MAMMARY AND PAROTID GLANDS IN GYNECOLOGY

article source: The Therapeutic Gazette, 1899


MAMMARY AND PAROTID GLANDS IN GYNECOLOGY

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Any consideration of the subject of organotherapy in gynecology would not be complete without reference to the results obtained from the administration of the desiccated powders of the parotid and mammary glands, or of the extracts of these glands, with which I have had no experience. These drugs have been employed by others with much satisfaction in the disorders and cachexias that seem to be consequent upon the presence of fibroid tumor of the uterus and certain chronic ovarian diseases. The credit of having brought the subject to the attention of the profession must be attributed to Dr. Robert Bell, of Glasgow, and Dr. John B. Shober, of Philadelphia.

As early as 1896, 1 Bell stated that it would appear that the parotid gland exerts a most powerful influence upon the ovaries, and that when disease exists in these organs it can be brought under subjection by the administration of the parotid glands of healthy young sheep, calves, and pigs. He further stated that it was beyond dispute that uterine fibromata, as well as hyperplasia and flaccidity of the uterus, can be most beneficially affected by the employment of the mammary glands of healthy animals. This, he said, is also true of certain diseases of the ovaries.

This form of treatment of ovarian, tubal, and uterine disease was suggested to him by the physiologic relationship which exists between these organs, as shown by mammary enlargement in pregnancy and metastasis from the parotid gland to the ovary in mumps. The effect of parotid gland upon a diseased ovary is so pronounced, especially if the uterine affection be simultaneously treated by ichthyol or other appropriate remedy, that it would be wrong, in his opinion, not to employ this remedy before resorting to operation.

In the Scottish Medical and Surgical Journal for July, 1897, Bell states that during the past two years he has obtained most favorable results in over sixty cases of enlarged and painful
ovaries which would certainly at one time have warranted oophorectomy. At the time of writing these women were not only perfectly well and free from pain, but also remained in possession of their ovaries. He also reported interesting cases of uterine fibromata, and uterine hemorrhages, that were either cured or remarkably benefited by the use of the elixirs of the parotid and mammary glands administered in drachm doses three times daily, or by the use of three five-grain palatinoids of the desiccated glands.

Bell reports that in cases of uterine hyperplasia there can be but little doubt that mammary gland administered in from five- to ten-grain doses three times a day has acted in a marvelously short time in promoting a speedy return to the normal condition.

  Menorrhagia and metrorrhagia, frequently accompanied by dysmenorrhea, have completely disappeared in the course of a few weeks, and when local treatment has simultaneously been adopted the recovery has been proportionately rapid.

John B. Shober,2 reports four cases of fibroid tumor of the uterus treated with mammary gland, and four cases of ovarian disease treated with parotid gland, with excellent results. He found that in the uterine cases — the women all being under the age of thirty - five years, and therefore far removed from the menopausal influence—and without the aid of any other form of treatment, there was a steady and progressive decrease in the size of the tumor, together with a steady improvement of the general health. Under the influence of the drug menorrhagia and metrorrhagia ceased, and the menstrual periods recurred at regular intervals. He believes that the mammary gland exerts a powerful influence upon the uterine muscle or connective tissue, acting in a manner somewhat similar to ergot, and quite distinct from thyroid extract, which influences especially the epithelial elements of the endometrium.

The mammary gland has never, in Shober's experience, given rise to any of the unpleasant and dangerous constitutional disturbances that often follow the prolonged use of thyroid extract; it acts rather as a tonic than as a depressant to the system. The effect of the drug in checking menorrhagia and metrorrhagia induced him to use it in hemorrhages  not
 dependent upon the presence of fibroids, and in one case of subinvolution after labor. The results were very gratifying. He employs the desiccated powder of the sheep's mammary gland, each grain of which is equivalent to ten grains of the fresh gland. Two grains (twenty grains of the fresh gland) is made into a tablet together with three grains of excipient, and from three to four tablets are exhibited daily. In larger doses cramp-like uterine contractions are produced. Positive results may be expected in from six to eight weeks.
Shober has used parotid gland only in cases of ovaritis, in enlarged, congested, and exquisitely tender ovaries, and in cases of ovarian neuralgia and ovarian dysmenorrhea. The desiccated powder is used in the same dose and form as the mammary gland. The results he obtained by this course of treatment in selected cases were most gratifying.

