Grogan, Richard A.

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The Linacre QuarterlyVolume 25 | Number 2 Article 5May 1958What Price Tubal Ligation?Richard A. GroganFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationGrogan, Richard A. (1958) "What Price Tubal Ligation?," The Linacre Quarterly: Vol. 25 : No. 2 , Article 5.Available at: http://epublications.marquette.edu/lnq/vol25/iss2/5wr·"AT PRICE TUBAL LIGATION?Richard A. Grogan, M.D.The author is a graduate of Holy Cross College and Harvard Medic ilSchool, where he is Instructor in Obstetrics and Gynecology. He is nthe active staffs of St. Elizabeth's Hospital, Brighton: Boston Lying-, 1,and Free Hospital for Women, Brookline. Dr. Grogan is a Diploma ·eof the American Board of Obstetrics and Gynecology.In the past decade there hasbeen an appalling increase in theincidence of surgical procedures designed specifically to interrupt the continuity of the fallopian tubes in an effort to prevent future p r egna n c y .  Coincidentally, the medical indications for therapeutic abortion have been drastically re­duced during this same peripd of time. This state of affairs is more than a paradox; medically speak­ing, it is an outright contradiction. terference - therapeutic interrn >­tion - a fact recognized by ev n the most ardent supporters of su h a practice, and the principal reas, n why this procedure has fallen ir, o medical disrepute. Further, the widely publiciz d educational programs to provi le better pre-natal care, the introdL ..:­tion of broad spectrum antibioti .:s to combat the threat of .infectic n. the advances in cardiac surgery o rehabilitate the previously inc 1-pacitated rheumatic patient, e',­change transfusions for infants with hemolytic anemia, and the crusade against the use of the classical cesarean section· with the hazard of potential uterine rup­ture in subsequent pregnancies are but a few of the many contribu­tions toward "safe deliverance"and the resultant decline in thera­peutic abortions. Both of the above procedures are similar insofar as they are primarily intended either to pre­vent a future pregnancy, by tubal ligation, or to destroy an existent one, by therapeutic abortion; and the motivating force behind each is obviously in direct opposition to the fundamental concepts of the natural 1 a w. However, careful analysis will also reveal that, from a purely medical point of view, they are contraindicated.Bitter experience has taught thatthe so-ca1Ied "increased load of pregnancy" has a decidedly less harmful impact upon the physical ·wel1-being of the individual than does the actual · termination of pregnancy by direct and wilful in-68 From the above, one would cer­tainly expect that the incidence of tubal sterilization should at least parallel the reduction in the num­ber of abortions - to postulate otherwise would seemingly con­tradict these tremendous accom­plishments in ·the fleld of obste- . tries. LINACRE QUARTERLY That su�h · is not the case, ho' ever, is obvious from mere pern' of the current literature wherem provided the answer to .th�s .; parent paradox. The maJonty " .. tubal sterilizations are perforr:· ,·. either at the suggestion of the i; • -sician or in response to pcJt1: .1.: request, and "great multiparit�, � ,s the motivating force. Such an ni ... i­cation is impossible to cond nc ona bona fide medical basis, and should be more appropriately caie­gorized in the social and/ o1 eco­nomic sphere. It would seem that the attending physician has as­sumed the role of the family soCialarid/or economic advisor, a. self­created position wherein he is �re­quently ill-advised and certamly ill-qualified.Further analysis of published reports on this subject indicate. �hat the proponents of tubal steriliza­tion speak glowingly in terms of success in the prevention of future pregnancies. Little or no concern is given to the possible conse­quences for the patient who sub­mits to this type of surgery; suchas the immediate post-operativemorbidity arid mortality __, admit­tedly infrequent, but ever a .thre�t and a factor for consideration m any contemplated surgical en­deavor. Again, late sequelae such as therapeutic failures ( subs�que.nt pregnancies)• psychosomatJC . �1s­tµrbances, menstrual irregulanttes, and the mental trauma which may and often does accompany therealization that reproduction is nolonger possible, are individualproblems which, at times, far out­weigh any medical justifi�ation forthe surgical interference itself. MAY. 1958Failure to appre1 '. te th . exist­ence of these pc., -steri: iz�tion complications may w · .be parti�llythe fault of the indi-. • .,al patientconcerned, for in this .:, of med­ical specialization a1: ' with the realization that the . 