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A History of Endometriosis pp 39–56Cite as

Microscopy and the Discovery of Endometriosis and Adenomyosis

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Abstract

Study of histologic sections of uterine tissue was essential to discover the new disease uterine endometriosis (adenomyosis) and to differentiate it from a degenerating uterine leiomyoma (fibroid) and from uterine cancer. Unfortunately, the Imperial reform of 1786 had demoted the mission and status of pathological anatomy by transferring microscopy to the department of physiology and thus deprived all subsequent pathological anatomic prosectors – including Rokitansky – use of the microscope.2 Then two publications appeared in the 1830s that demonstrated the importance of microscopy in pathological anatomy. Between 1835 and 1840 Johannes Müller of Berlin published his highly acclaimed Handbook of Human Physiology. Between 1837 and 1844, Joseph Berres of Vienna published the first atlas of the histology of the human body entitled Anatomy of the Microscopic Formations of the Human Body.3 Both works appeared at a crucial point in Rokitansky’s career and they undoubtedly aroused his interest in microscopy.

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Notes

  1. 1.

    Benagiano G, Brosens I. History of adenomyosis. Best Pract Res Clin Obstet Gynecol 2006;20:449–63:450.

  2. 2.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 68. Arleen Marcia Tuchman, Science, Medicine, and the State of Germany: The Case of Baden, 1815–1871 [New York: Oxford University Press, 1993], 86–7. Physiology amounted to “little more than microscopical anatomy accompanied by occasional chemical tests and investigations” until mid-nineteenth century when slowly the development of sophisticated instrumental techniques led to “a methodical approach to the study of function.”

  3. 3.

    Erna Lesky, 73–4. Berres (1796–1844), a Moravian surgeon-macroscopic-anatomist, stimulated by the work of a Viennese optician, had learned microscopy after he was appointed to Vienna.

  4. 4.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 99, 106.

  5. 5.

    Prim. Univ.-Prof. Dr. Roland Sedivy, e-mail message to author, September 2, 2007. “In his autobiography Rokitansky mentioned that he bought 1842 Brunner microscope (fig. attached!). More details are currently not known. But I found in one archive the free-hand graphics of some histological figures he used in his second edition of his textbook. The size of cells in these figures allow [one] to get some idea of what magnification he might have used. I presume that he referred to a magnification in total (ocular × objective) between 50–100x.” See Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 99.

  6. 6.

    Rickman John Godlee, Lord Lister [Oxford: Clarendon Press, 1924], 55: “the Rokitanskys…had dined at Upton [with Joseph Jackson Lister and his family] fourteen years earlier (1842).”

  7. 7.

    Sherwin B. Nuland, Doctors: The Biography of Medicine. New York: Alfred A. Knopf, 1989:351.

  8. 8.

    Michael J. O’Dowd and Elliott E. Philipp, The History of Obstetrics and Gynaecology [New York: Parthenon Publishing Group, 1994], 220. Nuland, Sherwin B. Doctors: The Biography of Medicine. New York: Alfred A. Knopf, 1989:352. Nuland quoted from Joseph Lister’s 1900 Huxley Lecture. In 1900, when surgical pathology was a reality, Lister recalled that his father’s investigations “had raised the compound microscope from little better than a scientific toy to the powerful engine for investigation.” See also: Rickman John Godlee, Lord Lister [Oxford: Clarendon Press, 1924], 11–12. “Between 1824 and 1843, whilst actively engaged in business, he found time to make his mathematical calculations, actually to grind the glasses himself, and to supply the necessary data to Tulley, Ross, and Smith, who were the manufactures. This work gained for him the Fellowship of the Royal Society in 1832, and brought him into contact with a large scientific circle.” He wrote a paper in 1842–3 entitled “On the Limit to Defining Power, in Vision with the Unassisted Eye, the Telescope and the Microscope” that remained unpublished until it appeared in Journal of the Royal Microscopical Society, 1913, Part I: 34–55.

  9. 9.

    RM Allen, The Microscope [New York: D. Van Nostrand Company, 1940], 8. Arleen Marcia Tuchman, Science, Medicine, and the State of Germany: The Case of Baden, 1815–1871 [New York: Oxford University Press, 1993], 57. The Frenchman, Charles Chevalier is credited with having improved resolution at high magnifications by “inserting a biconcave lens between several achromatic lenses.” E. M. Tansey, “From the Germ Theory to 1945,” in Western Medicine, ed. Irvine Loudon [Oxford: Oxford University Press, 1997], 108. Subsequent improvements in microscopes “were matched by advances in the techniques of preserving, cutting, and selectively staining sections for histological examination….Improvements in microscopes for static observations and measurements were also made, especially after the invention of the achromatic lens by Joseph Lister (1786–1869), father of the surgeon Joseph (Lord) Lister. These were matched by advances in the techniques of preserving, cutting, and selectively staining sections for histological examination.” Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 171–2. However, “staining and hardening techniques were still undeveloped in the late 1850s.” Alexander Hellemans and Bryan Bunch, The Timetables of Science: A Chronology of the Most Important People and Events in the History of Science, Touchtone Edition [New York: Simon & Schuster, 1988], 362–4. However, some advances such as the microtome to slice thin tissue sections were not invented until 1885. The microtome was invented by Charles Darwin, son of Charles Darwin, author of The Origin of Species.

  10. 10.

    The 1855 translation of the 1846 edition by the Sydenham Society

  11. 11.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], 76.

  12. 12.

    Carl Rokitansky, 174.

  13. 13.

    Carl Rokitansky, 176.

  14. 14.

    Carl Rokitansky, 184.

  15. 15.

    Carl Rokitansky, 197.

  16. 16.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], 209.

  17. 17.

    Carl Rokitansky, 208.

  18. 18.

    Carl Rokitansky, 220.

  19. 19.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 112.

  20. 20.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 115–6.

  21. 21.

    Erna Lesky, 171–2.

  22. 22.

    Erna Lesky, 112, 219. Lesky, p. 465. “However, the true home and source of microscopists in Vienna, despite the existence of an official Chair of Histology was the Institute of Physiology, of which all the newer institutes were off shoots.”

  23. 23.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 219.

  24. 24.

    Erna Lesky, 220. In German: Grundzüge der pathologischen Histologie, 1855.

  25. 25.

    Erna Lesky, 102.

