PATHOLOGY OF THE OVAKIES AS ENDOCRIN ORGANS 603 



Pathological processes may affect these two secretory structures separately 

 or together. Not only is the ovary subject to the general morbid changes in- 

 cident to other organs but owing to their special cellular nature the ovary 

 has disease processes that are characteristically ovarian. 



The morphologicopathological changes may be classified as due to in- 

 fections, errors of development, nutritional changes, new growths, and 

 changes secondary to pathological processes in the products of pregnancy. 



Gonococcal Infection 



The most common type of infection of the ovaries is that brought about 

 by the gonococcus. In the vast majority of these cases the disease limits 

 itself to a perioophoritis only, in which it is questionable whether much 

 or any of the secretory tissues suffer permanent damage. But in a per- 

 centage of cases, variously estimated from 2 to 5 per cent, low grade 

 abscesses of the ovaries develop by means of the entry of the gonococcus 

 into the recently ruptured Graafian follicle, there giving rise to a purulent 

 accumulation of greater or lesser activity. Many such cavities may become 

 infected giving rise to numerous isolated purulent foci. In such cases the 

 secretory surface of the corpus luteum is gradually broken up and the 

 cavity becomes lined by inflammatory tissue or, in less acute conditions, 

 lined by a flattened, compressed fibrous capsule infiltrated more or less 

 with leucocytes. 



In still more acute pelvic gonorrheal cases the whole ovary may become 

 enlarged, edematous, and infiltrated, and on resolution complete atrophy of 

 all oogenetic and special secretory structures may follow. 



Tubercular Infections 



Tubercular infections of the ovary are seldom, if ever, primary. Two 

 clinical types are easily differentiated. In the one there is a slow, pro- 

 gressive fibrosis of the ovary with enlargement of the whole organ and with 

 few areas of caseation. At times tlie ovaries so affected may reach a con- 

 siderable size. Giant cells may be few or many, and after the fibrotic 

 process has gone on the oogenetic and secretory tissues undergo destruc- 

 tion. On the other hand in the more acute infections the whole ovary 

 may become riddled with small and large tubercular cavities, and here 

 again all trace of secretory function and oogenesis disappears. 



Septic Infection 



This most frequently follows puerperal infection in which the ovaries 

 become involved with the other tissues of the pelvis, either by direct lym- 



