Battey’s Operation Was an Experiment in Human Endocrinology

On August 17, 1872, Robert Battey, MD, performed the first normal ovariotomy, defined as the removal of both ovaries in the absence of gross pathological abnormalities.¹ In the decades to follow, this procedure became a widely accepted surgery and was adapted to fit a variety of maladies, including hysteria.²

The removal of both ovaries drove women into early menopause and made them infertile. For those institutionalized with hysteria, this operation likely was performed without their consent.² While these women were harmed by the procedure, the widespread scope of the operation also advanced our knowledge of endocrinology by definitively establishing that ovaries play a role in menstruation. 

Dr. Battey was born in 1828 in Augusta, Georgia.² He earned his medical degree from Thomas Jefferson University in Philadelphia, Pennsylvania, then served as chief surgeon at several US Confederate Army hospitals during the Civil War.²

Following the Confederate surrender in 1865, Dr. Battey returned to Georgia to begin his practice. He performed his first ovariotomy—a term that later was replaced by oophorectomy in the 20th century—for a dermoid cyst on a physician’s wife in 1869. He became one of the most preeminent ovariotomists in the country, cofounding and serving as president of the American Gynecological Society in 1888.²

The first patient to undergo a normal ovariotomy was a 30-year-old woman named Julia Omberg.1 Since menarche, she had lived a lifetime of intense physical suffering in place of a menstrual cycle. Her symptoms included pelvic pain, epileptiform convulsions, rectal abscesses, and pulmonary congestion.

The decision to perform this novel operation was not made overnight. Dr. Battey diagnosed her with chronic corporeal endometriosis, and she underwent medical treatments for 7 years before an operation was suggested. In June 1872, Dr. Battey wrote to several physicians with his idea for a surgical cure, a “creature of his own thought,” which was discussed further at the Gynecological Society of Boston.² As the patient had failed several years of medical management, her surgery was ultimately performed later that year.

Dr. Battey performed the first normal ovariotomy with chloroform anesthesia.¹ He started with a midline laparotomy, explored the abdomen by palpation, and delivered the ovaries with his fingers. Finding no gross pelvic pathology to explain the symptoms, he tied off each ovary and its vascular pedicle with a silk suture. After Omberg’s operation, Dr. Battey stayed by her bedside for the first 10 days. She recovered after a monthlong stay in Dr. Battey’s residence with “all the evidences of the most perfect health,” according to an independent report published in 1872 by W. F. Westmoreland, MD, a professor of surgery in Atlanta, Georgia.² 

Leading gynecologists of the day hailed the operation as a success.³ Performing a normal ovariotomy on women without gross ovarian pathology rapidly gained popularity. “Battey’s operation” was ultimately employed for a diverse array of disorders: dysmenorrhea, oophoralgia, epilepsy, and ultimately for hysteria.²

In 1906, Ely Van de Warker, MD, who was a gynecological surgeon and cofounder of the American Gynecological Society, estimated that 150,000 women were subjected to bilateral normal ovariotomy for a wide variety of maladies.⁴ While this estimate was unsubstantiated, even a tenth of this number remains a significant cohort of women who were surgically castrated.

Many of the women diagnosed with hysteria likely underwent the operation without the agency to provide consent.² However, even women such as Omberg who did consent to the normal ovariotomy were unable to be fully informed of its consequences given the limited knowledge of endocrinology. The function of the ovaries was not fully understood, with hormones such as estrogen yet to be identified. The widespread adoption of Battey’s operation would inadvertently become a landmark surgical experiment in endocrinology.

At the turn of the 19th century, not all physicians thought that ovaries drove menstruation. In fact, many were skeptical that Battey’s operation would lead to menopause. Notably, R. Lawson Tait, MD, a Scottish pioneer in pelvic and abdominal surgery, believed that the fallopian tubes induced menstruation and thus performed a variation of Battey’s operation where he removed both the ovaries and fallopian tubes.³

After the publication of Dr. Battey’s first case report, E. S. Gaillard, MD, the editor of the Richmond and Louisville Medical Journal wrote that he regretted failing to publish the shared opinion of many authorities on the assertion that “ovaries do not have an effect on the menstrual cycle.”⁴ However, the hormonal theory was on the horizon, and Dr. Battey’s procedure was instrumental in its proof of concept.

Patients not only stopped menstruating but also developed associated symptoms, including hot flashes and vaginal atrophy after removal of their ovaries. The systemic symptoms that followed ovariotomy led to the hypothesis that some secreted substance was taken away with removal of the ovaries.⁵

In 1896, Viennese physician Emil Knauer, MD, proved this concept via animal experimentation by removing the ovaries from rabbits and observing uterine atrophy.³ He took the experiment a step further by reimplanting the rabbits’ ovaries into a distant site and restoring the size of the uterus. Subsequent physician-scientists such as W. Hubert S. Fosbery, MD, used these conclusions to try and address human symptoms of menopause by having women take pills containing ground-up ovarian tissue.⁵ Hormone replacement therapy remains a modern iteration of this idea.

In 1891, 3 years after Dr. Battey stepped down as president of the American Gynecological Society (AGS), the keynote address was delivered by incoming president A. Reeves Jackson, MD, who made a “scathing condemnation of their irrational surgical procedures, including Battey's operation.”³

The operation reached its peak at a time when physicians did not know about the existence of hormones such as estrogen. Regardless of the reasons the operation was performed, the outcome was the same. Female patients stopped menstruating, suffered systemic symptoms due to the withdrawal of estrogen, and lost their ability to bear children. These devastating consequences, combined with the widespread scale of the normal ovariotomy, created an incidental experiment in endocrinology. Battey’s operation solidified our knowledge that ovaries play a role in menstruation and advanced the nascent field of endocrinology, at a high cost for women.

Dr. Chloe Nobuhara is a third-year general surgery resident at Stanford University Hospital in Palo Alto, CA. She completed her medical education at Duke University in Durham, NC. 

References

1. Battey R. Normal ovariotomy-case. Atlanta Med Surg J. 1872;10(6):321-339.
2. Longo LD. The rise and fall of Battey's operation: A fashion in surgery. Bull Hist Med. 1979;53(2):244-267.
3. Sims JM. Remarks on Battey's operation. Br Med J. 1877;2(886):881-882.
4. Thiery M. Battey's operation: An exercise in surgical frustration. Eur J Obstet Gynecol Reprod Biol. 1998;81(2):243-246.
5. Santen RJ, Simpson E. History of estrogen: Its purification, structure, synthesis, biologic actions, and clinical implications. Endocrinology. 2019;160(3):605-625.