OVARY (ABNORMAL ANATOMY). 



575 



the parenchyma, or to the walls of particular 

 follicles, or may affect all these parts together. 



Hyperaemia of particular follicles, with con- 

 siderable enlargement of the sac and effusion 

 of blood into the cavity of the follicle, is not 

 unfrequently observed as an abnormal condi- 

 tion. But hyperaemia of single follicles with 

 effusion of blood into the cavity has been 

 already described, as being also a natural state 

 of the Graafian follicle, which is preparing for 

 dehiscence and discharge of an ovum.* 



It may be asked, therefore, in what respect 

 does the normal differ from the abnormal 

 state, and by what characteristics may the one 

 be distinguished from the other ? It appears 

 to me that Rokitansky, in the account which 

 he has given of hyperaemia of the Graafian 

 follicle f, has included under one head both 

 the natural and the morbid condition ; for 

 his description will very well apply to the 

 rising follicle, in its second stage, when the 

 escape of blood into the cavity has been 

 shown to be a normal, and in some animals a 

 constant occurrence. The presence, therefore, 

 of blood within the follicle, for the reasons al- 

 ready fully given (p. 556.), must not be regarded 

 as necessarily affording evidence of a morbid 

 state. There are, however, certain pecu- 

 liarities in the condition of the unhealthy fol- 

 licle, by which it may be distinguished from 

 that which is natural. The natural follicle, 

 when preparing for dehiscence, is always near 

 the surface, and often projects considerably 

 above the level of the ovary (J?g.380.). Its coats 

 are unequally thick ; the thinnest portion being 

 always found at the most prominent point of 

 the follicle. There is considerable vascularity 

 about this point, plainly visible externally, 

 and here the process of attenuation and ab- 

 sorption continues to be progressive until the 

 sac spontaneously ruptures. The walls of the 

 follicle are at this stage of a bright yellow 

 colour. The liquor folliculi is either clear and 

 limpid or intermixed with blood, or the centre 

 of the sac is filled by a coagulum, which is at 

 first bright red, and afterwards becomes pale, 

 and at length nearly white. The coagulum may 

 adhere to the walls, and undergo fibrillation 

 and subsequent conversion into a solid body, 

 or into a dense white membrane, or it may be 

 rapidly absorbed. 



On the other hand, the morbid follicle, al- 

 though it may not exceed nor even equal in 

 size that which is passing through its normal 

 changes, may yet be distinguished by many 

 characters which are the converse of those 

 just described. The morbid follicle is often 

 not peripheral, but is more or less central in 

 its position in the ovary. It may attain to 

 the size of or of the ovary, without ne- 

 cessarily causing any distinct prominence above 

 the surface (especially when occurring singly). 

 The walls are equally thick, and exhibit at no 

 part any evidence of attenuation or absorp- 

 tion. No preparation for rupture is indicated 

 externally by any peculiar arrangement of ves- 



* P. 556. 



t Manual of Pathological Anatomy. Sydenham 

 Society. Vol. ii. p. 328. 



sel, or by any marked increase of vascularity. 

 The walls do not exhibit the remarkable yellow 

 colour nor the cerebral foldings characteristic 

 of the advancing normal ovisac, but the tis- 

 sues of which they are composed are simply 

 those of the undeveloped Graafian follicle. 

 The contents of the sac are neither the clear 

 liquori folliculi, nor the bright clot, nor the 

 decolorised fibrin, but generally a collection of 

 dark coffee-ground matter, resulting from the 

 admixture of a quantity of decomposing blood- 

 corpuscles and fragments of membrana gra- 

 nulosa intermixed with a dirty fluid. On 

 washing out these contents, the walls of the 

 cyst, if the ovary has been injected, are seen 

 to carry numerous vessels, irregularly arranged, 

 but never presenting that rich network of 

 capillaries which are visible after a successful 

 injection of a healthy ovisac progressing to- 

 wards rupture, especially in those cases where 

 the quantity of yellow oil is not so great as 

 to obscure these vessels altogether. 



By these characteristics the morbid ovisacs 

 may generally be distinguished from those 

 which are healthy. There is enough of simi- 

 larity between them to prove their identity of 

 origin, and enough of dissimilarity to show 

 their divergence from a common starting point ; 

 the healthy follicle proceeding onward through 

 a course of different changes, which have been 

 already fully described ; the morbid follicle 

 exhibiting an apparently unlimited power of 

 growth and deformity, "such as will be pre- 

 sently more fully noticed. 



Fig. 392. exhibits the morbid follicle in one 

 of its earliest stages of growth. It may be con- 

 trasted viiihjigs. 381. and 385., for the purpose 

 of showing the points of difference which have 

 just been described. In Jig. 392. the morbid 

 follicle occurs as a single cyst in the midst of 



Fig. 392. 



Ovary containing a morbidly distended Graafian 

 follicle in an incipient stage. The rest of the organ 

 'is healthy. (A 



otherwise healthy tissues. Although occupy- 

 ing more than of the entire ovary, it scarcely 

 disturbs the even outline of that organ. Its 

 coats are of uniform thickness throughout. 

 There is no attenuation nor preparation for 

 dehiscence at any particular spot, nor external 

 sign of increased vascularity in one point. 

 But the walls of the follicle contain nume- 

 rous vessels, distributed nearly equally over 

 their surface. The cavity is filled with loose 

 flocculi of a dark chocolate colour, consisting 

 of decomposing blood clot mixed with patches 



