574 



UTERUS AND ITS APPENDAGES. 



minal visctis. But it may be displaced from its 

 normal position in either of these cavities 

 under various circumstances. The causes of 

 such displacements are chiefly, inflammation 

 of the surface of the ovary terminating in adhe- 

 sions, displacements of the uterus, and hernias. 



As a result of inflammation of its peritoneal 

 covering, the ovary may be bound down to 

 the side of the uterus, or Fallopian tube, to 

 the recto vaginal pouch, to the brim of the 

 pelvis, to the colon, to the convolutions of 

 the ileum, or to the omentum. 



The displacements of the uterus which 

 occasion a dislodgement of the ovary from its 

 normal position are, retroversion, inversion, 

 and procidentia, or complete prolapsus. 



In retroversion the ovaries are carried 

 downwards along with the uterus into the 

 hollow of the sacrum, where they occupy a 

 position on either side of the principal organ. 

 In inversion of the uterus, the ovaries, to- 

 gether with the Fallopian tubes, fill the in- 

 terior of the artificial pouch, which is formed 

 by the reversement of the organ ; whilst in 

 extreme prolapsus the ovaries, together with 

 the uterus, escape almost entirely from the 

 pelvis, and occupy the sac which is formed by 

 the inverted vagina. 



But the most remarkable displacements are 

 those in which the ovary constitutes a true 

 hernia. Such a hernia may consist of the 

 ovary only, or may include other organs, as 

 the Fallopian tubes, uterus, intestine or omen- 

 turn. A true hernia of the ovary alone is of 

 comparatively rare occurrence. It may hap- 

 pen on one or on both sides, and may be 

 either congenital or acquired. The celebrated 

 case of Mr. Pott was an example of a double 

 inguinal ovarian hernia. And this appears to 

 be the form under which this singular dis- 

 placement has been most frequently met with. 

 In these cases the ovary constitutes a solid 

 tumour of the size of a pigeon's egg, which 

 may be detained at the ring, or lie within the 

 inguinal canal, or even descend to the labium. 



An example of this kind of hernia, in which 

 the left ovary has for many years occupied 

 the inguinal canal, has recently come under 

 my notice. Deneux*, who was at the pains 

 to search out all the cases on record up to 

 his time, has collected examples also of crural, 

 ischiatic, umbilical, ventral, and vaginal hernia 

 of the ovary, and to these Kiwisch has added 

 a case of hernia through the foramen ovale. 



Diseases of the Tunics. 



Inflammation of the ovarian tunics, and parti- 

 cularly of the peritoneal coat, is most commonly 

 associated with acute puerperal metritis. But 

 inflammation, both in the acute and chronic 

 form, may affect the ovary independently of the 

 puerperal state. The resulting anatomical 

 changes in the coats of the organ are vascular 

 congestion in various degrees ; fihrinous exu- 

 dations upon their surface, followed occa- 

 sionally by the formation of artificial bands 

 or adhesions with surrounding parts j and 



* L. C. Deneux, Recherches sur la Heruie de 

 1'Ovaire. 1813. 



chronic thickening of these coats, whereby the 

 original smooth and even surface, (figs 368. & 

 369.) characteristic of the ovary in early life, is 

 lost. When inflammation of the ovary has ad- 

 vanced to the suppurative stage, and this organ 

 is converted into a bag of pus, the coats may 

 have become so attenuated and softened as to 

 burst when the attempt is made to lift the 

 parts from the body after death. 



Ulceration. Rupture. In the case of 

 large collections of fluid within the ovary, as 

 for example in large abscesses or in ordinary 

 ovarian dropsy, the surface of the ovary fre- 

 quently inflames and contracts extensive 

 adhesions with surrounding parts, and if the 

 latter happen to be hollow viscera, such as 

 the intestines, uterus, or bladder, a fistulous 

 communication may be established between 

 them and the sac of the ovary, through a 

 process of ulceration or absorption of the 

 common partition wall, and the contents of 

 the ovary may become discharged externally. 

 Or it may happen that by a similar attenua- 

 tion and rupture, or by a process of ulceration 

 and absorption of these tissues, the ovarian 

 walls give way, in some parts of their free 

 surface, and their contents escape into the 

 abdominal cavity. 



Hypertrophy of the ovarian tunics is almost 

 constantly observed in considerable enlarge- 

 ments of the organ, from whatever cause they 

 may arise. In the case of large ovarian cysts, 

 before adhesions have been occasioned by the 

 pressure of surrounding parts, the peritoneal 

 coat of the ovary, though much thickened, 

 retains its smooth, shining, external surface. 

 It may be generally stripped off with ease, 

 and displayed as a dense white membrane of 

 unequal thickness, but having undergone no 

 further change than that of a general hyper- 

 trophy of its ordinary component tissues. 

 The tunica albuginea in like manner becomes 

 thickened by simple increase of its ordinary 

 constituents, but in the case of very large, 

 and particularly of unilocular cysts, the cyst 

 wall becomes so intimately blended with the 

 common ovarian investment, that it is impos- 

 sible to determine how much of the now 

 united membranes was originally furnished 

 by the tunica albuginea, or ovarian stroma, 

 and how much by the proper wall of the cyst. 

 The hypertrophy in these cases is often so con- 

 siderable that the boundary walls of a large 

 ovarian cyst may measure one or two inches 

 or even more in thickness in some places. 



Ossification. Patches of ossific matter 

 more or less extensive are occasionally found 

 scattered over the surface of ovarian cysts. 

 It is probable, however, that these are de- 

 posited in the first instance upon the inner 

 surface, or in the proper walls of enlarged 

 cysts, and subsequently extend to the proper 

 coverings of the ovary, and that the fibro- 

 cartiiaginous degeneration which these cyst 

 walls sometimes exhibit, also commence in 

 the original cyst, and proceed from within 

 outwards. 



Diseases of the Tissues. 



Hypereemia of the ovary may be limited to 



