, one containing a tumour, were
separated by three-quarters of an inch of ovarian ligament.
The portion nearest the uterus was the unaffected portion;
" on the ovarian ligament, close to the angle of the uterus,
another ovary was seen "; then, three-quarters of an inch
further along the ovarian ligament, the " outer portion of
ovary had become cystic." This was removed, the healthy
portion remaining untouched.

Hence, the complete removal of this ovarian tumour
would not be synonymous with the complete removal of
all ovarian tissue.

Mr. Alban Dor an 3 reports a reliable case of accessory
ovary. He says:

" In one ovarian ligament I found an accessory ovary, a condition
which may, in some cases, explain the persistence of menstruation
and the possibility of normal pregnancy after the removal of both
ovaries in operations for ovarian tumours, inflammatory disorders
of the appendages, and ectopic gestation."

That it was a true additional mass of ovarian tissue was
proved by Dr. Cuthbert Lockyer, who examined it micro-

1 Bland-Sutton, " Diseases of Ovaries," 1896, p. 25.

2 Dr. Galabin, " Trans. Obstet. Soc.," vol. xliii., 1901, pp. 268, 269.

3 Alban Doran, " Trans. Obstet. Soc.," vol. xlvii., 1905, p. 384.


scopically. Dr. J. W. Ballantyne 1 has found an accessory
ovary which had ovulated " at least once, for a cicatrix
was found."

A further case is recorded by Dr. W. P. Manton, of
Detroit, in the "St. Louis Medical Review/' January 1906.
He describes the case as a third* ovary, which was found
beneath the peritoneum of Douglas's pouch:

" The patient was a woman from whom one ovary had been re-
moved and the other one resected. The third ovary was about
one inch long and three-quarters of an inch wide. It had always
been very sensitive to pressure, and apparently gave rise to back-
ache. It was removed on the occasion of a second operation, and
since that time the symptoms have been relieved. Microscopical
examination showed that the structure had typical ovarian stroma,
and contained a few degenerated Graafian follicles."

It is very doubtful if this was a true third or supernumerary
ovary. It was probably an additional patch of ovarian
tissue, or accessory ovary.

We are forced, therefore, to believe in the very occasional
presence of an accessory ovary, quite apart from fragments
of ovarian tissue which may be left behind, either in the
ovarian ligament or elsewhere, when attempts are made to
remove ovarian tumours, more especially in those found to
be bound down by adhesions. And this supplies another
anatomical reason for the occasional occurrence of the birth
of a child after unilateral ovariotomy, whose sex agrees with
the ovary thought to be removed. The sceptic may claim
that the child came from the untouched ovary, but this
fails him when both ovaries have been removed ; we then have
direct proof that all ovarian tissue has not been removed,
because ovulation must have occurred to permit of

Another reason why ovarian tissue may be left behind,
Sir /. Bland- SuMon* says, is:

" The ovaries may be so firmly fixed to the floor of the pelvis that
they break, and portions of ovarian tissue are left ; this often impairs
the subsequent results, as menstruation (and ovulation) continue
if only a small portion of an ovary is left."

1 Loc. cit., p. 130.

2 Bland-Sutton, " Diseases of Women," 1904, p. 485.


Dr. Cullingworth 1 reports a case which is an example of

" The much enlarged right ovary with the Fallopian tube . . .
were removed. The appendages of the opposite (left) side were then
separated; during the process rupture of the (left) ovary took place.
The (left) tube and ovary wer^ removed, the greater part of the ovary
remaining as part of the pedicle."

On examination of the parts removed

" The left Fallopian tube was beaded from kinking, but was other-
wise healthy. No ovarian tissue was found in the parts removed
on the left side."

So that the removal pf this left ovary was a complete
failure ; not only did the left ovary break, but the ' ' greater
part of it remained in the pedicle," and not even a portion
of the left ovarian tissue could be detected as having been
removed, with its accompanying left tube, and this in spite
of the statement that " the (left) tube and ovary were

The patient recovered from the operation, since when
" menstruation has been regular," because of the incomplete
removal of all ovarian tissue.

Olshausen (see Chapter X., p. 80) performed bilateral
ovariotomy. At the post-mortem he found that neither ovary
had been removed !

As ovarian tissue can be left behind when operating on
one ovary, so too it can occur if both ovaries are removed;
it is even possible that a piece of ovarian tissue might
remain on both sides, so that boy and girl twins might be
born after double or bilateral ovariotomy ! though I know
of no case.

There are on record now a dozen genuine cases of
pregnancy after double or bilateral ovariotomy ; and we
could not realise this were we not aware of the extreme
difficulty, amounting to impossibility in some cases, of
completely removing all ovarian tissue, more especially if
there has been any inflammatory action of, or around, the
ovarian tumour. And Mr. Alban Doran's 2 experience may
here be quoted:

1 Dr. Cullingworth, " Trans. Obstet. Soc.," vol. xxxiv., 1892, pp. 388, 389.

2 A. Doran, " Trans. Obstet. Soc.," vol. xliv., 1902, p. 249:


" When the base of the cyst burrowed and lay close against the
uterus the ovarian ligament could rarely be distinguished. In one
case, where Mr. Doran was obliged to remove the uterus, with the
burrowing adherent tumour, he found, on examining the specimen,
that it would have been practically impossible to leave the round
ligament or part of a pedicle without leaving also ovarian tissue, morbid or
healthy. As it was with a cystic tumour, so it was with inflamed
adherent appendages, and so it very often was with an ovary re-
moved to check the growth of a uterine fibroid."

