OVARIAN CYSTS. 113 



Many of the smaller, more recent \jystomata are of a more solid 

 structure, and upon section show numerous vesicles filled with gelat- 

 inous matter. Older tumors, which are often as large as the head, 

 and which sometimes widely distend the whole abdomen, and con- 

 tain fifty litres or more of liquid, consist mainly of a principal cyst, 

 in which the accessory cysts grow, and, as their walls become thin- 

 ner, finally burst. Thus the multilocular cysts tend to become uni- 

 locular. 



The contents of a cystoma are not always the same, but consist 

 generally of a stringy, thick, dirty-brown or yellowish-green liquid, 

 of specific gravity 1018 to 1024. More rarely, it is a thin liquid or 

 a stiff jelly. According to E. ~Eichwald y the chemical contents con- 

 sist of two series of organic substances : 1. Mucous matter, derived 

 from direct conversion of the cell-protoplasm of the epithelium. 

 M^cin is gradually converted into what is known as colloid matter, 

 and further is changed into mucopeptone (JEichwald), a substance 

 analogous to the albuminpeptone of albumen. 2. Albumen appears 

 either free or combined with soda. The latter is converted into 

 paralbumin (which then no longer coagulates upon heating), and 

 further into metalbumin, which will not precipitate with nitric acid. 

 Finally it becomes albuminpeptone, the last of the series. Wai- 

 deyer considers paralbumin and metalbumin as of value in a diag- 

 nostic point of view. The former is never wanting in ovarian cysts, 

 and never present in ascites. A more convenient test of the liquid 

 obtained from the abdomen by puncture is by the microscope, under 

 which the discovery of cylinder-cells is of the greatest importance. 

 Colloid globes (degenerate, swollen cells), blood, pigment, and cho- 

 lesterin-crystals are often found. Wandering cells are not found 

 unless the cyst-wall suppurates, which, however, is not very uncom- 

 mon. The liquid of ascites is usually of a clear, light-yellow color, of 

 specific gravity 1010 to 1015, and contains amoeboid corpuscles and 

 pavement-epithelium ; and upon standing exposed to the air, if any 

 blood. has become mingled with it during the puncture, it often, 

 after a lapse of twelve or twenty-four hours, throws down a clot .of 

 fibrin, which never occurs in ovarian liquid. If a viscid substance 

 of a somewhat dark color and a specific gravity of about 1018 or 

 1024 be drawn from an abdominal puncture, it is hardly necessary 

 to seek any further proof that ovarian cyst is its source. 



Ovarian cysts are attached by a pedicle, which is sometimes long 

 and narrow, sometimes short and thick, and which includes the 

 ovarian ligament, the tube, and the broad ligament of the womb. 

 Sometimes the seat of the tumor is upon the side of the womb it- 

 self. The main cyst-wall embraces the entire tumor, and in the 