  26. 26.

    Arleen Marcia Tuchman, Science, Medicine, and the State of Germany: The Case of Baden, 1815–1871 [New York: Oxford University Press, 1993], 76. German universities took the lead in introducing microscopy in the medical curriculum. “Between 1845 and 1855 fifteen medical faculties also began including microscopical demonstrations in their courses on pathology, histology, semiotics, and diagnostics.” Arleen Marcia Tuchman, Science, Medicine, and the State of Germany: The Case of Baden, 1815–1871 [New York: Oxford University Press, 1993], 82–83. By mid-century, the microscope had become for the symbol of excellence in teaching and research. In 1845, students in the University of Heidelberg held a torchlight parade in honor of Jacob Henle, a former assistant of Johann Müller, as a champion of microscopy in teaching and research, and “as a thinker and scientist who campaigns unremittingly and without stop at the head of those who are struggling and fighting against a desolate empiricism in our science.”

  27. 27.

    Erna Lesky, 221.

  28. 28.

    Owen H. Wangensteen and Sarah D. Wangensteen, The Rise of Surgery: From Empiric Craft to Scientific Discipline [Minneapolis, MN: University of Minnesota Press, 1978], 440.

  29. 29.

    Rickman John Godlee, Lord Lister [Oxford: Clarendon Press, 1924], 54–55. Earlier in the day Rokitansky spent over 3 h showing the Lister and other visitors specimens in the Vienna Pathological Museum.

  30. 30.

    Rickman John Godlee, 55: “The medical school at Vienna was the largest and most important he had yet seen. It provided much of general interest; (quoting Joseph Lister) ‘and best of all as yet, Professor Rokitansky, the most eminent pathologist in the world spend three hours and a quarter the other day, in going over his wonderfully rich museum of preparations of diseases, to me and some other visitors.’ Rokitansky was extremely hospitable; he had dined at Upton fourteen years before, and had been much impressed with Lister’s two sisters, though he had no recollection of the young surgeon, who, he said was ‘nothing in those days.’”

  31. 31.

    Rickman John Godlee, 22–23. Joseph Lister wrote two papers on microscopy, both published in the Quarterly Journal of Microscopical Science in 1853. The first dealt with muscular tissue of the iris of the eye. Joseph Lister, Quarterly Journal of Microscopical Science 1853;1:8. The second involved observations on the involuntary muscular fibers of the skin. Joseph Lister, Quarterly Journal of Microscopical Science 1853;1:262.

  32. 32.

    Not only did Rokitansky engage in scholarly debates with Rudolph Virchow in the medical literature, at least on one occasion – November 10, 1853 – he wrote a formal letter to Virchow commenting on the latter’s “discovery of subependymal corpora amylacea of the brain ventricle,” adding his own observations on the subject. This letter was written in immediate response to Rokitansky receiving the “first issue of volume 6 of your Archives.” See Christian Andree and Roland Sedivy, “Discovery of a letter from Rokitansky to Virchow about subependymal corpora amylacea,” Virchow’s Archive 2005;446:177–180. “Subependymal means beneath the ependyma (the cellular membrane lining the central canal of the spinal cord and the brain ventricles) and corpora amylacea means (one of a number of small ovoid or rounded, sometimes laminated, bodies resembling a grain of starch and found in nervous tissue, in the prostate, and in pulmonary alveoli; of little pathological significance, and apparently derived from degenerated cells or proteinaceous secretions.” Illustrated Stedman’s Medical Dictionary, 24th ed. [Baltimore, MD: Williams & Wilkins, 1982], 323, 473. Rokitansky’s letter to Virchow was found by Christian Andree at the Berlin-Brandenburg Academy of Sciences. Professor Sedivy sent the author an autographed reprint.

    In the first pages of volume 6 of his journal, Virchow “unexpectedly praised Rokitansky’s work and the Vienna School of Medicine.” Rudolph Virchow, Uber eine im Gehirn und Ruckenmark des Menchen aufgefundene Substanz mit der chemischen Reaction der Cellulose. Arch Path Anat u Physiol u Klin Med 1854;6:135–138. Shortly thereafter in the very pages of Virchow’s Journal, Rokitansky found an article on subependymal corpora amylacea (CA) written by Virchow that prompted a letter to Virchow from Rokitansky, the only known correspondence between the two men. This episode reveals that not only did Rokitansky faithfully read Virchow’s journal, but also that he must have been pleased to read the unexpected praise for his own work and that of the Second Vienna School of Medicine; words of praise from his old critic. Andree and Sedivy noted that “Virchow mentioned in the addendum to his article that Rokitansky and Kolliker had seen CA in the N. opticus and retina, respectively. When mentioning Rokitansky, Virchow used the passive voice, indicating that he was not sure whether Rokitansky really had observed them.” From this observation, Andree and Sedivy speculated “that this fact was the background behind his letter to Virchow.” See Christian Andree and Roland Sedivy, “Discovery of a letter from Rokitansky to Virchow abut subependymal corpora amylacea,” Virchow’s Archive 2005;446:177–180.

    To this may be added the further speculation that Rokitansky’s friendly, though formal letter to Virchow may have been possible in the first place because Virchow’s unexpected praise helped heal an old wound that Rokitansky had sustained in 1846. See Rudolph Virchow, Rokitansky, Handbuch der allgemeinen pathologischen Anatomie, Literarische Beilage, Preussische Medicinal-Zeitung 1846;XV:237–238, 243–244. Perhaps this rapprochement between the doyen of German pathology and the doyen of Austrian Pathology in 1854 may have contributed to Rokitansky’s greater interest in microscopy and histology that, further stimulated by the publication of Virchow’s Cellular Pathology in 1858, led Rokitansky to inaugurate Virchow’s lectures on pathology in his department in 1859.

  33. 33.

    7. E. M. Tansey, “From the Germ Theory to 1945,” in Western Medicine, ed. Irvine Loudon [Oxford: Oxford University Press, 1997], 102.

  34. 34.

