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Uselessness of the term “metropathy”
REVIEWS
AND
ABSTRACTS
27:i
The treatment consists of rest, building up the resistance, and the application trf’ heat. The use of iodine and ichthyol tampons has also been a valuable adjuvant. Treatments over a long period of time are often necessary, and a permanent cure should not be promised as recurrence may arise following chilling, exposurt’, 01 grippe. TRE~D~DORE TV. .Aoaxs. Seymour, II. F.: scope. British
Endoscopy of the Uterus. Medical
Journal,
With 1925, ii, 1229.
a Description
of a Hystero-
Rubin, of New York, has designed a hysteroscope which is a modification of the cysto-urethroscope of McCarthy and can only be used combined with gas inflation. The author found that it was not necessary to have an angled tube. The next problem was to get rid of the obscuration of the vie.w by blood and mucus. He constructed a hysteroscope based on the principle of the bronchoscope. In the wall of this tube are three channels, one for the rod which carries the light and one on each side for suction; either channel can be used for irrigation if need be. The hysterosoope is gentIy introduced; a swab ou a sponge holder is used RR an nbtu rator, and this prevents the lamp becoming obscured by blocmd. The author thinks that endoscopy of the uterus is going ‘to prove useful in diagnosing the uterine causes of genital bleeding, since it can reveal such lesions as glandular hyperplasia of the endometrium, polypi, retained products of conception, chorionepithelioma and carcinoma. A piece of tissue can easily be removed for F. L. +.DAIf:. microscopic purposes by direct vision. Pollart,
R.: Insufflation
of the Tubes.
Bruxcllcs
MBdical,
l!)?i, xi, 353.
Pollart has supplemented carbon dioxide gas in tubal insufflation by filtered air. The air is introduced by means of a syringe which is connected to a mercury manometer, for recording the pressure. He feels that this method is simpler and fully as satisfactory, since 100 c.e. of air are easily and quickly absorbed. The greatest value of the method is in determining nonpatency of the tubes in sterility cases where other means of examination reveal no pathology. It has also proved useful in the treatment of certain types of dysmenorrhea. However, it shauld be used only as an adjuvant to all other methods of gynecologic examination. TwenTHEODORE W. ADAMS. ty-two cases of tubal insufflation are reported. Adler, L.: Uselessness of the Term schrift, 1925, xxxviii, 605.
‘ ‘Metropathy.
”
Wiener
klinische
Wochen-
Adler objects to the term “metropathy ” which As&o&’ and Pankow introduced to describe certain uterine hemorrhages found in women who.ae genitalia are apparently normal. The term is useless in that it. describes the condition no better than does the term ‘ Luterine bleeding, ” it is useless because the underlying cause must be determined before the condition can be correctly treated, and the term is incorrect because the cause of the bleeding lies, not in the uterus, but elsewhere. He also objects to the term on the ground that no two men have the same clinical picture in mind when using it and quotes, at the two extremes, Schroeder and Sellheim. Schroeder considers it to be a persistence of the follielc with a cystic glandular hyperplasia of the uterine mueosa and Sellheim thinks of it in terms of struetural changes of the uterine mucosa and musculature without a functional disturbance, or of functional disturbances alone, or of a combined picture of structural and functional disturbances. Doederlein and Kroenig speak of C( metropathia inflammatoria chronica” in cases in which any inflammatory reaction can no longer be demonstrated.
274
THE AMERICAN
JOURNAL
OF OHRTETRICR Ai’Z;D GYXECOLOGY
Adler does not believe it necessary to have one term for so many different clin ical pictures and feels that more effort should be spent in trying to determine the The anatomic picture and the underlying pathology than on the nomenclature. hemorrhages due to local anatomic changes must be sharply differentiated from those due to functional derangements. RALPH A. REIs. Schil: True Hemorrhagic Paris, 1923, xxv, 503.
Metritis
and Its Treantment.
