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ENDOMETRIOMA OF THE VULVA
HUNTERIAN FESTIVAL DINNER
ENDOMETRIOMA OF THE VULVA To the Editor
of
THE LANCET
SzR, No single theory will explain the origin of Samson’s all endometrial tumours of the vulva. to account for such implantation theory appears cases as that reported to the North of England Obstetrical and Gynaecological Society on Oct. 30th by Mr. T. N. A. Jeffcoate (Lancet, 1936, 2, 1336), in which it was most likely that endometrial cells from the menstrual blood were implanted into the raw surface of a cavity formed by the rupture of a post-operative wound. Other cases, occurring in women who have undergone no previous operative measures, with no history of injury to the vulva, and in the absence of any hernial sac, can only be explained as developmental abnormalities. In the human embryo at the third month the inguinal fold can be demonstrated as an outgrowth from the Wolffian ridge. The point of the outgrowth is the junction of the uterine and Fallopian segments of the Mullerian ducts within the Wolffian ridge. In the inguinal fold the round ligament of the uterus is developed, and it is presumed that, to use a simile of Comyns Berkeley, during the building of the female genital house, some chips of the Mullerian structure are carried away by the developing round ligament to find a resting place in the part of the labium in which this ligament becomes dispersed ; and that these chips become activated during the reproductive period of life, perhaps under the influence of cestrin. In support of this explanation may be mentioned other tumours-to wit, dermoid cysts of the floor of the mouth, and teratoid tumours of the testicle-which rarely become clinically evident before
surface is firm, greyish-white, with darker points and small The sections show many areas scattered through it. dilated glands composed of tall columnar epithelium and surrounded by typical endometrial stroma. These glands strongly resemble those of the uterine endometrium. Most of them contain blood and fragmented granular material. The glandular structures are embedded in a rather dense fibrous tissue with a small amount of fat. .
"
CASE REPORT
Pathological diagnosis : endometriosis." We are, Sir, yours faithfully, FRANK RIGGALL, CECIL RIGGALL.
TRANSIT OF PREGNANT WOMEN BY AIR
To the Editor
of
THE LANCET
SiR,-The question of the transit of pregnant by aeroplanes has come up for consideration,
women
and is well
of importance to the medical profession to the general public. Several factors are involved, such as the distance to be travelled and the facilities which exist for medical aid at the landing-grounds as well as the condition of the patient herself. The rules formulated would presumably differ for those flying within European limits from those flying across Africa or Asia or to Australia, as
one as
and tentatively one might suggest a limit of one clear month from the expected date of delivery in the former and two months for the long-distance passengers. I should be grateful to members of the profession who would give their views on this question either in the columns of this journal or in private
correspondence. I am, Sir, yours
faithfully, F. P. MACKIE,
Colonel I.M.S. (retd.); Medical Adviser, Imperial Airways Ltd.