    Paul Strathern, A Brief History of Medicine from Hippocrates to Gene Therapy [New York: Carroll & Graf, 2005], 211–212. Henry E. Sigerist, Man and Medicine: An Introduction to Medical Knowledge [New York: WW Norton & Company, 1932], 124. Referring to Virchow’s Cellular Pathology of 1858, the medical historian Henry Sigerist opined that “Virchow placed the microscope into the hands of pathologists. This only made it possible to see the minuter changes and to undertake a more exact classification of disease. The microscope alone gave us the opportunity of observing other processes of disease, inflammation for instance.” The dominance of naked-eye macromorphology gave way to micropathology as the first major step in the long process of reductionism that led to ultramicroscopic pathologic investigation and molecular biology in the twentieth century.

  35. 35.

    Fielding H. Garrison, Contributions to The History of Medicine. [New York: Hafner Publishing Company, 1966], 190. “In the winter semester of 1859–60…Klob, Rokitansky’s assistant in Vienna, posted on his blackboard the following notice: ‘From Thursday on, lectures on pathological anatomy will be delivered according to the cell doctrine of Virchow.’” Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 172. By the late 1850s, cellular pathology was taught in Vienna and “even in Rokitansky’s own institute.” Lesky, p. 112. “Rokitansky was not a professional microscopist. The task that his time posed before him was of a macromorphological nature and as a macromorphopathologist he fulfilled it. From the very beginning, however, he considered it to be the task of pathological anatomy to raise pathology to physiological pathology. This comprehensive concept as held by Rokitansky makes it possible to understand why he, being a genuine macromorphologist, not only encouraged the development of medical chemistry, and pathological histology, but also that of experimental pathology, and why he acquainted his school with these methods of research when he had exhausted his own method. This took place in the middle of the fifties. The year 1858 marked the beginning of the epoch of cellular pathology.”

  36. 36.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 145.

  37. 37.

    Erna Lesky, 168.

  38. 38.

    Erna Lesky, 171.

  39. 39.

    Erna Lesky, 173.

  40. 40.

    Erna Lesky, 197. After Rokitansky’s retirement in 1874, the advent of Lister’s antisepsis would elevate surgery under Billroth to leadership in the University of Vienna. Billroth adopted antisepsis.

  41. 41.

    Erna Lesky, 293. Very high Austrian battle casualties were caused by the Prussian breech loading rifle in the Austro-Prussian War of 1866. The Prussian soldiers were able to fire and reload in the prone position which reduced their silhouette and vulnerability considerably. In contrast the Austrian soldiers had to stand upright when they reloaded their muzzle loading muskets which made them prime targets. “When the Medical Faculty submitted a proposal for a successor to Schuh in 1867, it demanded, on the initiative of Arlt, Brücke, Hebra, and Rokitansky, that the ministry appoint ‘a man to be professor of surgery of whom the greatest promotion of science may be expected, a man who is not only famous in the field of practical surgery, but also in areas of physiological and pathological research who has demonstrated a special genius as teacher, surgeon and writer, who is still in the prime of life, from whom it may be expected that he will represent the most modern trends in surgery in its relation to physiology and pathological anatomy, and who is able to establish a surgical school in Vienna which will bring fame to the university and the greatest benefit to the country.’” Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 261. To get some idea of the importance of this appointment, consider the words of Billroth: “…it almost seems a fairy tale that I am appointed Imperial Royal professor of the First Department of Surgery and the first Director of the Postgraduate Institute of surgery; appointed by His Apostolic Majesty, the Emperor of Austria…”

  42. 42.

    Erna Lesky, 274. With ready acceptance in Europe of Lister’s principles and practice of antisepsis combined with painless surgery afforded by general anesthesia, general surgery and gynecologic surgery assumed academic prominence over pathologic anatomy. Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 394. Europeans respected the impressive surgical results that the Englishman Spencer Wells (1818–1897) achieved in his operations for removal of ovarian tumors; surgical results supported by “objective statistical analysis.” There occurred a gradual shift from operating dead patients in the morgue to operating live patients in surgery, patients who now survived surgery in increasing numbers. This, in turn, generated need for examination of surgical specimens which led the transition from morbid to microscopic surgical pathology near the end of the century.

  43. 43.

    Henry E. Sigerist, Man and Medicine: An Introduction to Medical Knowledge [New York: WW Norton & Company, 1932], 124.

  44. 44.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], 189, 190.

  45. 45.

    Klemperer P. Notes on Carl von Rokitansky’s autobiography and inaugural address. Bulletin History Medicine 1961:374–380:378. In his professorial inaugural address of 1844, Rokitansky revealed the philosophical basis of his actions. “It is the painstaking study with all methods available to anatomic investigations of morphologic alterations according to tangible physical criteria; because soundest knowledge of morbid phenomena is gained by sensual perception of material appearances.”

  46. 46.

    Carl Rokitansky, Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. Zeitschift Gesellschaft der Aerzte in Wien. 1860;16:577–581. “Of the existing connective tissue tumors of the uterus, the round fibroids are to be differentiated from the so called fibrous polyps of the uterus in which glandular tubules are found. These are connective tissue tumors rooted in the basal stroma of the uterus and cannot be shelled out (Paget’s continuous growth) in contrast to the well circumscribe fibrous tumors.” Carl Rokitansky, Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. Zeitschift Gesellschaft der Aerzte in Wien. 1860;16:577–581. Carl Rokitansky, A Manual of Pathological Anatomy, Volume II. The Abdominal Viscera. trans. Edward Sieveking [Philadelphia, PA: Blanchard & Lea, 1855], ix. Editor’s Preface. Of the difficulties connected with the translation, I will only say that they are much increased by the figurative style of the author. He constantly uses terms in a sense peculiar to himself, and his total disregard for the ordinary rules of composition is an additional and frequent course of obscurity.” Translation of Rokitansky’s 1860 article was equally difficult.

  47. 47.

    Given that Rokitansky emphasized the fresh specimen, it is a reasonable to assume that the fresh surgical specimen caught Rokitansky’s attention and not one of the surgical specimens preserved in wine alcohol, nor any of the autopsy specimens.

  48. 48.

