[reprint from progress] 
PROFOUND LESIONS WITHIN THE PELVIS RESULTING 
FROM GONORRHEA GIVING RISE TO DISTRESS- 
ING INDIGESTION, MAL-NUTRITION, ETC. 
JAMES C. WOOD, A.M., M.D. 
Patient aet. 26. She came to me in July of 1902 emaci- 
ated, anaemic, dyspeptic, menorrhagic, constipated and had 
constant distress through the pelvic organs. She had had 
gonorrhea some two years before I saw her. For more than 
a year she had been under the care of a stomach specialist 
who treated her by lavage, predigested food, etc. She' obtained 
from this treatment nothing more than passing relief. Phy- 
sical examination showed the uterus to be retroflexed, tender 
and fixed, with the' ovaries evidently bound down by adhesions. 
The cervix had undergone almost complete cystic degeneration 
and there was hanging from the cervix a thick viscid dis- 
charge which not infrequently projected one or two inches 
from the vulva. There was also much tenderness over the 
appendix and there was a history of at least two mild attacks 
of appendicitis. There' was constant pain in the region of 
the stomach. 
On November 29, 1902, I dilated and curetted the uterus 
after which the cervix was amputated. The rectum was 
divulsed and a large hemorrhoid removed by the author's 
method. The abdomen was then opened in the Trendelenburg 
posture. The left ovary and tube were so firmly buried in 
inflammatory exudates that it required all the force I could 
command to deliver them. The ovarian stroma was almost 
completely destroyed. The right ovary and tube were' likewise 
adherent but were removed with much less difficulty. The 
right ovary was so much diseased that it did not seem wise 
to leave any portion of it behind. The appendix was thick- 
ened, indurated and adherent. It was therefore removed. 
The uterus was stitched in front with two chromicized catgut 
sutures. The abdominal wound was closed with two layers of 
catgut, silkwormgut tension sutures and a subcuticular silk- 
wormgut suture. The patient's convalescence was somewhat 
prolonged but within six months she had gained 20 pounds in 
flesh, her indigestion was entirely gone', her constipation was 
cured and she was perfectly free from pelvic pain. There 
were some distressing nervous phenomena incident to the forced menopause which bothered her for a year but these 
have now entirely disapeared. 
Remarks-This case demonstrates one of the dangers of 
"exclusive specialism." Had the gastrologist made a more 
thorough examination it is not probable that he would have 
subjected the patient to a year's local treatment of the stomach. 
The dyspepsia was so clearly reflex that had he applied the 
ordinary tests, familiar to the gynecologist, he would not 
have made the mistake which he did. I make this statement, 
not in a spirit of criticism, but for the purpose of showing 
the danger that all specialists in all departments are liable 
to run into, unless the patient is treated as a "totality of 
organs," rather than as a human being in whom there has 
been evolved one set of organs for one set of specialists. I 
have in my time made many similar mistakes so that I speak 
with no small degree of humility. 
Under the head of "Gastric Neuroses," in my Text Book 
of Gynecology, * I give the following points in differentiating 
an organic disease of the stomach from a gastric neurosis: 
1. The gastric symptoms subside upon curing the local 
lesion. 
2. Articles of diet which would aggravate organic le- 
sions are frequently the only one's retained in a neurosis. 
3. Exacerbation of the gastric symptoms occur simul- 
taneously with an exacerbation of the pelvic symptoms. 
4. Entire absence of the evidence of organic disease 
of the stomach. 
The local lesion does not necessarily have to be as severe 
as the one in the case under consideration in order to disturb 
the stomach. Not infrequently a displaced ovary or a retro- 
flexed uterus will cause distressing gastric neuroses. 
To consider the foregoing propositions seriatim: 
A patient with cancer of the stomach, for instance, or with 
acute gastritis, could not take without great distress, indiges- 
tible articles of diet; whereas one with a neurosis, as is fre- 
quently seen in pregnancy, can frequently take the most indi- 
gestible substances without causing inconvenience. 
It will be found in all instances where the gastric neurosis 
is reflected from the pelvic organs that the gastric symptoms 
are worse during menstruation, at which time all of the pelvic 
organs are congested. 
* Second Edition, page 230. It is by no means an easy matter to determine the entire 
absence of organic disease of the stomach or the duodenum 
by physical examination, unless indeed the abdomen is opened. 
However, if upon physical examination there is found absence 
of a tumor, or localized tenderness suggesting ulceration, and 
if upon continuing the physical examination there is found 
sufficient disease of the pelvic organs to account for the 
neurosis, one can be reasonably sure that he' has to deal with 
a reflex condition of the stomach rather than actual disease 
of that organ. 
These propositions have' been so thoroughly worked out 
by the gynecologist that it seems almost superfluous to em- 
phasize them. In another paper I published an article entitled 
"The Surgical Aspect of Indigestion and So-Called Gastral- 
gia," ** which was first presented to the New York County 
Homeopathic Medical Society, March 10,1904. In that article I 
discussed the surgical causes of indigestion under the heads 
of: 
1. Gastric Ulcers. 
2. Gastric Dilatation and ente'roptosis. 
3. Pyloric Strictures. 
4. Gall-bladder lesions. 
5. Movable or floating kidney. 
6. Chronic appendicitis. 
7. Intestinal strictures and adhesions. 
8. Diseases of the uterus and its adnexa. 
That paper was prepared to show how frequently indi- 
gestion is due to surgical lesions, and how difficult it may be 
permanently to relieve the stomach symptoms without sur- 
gical interference. The field is a large one and is being thor- 
oughly worked out by the abdominal and gynecological surgeon. 
I think that the general practitioner too often resorts to 
routine treatment of the stomach, when he is confronted with 
a case of indigestion, without studying the entire organism, 
just as the specialist too often confines his attention to the 
special organs embraced by his particular line of work, instead 
of resorting to general medication. 
** Medical and Surgical Reporter. April, 1904. 
Cleveland, Ohio