1 International Medical Journal, July, 1896, pp. 379-386; British Gynecological Journal, 1896-97, xii, pp. 157-170; Lancet, 1896, vol. i, p. 1496.

2 American Journal of Obstetrics, Volume 38, No. 3, 1898; Medical News, August 27,  1898; American Journal of Obstetrics, Volume 39, No. 2, 1899

Organotherapy in Gynecology: thyroid extract and uterine fibroids, endometriosis, etc.

article source: The Therapeutic Gazette, 1899

By W. A. Newman Dorland. A.M., M.D., Instructor in Gynecology in the Philadelphia Polyclinic; Assistant Obstetrician to the Hospital of the University of Pennsylvania.


THYROID THERAPY IN GYNECOLOGY

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Of all the forms of organotherapy it will without doubt be safe to assert the marked preeminence of the extract of the thyroid gland. None of the glandular extracts have been more frequently used, and certainly none in a greater variety of pathologic conditions.
Whatever the physiologic action of the thyroid gland may be, it has long been recognized that its secretion—as also the ovarian —exerts a profound influence upon the body metabolism, though of a directly opposite and conflicting nature. Its presence in a normal degree is essential to the maintenance of the physical equilibrium. Thus, through the investigations of the pathologists, we now know that in cretinism and its allied condition, myxedema, either this gland or its functional activity is absent; and in those cases of exophthalmic goitre in which extirpation of the gland was practiced a most alarming train of symptoms shortly developed, directly traceable to the removal from the system of the glandular influence. An excess in the normal secretion of the gland will likewise be followed by an annoying series of phenomena such as will be noted in hypertrophy of the gland or in Basedow's disease.

At once two propositions suggest themselves, namely, in cases of the first class — that is, where there is absent or deficient thyroid action—the administration of thyroid extract to supply the deficiency should be followed by an amelioration of the clinical phenomena; and in cases of the second class — that is, where there is excessive thyroid secretion — extirpation of a portion of the gland or the administration of some antagonistic extract should result favorably. These propositions were shortly tested clinically and found to be sound in theory. The administration of the various forms of thyroid extract in cases of altered or absent thyroid function is always followed by a marked improvement of the condition present, while partial thyroidectomy has frequently resulted most advantageously in the treatment of exophthalmic goitre.

To clinical experimentation based on the foregoing theory must be attributed a series of interesting and unexpected results in thyroid therapy, such as the value of its employment in gynecologic and obstetric conditions, and its undoubted usefulness in the reduction of obesity. The rationale of its employment in the latter condition has been suggested by Robert Hutchinson, 1 who explains its action by an increased combustion of the nitrogen-bearing substances in the body, especially of the fat, but of the muscles also to a lesser degree.


Jouin f, 2 was the first of the modern writers to call attention to the close relationship existing between the thyroid gland and the pelvic organs, although Catulle states that this relationship was well known to the ancients. In addition to the influence exerted by the uterus — especially at the time of the menopause, when the ovarian influence is dying out—upon the size of goitres, he was the first to observe a diminution in the size of a fibroid tumor under the administration of thyroid extract given to reduce obesity. He obtained a considerable amelioration, and at times even a cure, of uterine fibromata and their symptoms, and of metrorrhagia rebellious to all other conservative means. In cases of purely functional hemorrhage the results had been a complete and lasting cure; also in those of hemorrhage at the menopause or dependent on flexions, versions, and other displacements. In his hands the growth of fibrous tumors was always checked by it,
and it often led to their retrogression. When it was employed early it cured them. In consideration of his results obtained in cases of this kind, as well as in the case of keloid and prostatic enlargement, he suggests that this method of therapy may be of value if applied to tumors of less advanced development, as, for example, sarcomata.



