OVARIAN CYSTS. 



contained a more irritating liquid, or fat, hairs, etc., death resulted 

 from severe peritonitis. In the case above mentioned, rupture of 

 the cyst was caused by concussion of the body twenty years after 

 the formation of the cyst. At first only a moderate peritonitis was 

 induced by the escape into the abdomen of the thick, almost pulpy, 

 contents of the sac, which contained quantities of cholesterin. It 

 seeme^ as if the fall the woman had was really a piece of good 

 luck. The abdomen was entirely collapsed just after the rupture, 

 and only filled slowly ; but the fulness increased steadily, and, after 

 a few weeks, the abdomen was more distended than ever before. 

 It was evident that the inner wall of the ruptured cyst continued 

 to secrete liquid, which was emptied into the abdomen ; and, besides 

 this, there was peritoneal exudation. Tapping was repeatedly nec- 

 essary. At the first tapping there were drawn off twenty thousand 

 cubic centimetres of a mixture of the secretion of the cyst and of 

 peritoneal exudation, which weighed fifty-one pounds, being one- 

 third the* entire weight of the patient before tapping. Death from 

 exhaustion took place a few weeks after the fourth tapping. Au- 

 topsy entirely confirmed the diagnosis made during life. Lastly, 

 instead of rupturing suddenly, ovarian cysts may be gradually 

 opened by inflammation of their walls, and their contents may be 

 evacuated into the abdomen, unless the cyst has previously become 

 adherent to some neighboring organ, in which case they are emptied 

 into it. Such perforations most frequently occur iffto the rectum, 

 and atrophy of the cyst has been observed in a few cases as a con- 

 sequence of this. 



Not unfrequently ovarian cysts may be recognized by physical ex- 

 amination, even before they have risen out of the pelvis. If situated 

 in Douglas's cul-de-sac, or between the uterus and bladder, or even 

 to the side of the uterus, a distinct, sharply-bounded, and more or less 

 movable tumor may usually be felt through the vagina ; it displaces 

 the uterus in various directions, according to its position. Occa- 

 sionally, also, we may feel the tumor through the rectum. The 

 more distinctly we can perceive that the tumor does not perfectly 

 follow the movements of the uterus, the more certain is the diag- 

 nosis. If the ovarian cyst rises out of the pelvis, it usually forms a 

 round, movable, painless tumor, with a distinct upper border, and 

 there is more or less evident fluctuation. If we move the tumor 

 with one hand, while the other is in the vagina, we find that the 

 uterus .only moves with the tumor when the movements are very 

 extensive, and vice versa. 



[When the tumor is adherent to the uterus, this test, of course, 

 fails ; and then, unless its want of hardness gives the right clue, it 



