OVARY (ABNORMAL ANATOMY). 



577 



ing that purpose at all, and it is probable that 

 these, in preference to other and more healthy 

 follicles, become the seat of subsequent mor- 

 bid changes. 



For it must be remembered that the cir- 

 cumstances under which the male and female 

 generative elements escape from the place of 

 their original formation are essentially dif- 

 ferent. The male secreting organ, the testis, 

 is provided with an excretory duct for the 

 escape of the fertilising fluid ; but the female 

 gland is a shut sac. To the normal escape 

 of its products many barriers are opposed, 

 and it has already been shown by what com- 

 plicated machinery the shedding of the female 

 product is effected. But it is impossible to 

 regard this complex process without perceiv- 

 ing how easily a failure in any of those steps 

 may defeat the final object for which that 

 process is set on foot. The thickness of the 

 walls of the follicle, the density of the ova- 

 rian coverings, or of the parenchyma of the 

 ovary, if the follicle should fail to reach the sur- 

 face ;the chance of the ovum perishing before 

 it quits the ovisac, and so the stimulus to the 

 healthy development of the latter being lost ; 

 the chance of an excessive accumulation of 

 liquor folliculi or of blood within the follicle, 

 causing damage to the ovum, and replacing 

 a natmal by a morbid amount of exudation. 

 In these and other possible interruptions to 

 the natural completion of ovulation we may 

 discover the elements of many future morbid 

 changes. And although it would require a 

 long continued and deep research into the 

 aberrant functions of the ovary to determine 

 the true order and sequence of many of these 

 morbid processes, yet it is impossible to carry 

 anatomical investigation into the structure of 

 the morbid ovary, especially under incipient 

 forms of disease, to any extent without many 

 fragmental observations occurring suggestive 

 of the idea that the ovary, like any other 

 gland, may have its natural functions impeded, 

 and that many of the organic changes which 

 are observed in this part may owe their origin 

 to such interrupted processes. Some of the 

 observations which have led me to the adop- 

 tion of these views have been already given, 

 and some others will be detailed as suggestive 

 of a better basis for the study of ovarian 

 pathology than has hitherto been employed ; 

 for of all the organs of the body the ovary is 

 perhaps that whose pathological conditions 

 have been regarded with the smallest amount 

 of reference to its natural or deranged func- 

 tions. 



From these considerations, then, I have been 

 led to the conclusion that certain conditions 

 of the ovary, which, from their concomitant 

 symptoms during life have been deemed in- 

 flammatory, are not necessarily associated with 

 inflammation ; that it is probable, first, that 

 the natural process of ovulation is often ac- 

 companied by symptoms very similar to those 

 of inflammation ; and secondly, that the pro- 

 cess of ovulation is occasionally disappointed 

 or interrupted, and that the follicles, whose 



natural development has been interrupted, 

 may, like the hydatiform placenta, become the 

 seat of a low form of nutrition, terminating in 

 effusion and collection of various dropsical 

 fluids. 



With regard to the anatomical evidences of 

 inflammation of the ovary as furnished by 

 post-mortem examination, they are chiefly the 

 following, viz.: general redness or hypera?mia 

 of the ovarian parenchyma, or of the walls of 

 the follicles ; swelling of the ovary to the ex- 

 tent of increasing the organ to three or four 

 times its natural size, producing a round, oval, 

 or flattened form of the ovary ; a general tension 

 or hardness of the organ in the early stages of 

 inflammation, and subsequently softening, con- 

 sequent on degeneration of the tissues and 

 their infiltration by serous or purifonn eflii- 

 sions; and lastly, but rarely, gangrene of the 

 ovary. 



Of these morbid changes the only one which 

 appears to require a more particular account is 



Suppuration of the ovary. Pus may be 

 found in a circumscribed cavity within an en- 

 larged and highly vascular ovary, portions of 

 whose structure may still retain its natural 

 condition. Or the entire ovary may be con- 

 verted into a bag of pus, the natural tissues 

 being entirely destroyed, and the fluid bounded 

 only by the ovarian tunics. In such cases 

 the abscess " appears to rise from suppuration 

 in the substance of the viscus, similar in 

 every respect to phlegmonous abscess in any 

 part of the body, and not connected with any 

 cyst, or change, or addition of structure, the 

 product of morbid growth."* These abs- 

 cesses, which are sometimes of enormous size, 

 may burst into the general sac of the peri- 

 toneum, or, after forming adhesions with sur- 

 rounding parts, may discharge their contents 

 externally through the abdominal walls, or 

 into the Fallopian tube, uterus, vagina, blad- 

 der, rectum, or other part of the intestine. 

 Portal mentions cases of ovarian abscess as 

 large as an infant's head, and Dr. Taylorf of 

 Philadelphia has recorded an instance in which 

 the ovary contained twenty pints of pus. It 

 is highly probable that these and even still 

 larger collections of pus, which have been 

 found in the ovary, were, as M me Boivin has 

 suggested, origi nail}' cases of encysted ovarian 

 dropsy, but inflammation and suppuration 

 having been set up in the walls of the cyst, 

 the original contents have been gradually in- 

 termixed with pus, until the whole fluid has 

 appeared to be of that nature. Probably of 

 this kind also was the case recorded by Vater J, 

 in which the ovary was as large as the human 

 head, and " contained pus distributed into 

 several capsules." This, therefore, was a 

 multilocular abscess. 



Except in connection with acute metro- 

 peritonitis, suppuration of the ovary may 

 be considered as comparatively rare. Dr. 



* Seymour's Illustrations of some of the principal 

 Diseases of the Ovaria, p. 40. 



f North Amer. Med. & Surg. Journ. 1826. 

 I Haller, Uisp. Med. 



1' I 1 