1 oblem athand is not of an obstetrical na­ture, she is more likely to seek advice and treatment from a gyn�­cologist rather than from a �hysi­cian who limits his practice toobstetrics only.That such an explanation is plausible is evident from the rec­ords compiled at a renowned non­sectarian' university-connected gynecological hospital wherein at one time tubal ligations were con­sidered to be a sound surgicalprocedure primarily intend�d toprotect the physical well-bemg of the individual against the alleged burden of pregnancy. Since 1943, however, this pro� cedure has been looked upon with disfavor due, in most instances, to the increasing number of patientswho, subsequent to tubal ligation,were admitted for a superimposedgynecological problem necessitat­ing the additional surgery of hys­terectomy.In support of the above, a sta­tistical study was undertaken at this above-mentioned hospital to evaluate the end results of one hundred patients with previoustubal interruption. In each instance the ligation had been performedelsewhere, and the patients we�e admitted because of a gynecolog1-· cal disorder for which they sought treatment. A survey of the indications for the previous tubal ligation was _ap-69 praised by a a roup of physicians, and the expr · -�d opinion substan­tiated this a,. ·,r's contention, for more than 90'; had indicated no bona llde medical basis for the sterilization procedure. t, profuse and/or irregular m£ 1-s1 1al flow. Carcinoma of the £ 1-do,.1etrium and/or the cervix ,, is enfountered in 6% while an ad i­tional 7% disclosed marked a1 1-plasia which in itself would he ,enecessitated continued "follow 1- , ..examinations were the uterus rot removed. Three patients proved to be "surgical failures"-two rn s­carriages and one ectopic ges· �­tion. Of interest was the fact ti at tubal ligation was unsuspected p e­operatively in seven instances-' ,e patients were apparently unaw, re that such a procedure had bf' :n previously performed. Intractable pelvic pain and/or dysfunctional vaginal bleeding rep­resented the complaints of at least 90% of these patients upon read­mission. Four patients sought "de­ligation" in an effort to. restore the continuity of the tubes. Further, in each instance a total hysterectomy was considered the only logical procedure to correct the gynecological disorder associ­ated with a "sterile uterus" which, in itself, had no future purposeful physiological function. Histological study of the re­moved specimens - uteri, tubes, ovaries - revealed the following: pathological changes in the ovaries included peri-oophoritis, premature senescence, endometriosis and cor­tical stromal hyperplasia-each of which could well explain the men­strual irregularities, and was con­sidered the responsible factor in 59% of the series. Chronic sal­pingitis and the pain associated therewith was noted in only 7%. 18 % of the uteri contained either submucous leiomyomata or endo­metrial polypi which precipitated Thus, analysis of the above serves only to conllrm this autho-'s initial contention-that tubal st, r­ilization is a procedure whi, h. along with therapeutic aborti, ,n. should be recognized as obsolete. since it is not only morally untr·n­able but obviously medically un­sound. Furthermore. the physical well­being of the individual will be bet­ter protected when the medical profession at large appreciates the high incidence of these late se­quelae which often necessitates ad­ditional surgery such as hysterec­tomy and thereby nullilles any benellt allegedly accruing from the initial procedure itself. A PAINFUL VERSE 70 THE WARD WAS FULL OF AILING MEN, THE AIR WAS PULL OP GROANING, THE DOCTOR ENTERED, FULL OP FUN, "Gooo MOANING, MEN, GOoD MOANING." Reprinted from St. Francis Thermometer St. Francis Hospital, Carlsbad, New Mexico LINACRE QUARTERLY PLAN EARLY FOR ST. LUKE'S D Preparations for The White Moss. Patron of Physicians, on October I 8 To give assistance in making plans Louisiana Guild is indicated here. motional brochure concerning the ' OBSERVANCE .... annual obse"rvance to Feast Day, will soon b, oublicity prepared by . th on invitation is inclu s, set forth below. ,or S Luke, ode locally. Shreveport, ,he infor-What is th<' White Mass? ft is an annual gathering for public u urship by those who care for the sick: -in adoration of the Creator of all life by the men and women who cooperate with God in its preservation here on ear�. -in union with Our Lord Jesus Christ, Healer of bodies as well as Savior of souls Divine Comforter of the afflicted and the halt and lame .  -under the patronage of St. Luke the Evangelist, hi�self a phy_sic1an and for nineteen centuries world-wide model for the medical profes�1on. -to emphasize the truth of the Spirit in man, who through the subhme instrumentality of parenthood is composed of body and soul, matter and spirit, immortal through the endless ages after death. . ....:.in testimony that we humans are made to the image and hkeness of God, made to know Him, love and serve Him that we might become sharers Ill His Divine Life here and in the eternity to come. The White Mass. th� Memorial Sacrifice of Our Lord's death on the Cross, is likewise offered: -a group tribute to all in our community who care for the sick, -that their dedication to their Christ-like vocation may be renewed with the noblest of motives. . . . h -to express our admiration for medical science and its never tlnng researc to relieve man's suffering, f ·11 -in appreciation by mothers and fathers for the dev<;>tion and. sel -s�cn ce of doctor, nurse and all others who care for our families and friends in time of crisis and sorrow. d 1 · · f -in token of homage and esteem by our Bishop an c ergy a.s m,msters. o souls and to you who minister to the body and mind of man s natural l,fe. ' PROPOSED PLAN FOR OBSERVANCE OF THE "WHITE MASS" Arrangements Committee - all members, Catholic . . Chairman - President of Guild, with two other members asS1St1ng One Dentist Two Nurses Laboratory technician X-ray technician Pharmacist Pharmaceutical detail man Hospital Administra'tor Physic-therapist . . One representative from each private nursing registry Two medical students Nursing student (one from each training school). Women's Auxiliary Catholic Hospital and Medical Society. one each Physician from Veterans' Hospital Physician from local Army, Navy or A,r Force Chaplain of the Guild MAY, 1958 71 Each m€ ,er is responsible for inf "White ,s" and of mailing invite (even ini ception that includes rr and th,, :.m ilies. The notice she bulletin rhe groups and onnounc, missicr. , post on invitation on bullet Publicity Committee Secular Press Diocesan Press Catholic Church Bulletins Entertainment Committee �g respective organization of ,e which advise of place, time, c 1d ers, Catholic and non-Catha ·c, e published in oil the man ,ly meetings. Secure hospital F >r-)Ord. Arrange for refresh_ments after Moss, sc0ved by wives of Guild membe, Ushers Committee Guild members should form this committee and direct the seating. Servers Committee If possible, hove Guild members serve the "White Moss."Speaker's Committee The Moderator of the Guild should, if possible, offer the Moss. The Ordinary of the diocese or some outstanding priest speaker she Jld be asked to give the sermon. Every effort should be mode to make this o united offering of the "W ,iteMoss" by all men and women "in white" who serve the sick. If possible·, it should be o Dialogue Moss, with the leaflet missal distrib, ed to those attending and following in English, if that is more feasible. An added touch is for oil Guild members to wear o white carnation. Assign oil Guild members to o committee to give them on active port in theobservance of the "White Moss." 72 FEDERATION EXECUTIVE BOARD MEETING SCHEDULED The Executive Board of The Federation of Catholic Physicians' Guilds will meet June 25, 1958, 9:30 a. m. at the Sir Francis Drake Hotel, San Francisco, California. The Officers of the Federation and one delegate from each active constituent Guild constituting the Boord will conduct business. LINACRE QUARTERLY CATHOLIC PHYSICIANS' GUILm The listing below gives the name cf Physicians' Guild affiliated with the F ·, organization. ALABAMA Mobile President J. 0. MUSCAT255 St. Francis StreetARIZONA Phoenix VICTOR A. MULLIGAN, M.D. 5340 North 25th Place CALIFORNIA Los Angeles FRANCIS C. WERTS, M.D. 1233 N. Vermont Avenue Sacramento ARTHUR F. WALLACP., M.D. Forum Building COLORADO Denver JOHN F. HARRINGTON, M.D. 1850 Williams St. CONNECTICUT New Haven DAVID CoNWAY, M.D. H27 Chapel St. Norwich JOHN W. SUPLICKI, M.0. 40 Slater Avenue Stamford JAMP.S V. HALLORAN, M.D. Mason Street Greenwich, Conn. DELAWARE Wilmington JOHN G. GRAPP, M.D. 1407 Woodlawn ILLINOIS Bdleville JAMP.s KuEBP.L, 0.0.S. 10024 Bunkum Road Caseyville, Illinois Rock Island C. P. CUNNINGHAM, M.D. 4H Safety Bldg. Rock Island, IllinoisMAY, 1958 ,resident and moderator of • Catholic 'on. These groups constitute national Moderator Rev. P. H. YANCEY, S.J. Rev. JOHN P. DoRAN RT. REV. MSGR. J. J. TRUXAW RT. RP.v. MSGR. THOMAS MARKHAM VERY REV. MSGR. DAVID MALONEY REV. JOHN C. KNOTT RT. REV. MSGR, JOHN J. REILLY, V.G. RT. REV. MSGR, N. P. CoLl!.MAN REV. EUGENE CLARAHAN RP.v. CLEMENT G. SCHINDLER REV. JOHN O'CONNOR 73 

What Price Tubal Ligation?

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What Price Tubal Ligation?

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