Hertoghe, 3 has found that women deprived of the thyroid gland are subject to excessive menstrual discharges; as they grow older the menses last longer, and finally become almost a constant flow. He has also noticed that a hypertrophied thyroid is always accompanied by an early and copious mammary secretion. He has demonstrated by tests on milch cows and other animals that the secretion of milk is much increased by the ingestion of thyroid extract. From his experience he concludes that myxedematous hemorrhage is directly amenable to thyroid treatment, and also hemorrhages due to even an old endometritis or ovaritis. Cancerous hemorrhages cease after three or four days of thyroidization. The pain, swelling, and congestion also decrease to a noticeable extent. Thyroid treatment, he claims, is especially indicated in cases of frequent abortion, in which the menstrual flow is so excessive that it sweeps away the impregnated ovum. He cites an instance of a woman who was able to conceive and bear a child through the action of thyroidin after many years of sterility. Thyroidin, he finds, is also useful in cases of uterine myoma, prolapsus, or retroflexion with hemorrhage, and, in general, in all cases in which it is necessary to reduce the size, sensibility, or congestion of the uterus. On account of the peculiar action of thyroidin in stimulating the lactal secretion, it should be administered if this secretion seems to be diminishing. It has also been found that in some phases of insanity, particularly those of the puerperal, adolescent, and climacteric periods, thyroid extract seems to have marked beneficial effects.

H. B. Stehman, 4 of Chicago, administered  thyroid tablets thrice daily to six patients exhibiting various forms of menstrual and other disturbances, including menorrhagia, metrorrhagia, amenorrhea, ovarialgia, and extreme nervousness. Each tablet represented about one-sixth of a sheep's thyroid. In each instance a most notable improvement was


  observed within the space of several weeks. It seems conclusive, therefore, that in these cases of pelvic congestion and sexual neurasthenia thyroid extract exerts a most remarkable and beneficial effect.



M. R. Latis, 5 believes that the thyroid juice exerts an inhibitory or vasoconstrictor power upon the pelvic genital organs, which is proved by the gradual diminution and final cessation of the menstrual flow under the prolonged use of the remedy. Menorrhagia and hemorrhages due to endometritis, ovaritis, and even cancer are greatly benefited by it.
Robert Bell, 6  quotes the experience of various surgeons and neurologists with reference to the thyroid gland and the genital organs. He states that Charcot, having seen women affected with exophthalmic goitre cured after pregnancy, did not fail to advise marriage, on therapeutic grounds, in the treatment of this disease. Bouilly, Tuffier, Guinard, Picque, and Bloch, having had occasion to operate on patients affected with fibroma of the uterus or salpingo-oophoritis, in whom coexisted goitres, some of which had previously resisted all treatment, have seen the thyroid tumors disappear, or at least be considerably diminished in size, after the extirpation of the pelvic organs. Bell especially emphasizes the pathologic relationship of the thyroid body to the womb and believes that the vitality of the latter may depend to a large extent on the integrity of the thyroid function. This fact especially seems to be exemplified by the marked prevalence of metrorrhagia in myxedematous conditions. He believes also that the thyroid gland especially influences the health of the skin and mucous membranes and subjacent connective tissue.

In three cases of uterine fibroids Kleinwachter, 7  found that thyroid extract exerted a favorable action in controlling the hemorrhage. In these cases the intermenstrual period was also prolonged or menstruation ceased entirely for a number of weeks. It was impossible to determine any diminution in the size of the tumors.

W. M. Polk, 8 states that during the past two years he has employed thyroid extract in fifteen cases of fibroid tumor of the uterus. In all but one he obtained good results. In four of the cases there occurred a distinct diminution in the size of the growth. He recommends the early and long administration of the extract in daily doses of 2% grains. 



J. Inglis Parsons, 9 employed thyroid extract in five cases of fibromyoma of the uterus. Four of these were women of about the age of forty years, with old hard fibromata of many years' standing. No appreciable diminution in size followed after a three months' course. In the fifth case, a young woman twenty-five years of age, with a large, hard, nodular fibromyoma almost filling the pelvis and dipping down into Douglas's pouch, there occurred a distinct reduction in size. The symptoms of morning sickness and attacks of retention of urine entirely disappeared in three months' time.