    Owen H. Wangensteen and Sarah D. Wangensteen, The Rise of Surgery: From Empiric Craft to Scientific Discipline [Minneapolis, MN: University of Minnesota Press, 1978], 440. Kussmaul spent 4 months assisting Rokitansky in his morgue. “During all that time the only words Rokitansky spoke to him occurred during an interruption of work while the two stood together for a few minutes in the doorway on a fine autumn morning. Rokitansky said: ‘Today we have beautiful weather.’ The astounded Kussmaul pulled himself together and replied, ‘Yes, it is truly a beautiful day.’” Robert Meyer, Autobiography of Dr. Robert Meyer (1864–1947): A Short Abstract of a Long Life [New York: Henry Schuman, 1949], 16–17. Meyer recalled his teacher, Adolph Kussmaul. “The most brilliant teacher was the internist, Adolf Kussmaul, known among the gynecologists for his book The Malformations of the Uterus. His diagnoses were not far from infallible, so that when he retired in 1887, von Recklinghausen at a banquet could say of him that he had not once been able to reverse a diagnosis after dissecting one of his patients. It was always astonishing how carefully he examined his patients in order to arrive at a diagnosis.”

  49. 49.

    Roland Sedivy, 200 Jahre Rokitansky – sein Vermachtnis fur die heutige Pathologie Wiener Klinische Wochenschrift 2004;116/23:779–787: Table 1, page 780. Histopathology for benign disease never became a routine in Rokitansky’s autopsy house.

  50. 50.

    Carl Rokitansky, Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. Zeitschift Gesellschaft der Aerzte in Wien. 1860;16:577–581.

  51. 51.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. 189, 190.

  52. 52.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], 189, 190. See also Robert Meyer, Autobiography of Dr. Robert Meyer (1864–1947): A Short Abstract of a Long Life [New York: Henry Schuman, 1949], 34. Meyer “stressed the fact that the infiltrative proliferation alone does not necessarily mean malignancy (1903).”

  53. 53.

    Carl Rokitansky, 1860;16:577–581. See also Emge LA. The elusive adenomyosis of the uterus: its historical past and its present state of recognition. Am J Obstet Gynecol 1962;83:1541–1563:1542. “It is just one hundred years ago that there appeared in the Transactions of the Vienna Medical Society a report describing unusual proliferative qualities of the endometrial stroma and glands. Its author, the eminent pathologist Carl Rokitansky.” Though published in 1962, Ludwig A. Emge delivered the Eleventh Joseph L. Baer Lecture of the Chicago Gynecological Society on 21 October 1960, the 100th anniversary year of the discovery of endometriosis.

  54. 54.

    Carl Rokitansky, 1860;16:577–581.

  55. 55.

    Sarcoma adenoids uterinum of Rokitansky is equivalent to adenomyoma of von Recklinghausen which is equivalent to diffuse adenomyoma of Cullen and equivalent to the term internal endometriosis.

  56. 56.

    Carl Rokitansky, Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. Zeitschift Gesellschaft der Aerzte in Wien. 1860;16:577–581.

  57. 57.

    This was not Johannes Peter Müller (1801–1858).

  58. 58.

    Carl Rokitansky, 1860;16:577–581. His reference to Müller reads: “The mucosa hypertrophies in one or more circumscribed places accompanied by elongation of glands producing the bulge.” (H. Müller: Verhandl. D. Phys. Med. Gesellschaft in Würzburg, 4.1854.)

  59. 59.

    Carl Rokitansky, Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. Zeitschift Gesellschaft der Aerzte in Wien. 1860;16:577–581. Rokitansky’s reference to Paget reads: “Of the existing connective tissue tumors of the uterus, the round fibroids are to be differentiated from the so called fibrous polyps of the uterus in which glandular tubules are found. These are connective tissue tumors rooted in the basal stroma of the uterus and cannot be shelled out (Paget’s continuous growth) in contrast to the well circumscribed fibrous tumors. They commonly develop within or form the submucosal stratum and grow into the uterine cavity as so called polyps of various shapes (cylindric-, pear – or club shaped) and are covered by an adherent uterine mucosa. The various changes in its texture may appear identical to the changes seen as a result of chronic inflammation. In contrast to the easily removable fibrous tumors, we commonly consider these connective tissue tumors as sarcoma, here specifically as uterus sarcoma. These tumors growing into a mucosal cavity generally retain their old name of polyp and uterus polyp and, according to the discussion above, would be distinguished from the round fibroids prolapse into the uterine cavity.”

  60. 60.

    Carl Rokitansky, Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. Zeitschift Gesellschaft der Aerzte in Wien. 1860;16:577–581. “A sarcoma containing uterine glandular tubules is also found in the ovaries and some cystic structures of the ovaries, therefore become Cystosarcoma adenoids uterinum.”

  61. 61.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], 189, 190.

  62. 62.

    Carl Rokitansky, Lehrbuch der pathologischen Anatomie [Wien: Braumüller, 1861], III: 475–490.

  63. 63.

    Colin Tudge with Josh Young, The Link: Uncovering Our Earliest Ancestor [New York: Little, Brown and Company, 2009], 192, 193.

  64. 64.

    Vanessa R. Schwarz, Spectacular Realities: Early Mass Culture in Fin-de-Siecle Paris [Berkeley, CA: University of California Press, 1999], 49, 58. The first morgue in Paris was built in 1718. In 1864, 3 years after Rokitansky identified and described uterine endometriosis, a new Paris Morgue was built behind Notre-Dame on the quai de l’Archeveche. This morgue “can be seen in the context of growing state interest in and responsibility for the dead and as part of an ever-increasing reliance on the ‘expert knowledge’ of a professionalized corps of doctors of forensic medicine.” But it was not until 1882 that “the administration installed a system for the refrigeration of the corpses-a system that slowed their decay and thus extended display time…The new refrigeration system, modeled on one developed for the transport of meat to markets, ‘has served as a model for all the large European cities.’”

  65. 65.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855]. “In an extended sense, the collective term fibroid texture may be made to comprise all fibrous tissues, the development of which has been already delineated, and the occurrence of which as a more or less essential component of various new growths, it becomes our business to discuss.” “Nowhere is the insufficiency of a mere anatomical principle more felt than here - a principle which would need occasion us to class side by side, the most heterogeneous new growths, for example, fibro-carcinoma and the perfectly benign fibroid tumor.”

  66. 66.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], 168. “Let us begin with the results of an examination with the naked eye of perfect cysts, and in particular of the exquisite specimens so frequently met with in the ovaries…We have the simple (unicancellated) and the compound cyst (Müller’s compound cystoid).” Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], 34. [Author’s] Introduction. “The female sex greatly favors the occurrence, in the sexual system, of cystoids, of cystosarcoma, of the majority of cancerous growths.”