Journal
de &%decine
de
In the light of recent investigations, many of the cases formerly designated as L‘hemorrhagic metritis ’ ’ can now be more accurately ascribed to an ovarian hypofunction, to pelvic congestion or other pathologic states. There remains, however, a certain number of cases exhibiting uterine hemorrhages where no definite pathology can be found. For these he uses the term L ‘ true hemorrhagic metritis. ” By using the uterine endoscope he is able to recognize four types of endometritis: the villositic, the fungoid, the polypoid and the cystic. He emphasizes the necessity of ruling out a beginning uterine malignancy in these cases. Three methods of treatment exist: The chemical which consists in the intrauterine application of some caustic substance as zinc chloride. While giving good results in the majority of cases it is a dangerous method, terminating fatally in o.ne of his cases. For this reason Schil has abandoned this method. The second method is the intrauterine use of radium. This, the author also states, is a dangerous and unsatisfactory procedure. The third type of treatment and the one now advocated by Schil is dilatation and curettage. This not only effects a cur&in the majority of cases but permits a microscopic examination of the removed curettings. THEODORE W. ADAMS. Seite, A: The Causes and Treatment schrift, 1925, iv, 1920.
of GSmecOlOgic Bleeding.
Klinische
Wochen-
The most essential thing in determining the cause of gynecologic bleeding is an exact general and especially menstrual past history. The author recognizes three types of uterine hemorrhage: (1) Hyp ermenorrhea-the individual period is profuse, longer than normal, or both. The menstrual cycle is normal. (2) Polymenorrhea-profuse bleeding with a shortened interval, the interval often being irregular. (3) Metrorrhagia-continued irregular bleeding of no definite type. There is an irregularity both of interval and duration. Hypermenorrhea is caused by: (1) Disturbance of blood supply. (a) Passive hyperemia in the lesser pelvis, (b) Active hyperemia. (2) Localized disturbances in the uterus. (a) All conditions which decrease contractility of uterus cause a more profuse menstrual flow, (b) hypertrophy of endometrium, possibly due to hyperovarialism. (3) Abnormally long clotting time of blood due to constitutional causes. (4) Malposition, especially retroflexion. Usually the uterine mucosa andovary are normal, at most there might be an interstitial endometritis. Biopsy might reveal tuberculous endometritis or malignancy. A negative finding rules out any local cause for the bleeding. The author emphasizes the following general rules for the treatment of hypermenorrhea: (1) Anomalies of blood distribution should be corrected. (2) Habits, where faulty, must be regulated. (3) Inflammation should be relieved either by physical and dietetic treatment or, if necessary, by operative interference. (4) h&lpositions of the uterus are to be corrected. (5) In plethora and arterial hypertension one may use hydrotherapy or at times venesection. (G) For local disturbances of the uterus curettage and ergot are employed, also for infantile and hyperplastic
AND
ABSTRACTS
27:i
The treatment consists of rest, building up the resistance, and the application trf’ heat. The use of iodine and ichthyol tampons has also been a valuable adjuvant. Treatments over a long period of time are often necessary, and a permanent cure should not be promised as recurrence may arise following chilling, exposurt’, 01 grippe. TRE~D~DORE TV. .Aoaxs. Seymour, II. F.: scope. British
Endoscopy of the Uterus. Medical
Journal,
With 1925, ii, 1229.
a Description
of a Hystero-
Rubin, of New York, has designed a hysteroscope which is a modification of the cysto-urethroscope of McCarthy and can only be used combined with gas inflation. The author found that it was not necessary to have an angled tube. The next problem was to get rid of the obscuration of the vie.w by blood and mucus. He constructed a hysteroscope based on the principle of the bronchoscope. In the wall of this tube are three channels, one for the rod which carries the light and one on each side for suction; either channel can be used for irrigation if need be. The hysterosoope is gentIy introduced; a swab ou a sponge holder is used RR an nbtu rator, and this prevents the lamp becoming obscured by blocmd. The author thinks that endoscopy of the uterus is going ‘to prove useful in diagnosing the uterine causes of genital bleeding, since it can reveal such lesions as glandular hyperplasia of the endometrium, polypi, retained products of conception, chorionepithelioma and carcinoma. A piece of tissue can easily be removed for F. L. +.DAIf:. microscopic purposes by direct vision. Pollart,
R.: Insufflation
of the Tubes.
Bruxcllcs
MBdical,
l!)?i, xi, 353.
Pollart has supplemented carbon dioxide gas in tubal insufflation by filtered air. The air is introduced by means of a syringe which is connected to a mercury manometer, for recording the pressure. He feels that this method is simpler and fully as satisfactory, since 100 c.e. of air are easily and quickly absorbed. The greatest value of the method is in determining nonpatency of the tubes in sterility cases where other means of examination reveal no pathology. It has also proved useful in the treatment of certain types of dysmenorrhea. However, it shauld be used only as an adjuvant to all other methods of gynecologic examination. TwenTHEODORE W. ADAMS. ty-two cases of tubal insufflation are reported. Adler, L.: Uselessness of the Term schrift, 1925, xxxviii, 605.