The following cases too, quoted by Sir J. Bland-Sutton , l
show the excessive difficulty in some cases of entirely
removing both ovaries:

" Dr. Angus Macdonald attempted bilateral oophorectomy on a
young woman. He removed the left ovary and tube, but failed
to find the right one. In March 1886, Mr. Lawson Tait tried to find





the right ovary, but failed. He took away the fundus of the uterus.
In spite of this menstruation continued. In 1890 Dr. Keith re-
opened the belly, found and removed the right ovary and its corre-
sponding portion of tube. The patient recovered, and menstruation
permanently ceased."

" Mr. Martin removed the uterus two years after removing both
ovaries. He found that a piece of ovary had been left behind."

Dr. Amand Routh, 2 too, has stated "it is sometimes
impossible to remove both ovaries completely." 1

Pinesse concludes " that persistence of menstruation after
the removal of both ovaries and tubes is due to portions of

1 Bland-Sutton, " Diseases of Ovaries," 1896, p. 416.

2 Dr. A. Routh, " Brit. Med. Journ.," October 1903, p. 801.


ovarian tissue left behind/' and states that " in second
operations corpora lutea were seen on the stumps of the
pedicle left after the primary operations."

Sir J. Bland-Sutton 1 has the drawing on p. 165 illustrating
this completely, a portion of ovary with a corpus luteum in
it (evidence of ovulation) being shown. It was found at
a second operation, and had been left after a supposed
complete double oophorectomy. He says:

" Such a retained portion of ovary is sufficient to maintain not
only menstruation, but ovulation, and it will form corpora lutea."

Ovulation is the function of the ovaries; hence if all
ovarian tissue be removed ovulation is arrested, the woman
is absolutely sterile, and menstruation permanently ceases.

And here it will be well to inquire how much or, rather,
how little ovarian tissue will be sufficient to ovulate, and
thus lead to the birth of a child.

The ova being microscopic, we should expect from this
that an exceedingly small portion only would be necessary,
and this is what we find to be the case.

The following extracts prove it:

Dr. Galabin 2 showed tumours of both ovaries removed at
the fourth month of pregnancy.

" The right tumour was a dermoid cyst Containing gruel-like fluid,
which solidified on cooling.

" The left tumour was an ordinary cystic adenoma, except that
three small cysts in it were evidently dermoid. In the left tumour
was seen a large corpus luteum of pregnancy, and near it a small
fragment of unaltered ovary."

A paper, too, by Dr. Condamin, 3 of Lyons, on pregnancy
in women suffering from large bilateral ovarian dermoids,
shows how little ovarian tissue is requisite to give rise to
a fertilisable ovum; and Dr. Herman 4 says that, " even in
bilateral ovarian disease, so advanced that healthy ovarian
tissue cannot be detected by the naked eye, the patient
may become pregnant."

1 " Diseases of Women," 1904, Fig. 126, p. 495.

2 Galabin, " Trans. Obstet. Soc.," 1896, p. 101.

3 Condamin, " Annals of Obstetrics and Gynaecology," March 1904, p. 188.

4 Herman, " Diseases of Women," p. 763.


Further, Sir J. Bland-Sutton 1 says:

" Both ovaries may be so distorted and destroyed by dermoids that
the true ovarian tissue is unrecognisable to the naked eye; yet these
organs are not only able to dominate menstruation, but to discharge
their egg-bearing functions successfully."

Again, he says, in a case where

" Bantock performed double ovariotomy on a woman in the third
month of pregnancy, both tumours were dermoid. He made a very
careful microscopical investigation of them, but was unable to detect
normal ovarian tissues."

Yet some normal tissue had provided the ovum that was
fertilised in both Dr. Bantock 's and Dr. Galabin's cases;
so we see what an infinitesimally small portion of ovarian
tissue, if left behind at an operation, or undamaged by
tumour growth, is capable of yielding fertilisable ova in
fact, a single Graafian follicle is enough to accomplish
the purpose.

In the following case Lefas 2 found:

" To one of the fimbriae of the right tube was attached a little round
tumour, perfectly separate from any other structure, besides the fimbriae
which formed its pedicle. Microscopically it was a true corpus

So this tiny piece of ovarian tissue, quite separate from
the ovary, attached only to the abdominal end of the tube,
had ovulated so that pregnancy might have followed the
removal of that ovary.

With what Morgagni said, " a woman may conceive if
there remain as much of one ovary, sound, as belongs to one
mature vesicle," we must therefore agree.

