116 DISEASES OF THE OVARIES. 



from the various disturbances of the organs engaged in the forma- 

 tion of blood. Anaemia and hydraamia are developed ; the patient 

 loses strength and emaciates ; the menses, which have previously 

 been regular, cease ; even where there is no compression of the 

 veins, the lower extremities become cedematous as a result of the 

 hydrsemia ; finally, the patient dies, with the symptoms of general 

 marasmus. 



The duration of the disease before its fatal termination varies 

 greatly. It often continues for years ; sqme patients, however, die 

 much sooner from mtercurrent diseases, and not a few as the result 

 of their treatment. The tumor does not usually grow steadily, but 

 increases at intervals. Scanzoni has observed cases where the liquid 

 in the cyst increased and decreased periodically. Just before men- 

 struation, the tumor increased in size, as a result of increased secre- 

 tion from the wall ; when the menses ceased, it diminished again. 

 Some cysts only attain a moderate size, and then remain stationary. 

 In one case that I saw, an ovarian cyst, which developed when the 

 patient was eighteen years old, and rapidly attained a considerable 

 size, remained for twenty years without growing any more. It has 

 not been clearly proved that ovarian cysts can entirely disappear 

 from reabsorption of their contents, but a diminution in size seems 

 to occur occasionally from metamorphosis of the walls, such as 

 ossification. 



Among the complications that may arise during the disease,* we 

 shall first mention the peritonitis which is so frequent ; this some- 

 times occurs spontaneously when the cyst grows very rapidly, some- 

 times it is the result of operation. It is characterized by more or 

 less pain, which is increased by pressure, and by fever. Since it 

 causes adhesion of the ovary to the neighboring parts, it is very im- 

 portant for the prognosis of ovariotomy. Inflammations of the inner 

 surface of the cyst-wall are rarer and more difficult to recognize 

 than inflammation of the external surface. They are usually caused 

 by tapping, and induce a change in the quality of the contents of 

 the cyst. This inflammation is generally painless, and a slight fever 

 is usually its only symptom. Occasionally ovarian cysts burst from 

 excessive distention, or from the action of external forces, and their 

 contents enter the abdominal cavity. This accident may be favor- 

 able, or the reverse, according to the quality of the contents. There 

 have been cases where purely serous fluid was evacuated into the 

 abdomen, and was quickly absorbed, and the cyst did not fill again 

 for a long while, and in some cases it never filled. But even in such 

 cases the escape of the fluid into the abdomen is accompanied by 

 severe pain and constitutional disturbance. Where the ruptured cyst 



