REPRINTED EROM 
CERTAIN ERRONEOUS PRINCIPLES AND METHODS 
IN GYN/ECOLOGY. 
BY G. BETTON MASSEY, M.D., 
PHILADELPHIA. ' Certain Erroneous Principles and Methods in 
Gynaecology? 
BY G. BETTON MASSEY, M.D., 
It is by no means my intention to 
canvass the whole field of gynaecology 
in this paper, pointing out all the 
views and practices that I regard as 
erroneous. Such a course would be 
at least open to the objection of 
wearying the listener, for the moot 
points in gynaecology as now prac- 
tised are many, and the day has long 
passed when questions of this char- 
acter can be regarded as settled 
beyond dispute by the ipse dixit of an 
alleged authority, or even by the con- 
sensus of opinion and practice of 
many physicians. The history of 
medicine teaches many things, but 
nothing more clearly than that large 
bodies of the profession may griev- 
ously err in their views and practices. 
My own views of present errors are 
merely given for what they are worth, 
as they are tested in the crucibles of 
practice and common sense. 
IS GYNECOLOGICAL SURGERY SYNONY- 
MOUS WITH GYNECOLOGY ? 
Probably the most fundamental 
error of the day in this matter is the 
tacit assumption of many that gynae- 
cology is synonymous with gynaeco- 
logical surgery. I have possibly dwelt 
upon this before, but it is none the 
less true, and I am impelled to repeat 
it, and drive it home into our inner 
consciousness by reason of that 
scientific quality of mind as well as of 
matter, inertia, which permits us to 
change habits of thought but slowly 
when a certain impetus has been 
gained in the wrong direction. This.' 
assumption that the diseases of women 
are the exclusive domain of the sur- 
geon had its bad results at its incep- 
tion, but was at that time by no 
means so freighted with dangerous 
possibilities as at the present, when, 
under the stimulus of a reduced mor- 
tality, due to the slowly-perceived 
duties of surgical cleanliness, the 
1 Read before the Obstetrical Society of Philadel- 
phia, March i, 1894. 2 
G. BETTON MASSEY. 
most heroic operations are daily prac- 
tised by these alleged masters of the 
whole art of curing womanly ills. 
Gynaecology should be understood as 
embracing the whole field of the 
affections commonly found in women, 
particularly those likely to be con- 
founded with purely local faults, such 
as disorders of the nervous, digestive, 
and eliminative systems. 
I do not for a moment wish to de- 
cry the value and signal services of 
surgery in these affections ; it is only 
the assumption that this department 
of gynaecology is the whole of it that 
I desire to point out as an important 
error and one that is responsible 
for many radical mistakes in treat- 
ment. 
IS REMOVAL THE ONLY PROPER COURSE 
TO PURSUE WITH DISEASED ORGANS ? 
A sufficient text upon which to 
arraign some of these erroneous views 
thus conceived and born may be found 
in a few words spoken by a visiting 
surgeon in a discussion in this society 
during the present winter. At the 
close of his remarks on a paper read 
by Dr. Goodell, this speaker asserted 
his conviction that where seriously 
diseased structures are found in the 
pelvis he still regarded their removal 
as the only proper course. Without 
invidious distinction, this sentiment 
may be taken as the working creed of 
the whole body of surgical gynae 
cologists, who regard certain ultra- 
mechanical methods with which they 
are familiar as applicable to all dis- 
eases of women. But if the only 
proper course to pursue in pelvic dis- 
eases is to remove diseased organs, 
how happens it that this principle has 
not been applied to other portions 
of the body ? Typhoid fever, dys- 
pepsia, chronic metritis, and the whole 
list of organic inflammations are 
clearly due to local diseased organs, 
yet we do not hear of the removal of 
these structures being either proposed 
or practised. It may be said, of course, 
that the preservation of life would be 
impossible should the organs be re- 
moved in these cases, but such ques- 
tions of expediency do not have place 
when the parts affected are not more 
essential to life than the pelvic organs, 
yet we still fail to hear of any penis 
being removed for gleet or stricture, 
testis for mere orchitis, limbs for an 
arthritis, or eyes for a keratitis. It is 
even considered justifiable to remove 
the ovaries for an ecchymotic extra- 
vasation of blood into the broad 
ligament or surrounding cavities or 
tissues, when it is well known that a 
much larger haematoma of the orbit, 
a black eye, will get well in a few 
days. 