Confirmatory of the difficulty of affirming that no ovarian
tissue had been left behind, are the remarks by Dr. Eden in
the discussion of a case at the Obstetrical Society of London ;
March 2, 1904. He said:

" It was impossible to be sure, by simple inspection at the time
of operation, that the whole of the ovary or ovarian tissue had been
removed. Only careful microscopical examination by serial section
of every small mass, elevation, or nodule possible only after a post-

1 Bland-Sutton, " Diseases of Ovaries," 1896, p. 61.

" Journal of Obstetrics and Gynaecology," vol. i., Jan. 1902, p. 109.


mortem could negative the existence of unremoved ovarian tissue
lying in the ovarian pedicle or between the layers of the broad

Having thus seen how infinitely small the piece of ovarian
tissue left behind may be, we must next point out that there
are reasons to believe that these unremoved portions may
grow, in much the same manner as does a tonsil stump after
the removal of a portion of the tonsil.

Belief in the growth and development of these portions
of ovary and their contained follicles was stated by Dr.
Amand Routh. 1 He said:

"He thought it likely that a small piece of the hilum of one ovary
might be left containing no Graafian follicles sufficiently developed
to come immediately to maturity. He believed that such a piece
of ovarian stroma, together with the follicles, became in a few months
further developed, and ovulation and menstruation then recurred."

There are some specimens in the Royal College of Surgeons
Museum showing the results of incomplete castration in
cockerels, and they seem to strengthen the belief that
portions of. unremoved ovarian tissue may grow, for the
glands in cockerels, if only partially removed, are repro-
duced, and the birds acquire the full male characters.

As a result of the appreciation of the fact that a portion
of ovary is sufficient to ovulate, the operation of^ resection
of an ovary has been introduced. This consists in cutting
out the tumour or diseased part, and leaving the healthy
remainder. This has been often done now, and with the
best results, pregnancy having followed such an operation.

Besides pregnancy following as the result of ovarian tissue
being left behind, either accidentally or intentionally as a
result of resection of an ovary, we can also have tumours
arise in the unremoved pieces.

Thus Dr. Herbert Spencer? when discussing a case of
pregnancy after incomplete bilateral ovariotomy, said he

" that some portion of one of the tumours had probably been left
behind in separating the adhesions. He had known an ovarian
tumour develop after double ovariotomy from this cause."

1 Dr. A. Routh, " Trans. Obstet. Soc.," vol. xliv. 1902, p. 248.

2 Dr. H. R. Spencer, " Trans. Obstet. Soc./' vol. xliv. 1902, p. 247.


This leaving a portion of ovarian tissue, due to adhesions
round a tumour, is evidently what had happened to Dr.
Spencer when, in vol. xlii., p. 396, he announced the birth
of boy and girl twins after he had " removed a left-sided
ovarian tumour completely "; but which he also stated was
" bound down by adhesions," when he described the case.
So that case does not negative my theory.

Other operators have noted tumours arising in ovarian
remnants. Thus Mr. Alban Dor an has seen " an ovarian
cyst develop on the distal side of a ligatured stump."

Mr. J. D. Malcolm, 1 in the " Lancet," reported four cases:
in three bilateral ovariotomy had been performed, and a
tumour grew on one or other side; in the other case the
tumour recurred on the side the ovarian tumour was re-
moved from. Mr. Malcolm stated that

" some portion of the ovary had been left, and it was most interest-
ing and important to know that a small piece of an ovary remaining
in this way could give rise to an ovarian tumour."

We therefore see that complete removal of an ovarian
tumour is not synonymous with the complete removal of all
ovarian tissue, and my theory remains quite unshaken.

Although I have thus clearly shown that (a) portions of
ovarian tissue may be left behind after operations; and
further that (b) ovarian tissue in small detached pieces
may occur some distance from the operation site, yet the
general rule holds good that the removal of the anatomical
ovary on one side removes all the ovarian tissue from that

And the result is the birth of only one-sexed children
after such an operation.

The two or three cases brought forward to the contrary
disprove not my theory, for in these few exceptional cases
who shall say some true ovarian tissue had not been left
behind ? or that there was no accessory ovarian tissue ?

1 J. D. Malcolm, "Lancet," Oct. 31, 1903; "Trans. Obstet. Soc.,"
1893- P- 37-


WE have seen that ovulation is a spontaneous, usually
painless, unilateral process, and, I maintain, an alternate
one. 1

To prove that ovulation takes place practically alternately
from the two ovaries, besides referring the reader to
Chap. VI., p. 49, where I quote Negrier and give other
proofs, the following facts should be conclusive:

From Chap. XL, p. 82, we learnt that each half of a double
uterus has only one ovary attached thereto, so that we can
be sure in such cases that one ovary only is associated with
the menstruation from one-half of the uterus; for the two
ovaries do not normally ovulate at the same time, neither
do the two halves of a double uterus menstruate synchron-

1 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18

Online LibraryErnest Rumley DawsonThe causation of sex in man; a new theory of sex based on clinical materials together with chapters on forecasting or predicting the sex of the unborn child and on the determination or production of either sex at will → online text (page 13 of 18)