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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    Near the break of the present century, Ivanoff proposed the theory that extra-uterine endometriosis might arise from a metaplasia of the pelvic peritoneum—a theory that found a stout advocate at a later date in Robert Meyer. According to Meyer, the impulse that starts the peritoneum on its wayward changes and wanderings is attributed to an antecedent inflammation of the peritoneum or its immediate neighbor¬ hood. Once the peritoneum has departed from its normal structure and normal function, there would seem to be no limits to its digression in respect to these two factors. This theory finds its chief base of support from the embryonic history of the peritoneum—celomic epithelium—which is the ancestor of most of the abdominal structures, and therefore, being almost totipotential, may, in an abnormal or in a new set of circumstances during adult life, revert to its embryonic potentialities and reproduce these structures de novo. Whether such reversions are possible in an adult peritoneum, and whether, granting such reversions possible, these embryonic cells could reproduce such highly specialized tissues as the endometrium and endow them with full function, will come up for further discussion under the heading of ^origin of endometriosis. This peritoneal meta¬ plastic theory of the origin of endometrial growths was later emphasized by Gough, and still later by Spencer and Cullen. For a clear understanding of another theory—the germinal epithelial origin of endometriosis of the ovary—we must revert to an earlier date in the history of this disease. In 1870 Waldeyer sought to explain the origin of epithelial new growths of the ovary by invasions of the ovarian stroma by its covering germinal epithelium, which under the stimulus of unexplained causes might take on invasive and vitiated growth by reverting to the properties of its embryonic phase. This theory was later adopted to explain the origin of endometrial invasions of the ovary. Here, again, no account was taken of the menstrual function. How could such tissue take on hemorrhagic characters? Whitridge Williams added his support to this theory by finding tall ciliated columnar epithelium on the surface of the ovary in adults. In his early work Russell attributed the origin of endometrial tissue in the ovary to ectopic or misplaced miillerian rests, either on the surface of the ovary or within its tissues, and Blair Bell, in support of this theory, described a case of endometrioid tissue of the ovaries which was associ¬ ated with marked hyperplasia of the involuntary muscle, giving to this condition the descriptive name of endometrioma. This miillerian theory also found support in the work of Janney in 1922, and of Blair in 1923. As a stimulus activating these miillerian embryonic rests, they inculpate general corporeal changes and local modifications of environment, acti¬ vating the quasi-quiescent embryonic tissues.