But even if it were the practice to 
remove organs not hopelessly diseased 
in other departments of surgery, it 
would still be proper to protest against 
such a low estimate of medical respon- 
sibilities in this or any department, 
and to point out that even a cure of 
an affection gained by the loss of a 
portion of the human body is a con- 
fession of scientific incompleteness 
with which we should not be satisfied. 
PREVAILING MECHANICAL METHODS 
INCONSISTENT WITH RECENT BACTE- 
RIAL DISCOVERIES. 
A great majority of these hasty 
and useless amputations of pelvic 
organs that are still amenable to cure, 
as well as many ultra-mechanical 
methods in minor gynaecology, arise 
in a misconception of the nature and 
course of certain affections essentially PRINCIPLES AND METHODS IN GYNAECOLOGY. 
3 
catarrhal in character. The advent 
of exact knowledge of the microbic 
nature of these affections proving 
them to be primarily traceable to dis- 
eased mucous membrane, has laid to 
rest many theories of pelvic disease, 
notably those relating to displace- 
ments and obstruction, yet, sad to 
say, these same affections are still 
treated in accordance with the dead 
theories, and a large portion of the 
income of instrument-makers flows 
from their sale of pessaries and 
dilators. 
Entrenched behind an old belief 
that the uterine congestion and en- 
gorgement that accompanies back- 
ward and downward displacements of 
the uterus were secondary to the dis- 
placement, the method of treatment 
is the correction of the displacements 
first by mechanical means, in the 
hope that a proper position and easier 
circulation will cure the case. That 
relief will at times follow this proce- 
dure is unquestioned, but the far 
greater number in which it fails to 
either reduce the hyperplasia or the 
subjective symptoms proves that the 
reasoning is at fault. This mechani- 
cal theory of the causation of hyper- 
plasia is, in fact, a unique survival 
amidst the present facts of the true 
natureof endometritis and its sequelae, 
-the various atrophies and connec- 
tive-tissue replacements of the uterine 
muscle. Modern pathology points 
clearly to microbic agencies as the 
initial cause of the more common 
alterations in the health of the endo- 
metrium and consecutive changes 
within the parenchyma, even if a 
trauma, such as a laceration, be the 
means of admitting the germs to a 
foothold within the tissues. Flexions 
are doubtless due to local, one-sided 
atrophies of the uterine muscular tis- 
sue, while downward and backward 
displacements are the conjoint effect 
of hyperplasia, tight lacing, and re- 
laxation or injuries to the pelvic 
floor. 
The most important conditions pre- 
sent, therefore, in endometritis, flex- 
ions and displacements are histologi- 
cal alterations within the tissues of 
the uterus. Great relaxation of liga- 
ments, and even considerable impair- 
ment of the pelvic floor, may exist 
without material alteration of the 
situation of the uterus, and without 
subjective symptoms of any kind, as 
can be readily proven by any one who 
examines any number of multiparous 
women who do not consider them- 
selves ill. The majority of women, 
in fact, who have had three or more 
children, present these symptoms of 
relaxation without descensus, and un- 
less there is a descensus due to a still 
existent hyperplastic inflammation, or 
a rectocele or cystocele, they have no 
complaints to make. 
In view, therefoie, of the easily 
demonstrable histological changes al- 
ways present in flexions and displace- 
ments that cause suffering to the 
patient, it is manifestly proper to com- 
bat the morbid processes within the 
uterus by curative agencies adapted 
to the conditions rather than by dis- 
tending and paralyzing the vagina in 
an effort to remove a remote conse- 
quence of the disease, or by excising 
a mere portion of the diseased organ. 
A restoration of tone and function to 
the parts should be the result of well- 
directed efforts. 
THE CERVICAL LACERATION MYTH. 
