Skip to main content

Full text of "Changes in the Female Genital Organs in Basedowʼs Disease"

See other formats


492 


PROGRESS OF MEDICAL SCIENCE. 


retightening the first 4. The division of the pedicle is a most important 
detail, to the neglect of which many cases of slipping are due. The writer 
emphasizes the fact that it makes little difference bow much tissue is left on 
the distal side of the ligature; a short-cut pedicle, and especially one that is 
divided straight across, is always dangerous. If it is thin and broad, it 
should be divided as in making the flaps in an amputation. 

Membranous Dybmenorbhcea. 

Duke (Medical Press and Circular, July 10,1895) has met with satisfactory 
results with the following treatment: The os externum is scarified at inter¬ 
vals of three or four days between the periods; just before the flow is 
expected the cervix is dilated, the interior of the uterus is thoroughly 
curetted, and a spiral wire stem is introduced, which is worn continuously 
during at least three subsequent periods, the patient being directed to take 
hot vaginal douches even when menstruating. No harm has resulted from 
the use of the stem, and the patient is able to attend to her ordinary duties. 

Normal and Pathological Positions of the Uterus. 

Mackenbodt (Archiv fur Oynalologie , Band xlviii. Heft 3) summarizes 
a paper on this subject as follows: Contrary to the usual statement the 
pelvic fascia is not perforated by the vaginal canal, but surrounds and sends 
off to the cervix and vagina firm bands, those attached to the latter form¬ 
ing with it the strongest point of resistance to the abdominal pressure. The 
cervix uteri is so attached by the pelvic fascia as to occupy the position of 
slight anteflexion seen in the embryo. This normal flexion takes place in 
the cervix, the corpus uteri being inclined forward, while its axis remains 
perfectly straight. The uterus is kept in a position of anteversion by its 
ligaments, but remains passive, in the direction of the upper portion of the 
cervix. Its own weight and the intra-abdominal pressure also assist the 
organ in maintaining its normal position. The perineum offere only a slight 
resistance to the intra-abdominal pressure. The real support of the uterus 
in its normal position is afforded by the attachment of the pelvic fascia to 
the cervix. Hence the deduction that the true cause of posterior displace¬ 
ments of the organ is to be sought for in relaxation of this fascia. In pro¬ 
lapsus the same condition is present plus atrophy of the muscles forming the 
pelvic floor, which may be due as much to general as to local causes. 

Papillary Growths of the Ovary. 

Pfannenstiel (Ibid.) concludes an elaborate paper on this subject with 
these practical deductions: The clinical history and prognosis of these 
neoplasms vary greatly. While papillary parovarian cyBts and hydrops fol- 
liculi are quite innocent, ovarian Barcoma and carcinoma of the papillary 
variety are extremely malignant. Between these extremes stands papillary 
adenoma, the prognosis of which is favorable, provided that the entire 
tumor is removed and there are no metastases on the peritoneum. Even 
when portions of the tumor are left behind, the progress of the case to a 



GYNECOLOGY. 


493 


fatal termination is slow. On the other hand, a considerable proportion of 
these papillary cysts are primarily carcinomatous. Malignant degenera¬ 
tion of a true adeno-papilloma is by no means so common as has been 
stated. Removal of the tumor without delay is the only proper course to 
be pursued, since we cannot certainly tell beforehand whether it is malig¬ 
nant or not; even in the case of a growth which is histologically benign 
the development of secondary masses in the peritoneum must render the 
prognosis less favorable. Contact of the fluid with the peritoneum during 
the operation should be avoided, and explorative puncture is especially 
reprehensible. The opposite ovary should be removed in every case of this 
nature, even when it is microscopically normal, since there is great prob¬ 
ability that if left it will also become the seat of a papillary growth. The 
urgent wish of the patient expressed before operation should alone induce 
the surgeon to vary from this rule. 

The Ovaries in Osteomalacia. 

Rossier {Ibid.) made careful examinations of the ovaries in three cases in 
which castration was performed for the cure of osteomalacia. To the naked 
eye they showed nothing abnormal except general hypertBmia. Micro¬ 
scopically the stroma and follicles presented a normal appearance, but in the 
cortical substance the vessel-walls were hypertrophied and were the seat of 
extensive hyalin degeneration. Whether this points to a peculiar condition 
of the blood or not is mere inference. As regards the etiology of the dis¬ 
ease, the writer regards Fehling's explanation as the most plausible, that it 
is a tropho-neuroais of the bones due to some reflex influence originating in 
the ovaries. 

Changes in the Female Genital Organs in Basedow's Disease. 

Theilhaber {Ibid.) from personal observation in several cases infers that 
in certain individuals who are predisposed to morbus Basedowii it may result 
from pathological conditions of the pelvic organs, while, conversely, disturb¬ 
ances of these organs may be directly due to the disease itself. Pregnancy, 
hemorrhages, and operations, especially castration, may be etiological 
factors. Atrophy of the uterus and adnexa may result, as shown by the 
fact that menstruation is always scanty or absent. That more cases have 
not been reported is doubtless due to the fact that few patients have 
been carefully examined with the view of determining this point. This 
atrophy is due to vasomotor influences, and not to anaemia, as is usually 
stated. In a case of the writer's, atrophy of the uterus preceded the usual 
signs of the disease. With improvement in the patient’s condition the 
organ may return to its normal condition, as in cases of hyperinvolution 
during lactation. 

