A study of endometriosis, endosalpingiosis, endocervicosis, and peritoneo-ovarian sclerosis : a clinical and pathologic study / by James Robert Goodall.

  • Goodall, James Robert, 1877-1947.
Date:
1943
Catalogue details

Licence: In copyright

Credit: A study of endometriosis, endosalpingiosis, endocervicosis, and peritoneo-ovarian sclerosis : a clinical and pathologic study / by James Robert Goodall. Source: Wellcome Collection.

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    extrapelvic organs not susceptible to these environmental changes. The mucous membrane of the nose is the one membrane that is subject, to a slight degree, to these sexual changes of congestion and diapedesis. Hence the frequency of nosebleeds at menstrual periods, the recognition of vicarious nasal menstruation, the intractability of nasal infection during the menstrual phases, and the nasal erectile influence during sexual excitement. Let me detail a recent case of parietal endometriosis with small hemorrhages. A woman aged 37 years, married 15 years and sterile, consulted me for metrorrhagia. She had been previously regular and normal. She had been bleeding steadily and profusely for 18 days. On examination I found the uterus hard, and symmetrically enlarged to the size of a two-months’ pregnancy. Intramural fibroid was suspected, but there was a distinct infiltration of the tissues posterior to the cervix. The bleeding stopped spontaneously, and menstruation recurred normally twice afterwards. As I had recommended operation at her first visit, she insisted upon that policy being carried out. Upon opening the abdomen the uterus was found enlarged, symmetrical, and fixed at its vaginal attachments. The peritoneum was free everywhere, and the ovaries normal except for a small cyst on the left. But the posterior wall of the enlarged uterus showed blue-black subperitoneal spots which were at once diagnosed as uterine endometriosis with hemorrhagic cysts. Consequently both ovaries were removed, and a total hysterectomy was performed in which the cervix was bound posteriorly in dense endo¬ metrial invasion. On section of the uterine wall, the whole was dissem¬ inated with endometriosis and small endometriomata, with small hem¬ orrhages of various sizes from microscopic points to that of a pea. The blood was old and black. Under the microscope only about one cystic cavity in 50 had bloody contents, and there wTere evidences in the ovary of old interstitial hemorrhages that had occurred synchronously with the metrorrhagia. The ovaries were otherwise normal and absolutely free from endometrial invasions. This case, and a few others with somewhat similar experiences, empha¬ size the rarity of intramural endometrial hemorrhages. Parietal endo¬ metriosis, however, I consider one of the commonest gynecologic dis¬ eases, outnumbering ovarian and other forms of endometriosis in the ratio of about three to one. And yet intramural hemorrhages in these cases are quite exceptional, whereas in ovarian endometriosis hemor¬ rhages are the rule and not the exception. In all cases of active parietal endometriosis there is hypertrophy of the normal muscular and con¬ nective-tissue elements of the uterine wall; in the third and fourth decades the coincidence of tumors of these elements in the form of fibromata, myomata, and fibromyomata is frequent; and endometrial elements are