  67. 67.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume II. The Abdominal Viscera. trans. Edward Sieveking [Philadelphia, PA: Blanchard & Lea, 1855], 248, 249. Chapter III. Abnormalities of the Female Sexual Organs.

  68. 68.

    Roswell Park, An Epitome of the History of Medicine, 2nd ed. [Philadelphia: FA Davis Company, 1908], 250–1. One year later a magnificent new Institute of Pathological Anatomy was erected specially for him, a building Rokitansky had demanded for years. Erna Lesky published illustrations of Rokitansky’s postmortem rooms from his student days until 1862 and of his new institute. Author’s note: Thus we are reassured by Erna Lesky that Rokitansky identified uterine and extrauterine endometriosis in his old “primitive” Leichenhaus described by Roswell Park. Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 262. “Rokitansky received an institute of pathological anatomy in 1862, something he had demanded persistently for thirty-years; in 1868 laboratory space for experimental pathology also was made available in this building. In 1874 a separate institute was founded for medical chemistry, and in 1873 one for embryology.” Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], Illustration 20. “Rokitansky’s post-mortem rooms.” Illustration 21. Rokitansky’s new Institute of Pathological Anatomy. Both illustrations are at the back of the book.

  69. 69.

    Carl Rokitansky, Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. Zeitschift Gesellschaft der Aerzte in Wien. 1860;16:577–581. “The various changes in its texture may appear identical to the changes seen as a result of chronic inflammation…In view of the above discussion, it is important to recognize the changes occurring in the mucosa and the submucosal stratum of the uterus as consequences of chronic inflammation…7. The ones in question and the mucosa lined uterine polyps as a whole undergo changes in their texture which similarly occur in the uterine mucosa in the course or as the end result of chronic inflammation.” For many years the eminent gynecologic pathologist, Robert Meyer, would also believe chronic inflammation the pathogenesis for uterine endometriosis; eventually he changed his opinion.

  70. 70.

    Carl Rokitansky, 1860;16:577–581.

  71. 71.

    Knud Faber, Nosography in Modern Internal Medicine [New York: Paul B. Hoeber, Inc., 1923], 8–15, 37–39, 45, 53–54.

  72. 72.

    Ziporyn, Terra. Nameless Diseases. New Brunswick, NJ: Rutgers University Press, 1992:36–39. A disease remains nameless until recognized, described, and named by a medical scientist or medical practitioner. Similarly, in clinical practice a disease in the patient remains nameless until correctly diagnosed by her medical practitioner.

  73. 73.

    Owen H. Wangensteen and Sarah D. Wangensteen, The Rise of Surgery: From Empiric Craft to Scientific Discipline [Minneapolis, MN: University of Minnesota Press, 1978], 438. “In 1969 the senior author outlined three criteria to decide the role of discover: (1) who first showed the way; (2) continuance of the practice; (3) influence of the discovery upon contemporary and current practice.”

  74. 74.

    Emge LA. The elusive adenomyosis of the uterus: its historical past and its present state of recognition. Am J Obstet Gynecol 1962;83:1541–1563. Although Rokitansky only gave internal endometriosis a descriptive name, “cystosarcoma adenoids uterinum,” and not a proper name such as adenomyosis, Emge – a life-time student of adenomyosis – contended: “the honor of having rendered the first detailed description of adenomyosis, or internal endometriosis, rightly goes to him.”

  75. 75.

    Emge LA. The elusive adenomyosis of the uterus: its historical past and its present state of recognition. Am J Obstet Gynecol 1962;83:1541–1563:1542. According to Emge, Virchow did identify stromal endometriosis in 1864, 3 years after Rokitansky identified adenomyosis. Emge did not give a reference to Virchow’s contribution.

  76. 76.

    Owen H. Wangensteen and Sarah D. Wangensteen, The Rise of Surgery: From Empiric Craft to Scientific Discipline [Minneapolis, MN: University of Minnesota Press, 1978], 438.

  77. 77.

    Hudelist G, Keckstein J, Wright JT. The migrating adenomyoma: past views on the etiology of adenomyosis ad endometriosis. Fertil Steril 2009;92:1536–43.

  78. 78.

    Recklinghausen F. Uber die Adenocysten der Uterustumoren und Ueberreste des Wolff’schen Organs. Deutsche Medicinische Wochenschrift 1893;xix:825–826.

  79. 79.

    Friedrich v. Recklinghausen, Die Adenomyome und Cystadenome der Uterus- und Tubenwandung ihre Abkunft von Resten des Wolff’schen Korpers. Im Anhang: Von W. A. Freund, Klinische Notizen zu den voluminosen Adenomyomen des Uterus [Berlin: Verlag von August Hirschwald, 1896.]

  80. 80.

    Juan Rosai, A tribute to Robert E. Scully on his 80th Birthday. Seminars in Diagnostic Pathology. 2001;18:151–154. “Sometimes the question arises as to how many cases of an undescribed entity somebody needs to see before concluding that one is dealing with something ‘new.’” Dr. Scully, known to the world at large as “Mr. Gynecologic Pathology…gave me once the answer as it applies to himself when joking about the fact that he keeps a box of slides (he did not say whether in his office or in his head), each of them from a case that he thinks represents an undescribed entity, and he is simply waiting for the second case to come along and prove it.”

  81. 81.

    Henry E. Sigerist, Man and Medicine: An Introduction to Medical Knowledge [New York: WW Norton & Company, 1932], 127.

  82. 82.

    Carl Rokitansky, Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. Zeitschift Gesellschaft der Aerzte in Wien. 1860;16:577–581.

  83. 83.

    Benagiano G, Brosens I. Who identified endometriosis? Fertil Steril 2011;95:13–16.

  84. 84.

    Benagiano G, Brosens I. Who identified endometriosis? Fertil Steril 2011;95:13–16.

  85. 85.

    Carl Rokitansky, Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. Zeitschift Gesellschaft der Aerzte in Wien. 1860;16:577–581.

  86. 86.

    Benagiano G, Brosens I. History of adenomyosis. Best Pract Res Clin Obstet Gynecol 2006;20:449–63.

  87. 87.

    Carl Rokitansky, Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. Zeitschift Gesellschaft der Aerzte in Wien. 1860;16:577–581.

  88. 88.