puberty. The comparative rarity of endometrial tumours of the vulva, of whatever origin, is shown by the fact that Jeffcoate, before reporting his case, was able to find only six others on record. Mrs. A., of Hog Eye, Arkansas, nullipara, aged 36, first consulted us in regard to a painful swelling, of one year’s duration, in the right labium majus, on Feb. 1st, 1936. She described it as feeling as though there were a cockleburr under the skin, which became more painful during the latter half of her menstrual period, and partially subsided during the following week. She believed it was a hernia, for which she had been wearing a truss for two years. On examination the inguinal region was normal. The upper half of the right labium was swollen, and at the extreme upper end could be felt a firm tumour, approximately almond-sized. Bimanual examination of the pelvic organs revealed no abnormality, and there had been no change in the menstrual habit, which was 28/5. Subsequent examinations at appropriate intervals confirmed the patient’s history of periodicity. A diagnosis of endometrioma was made and the nature of the tumour explained to the patient, who readily consented to its
475
HUNTERIAN FESTIVAL DINNER THE biennial dinner of the Royal College of Surgeons England was served in the library of the College on Feb. 15th under the happiest auspices. Immein overhead the reconstruction was diately progress of the three upper floors of the College to make a new and adequate institute of surgical research and incidentally completing Sir Charles Barry’s beautiful facade. The company over which Sir CUTHBERT WALLACE presided included five Hunterian trustees, the treasurers of the four Inns of Court, eight masters of City Companies, and the medical directors of the three Defence Forces. Sir CHARLES GORDON-WATSON who toasted The Guests paid special attention to Lord Russell of Killowen and Sir Plunket Barton who were sitting by him, but the real guest of the evening was John Hunter whose memory was drunk in reverent silence. of
"I like," said Sir Cuthbert, "to think about three removal for histological study. Operation was performed characteristics of the man. First, there was his curiosity. at the Elizabeth Hospital, Prairie Grove, Ark., onThis word is now perhaps of ill favour, but in its best March 10th, under general ansesthesia, to permit of direct i sense it describes well Hunter’s childlike desire to find out inspection of the right inguinal canal and abdominalhow things work, and caused him, if not to originate, to : and amplify the experimental method. Secondly, inguinal ring. These were seen to be normal, the incision improve was closed, and the tumour then removed through a there was his diligence. He was a whole-time worker, separate incision into the labium. Recovery was uneventful, though not in the modern sense. Hunter had a large and there has been complete freedom from symptoms up practice, the gain from which he devoted to paying for to the present time. The truss has been abandoned. : his researches. He was late and early in his workroom, The tumour was submitted to Dr. J. H. Fisher, professor and left himself but four hours for sleep. Then there was of pathology in the University of Western Ontario, London, l his courage when stricken with a terrifying disease. Canada, to whom we are indebted for his kind permissionHunter calmly continued his work and made himself an to publish his report, which is as follows : " Specimen is , object of his own study." roughly spherical, measuring 2 cm. in diameter. The And, having said this, Sir Cuthbert gave the welcome outer surface presents a roughened appearance with tags of fibrous and fatty tissue attached. On section the cutnews that the Bernhard Baron trustees who had
ENDOMETRIOMA OF THE VULVA To the Editor
of
THE LANCET
SzR, No single theory will explain the origin of Samson’s all endometrial tumours of the vulva. to account for such implantation theory appears cases as that reported to the North of England Obstetrical and Gynaecological Society on Oct. 30th by Mr. T. N. A. Jeffcoate (Lancet, 1936, 2, 1336), in which it was most likely that endometrial cells from the menstrual blood were implanted into the raw surface of a cavity formed by the rupture of a post-operative wound. Other cases, occurring in women who have undergone no previous operative measures, with no history of injury to the vulva, and in the absence of any hernial sac, can only be explained as developmental abnormalities. In the human embryo at the third month the inguinal fold can be demonstrated as an outgrowth from the Wolffian ridge. The point of the outgrowth is the junction of the uterine and Fallopian segments of the Mullerian ducts within the Wolffian ridge. In the inguinal fold the round ligament of the uterus is developed, and it is presumed that, to use a simile of Comyns Berkeley, during the building of the female genital house, some chips of the Mullerian structure are carried away by the developing round ligament to find a resting place in the part of the labium in which this ligament becomes dispersed ; and that these chips become activated during the reproductive period of life, perhaps under the influence of cestrin. In support of this explanation may be mentioned other tumours-to wit, dermoid cysts of the floor of the mouth, and teratoid tumours of the testicle-which rarely become clinically evident before
surface is firm, greyish-white, with darker points and small The sections show many areas scattered through it. dilated glands composed of tall columnar epithelium and surrounded by typical endometrial stroma. These glands strongly resemble those of the uterine endometrium. Most of them contain blood and fragmented granular material. The glandular structures are embedded in a rather dense fibrous tissue with a small amount of fat. .
"
CASE REPORT
Pathological diagnosis : endometriosis." We are, Sir, yours faithfully, FRANK RIGGALL, CECIL RIGGALL.