The same objections lie against the 
idea that a healed tear of the cer- 4 
G. BETTON MASSEY. 
vix has any true pathological impor- 
tance, unless the laceration, by virtue 
of its extent, interferes with preg- 
nancy. The symptoms attributed to 
the tear are due to the consequences 
of microbic invasion of the uterus, 
and though the rest and hygienic ac- 
companiments of the operation for 
repair at times favorably affect the 
patient for awhile, there is rarely any 
improvement noted in cases suffering 
from symptoms traceable to the ute- 
rus. The cause of the suffering is not 
the hiatus in the lips of the uterus, 
nor the much-maligned scar tissue at 
the apex, but lies in the chronically- 
inflamed uterus. To cure the patient 
we must cure the endometritis, metri- 
tis, or hyperplasia, as well as any en- 
feeblement of the nervous system 
consequent upjn them. After that is 
done it is time to considerthe wisdom 
of repairing the tear, if it is a bad 
one. If hot water, glycerin tampons, 
and iodine to the vault have failed, 
the patient should be placed on mixed 
galvanic and faradic treatment, ap. 
plied within the cavity of the uterus 
by means of a pliant electrode cov- 
ered with moist absorbent cotton. It 
is extremely rare that improvement 
does not show itself imjnediately, as 
the contractile effects of the two cur- 
rents are efficiently assisted by the 
microbicidal and decongestive action 
of the positive pole of the galvanic 
current. 
OOPHORECTOMY AS A DISEASE. 
As to the buckets filled with ovaries 
and tubes that are nightly paraded in 
our societies, words fail me. The dis- 
ease for which these organs are re- 
moved exists in the minds of the oper- 
ators rather than in the bodies of the 
patients, and has stained the last quar- 
ter of the nineteenth century with an 
indelible blot on the fame of medical 
practice. I leave the discussion of 
this woful epidemic to posterity, and 
will merely remark that the catarrhal 
and inflammatory affections of the 
tubes and ovaries for which these 
organs are thus amputated are gener- 
ally amenable to curative influences 
patiently prosecuted, chief of which 
is the direct application of the gal- 
vanic current to the uterus, or the in- 
direct application of the same, and 
the faradic current to the ovary itself. 
Probably the most powerful means is 
the uterine method when it can be ' 
safely employed, for we can thus in- 
itiate a curative process at the point 
in the mucous tract from whence the 
initial inflammatory condition had its 
start, and where it still remains in 
most cases. 
THE PREVENTION OF OVARIAN DIS- 
EASE. 
But a more easily applied remedy 
lies in the prevention of tubal and 
ovarian disease by a recognition that 
they are simply extensions upward of 
microbic infections of the uterus. In 
the early cure of virginal endometri- 
tis, subinvolution, and gonorrhoeal in- 
vasions by intrauterine galvanic appli- 
cations, associated with proper hy- 
gienic measures, we may stamp out 
the disease as a conspicuous factor in 
modern life, even though hampered as 
we are with the catarrh-breeding en- 
vironment of American climate and 
habits. It is while this affection is 
still in the uterine stage of its exist- 
ence that these young women may be 
saved from the future invalidism of 
ovarian disease, with its unwelcome 
vista of a suggested sexless future; 
and I have had the pleasure of seeing PRINCIPLES AND METHODS IN GYNAECOLOGY. 
5 
for an internal os that admitted the 
sound with difficulty at other times 
was quite patulous during the pain. 
A rational review of this question is 
convincing that menstrual pain is 
either due to ovarian or nervous ere- 
thism, the actual attack being a neuro- 
muscular storm in a series of organs 
imperfectly prepared to functionate, 
the exciting cause being often a catar- 
rhal endometritis, though by no means 
always. For a disease of such varied 
relationships and bearings it is mani- 
festly improper to practise the routine 
method of dilatation, which is irra- 
tional, rarely of permanent benefit, 
harsh, and often productive of dan- 
gerous results. The causation and 
pathology teach the need of therapeu- 
tic measures to improve the general 
health and nerve tone, and to combat 
the'local congestions and catarrhs, if 
such exist ; and the readiness with 
which these cases respond to such 
combined measures offers no excuse 
for resort to operations whose only 
rationale is a disproved theory. It 
surely does not need the many uncured 
cases that come under our observation 
to prove the impropriety of this oper- 
ation, which produces the very lacer- 
ations so laboriously and expensively 
sewed up after childbirth. 
