DISEASES OF THE OVARIES. 



is liable to be mistaken for a fibroma of the womb. It is also diffi- 

 cult sometimes to distinguish between such a growth and a cyst of 

 the ligament, or dropsy of the tube. Parametritic and perimetritic 

 exudations, especially when situated in Douglas's space, can be felt 

 through the vagina as rounded masses ; but under conjoined manip- 

 ulation, it can be ascertained that they are not well-defined ball- 

 like tumors. Moreover, they are accompanied by the symptoms of 

 an inflammation of which they are the product, and after abatement 

 of the inflammation increase no further, but rather tend to diminish. 

 Faecal masses which are often to be felt through the vagina can be 

 indented like putty by the finger, and disappear after unloading the 

 bowel. As it grows, the tumor rises out of the pelvic cavity, unless 

 held down by adhesions in Douglas's cul-de-sac, in which case vio- 

 lent symptoms arise like those which are presented by the retro- 

 flexed gravid womb in a case of incarceratio uteri. 



The tumor first appears as a round body in one or other iliac 

 fossa, recognizable by percussion and palpation, sharply marked 

 above, and painless. It may be confounded with sundry other 

 pelvic tumors. From a distended bladder it may be distinguished 

 by the introduction of a catheter. From haemometra, from inter- 

 stitial fibroid, and from pregnancy, it may be distinguished by care- 

 ful palpation per vaginam, showing that the latter tumors are all 

 directly in connection with the vaginal portion of the womb, besides 

 possessing other peculiarities. 



As the tumor grows larger it rises in the belly, assuming a mid- 

 dle position, so that when the pedicle is long it is difficult to decide 

 whether the growth springs from the right or left side of the pelvis. 

 Since the bowels are attached to the back of the abdomen, they 

 necessarily yield backward as the tumor mounts in the cavity, so as 

 to lie behind and beside it, although sometimes a coil of bowel lies 

 in front of it. Upon making the patient lie upon her back, the 

 tumor may be grasped more or less distinctly, and fluctuation sooner 

 or later becomes perceptible, notwithstanding the fact that these 

 growths are generally multilocular, because many of the small cysts 

 gradually coalesce so as to form large ones. The tumor may present 

 a uniform surface, or its multilocular character may be disclosed by 

 the distinct ball-like prominences on the abdomen. Its consistence 

 is sometimes uniform, and sometimes elastic and fluctuating in one 

 portion, while at others solid masses may be felt, consisting of 

 papillary growth or extensive proliferation of the cellular tissue. 



It is easy to distinguish an ovarian cystoma from corpulence of 

 the abdomen and from meteorism. In such cases the percussion - 

 sound is tympanitic. An ovarian sac with its walls not very tightly 