TRANSIT OF PREGNANT WOMEN BY AIR
To the Editor
of
THE LANCET
SiR,-The question of the transit of pregnant by aeroplanes has come up for consideration,
women
and is well
of importance to the medical profession to the general public. Several factors are involved, such as the distance to be travelled and the facilities which exist for medical aid at the landing-grounds as well as the condition of the patient herself. The rules formulated would presumably differ for those flying within European limits from those flying across Africa or Asia or to Australia, as
one as
and tentatively one might suggest a limit of one clear month from the expected date of delivery in the former and two months for the long-distance passengers. I should be grateful to members of the profession who would give their views on this question either in the columns of this journal or in private
correspondence. I am, Sir, yours
faithfully, F. P. MACKIE,
Colonel I.M.S. (retd.); Medical Adviser, Imperial Airways Ltd.
puberty. The comparative rarity of endometrial tumours of the vulva, of whatever origin, is shown by the fact that Jeffcoate, before reporting his case, was able to find only six others on record. Mrs. A., of Hog Eye, Arkansas, nullipara, aged 36, first consulted us in regard to a painful swelling, of one year’s duration, in the right labium majus, on Feb. 1st, 1936. She described it as feeling as though there were a cockleburr under the skin, which became more painful during the latter half of her menstrual period, and partially subsided during the following week. She believed it was a hernia, for which she had been wearing a truss for two years. On examination the inguinal region was normal. The upper half of the right labium was swollen, and at the extreme upper end could be felt a firm tumour, approximately almond-sized. Bimanual examination of the pelvic organs revealed no abnormality, and there had been no change in the menstrual habit, which was 28/5. Subsequent examinations at appropriate intervals confirmed the patient’s history of periodicity. A diagnosis of endometrioma was made and the nature of the tumour explained to the patient, who readily consented to its
475
HUNTERIAN FESTIVAL DINNER THE biennial dinner of the Royal College of Surgeons England was served in the library of the College on Feb. 15th under the happiest auspices. Immein overhead the reconstruction was diately progress of the three upper floors of the College to make a new and adequate institute of surgical research and incidentally completing Sir Charles Barry’s beautiful facade. The company over which Sir CUTHBERT WALLACE presided included five Hunterian trustees, the treasurers of the four Inns of Court, eight masters of City Companies, and the medical directors of the three Defence Forces. Sir CHARLES GORDON-WATSON who toasted The Guests paid special attention to Lord Russell of Killowen and Sir Plunket Barton who were sitting by him, but the real guest of the evening was John Hunter whose memory was drunk in reverent silence. of
"I like," said Sir Cuthbert, "to think about three removal for histological study. Operation was performed characteristics of the man. First, there was his curiosity. at the Elizabeth Hospital, Prairie Grove, Ark., onThis word is now perhaps of ill favour, but in its best March 10th, under general ansesthesia, to permit of direct i sense it describes well Hunter’s childlike desire to find out inspection of the right inguinal canal and abdominalhow things work, and caused him, if not to originate, to : and amplify the experimental method. Secondly, inguinal ring. These were seen to be normal, the incision improve was closed, and the tumour then removed through a there was his diligence. He was a whole-time worker, separate incision into the labium. Recovery was uneventful, though not in the modern sense. Hunter had a large and there has been complete freedom from symptoms up practice, the gain from which he devoted to paying for to the present time. The truss has been abandoned. : his researches. He was late and early in his workroom, The tumour was submitted to Dr. J. H. Fisher, professor and left himself but four hours for sleep. Then there was of pathology in the University of Western Ontario, London, l his courage when stricken with a terrifying disease. Canada, to whom we are indebted for his kind permissionHunter calmly continued his work and made himself an to publish his report, which is as follows : " Specimen is , object of his own study." roughly spherical, measuring 2 cm. in diameter. The And, having said this, Sir Cuthbert gave the welcome outer surface presents a roughened appearance with tags of fibrous and fatty tissue attached. On section the cutnews that the Bernhard Baron trustees who had