ARTICLE XXII.

THE RELATIONS EXISTING BETWEEN RESPIRATORY AND INTRAPELVIC DISEASES.

BY DANIEL H. CRAIG, M.D.

OF BOSTON.

READ JUNE 10, 1903.

THE RELATIONS EXISTING BETWEEN RESPIRATORY AND INTRAPELVIC

DISEASES.

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IN 1878 Professor Skene, in his inaugural address, called the attention of the New York Obstetrical Society to the very common occurrence of prolapse of the ovary, and requested the members to devote their energies to the discovery of the causes of this lesion in cases in which the cause was not manifest and in which the prolapse was unassociated with either disease in the ovary itself or uterine displacement. During the ensuing year, Drs. Mundé 12 and Goodell' each presented monographs upon the subject, not only considering the causes, but also the course, symptoms, diagnosis and treatment. Various authors have contributed to the subject since and practically all have quoted the list of causes as given in the above papers, and it is because I feel that I can aid a cause which will account for cases not explained by any causes mentioned heretofore that I have undertaken the work of which I trust you will consider this as but a preliminary report.

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Clinically, the condition is of immense importance, for Mundé 1 found uncomplicated prolapse in practically ten per cent. of his cases and they are even more frequent now. In the last 500 cases of pelvic disease personally diagnosticated, I have found prolapse of the ovary to play a clinical part as follows:

Total number of cases 500.

Cases in which ovarian prolapse was not a

factor

296 or 59 %

Cases in which the utertus was retrodisplaced, the ovaries not being coincidently prolapsed

Cases in which retrodisplacement and ovarian prolapse co-existed

Cases in which ovarian prolapse existed with no retrodisplacement of the uterus.

62 or 124%

69

or 14 %

73

or 14%

500 100%

The increase of four per cent. in the frequency might be accounted for by the recent greater prevalence of respiratory diseases incident to the annual epidemics of influenza which had not occurred at the time of Munde's paper in 1879.

My attention was first directed to the relations existing between respiratory and intrapelvic lesions by the fact that patients with pelvic lesions, and especially those with ovarian prolapse, were invariably made worse and their favorable progress under treatment arrested by the intercurrence of any cough-accompanied lesion. In accordance with this conception particular attention was given to the question of antecedent respiratory lesions in all cases in which ovarian prolapse obtained, and especially in those cases specified by Skene in which no cause was manifest. Positive histories were obtained too frequently to allow of its being considered merely coincidental. Very many histories might be adduced to substantiate this statement but I have chosen three which seem sufficient for the present need.

CASE I.-M. B. M. Single. Æt. 20. Single. Et. 20. Never pregnant. Never any pelvic infection. For a few months acted as clerk in a drug store. For two years has been "running down. Family history strongly tubercular, but father and mother and one sister living and free from tuberculosis. Three years ago had enlarged glands removed from cervical region. Three small glands now palpable on right. Takes cold easily and always has persistent cough following each cold.

Cough has at times persisted for months until phthisis was feared. About one year ago began to suffer from backache and leucorrhoea, and pain in iliac regions. Catamenia began at thirteen. Regular until recently. Painless. Duration five days until recently; now three or four days. Two napkins a day. No clots. Leucorrhoea variable in amount and not absolutely constant. Exertion increases leucorrhoea which is then thick and yellowish. Has used douches. Not much backache now, but severe at times. Appetite poor. Digestion fair. Bowels fairly regular.

Micturition normal.

Physical Examination.—Chest and abdomen negative. Hymen intact but distensible. Nulliparous. Cervix long and conical. Uterus in good position, not enlarged nor tender. Some thickening of the right broad ligament. Left tube and ovary prolapsed and the ovary slightly enlarged [cystic?].

CASE II.-B. E. B. Single. Et. 24. Never pregnant. Family and past history irrelevant. Catamenia began at twelve. Rather irregular, often varying between three and five weeks. In spring of three past years has menstruated every two or three weeks. Painless. Painless. Duration six to seven days, using thirty napkins which are well saturated. Clots are frequent, their evacuation being accompanied with pain. Last April (date of history, Sept. 9, 1899) after a severe attack of la grippe in which. she narrowly escaped pneumonia she suddenly began to feel pressure in the head, most persistent at the vertex. This vertical pain has been constant since. Worse at times. Often disturbs sleep, pain being worse at night. Can get no specific history. Paternal grandfather lived "a sporty life." Vertigo. Constant leucorrhoea, sufficient at times to demand protection, and of a thick, Bowels regular. Micturition normal. General health good except that she is subject to winter cough. Appetite good. Digestion good.

whitish character.