    Carl Rokitansky, Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. Zeitschift Gesellschaft der Aerzte in Wien. 1860;16:577–581. “A sarcoma containing uterine glandular tubules is also found in the ovaries and some cystic structures of the ovaries, therefore become Cystosarcoma adenoids uterinum.”

  89. 89.

    Carl Rokitansky, Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. Zeitschift Gesellschaft der Aerzte in Wien. 1860;16:577–581.

  90. 90.

    Benagiano G, Brosens I. Who identified endometriosis? Fertil Steril 2011;95:13–16.

  91. 91.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy trans. William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], 189, 190. See also Robert Meyer, Autobiography of Dr. Robert Meyer (1864–1947): A Short Abstract of a Long Life [New York: Henry Schuman, 1949], 34. Meyer “stressed the fact that the infiltrative proliferation alone does not necessarily mean malignancy (1903).”

  92. 92.

    Fielding H. Garrison, Contributions to The History of Medicine. [New York: Hafner Publishing Company, 1966], 190. “In the winter semester of 1859–60…Klob, Rokitansky’s assistant in Vienna, posted on his blackboard the following notice: ‘From Thursday on, lectures on pathological anatomy will be delivered according to the cell doctrine of Virchow.’” Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 172. By the late 1850s, cellular pathology was taught in Vienna and “even in Rokitansky’s own institute.” Lesky, p. 112. “Rokitansky was not a professional microscopist. The task that his time posed before him was of a macromorphological nature and as a macromorphopathologist he fulfilled it. From the very beginning, however, he considered it to be the task of pathological anatomy to raise pathology to physiological pathology. This comprehensive concept as held by Rokitansky makes it possible to understand why he, being a genuine macromorphologist, not only encouraged the development of medical chemistry, and pathological histology, but also that of experimental pathology, and why he acquainted his school with these methods of research when he had exhausted his own method. This took place in the middle of the fifties. The year 1858 marked the beginning of the epoch of cellular pathology.”

  93. 93.

    Carl Rokitansky, A Manual of Pathological Anatomy, Volume I. General Pathological Anatomy. trans.

    William Edward Swaine [Philadelphia, PA: Blanchard & Lea, 1855], 189, 190.

  94. 94.

    Carl Rokitansky, Ueber Uterusdrüsen-Neubildung in Uterus- und Ovarial-Sarcomen. Zeitschift Gesellschaft der Aerzte in Wien. 1860;16:577–581. Carl Rokitansky, Lehrbuch der Pathologischen Anatomie III. Auflage 1855–1861. III. Band p. 488–491.

  95. 95.

    Recklinghausen F. Uber die Adenocysten der Uterustumoren und Ueberreste des Wolff’schen Organs. Deutsche Medicinische Wochenschrift 1893;xix:825–826. See also: Friedrich v. Recklinghausen, Die Adenomyome und Cystadenome der Uterus- und Tubenwandung ihre Abkunft von Resten des Wolff’schen Korpers. Im Anhang: Von W. A. Freund, Klinische Notizen zu den voluminosen Adenomyomen des Uterus [Berlin: Verlag von August Hirschwald, 1896.]

  96. 96.

    Cullen, Thomas S. Adeno-myoma uteri diffusum benignum. Johns Hopkins Hospital Reports, 1897, vol. vi, p. 133. Cullen, Thomas Stephen. Cancer of the Uterus: Its Pathology, Symptomatology, Diagnosis, and Treatment. Also the Pathology of Diseases of the Endometrium. New York: D. Appleton and Company, 1900: 535–536. Rokitansky is mentioned in the text, but not in the index. Cullen, Thomas Stephen. Adenomyoma of the Uterus. Philadelphia: WB Saunders Company, 1908. Cullen, Thomas Stephen. Cancer of the Uterus: Its Pathology, Symptomatology, Diagnosis, and Treatment. Also the Pathology of Diseases of the Endometrium. Philadelphia: WB Saunders Company, 1909: 535–536. The 1909 edition seems to be a reprint of the 1900 edition, with minor changes, but with a different publisher. A minor change: Rokitansky is mentioned in the text and in the index.

  97. 97.

    Emge LA. The elusive adenomyosis of the uterus: its historical past and its present state of recognition. Am J Obstet Gynecol 1962;83:1541–1563. Although Rokitansky only gave internal endometriosis a descriptive name, “cystosarcoma adenoids uterinum,” and not a proper name such as adenomyosis, Emge – a lifetime student of adenomyosis – contended: “the honor of having rendered the first detailed description of adenomyosis, or internal endometriosis, rightly goes to him.”

  98. 98.

    Benagiano G, Brosens I. History of adenomyosis. Best Pract Res Clin Obstet Gynecol 2006;20:449–63. Interestingly, the same authors in 1991 do not mention Rokitansky. See: Benagiano G, Brosens I. The history of endometriosis: Identifying the disease. Hum Reprod 1991;6:963–8.

  99. 99.

    Hudelist G, Keckstein J, Wright JT. The migrating adenomyoma: past views on the etiology of adenomyosis and endometriosis. Fertil Steril 2009;92:1536–43.

  100. 100.

    Pick L. Ueber Neubildungen am Genitale bei Zwittern nebst Beitragen zur Lehre von den Adenomen des Hodens und Eierstockes. Arch f Gynaek 1905;lxxvi:251–275. On page 262, Pick cites Rokitansky: “1) Vielleicht ist diese Geschwulstform identisch mid dem alten Rokitansky-schen Cystosarcoma adeoides ovarii uterinum. (Lehrb. D. pathology. Anatom. III. Aufl. Bd.III. 1861. Wien. S. 423, 431).

  101. 101.

    Sampson JA. Heterotopic or misplaced endometrial tissue. Am J Obstet Gynecol 1925;10:649–664:655.

  102. 102.

    Hudelist G, Keckstein J, Wright JT. The migrating adenomyoma: past views on the etiology of adenomyosis and endometriosis. Fertil Steril 2009;92:1536–43.

  103. 103.

    Sampson JA. Heterotopic or misplaced endometrial tissue. Am J Obstet Gynecol 1925;10:649–664:655.

  104. 104.

    John H. Ridley, The histogenesis of endometriosis: A review of facts and fancies. Obstetrical and Gynecological Survey 1968;23:1–35.

  105. 105.

    Knapp VJ. How old is endometriosis? Late 17th- and 18-century European descriptions of the disease. Fertility Sterility 1999;72:10–14.