‘ ‘Metropathy.
”
Wiener
klinische
Wochen-
Adler objects to the term “metropathy ” which As&o&’ and Pankow introduced to describe certain uterine hemorrhages found in women who.ae genitalia are apparently normal. The term is useless in that it. describes the condition no better than does the term ‘ Luterine bleeding, ” it is useless because the underlying cause must be determined before the condition can be correctly treated, and the term is incorrect because the cause of the bleeding lies, not in the uterus, but elsewhere. He also objects to the term on the ground that no two men have the same clinical picture in mind when using it and quotes, at the two extremes, Schroeder and Sellheim. Schroeder considers it to be a persistence of the follielc with a cystic glandular hyperplasia of the uterine mueosa and Sellheim thinks of it in terms of struetural changes of the uterine mucosa and musculature without a functional disturbance, or of functional disturbances alone, or of a combined picture of structural and functional disturbances. Doederlein and Kroenig speak of C( metropathia inflammatoria chronica” in cases in which any inflammatory reaction can no longer be demonstrated.
274
THE AMERICAN
JOURNAL
OF OHRTETRICR Ai’Z;D GYXECOLOGY
Adler does not believe it necessary to have one term for so many different clin ical pictures and feels that more effort should be spent in trying to determine the The anatomic picture and the underlying pathology than on the nomenclature. hemorrhages due to local anatomic changes must be sharply differentiated from those due to functional derangements. RALPH A. REIs. Schil: True Hemorrhagic Paris, 1923, xxv, 503.
Metritis
and Its Treantment.
Journal
de &%decine
de
In the light of recent investigations, many of the cases formerly designated as L‘hemorrhagic metritis ’ ’ can now be more accurately ascribed to an ovarian hypofunction, to pelvic congestion or other pathologic states. There remains, however, a certain number of cases exhibiting uterine hemorrhages where no definite pathology can be found. For these he uses the term L ‘ true hemorrhagic metritis. ” By using the uterine endoscope he is able to recognize four types of endometritis: the villositic, the fungoid, the polypoid and the cystic. He emphasizes the necessity of ruling out a beginning uterine malignancy in these cases. Three methods of treatment exist: The chemical which consists in the intrauterine application of some caustic substance as zinc chloride. While giving good results in the majority of cases it is a dangerous method, terminating fatally in o.ne of his cases. For this reason Schil has abandoned this method. The second method is the intrauterine use of radium. This, the author also states, is a dangerous and unsatisfactory procedure. The third type of treatment and the one now advocated by Schil is dilatation and curettage. This not only effects a cur&in the majority of cases but permits a microscopic examination of the removed curettings. THEODORE W. ADAMS. Seite, A: The Causes and Treatment schrift, 1925, iv, 1920.
of GSmecOlOgic Bleeding.
Klinische
Wochen-
The most essential thing in determining the cause of gynecologic bleeding is an exact general and especially menstrual past history. The author recognizes three types of uterine hemorrhage: (1) Hyp ermenorrhea-the individual period is profuse, longer than normal, or both. The menstrual cycle is normal. (2) Polymenorrhea-profuse bleeding with a shortened interval, the interval often being irregular. (3) Metrorrhagia-continued irregular bleeding of no definite type. There is an irregularity both of interval and duration. Hypermenorrhea is caused by: (1) Disturbance of blood supply. (a) Passive hyperemia in the lesser pelvis, (b) Active hyperemia. (2) Localized disturbances in the uterus. (a) All conditions which decrease contractility of uterus cause a more profuse menstrual flow, (b) hypertrophy of endometrium, possibly due to hyperovarialism. (3) Abnormally long clotting time of blood due to constitutional causes. (4) Malposition, especially retroflexion. Usually the uterine mucosa andovary are normal, at most there might be an interstitial endometritis. Biopsy might reveal tuberculous endometritis or malignancy. A negative finding rules out any local cause for the bleeding. The author emphasizes the following general rules for the treatment of hypermenorrhea: (1) Anomalies of blood distribution should be corrected. (2) Habits, where faulty, must be regulated. (3) Inflammation should be relieved either by physical and dietetic treatment or, if necessary, by operative interference. (4) h&lpositions of the uterus are to be corrected. (5) In plethora and arterial hypertension one may use hydrotherapy or at times venesection. (G) For local disturbances of the uterus curettage and ergot are employed, also for infantile and hyperplastic