OVARIAN CYSTS. 115 



SYMPTOMS AND COURSE. In some few cases the symptoms as- 

 cribed to ovaritis in the last chapter precede hydrops' ovarii. More 

 frequently there are no premonitory symptoms, and even the cysts 

 themselves excite no symptoms as long as they are small and do not 

 press against any neighboring organ. It depends on the position 

 of the cyst whether it will cause trouble on attaining some size, and 

 as to what the nature and amount of this trouble will be. Cysts of 

 even moderate size, situated behind the uterus in Douglas's cul-de- 

 sac, and pressing the uterus against the bladder, may cause severe 

 urinary difficulty ; this may be either strangury or dysuria, accord- 

 ing to the part of the bladder pressed upon. Defecation may also 

 be hindered by small tumors ; and pressure on the nerves running 

 along the posterior wall of the pelvis may cause pain in the small 

 of the back, or signs of pressure on the nerves of the extremities ; 

 these are sometimes pains, sometimes a feeling of numbness. Last- 

 ly, oedema and varices of the lower extremities sometimes result 

 from pressure of an ovarian cyst on the venous trunks in the pelvis. 

 Besides the above symptoms, there are sometimes changes in the 

 breasts, particularly swelling, discoloration of the areola, and even 

 secretion of colostrum. Occasionally, too, there is sympathetic 

 vomiting, and a general disturbance like that which takes place at 

 the commencement of pregnancy. 



As the tumor grows and rises out of the pelvis, the symptoms 

 of pressure on the pelvic organs usually subside. Many patients 

 then feel quite well, and the disease can only be recognized by ex- 

 amination, of which we shall speak hereafter. In some cases, how- 

 ever, the inconveniences continue. For instance, in spite of the 

 enlargement of the other parts, the wedge-shaped, thin portion of 

 the cyst may extend far down into the pelvis, and continue to cause 

 the symptoms of pressure on the pelvic organs. On the other hand, 

 as it rises, the cyst may stretch the bladder, and thus induce more 

 trouble with the urine. 



As the tumor continues to enlarge, the space in the abdomen is 

 gradually lessened ; the movements of the diaphragm are hindered, 

 and it is pressed upward. Then we have the symptoms of com- 

 pression of the abdominal viscera and of the lower lobes of the 

 lungs. Even a moderate fulness of the stomach, or a slight disten- 

 tion of the intestines by gas, becomes very annoying ; vomiting is 

 easily excited ; the patient becomes short of breath, and bronchial 

 catarrh results from the collateral fluxion to the upper lobes of the 

 lungs. Even the secretion of urine maybe interfered with by com- 

 pression of the kidneys and their vessels. Finally, the general nu- 

 trition, which has usually been unimpaired up to this time, suffers 



