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Page 43
With our present knowlege, the simple process of tubo-ligature renders
unsexing absolutely unnecessary in order to effect complete and
permanent sterility. As the lesser operation vasectomy, is effectual in
men, so is a lesser operation, tubo-ligature effectual in women. And it
has this paramount advantage that, whereas vasectomy being an occlusion
of a secretory duct, leads to complete atrophy and destruction of the
testis, ligature of the Fallopian tube, which is only a uterine
appendage and not a secretory duct of the ovary, has absolutely no
effect whatever on that organ.
A simple ligature of each Fallopian tube would effectually and
permanently sterilise, without in any way whatever altering or changing
the organs concerned, or the emotions, habits, disposition, or life of
the person operated on.
The Fallopian tubes are two in number, attached to the upper angles of
the uterus, and communicating therewith. Each is about five inches in
length, and trumpet-shaped at its extremity, which floats free in the
pelvic cavity.
Attached to the margin of this trumpet-shaped extremity, is a number of
tentacle-like fringes, the function of which is to embrace the portion
of the ovary, where an ovum has matured during or immediately after
menstruation.
At all other times these tubes are practically unattached to the
ovaries. Ova may and do mature on the surface of the ovaries, but do not
always pass into the Fallopian tubes; being almost microscopic, they are
disintegrated and reabsorbed. If they do pass into a tube they are lost
or fertilized as the case may be.
It can be seen that the function and vitality of the ovaries are in no
way affected by the tubes. The ovarian function goes on, whether the
tubes perform their function of conveyance or not, and if this function
can be destroyed, life-long sterility is assured. There is no abdominal
operation more simple, rapid and safe, than simple ligature of the
Fallopian tubes. It may be performed by way of the natural passage, or
by the abdominal route, the choice depending on various circumstances.
If the former route be taken, there may be nothing to indicate, in some
cases not even to a medical man, that such an operation has been
performed.
The Fallopian tubes have been ligatured by Kossman, Ruhl and Neuman for
the sterilization of women with pelvic deformities; but all testify to
the danger of subsequent abnormal or ectopic pregnancy, and several
instances are given. Mr. Bland Sutton relates a case in an article on
Conservative Hysterectomy in the British Medical Journal.
After numerous experiments on healthy tubes, I have found that simple
ligature with even a moderate amount of force in tying will cut the tube
through in almost any part of its length. The mucous lining is so thrown
into folds that its thickness in relation to the peritoneal layer is
considerable. Because of this, the tube when tied alone is brittle, and
a ligature applied to it will very easily cut through, and either allow
of reunion of the severed ends or leave a patent stump. In a recorded
case in which pregnancy occurred after each tube was ligatured in two
places, and then divided with a knife, a patent stump was no doubt left.
In order to obviate this danger the peritoneal layer must be opened, and
the mucous membrane, which is quite brittle and easily removed, must be
torn away for about one quarter of an inch. A simple cat-gut or silk
ligature lightly tied would then be sufficient to insure complete and
permanent occlusion.
Nature often performs this operation herself, with the inevitable and
irrevocable result, lifelong sterility, with no tittle of positive
evidence during life of its occurrence.
Here are a few examples:--A young married woman has a miscarriage; it is
not severe, and she is indiscreet enough to be about at her duties in a
day or two, but within a few days or so she finds she must return to
bed, with feverishness and pelvic pain. Before a month is past she is up
and quite herself again. But she never afterwards conceives. What has
happened? To the most careful and critical examination nothing abnormal
is detected. Her general health, her vitality, her emotional and sexual
life, her youthful vigorous appearance, all are unimpaired. But she is
barren, and why? A little inflammation occurred in the uterus and spread
along the tubes. The sides of the tubes cohered, permanently united by
adhesive inflammation, and complete and permanent occlusion resulted.
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