DANGEROUS OPERATIONS FOR BENIGN 
TUMORS. 
A different reason applies to any 
opposition I may express to operations 
for the removal of fibroid tumors of 
the uterus. These growths are dis- 
tinct deformities of the uterus, and, 
when large, are deformities of the 
person. Surgical operations for their 
removal are therefore proper enough, 
and the question becomes one of expe- 
diency only. 
a number of cases thus rescued, both 
from unsound health and from the 
irrevocable consequences of an un- 
wisely-suggested castration. 
ENDOMETRITIS THE INITIAL LESION 
IN MANY PELVIC DISEASES. 
In spite of the practical neglect of en- 
dometritis by most of our active gynae- 
cologists, who are merely content to re- 
move rather than cure its conse- 
quences, there can be no question of its 
great practical importance in the aetiol- 
ogy of pelvic inflammatory disease, and 
he who cures a chronic case accom- 
plishes results of far-reaching conse- 
quence to his patient. I have already 
indicated my own methods in dealing 
with this affection in the paragraph 
on laceration. 
MENORRHALGIA AND THE OPERATIVE 
PRODUCTION OF LACERATION. 
Closely allied to this question is 
that of painful menstruation, for 
which I have suggested the term 
menorrhalgia as preferable to dys- 
menorrhoea. To the minds of care- 
ful investigators the old theory that 
this symptom was due to a mimic labor 
with an obstructed outlet has been 
completely disproved. No accumula- 
tions have ever been shown to occur 
in these cases, and the fact that a large 
dilator can be inserted within the cav- 
ity of the cervix disproves the exist- 
ence of any obstruction to the flow 
of the menstrual fluid. Spasmodic 
contractions of the circular muscular 
fibres of the internal os may be pro- 
duced by the irritation of a sound, but 
it is by no means proved that these 
fibres are contracted at the time of 
flow; a case of my own, in which I 
inserted the sound during an attack 
of pain, tends to prove the contrary, 6 
G. BETTON MASSEY. 
It has been amply demonstrated 
that all small fibroids, and solid and 
interstitial varieties of large ones, are 
amenable to arrest and retrogression 
by the use of the Apostoli method of 
electrical treatment. In my own ex- 
perience this has occurred in seventy- 
six out of eighty cases, in seven of 
which the tumor disappeared entirely. 
The claims of this method in prefer- 
ence to the knife are, therefore, of 
very great importance, particularly 
when the large mortality of the oper- 
ation is contrasted with the slight 
mortality of the tumors left to them- 
selves, and when it is also remembered 
that a successful hysterectomy ren- 
ders the patient sexless, and leads so 
often to a troublesome hernia at the 
site of the abdominal incision. De- 
generating or suppurating tumors do 
not permit us to select any other 
alternative than the knife. 
RESTORATION OF FUNCTION. 
The highest aim of the gynaecolo- 
gist should be the restoration of func- 
tion, yet how seldom do we hear of 
this, in its broadest sense, being an 
ever-present consideration with the 
operator in gynaecology as it is prac- 
tised. The cure of sterility, it is true, 
is frequently aimed at, but a reader of 
our most recent works on the diseases 
of women will make wondrous excur- 
sions into the realms of antiseptic 
surgery and abdominal section, will 
read of gross diseases and endless 
amputations as remedies, but will 
probably see no mention whatever 
of the analogous conditions and weak- 
nesses peculiar to their sex, which 
surely women suffer from as well 
as men. The gynaecologist knows 
much of intestinal anastomosis and 
cholecystectomy, but nothing of ma- 
tronal impotences. It is like the 
play of' Hamlet without Hamlet. In 
these neglected fields lie some of 
the remote causes of pelvic disease, 
and many of the more trifling com- 
plaints which mar the conjugal and 
social life of women.