Having observed in conjunction with the good results following the employment of thyroid extract in the treatment of sporadic cretinism, myxedema, and some cases of mental feebleness, more or less marked increase in the activity of the metabolic processes of the body, Stawell, 10 was led to believe that the same agent might be reasonably expected to increase the metabolism of the mammary gland in suitable cases. Accordingly he employed thyroid tablets (presumably each representing one grain of dried gland), given from three to five times a day, in nine cases of nursing women, and in seven of these distinct increase in the quantity and apparent improvement in the quality of milk secreted followed.

R. v. Braun. J, 11 also reasoning from the same basis of profound alteration in the bodymetabolism as a result of thyroid medication, has suggested the use of the drug in obstetrics in cases of contracted pelvis in order to prevent heavy development of the fetus. He cites an instance of a woman with a funnel-shaped pelvis, protruding ischiatic spines, and an exostosis at the right iliopubic eminence, who had been delivered by craniotomy several months previously. In her succeeding pregnancy from the beginning of the fifth month she was put on one tablet of thyroidin daily. During the first part of the remaining period of pregnancy she increased slightly in weight, and during the latter part she decreased. The fetus seemed to remain small and was allowed to go to term. She was then delivered of a 3200-gramme living child. The previous child weighed 4000 grammes


 at birth. The difference in weight of the two children may or may not have been due to the thyroid in.



Cheron, 12 holds that thyroid extract is an excellent remedy in threatened abortion with hemorrhage, and is valuable in preventing the arrest of uterine involution after childbirth, and that it is potent against the premature return of the monthly periods. Moreover, it is a valuable galactagogue. In other, words, it stimulates the mammary secretion while it lessens functional activity of the uterus. In his hands it has also proved valuable in the control of all forms of uterine hemorrhage, whether this be due to endometritis, tumor, or lesions of the adnexa.

The contraindications to the employment of the drug are: tuberculosis, since this seems to be stimulated rather than arrested, and grave heart disease, where it should be administered with the utmost care, and should be discontinued at once upon the first suggestion of tachycardia. The symptoms of thyroid intoxication are tachycardia, oppression, exophthalmus, glycosuria, albuminuria, and irritability. In certain cases the drug produces rapid emaciation, and sometimes gastric vertigo will be observed.
Four cases of uterine fibromata and two cases of hemorrhagic endometritis have been treated by me during the past winter by means of thyroid extract, with the following results:

Case I.—A. E., colored, thirty-eight years of age, gave birth to her last child twenty-two years ago. She complained of great loss of flesh during the preceding six months, associated with severe radiating pain in the lower abdomen. Examination revealed a number of fibroid nodules on the anterior uterine wall. Five-grain tablets of thyroid extract were administered thrice daily, and in one week's time she reported a marked diminution in her pelvic pain.

Case II.—S. K., colored, aged forty-seven years, single, complained of pain in the back and right ovarian region, and a persistent though slight leucorrhea. Her menses had never been regular, and were now profuse. Under the thyroid extract in two weeks she pronounced herself much better. The duration and quantity of the menstrual flow were greatly diminished.

Case III. — M. M., colored, aged forty-eight years, had given birth to her last child thirty


 years before. She was suffering from the menopausal hot flashes, a constant leucorrhea, and pain in the back and left ovarian region. She had a small fibroid in the posterior uterine wall. On December 3, 1898, the thyroid medication was begun, and on the 16th she stated that she was improved and the pain in her back was gone. Four days later her menses began and lasted for four days, the shortest time for years. They had formerly been profuse and persisted for from seven to ten days. The leucorrhea was also much less in amount.