  106. 106.

    John H. Ridley, The validity of Sampson’s theory of endometriosis. American Journal Obstetrics Gynecology 1961;82:777–82.

  107. 107.

    C. Breus, Pamphlets-Liepzig und Wien-Pamphlet Vol. 4054 - Army Med. Library, Washington, DC While in Washington, DC, I attempted to get this pamphlet [Ridley’s reference number 10] but was unsuccessful. However I was successful in obtaining a pamphlet by C. Breus [Ridley’s reference number 9] that fits the description and which I believe is the same publication that Ridley refers to in his reference number 10. In short, I believe that Pamphlet Vol. 4054 by Breus and the 1894 pamphlet by Breus are one and the same publication. Carl Breus, Uber Wahre Epithel Führende Cystenbildung in Uterusmyomen [Leipzig und Wien: Franz Deuticke, 1894], 1–36. Appended are 25 pages of advertisements, a good source for contemporary books and data. In 1894, Breus was Privatdocent in Obstetrics and Gynecology at the University of Vienna. Appropriately, this small pamphlet on developmental pathology was dedicated to the memory of Hans Kundrat, former assistant to Rokitansky who was the second pathologist to succeed to Rokitansky’s chair as professor of pathological anatomy in Vienna. This volume was borrowed from The John Crerar Library in Chicago. Breus mentioned Kiwisch, Klinische Vortrage. II. Auflage. 1852. 1. Abtheilung, p. 389. The author was unable to obtain this document.

  108. 108.

    John H. Ridley, The histogenesis of endometriosis: A review of facts and fancies. Obstetrical and Gynecological Survey 1968;23:1–35.

  109. 109.

    Carl Breus, Uber Wahre Epithel Führende Cystenbildung in Uterusmyomen [Leipzig und Wien: Franz Deuticke,1894]. On pages 20, 21, Breus discussed congenital anomalies, embryonic rests; on pages 19, 23, 24 vestiges of the Gartner, Wolffian, and Müllerian ducts with an illustration on page 25.

  110. 110.

    Carl Breus, 26, figure 7. Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 266. Lockyer, like Breus before him, illustrated some cystic and cavernous adenomyomas that stretch the imagination of the modern viewer accustomed to imaging techniques that would have detected them before they could reach such bizarre configurations and size.

  111. 111.

    Carl Breus, 27.

  112. 112.

    Carl Breus, 27, 29. See also Cuthbert Lockyer, Fibroids and Allied Tumours (Myoma and Adenomyoma): Their Pathology, Clinical Features and Surgical Treatment [London: Macmillan and Company, 1918], 266. “Breus records a case of a voluminous tumour which contained 7 liters of fluid, and on section presented many cysts lined by ciliated epithelium. The general structure was that of a myoma which had spread out into the broad ligament. There was a second growth, the size of a child’s head, in the posterior wall of the uterus, and this communicated with the cavity of the uterus by a canal.”

  113. 113.

    Carl Breus, 29, 33.

  114. 114.

    Carl Breus, 33, 34.

  115. 115.

    Rokitansky, Lehrbuch III. Auflage 1861. III. Band p. 488.

  116. 116.

    Carl Breus, Uber Wahre Epithel Führende Cystenbildung in Uterusmyomen [Leipzig und Wien, 1894], 1–36. [Ridley’s reference number 9]

  117. 117.

    Erna Lesky, The Vienna Medical School of the 19th Century [Baltimore, MD: Johns Hopkins University Press, 1976], 424, 516. Karl Breus, an associate professor of gynecology and Alexander Kolisko (1857–1918), a student of Kundrat and a professor of forensic medicine wrote “the standard work Die Pathologischen Beckenformen (Pathological Forms of the Pelvis) (Vienna and Leipzig. 1900–1912.”

  118. 118.

    Carl Breus, 1–36 plus 25 pages of advertisement. In 1894, Breus was Privatdocent in Obstetrics and Gynecology at the University of Vienna. Appropriately, this small monograph on developmental pathology was dedicated to the memory of Hans Kundrat, former assistant to Rokitansky who was the second of Rokitansky’s assistants to succeed to Rokitansky’s chair as professor of pathological anatomy in Vienna. This volume was borrowed from The John Crerar Library in Chicago.

  119. 119.

    John H. Ridley, The histogenesis of endometriosis: A review of facts and fancies. Obstetrical and Gynecological Survey 1968;23:1–35:2. For example, Ridley specified that Breus cited Kiwisch (1852) (The author has not been able to identify Kiwisch or find his work) and “Cruveilhier who in 1835 referred in his textbook of human anatomy to the existence of cysts of the adnexa, uterus, and vagina, forming along the course of the Wolffian (mesonephric) and Mullerian (paramesonephric) remnants.” (Jean Cruveilhier, Anatomie Pathologique du Corps Humain. Livraison XIII, Planche IV, Paris, 1835.) Then Ridley issued a disclaimer: “Although, here lacking are accurate descriptions, both gross and microscopic, it is plausible to think that such “cysts” were probably of an endometrial nature.” Parenthetically, it should be noted that Rokitansky had noted similar cystic formations about female internal reproductive organs in the 1846 edition of his Manual of Pathological Anatomy, translated by the Sydenham Society in 1855. (Carl Rokitansky, A Manual of Pathological Anatomy, Volume II. The Abdominal Viscera trans. Edward Sieveking [Philadelphia, PA: Blanchard & Lea, 1855], 248, 249. Chapter III. Abnormalities of the Female Sexual Organs. “In no part of the body are cysts so frequent, or so various as in the ovary, in the peritoneum, in the neighborhood of the internal sexual organs, or in the subperitoneal cellular tissue; as, for instance, between the laminae of the broad ligaments, and at the fimbriated extremities of the tubes. Moreover, the size attained by the ovarian cysts is extraordinary.”

  120. 120.

