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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    As to the question of sterility, one may be more emphatic. The history of sterility which precedes practically every case of endometriosis, and the very rare association of pregnancy with even the mildest form of endometriosis, give us adequate conviction that this question of sterility has already solved itself by the plans of nature. II. The Extent and Character op the Disease The problem of extensive endometriosis in the third decade of life is a serious one. The decision whether to operate--and, having opened the abdomen, how much to do—is one in which lack of experience cannot be compensated for by any other attribute. There are all degrees of acuteness, and chronicity of the disease, and all degrees of extension, both intraperitoneally and parametria! I>% from a few small peritoneal or ovarian black bead-like cysts without adhesions, to a massive conglom¬ erate disease, or from slight shortening of one broad ligament in para¬ metria! disease to complete infiltration of all the cellular tissues. Inasmuch as (so far) there has been no specific cure discovered for endometriosis, then must we use our best judgment in each individual case. We must weigh each patient’s resistance against the disease. In the mild forms of the disease, consisting of a few cysts, it is my policy to close the abdomen and treat the patient as if for some chronic disease. Rest, nutritious food, climatic treatment are all adjuvants that help to overcome the tendency to development or recurrence. It must be emphasized that endometriotic disease is an expression of endocrine imbalance, and, like all imbalances, there may be mild and virulent types—some of short duration with tendency to recurrences; others essentially chronic and therefore very destructive. We have established in our work that two-thirds of the cases that come to operation are spontaneous cures, that is, cures of the active disease, but not of the symptoms arising out of the impediment to, or destruction of, function in the affected tissues or organs. It is of the highest importance to determine at operation, or before if possible, whether the disease is active or inactive. Have we any means at our disposal to ascertain in any given case? 1. It was stated elsewhere that when the disease becomes quiescent, retrograde changes occur. The first tissues to be absorbed are the specific cellular elements of endometriosis. The fibrous adhesions remain. These become more organized, more adult and tough. The friability of active endometriosis is therefore lost. The estimation of these ovarian changes requires considerable experience in the surgery of these cases. 2. A much more reliable evidence and one more easily appreciated is the character of the contents of the blood cysts (if any remain). In active cases the contents of the cysts is a black, broken-down blood. As