Case IV.—L. R., colored, aged thirty-five years, single, complained of pain in the left ovarian region, frequency of micturition, and a mucopurulent leucorrhea. Her menses occurred at three-week intervals and lasted profusely for five days. Examination showed the presence of uterine fibroids with a small mass firmly fixed in the pelvis and fibroid in nature. On September 13, 1898, the thyroid tablets were administered. One week later her pain was less and she thought she was a little better, though there was no change in the micturition. At that time the tumors seemed to be undergoing some alteration in shape, and the mass in the pelvis had become freely movable. Six days later she stated that she knew she was better than when she first came for treatment; she had less pain in the back and side. On October 6 she was feeling better generally; her menses had returned on September 27 and lasted three days. They were profuse, but no more than usual. On November 1 the tumor was decidedly smaller and freely movable. Her bleeding was not so pronounced. At her last visit, on December 6, all of her symptoms were relieved.

Case V.—K. G., white, aged twenty-seven, married three years, and sterile, came for the relief of sterility. Her menses had been profuse from puberty, lasting for five or six days, and always clotted. In August, 1898, rapid dilatation and curettage were performed in the hope of relieving the sterility. On March 3, 1899, she returned and stated that she had been flooding for seven weeks, and was suffering from severe left ovarian pain. Examination showed a slightly enlarged endometritic uterus. The thyroid extract was administered, and in forty-eight hours the bleeding ceased and has not returned at the time of writing. The pain also had disappeared and the patient was feeling well.


Case VI. — E. E., a single girl, nineteen years of age, had been flooding for three weeks. The uterus was normal in size, though very sensitive. Thyroid extract in doses of grains three times daily controlled the bleeding in three days time, and also materially lessened the amount of pain.

The following deductions would seem justifiable in the light of the foregoing reports:

1. The thyroid gland, in addition to its general effect upon the metabolism of the body, exerts an inhibitory action upon the pelvic genital organs, and upon the uterus in particular. This action seems to be especially marked upon the epithelial elements of the endometrium.

2. As a result of this inhibitory or vasoconstrictor action there follows a retardation of hemorrhages from the uterine mucosa.

3. This action is directly antagonistic to that exerted upon the uterus by the ovarian secretion.

4. In cases in which this conservative influence is deficient or absent, it may be restored by the ingestion of fresh thyroid gland or desiccations or extracts of that organ.

5. In gynecology, thyroid therapy is especially indicated in hemorrhagic affections of the uterus and in all forms of pelvic congestion, notably in uterine fibromata, hemorrhagic endometritis, menopausal hemorrhages, and chronic tubal disease.

6. The best results are to be expected in fibromata and pathologic conditions of recent development. The more chronic the case the more rebellious will it prove to thyroidization.

7. The thyroid influence is also found to cause an increase in the metabolism of the mammary gland, and the treatment is therefore indicated in all cases of insufficient lactation.

8. The drug may be administered in the form of the fresh gland substance; as a desiccated powder of the fresh gland; in tabloids of the desiccated gland; as the fresh juice; or in one of the various extracts of the gland, administered preferably in the form of tabloids. The same results may be obtained by direct transplantation of the thyroid gland from the sheep to the human subject. Because of the difficulty experienced in procuring the fresh gland and the repugnance which patients exhibit in consuming it, it is well to administer it in the dry form prepared by druggists—in tablets, pastilles, or capsules —in doses of 2% to 5 grains three or four times daily. The average daily dose is 15 grains.

9. Owing to the tendency to thyroid intoxication it is well to discontinue the drug for a period of a week to ten days at regular intervals during the course of the treatment.

1) British Medical Journal, July 16, 1898




 2) Nouv. Arch. d'Obstet. et de Gynic, 1895, No. 6; La Gynic, June, 1806.

3) Rev. Med., Jan. 4, 1899

4) American Gynecological and Obstetrical Journal February, 1897

5) Dublin Journal of Medical Science, Sept. I, 1897 

6)  Scottish Medical and Surgical Journal, July, 1897

7) Zeitch f Geb u Gynak, 1898

8) Medical News, July 3, 1897

9) Lancet, July 23, 1896 

10) Intercolonial Medical Journal of Australasia, April 20, 1897

11) Cent F. Gynak, 1896

12) Rev Medico-Chirurg, des Maladies des Femmes, Nov 25 and Dec 25 , 1896