    King, Helen. The Disease of Virgins: Green Sickness, Chlorosis, and the Problems of Puberty. New York: Routledge, 2004, Helen King, The Disease of Virgins: Green sickness, chlorosis, and the problems of puberty [New York: Routledge, 2004], 30. Originally, amenorrhea or the absence of menstruation had been the defining characteristic of the disease of virgins. Helen King, The Disease of Virgins: Green sickness, chlorosis, and the problems of puberty [New York: Routledge, 2004], 24. Parenthetically, by the eighteenth century, diversion of menstruation or vicarious menstruation from various body orifices and tissues was considered by some physicians as disease; however there was nothing to suggest the clinical signs and symptoms of endometriosis. Helen King, The Disease of Virgins: Green sickness, chlorosis, and the problems of puberty [New York: Routledge, 2004], 30. By mid-nineteenth century, the focus on the disease of virgins changed from amenorrhea to the green color of the skin – green sickness or chlorosis. Helen King, The Disease of Virgins: 33. In reality, the skin color was not green, but pale or white, perhaps with a greenish hue. Helen King, The Disease of Virgins: Green sickness, chlorosis, and the problems of puberty [New York: Routledge, 2004], 116. Finally, “By the end of the nineteenth century, chlorosis had been reinvented yet again, this time as a blood disorder: hypochromic [iron deficiency] anaemia. In its earlier incarnation as the disease of virgins, blood was responsible for the symptoms because it was too thick and sticky to pass through a virgin’s narrow channels into the womb; its thickness could be due to a faulty diet.” King’s entire treatise resolves around iron deficiency anemia with none of the signs or symptoms of endometriosis. Several years ago, before publication of her book, the author spoke to Helen King at a meeting of the American Association of the History of Medicine when she spoke on this subject. At first hearing I thought the disease of virgins might be endometriosis, but when I read the book, it was obviously not. Jacalyn Duffin, History of Medicine: A Scandalously Short Introduction [Toronto: University of Toronto Press, 2000], 181–2. “Andral was the first to suggest that anemia could occur if red cells were destroyed (hemolysis), and he described anemia as a decrease in the number of red cells. He associated anemia with pregnancy and with chlorosis. Once called the ‘green sickness of virgins’ for the peculiar cast it gave to the complexion, chlorosis had been described in the sixteenth century by Johannes Lange, who recommended marriage as therapy. It has come to be synonymous with what we would now call iron-deficiency anemia, although it also resembles anorexia nervosa. Andral was the first to observe the small size of red cells in chlorosis.”

  121. 121.

    Knapp VJ. How old is endometriosis? Late 17th- and 18-century European descriptions of the disease. Fertil Steril 1999;72:10–14. Knapp thanked Jerome F. Strauss, III, MD and Celso-Ramon Garcia, MD, the latter an authority on endometriosis from the University of Pennsylvania, “for encouraging this study throughout.” Knapp also thanked Marc Laufer, MD of Harvard University, an authority on adolescent endometriosis, “for suggesting refinements in the text.” Knapp had published a book on disease in 1989: Vincent J. Knapp, Disease and Its Impact on Modern European History [Lewiston, NY: Mellon E. Press, 1989]. This treatise dealt with infectious diseases: plague, syphilis, smallpox, typhus and cholera, tuberculosis, and influenza and their demographic and sociological consequences. In addressing the possible early recognition of endometriosis, Knapp dealt with a chronic disease. Nevertheless, this was not his first venture into history of disease.

  122. 122.

    Knapp VJ. How old is endometriosis? Late 17th- and 18-century European descriptions of the disease. Fertil Steril 1999;72:10–14:13–14.

  123. 123.

    Brosens I, Steeno O. A compass for understanding endometriosis. Fertil Steril 2000;73:179–180. Brosens and Steeno recommended the reading of the manuscript of Daniel Schroen [note different spelling] published by Krebs in Jena in 1690. Ivo Brosens, the doyen of Belgian gynecology, is an internationally recognized scholar and authority on endometriosis and adenomyosis.

  124. 124.

    Benagiano G, Brosens I. History of adenomyosis. Best Pract Res Clin Obstet Gynaecol 2006;20:449–63: 450.

  125. 125.

    Ronald E. Batt. A compass for understanding endometriosis. Fertil Steril 2000;73:179. Questions asked of Professor Knapp: “What were the ages at menarche and at autopsy? Under what circumstances did these women come to autopsy? Were they ‘executed criminals or recently deceased indigents’? Absence of endometriotic lesions in Douglas’ pouch is unusual, because this is a common site for peritoneal endometriosis. Were the observations made in situ at autopsy or after removal of the reproductive organs from the body? Were the 17th and 18th century authors physician-professors and surgeons as described by Roger? Did the authors perform the autopsies? [Professor Knapp stated: ‘What is remarkable about this epistemology is that virtually every published investigator of the time said exactly the same thing.’] Did they make reference to each other? Did they make reference to even earlier authors?”

  126. 126.

    This conclusion is drawn from evidence in the literature, but with the caveat that at some time in the future all the “Knapp manuscripts” should be examined by a team consisting of eighteenth-century scholars and linguists as well authorities on endometriosis in order to establish a definitive judgment.

  127. 127.

    Benagiano G, Brosens I. Who identified endometriosis? Fertil Steril 2011;95:13–16.

  128. 128.

    Emge LA. The elusive adenomyosis of the uterus: its historical past and its present state of recognition. Am J Obstet Gynecol 1962;83:1541–1563. Ludwig A. Emge spent his professional life time studying adenomyosis, beginning shortly after Cullen published Adenomyoma of the Uterus in 1908. On the occasion of the 100th anniversary of Rokitansky’s description of adenomyosis, Emge presented his lifelong experience with the disease and recounted its history and pathogenesis and etiology at the eleventh Joseph L. Baer Lecture of the Chicago Gynecological Society in 1960 at which time he discussed both its pathogenesis and etiology. Even appendicitis was an unsolved problem at this time. Rickman John Godlee, Lord Lister [Oxford: Clarendon Press, 1924], 123. For the history of the recognition of appendicitis, see Smith DC. A historical overview of the recognition of appendicitis – Part I. NY State J Med 1986;86:571–83. Smith DC. A historical overview of the recognition of appendicitis – Part II. NY State J Med 1986;86:639–47. Smith DC. Appendicitis, appendectomy, and the surgeon. Bull Hist Med 1996;70:414–41.

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    Ronald E. Batt M.D., Ph.D. (Professor of Gynecology)

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Batt, R.E. (2011). Microscopy and the Discovery of Endometriosis and Adenomyosis. In: A History of Endometriosis. Springer, London. https://doi.org/10.1007/978-0-85729-585-9_3

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