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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    PERSONAL AND FAMILIAL SUSCEPTIBILITIES been astounded at the frequency of endometriosis in our clinics, and have been equally astounded at their previous inability to recognize the less obvious signs. It is impossible to form any idea of the incidence of the disease in all its manifold manifestations, especially in those cases of uterine infiltration by the endometrium, because we don’t know where to draw the line accurately between physiology and pathology. These border¬ line cases are numerous, but they have little clinical significance except as an expression of something wrong in the interior economy of the nature of an instability with a temporary or permanent deviation from the normal. PERSONAL AND FAMILIAL SUSCEPTIBILITIES This ground is almost virginal, so one treads warily and with some awe. However, there are facts which taken singly have no weight, but when taken collectively deserve some recognition. The problem of causation was discussed speculatively in a previous chapter, and it was pointed out there that hyperestrinism was thought to be the likely culprit, as garnered from the evidence. It was also pointed out (a philosophical generalization) that any given disease is not the product of any one cause, but of a succession of causes and effects. So I believe that endometriosis is no exception, and that behind the apparent cause are other causes more obscure, more intimate, which make for susceptibility to the immediate agent. What these deeper chemical sus¬ ceptibilities are would be folly to conjecture with our present state of knowledge. But that there is a deeper personal susceptibility cannot be denied. It is this factor, or the lack of it, which makes experimental endometriosis so difficult. That many women may have hyperestrinism and show no ill effects is tantamount to stating the well-known truth that many persons may be hyperglycemic without showing any recognizable clinical or pathologic changes. Reactions to abnormal endocrinology are chiefly in the nature of allergy, and not all persons are allergic in the same degree. The various forms of endometriotic manifestations described in the foregoing pages show not only a personal susceptibility to the abnormal agency, but an organ susceptibility. In one case it is the uterus which shows the chief manifestation of the reaction. In another it is the ovary; in still another it is the peritoneal change that is dominant; and in still others there may be combinations of any or of all of these. Familial tendencies seem to play a part. In my experience there have been decided family incidences. In one such case the mother at 45 was operated upon for a rather severe type of ovarian endometriosis. Three of her daughters, at various times, have had to have total ablations for most virulent types of intraperitoneal endometriosis. Two of these were among my four cases of spontaneous intraperitoneal rupture of large chocolate