Ralph E. Campbell

Pituitary gonadotropic extracts for treatment of amenorrhea menorrhagia, and sterility

Abstract From an experience with use of genuine pituitary gonadotropic extracts for seven years, we are reporting examples of the results which may be expected in treating women for primary or secondary amenorrhea, for menorrhagia and irregularity of menstrual cycles, and for relief of sterility. All the syndromes presented here are considered to be the result of underactivity of ovarian hormones, dependent presumably upon underactivity of the anterior pituitary in supplying gonadotropic hormones. For accurate diagnoses and conduct of treatment the use of endometrial biopsy and vaginal epithelial samples secured by pipette, as well as of pregnandiol determinations in urine, are shown to be important aids. If these aids fail to show definite response to treatment, even though menstrual flows are occurring at fairly regular intervals, the treatment may well be increased or abandoned. The use of long series of repeated daily doses, extending for five to 15 days at the beginning of each menstrual cycle, seems necessary and is demonstrated to be safe. Results are not achieved in a single month. This study indicates the need for individualization of dose, and for the preparation of more concentrated pituitary extracts.

Endocrinopathic amenorrhea: Causes and treatment

Abstract Amenorrhea may result from failure of the ovaries to respond to pituitary gonadotropic stimulation, or from deficient pituitary secretion. Ovarian failure is characteristic of the menopause, and is to be treated for symptomatic control only, and by the use of estrogenic substances. Pituitary inadequacy may be substituted for by gonadotropic substances obtained from animal pituitary or from serum of pregnant mares. Hypodermic injections of these extracts are advised in series of five to fifteen doses, during the first two weeks of the menstrual cycle, or at intervals beginning not oftener than every four weeks, to attempt reestablishment of cyclic flowing. Determination of the ability of the ovaries to respond is facilitated by the use of vaginal smears showing the estrogenic effects on vaginal mucosa.

The use of corpus luteum in the treatment of dysmenorrhea

T HE treatment of dysmenorrhea b;v glandular therapy has not been successful in the majority of instances; failure has been in part dependent upon the unsnccessful isolation rhemically of hormones in pure product. Recent advance in biologic research by Hisaw and Fevold, Corner, and others, has made the corpus luteum hormone available as a pure product for medical use. We wish to emphasize that many biologic products have been marketed in the past as corpus luteum, which have contained very little of this hormone, if any. These products up to now have had a wide usage and a uniformity of failure in the treatment of dysmenorrhea. This result needs no furt.her explanation. We have been using a product of s pure corpus lutcum hormone designated as corporin, by Hisaw. This preparation has been produced in the laboratories of Hisaw, according to his methods of extraction; it has been biologically tested to show the lack of follicular stimuiation in the vagina of animals, which indicates a pure chemical separation of the corpus luteum h0rmone.t The rationale of the treatment of dysmenorrhea by corporin has been known for years from the physiologic standpoint. It 1~s lIeen shown

The management and treatment of habitual abortion

Abstract Habitual abortion is still one of the most discouraging conditions to deal with in the field of medicine. Spontaneous abortion presents a diversity of causes, such as: abnormalities, displacements, and inflammations of the genital tract; infectious diseases; germ plasm defects; tumors of the genital organs; dietary deficiencies; vitamin deficiencies; many alleged causes indicating serious investigation; and, last, the endocrine system in which the thyroid, ovaries, and pituitary gland are so important. Important chemical investigations in endocrinology as related to the thyroid gland, ovaries, and pituitary gland, coupled with recent experimental data upon function, have been responsible for such advances in therapy as the use of progesterone and progestin-like extracts in the treatment of habitual abortion. It has been very well established in the human being that the corpus luteum remains active until about the fourth month of pregnancy, and then begins to degenerate slowly until about the seventh month, when there remains little evidence of its presence or activity. It has been shown experimentally in animals that the corpus luteum substance is necessary for the maintenance of normal pregnancy. There is every reason to believe that this stabilizing factor is present in the human being until the placenta is a controlling factor. Experimental studies by Falls and his collaborators show very clearly in the human being that the estrogenic substance increases uterine irritability and muscle contraction, and the corpus luteum substance is the antagonistic factor. It was also shown that progesterone nullifies posterior pituitary response. These findings are important in relation to habitual spontaneous abortion and its treatment.

The treatment of pelvic tuberculosis in the female by radiation therapy based upon experimental evidence in the animal and clinical results in the human

Roentgen-ray therapy for genital tuberculosis was introduced by Bircher in 1908. According to the original report of Bircher, roentgen-ray therapy is indicated primarily (a) in those cases with adhesive or plastic peritoneal tuberculosis in which operation offers but little help, (b) in cases with cachexia in which operation is contraindicated, (c) in cases which refuse operation, and (d) in slight and benign cases. Cases in which roentgen-rays are to be used secondarily include (a) those in which the exudate reappears soon after operation, and does not disappear within fourteen days, and (b) all cases in which the symptoms return after operation. Among the many reports favoring this type of therapy-alone or combined with surgery-may be mentioned Bumm, Krijnig, and Zweifel in Germany ; Schauta in Vienna ; Solomons in Ireland ; and Ford, Polak, and Jameson in the United States. Since Bircher’s original paper, Martius, Kolischer, and Gibert feel that roentgen-ray therapy should be extended to include all types of pelvic tuberculosis. While others, such as Edling, Weibel, and Pestalozza believe roentgenray therapy has its greatest indicatron as a postoperative measure following conservative or radical surgery. This group does not feel that it is a question of the roentgen-rays versus surgery, but a combination of the two methods.

Complications of the Third Stage of Labor

This paper includes management of the third stage of labor which should end with a critical period one hour after the delivery of the placenta. Placental delivery should exclude a radical, forcible and manual expression as a general policy, except in hemorrhage, and should be replaced by watchful waiting. Complications discussed are: postpartum hemorrhage, bleeding from cervical and vaginal lacerations, retained placental remnants, retention of placenta or retained placenta, placenta accreta, inversion of the uterus and retraction ring.