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
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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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    14 The Cause or Causes of Endometriosis In the previous chapters we were dealing with facts gleaned by observa¬ tion of a large number of cases. In this chapter we step into the realm of speculation. It is well known that any disease has not one causal agent, but a succession of active dyscrasias of which the disease is the last expression. The immediate cause is usually easily found, but behind this is another cause of which the immediate cause is but an effect, and if we trace these successive causes and effects we finally reach an impasse. When we bring this knowledge to bear upon endometriosis to ascertain the cause or causes of so many varied manifestations, we finally reach the constant impasse. But before reaching this point it is possible to determine the probable primary factor in the production of this disease. Any advance in scientific knowledge is built upon a hypothesis deduced from observa¬ tions, and then we look to see if all the facts fit into the hypothesis; if it explains the facts better than any other hypothesis, it is retained as a working hypothesis. The line of reasoning is as follows: The ovary is a constant necessity for the initiation of endometriosis. The ovary is almost a constant necessity for a continuation of the endo- metriotic activity. The exceptions to this last statement are so few as to confirm the rule. Therefore it is logical to assume that the immediate and activating cause lies in the ovary. Whether the ovary is the only organ that is involved in the initiation and continuance of the disease is quite another and a more difficult question to answer. Myer contends that there is an infective agent in all cases of endometriosis, but I have never been able to prove this to my entire satisfaction. But let us suppose that the pituitary—and, to be more specific—prolan A, is the next or mediate causative agent, then the ovary becomes an essential intermediary be¬ tween the pituitary and the endometriosis. The ovary is the essential intermediary because cessation of the ovarian function, either by surgical ablation or by destruction of function by x-ray or radium, brings about a prompt regression in the endometrial pathology. If, therefore, the ovary is an essential organ, then vitiated products of function of the ovary must be the underlying cause of endometriosis. The functions of the ovary are