As a practical deduction from the foregoing the writer states that young 
women with Basedow’s disease should be advised not t6 marry, while the 
married are warned that the course of the disease may be unfavorably 
affected by pregnancy and the puerperium, and that the children which they 
bear are likely to be highly neurotic. Atrophy of the genitals demands no 
treatment, which, in fact, is useless. The prognosis iB not hopeless, since 



494 


PROGRESS OF MEDICAL SCIENCE. 


their functions may be restored with an improvement in the disease. Local 
treatment is only required in the rare cases in which the existing antenna is 
increased by profuse uterine hemorrhages, when curettage is indicated. 
Neoplasms should, of course, be dealt with according to the usual rules. 

Castration for the cure of Basedow’s disease has been advocated by 
Blocq, but there are no scientific grounds for its support. 


Sabcoma Deciduo-cellulare. 

Launen (Ibid.) describes a case of this rare neoplasm in which he diag¬ 
nosticated the condition by the examination of tissue removed with the cu¬ 
rette, and extirpated the uterus successfully a few days later. Seven mon ths 
after the operation the patient was perfectly well and had gained twenty 
pounds in weight. This case was the fifth in which a radical operation had 
been performed, but only the second in which the patient was still living. 
The diagnosis was made from the history of a previous pregnancy and abor¬ 
tion, irregular hemorrhages and foul discharge, accompanied with septic symp¬ 
toms, vomiting, and cachexia. On examining the uterine cavity with the 
fingers a Boft neoplasm could be felt, portions of which were removed and 
examined microscopically, when the diagnosis was confirmed by finding pro¬ 
cesses of decidual cells which invaded the muscle-fibres, thus proving the 
malignancy of the growth as well as its decidual origin. The writer con¬ 
cludes that while one may not succeed in removing a specimen for diagnostic 
purposes which presents such a typical appearance, the clinical history will 
at least make it clear that a malignant intrauterine growth exists, and that 
total extirpation is accordingly indicated. 


PEDIATRICS. 


UNDER THE CHARGE OF 

LOUIS STARR, M.D., 

Or PHILADELPHIA ; 

Assisted bt 

Thompson S. Westcott, M.D., 

Or PHILADELPHIA. 


Lead-palsy in Children. 

New mark (Medical News, May II, 1895) reports a case of lead-paralysis 
in a girl of six years, who had been exposed to the drug by sleeping in a 
crib which had been painted with a mixture containing white lead; this 
covering of paint was very slow in drying, requiring many months, and the 
patient was in the habit of scratching it off with her finger-nails. The blue 
line on the gums was well marked. There was bilateral wrist-drop; on the 



P^DIATKICS. 


495 


right aide all the muscles supplied by the radial nerve were paralyzed, ex¬ 
cept the triceps and supinator longus; on the left side the triceps, supinator 
longus, and abductor pollicis longus were preserved. Fibrillary twitchings 
were absent, but a jerky tremor was observed. The triceps-reflex was pres¬ 
ent in each arm, sensibility was intact, and the affected muscles gave com¬ 
plete reaction of degeneration. 

The patient was able to walk, but she occasionally Btumbled, owing to 
failure to clear the ground completely, for there was bilateral ankle-drop. 
She could, however, extend the proximal phalanges of the toes quite well, 
this movement being the only one that could be executed by muscles sup¬ 
plied by the external popliteal nerve. The tibialis anticus was also affected, 
and all the affected muscles showed the reaction of degeneration. 

The case illustrates the fact signalized by Putnam that in children it is the 
rule for the legs to be “ affected as much as the arms, or more, as in paralysis 
from alcohol and arsenic, the symptoms generally appearing first in them.*' 
It is also to be noted in this case that, although the arms and legs were 
equally affected, functional recovery took place much earlier in the former 
than in the latter. Chapin, in two cases, and Sinkler, in one of his three 
{Medical News, July 28, 1894), made the same observation; and according to 
Newmark’s Btudy no case has been found where the disorder persisted in the 
upper extremities after the lower had completely recovered. 

Hypertrophic Cirrhosis with Chronic Icterus in the Child. 

Gilbert and Fournier {Revue Mermielle des Maladies de VEnfance , July, 
1895, p. 309) report seven cases of hypertrophic cirrhosis occurring in chil¬ 
dren or adolescents, the debut of which dated back to ages varying from five 
and one-half years in the youngest to seventeen years in the oldest of the cases 
described, thus indicating that the disease is not excessively rare in child¬ 
hood. In general characteristics the clinical picture of the disease in the 
child differa in no essential from that presented in adult age. There is the 
hypertrophy of liver and spleen and the deformations which are thus pro¬ 
duced, the jaundice with its train of secondary symptoms, the same absence 
of ascites, and the maintenance, for a long time, of the appetite and general 
health. There are, however, some special points of distinction to be noted 
in the author’s cases. In three of these the hypertrophy of the spleen 
greatly exceeded that occurring in the liver, so that while the latter organ 
was found to extend only one or two fingers’ breadth below the false ribs, the 
spleen filled the entire left flank, reaching the umbilical line and descending 
well into the pelvis. Such a disproportion between the liver and spleen does 
not occur in adult cases, and this feature in the cases under discussion is 
thought to pertain especially to childhood and adolescence. 

Another peculiarity in three of the cases was found in certain nutritive 
changes in the bones of the phalanges of fingers and toes, and in the extrem¬ 
ities of other bones—alterations which have not been hitherto described in 
connection with this disease. In the first case the distal phalanges of the 
fingers and those of the great toes were enlarged to resemble a drum-stick; 
the lower extremities of the femurs and both ends of the tibise were also en¬ 
larged, and the knee-joints were painful and contained a small effusion. In