DISEASES OF THE OVARIES. 



larger cystomata adhesions more or less extensive to the neighbor- 

 ing serous surfaces are often found a matter of great importance 

 in a question of ovariotomy. 



Regarding the causes of ovarian cysts little that is trustworthy 

 is known. In exceptional instances such growths are met with even 

 in childhood, and it is probable that many which are not detected 

 until adult age have existed during youth. Of three hundred and* 

 forty-eight cases observed by Lee, West, Scanzoni, and Schroeder, 

 ninety-seven were prior to the thirtieth year, one hundred and 

 forty -five between the thirtieth and fortieth years, seventy between 

 the fortieth and fiftieth years, thirty-one between fifty and sixty, 

 and two between seventy and eighty. Both ovaries are very often 

 found diseased (fifty out of ninety-nine times, Scanzoni) ; but the 

 changes in the less affected ovary are usually stationary, and both 

 ovaries are seldom found simultaneously in such a state of cystic 

 degeneration as to form large tumors, and it is equally rare for the 

 extirpation of one ovary to be followed by the growth of a tumor 

 upon the other. 



3. Dermoid cystomata are always congenital. From the sketch 

 given by His and Waldeyer of the embryonal development of the 

 so-called axischord, from which the rudiments of the genitals de- 

 velop, it will be seen that in this part, in which the different ele- 

 ments of the embryonal rudiments grow into one another, and in 

 which especial germinal Iamina3 are no longer distinguishable, ele- 

 ments of skin, fat, nerves, muscle, and bone might stray into the 

 sexual sphere. Dermoid cysts do not usually become developed 

 until after puberty ; they are rare during childhood. As a rule, 

 they are relatively small (about the size of an apple or fist), but 

 sometimes grow as large as the head. The structure of the interior 

 wall of the cyst closely resembles that of the skin. There is an 

 epidermic covering, beneath which is a layer of connective tissue 

 resembling the cutis, and in which irregularly-arranged papillae can 

 sometimes be found. A layer of fat (panniculus adiposus) is very 

 constantly found beneath the cutis. Sometimes deposits of true 

 bone are found in the connective tissue, which may even contain 

 rudimentary teeth embedded in alveolar processes. More rarely a 

 growth of gray nsrve-substance or of transverse striped muscular 

 fibres is made out. The wall of the cyst, like the skin, contains 

 sebaceous hair-follicles, sometimes even sweat-glands ; and the cav- 

 ity of the cyst is filled with the products of these organs, a mixture 

 of epidermic cells, sebaceous secretion, masses of fat and choles- 

 terin, and of hair either still growing or cast off and rolled into a 

 ball.] 



