576 



UTERUS AND ITS APPENDAGES. 



of membrana granulosa. The walls of the 

 follicle are not yellow, and contain no oil 

 globules. They * are slightly thicker than 

 those of the healthy follicle. Their compo- 

 nent tissues are precisely those which have 

 been already described as characterising the 

 ovisac in its normal condition ; the chief 

 bulk of their texture being made up of gra- 

 nules and embryonic fibres intermixed with a 

 few developed fibres of ordinary white fibrous 

 tissue. 



Such a condition may, for want of a better 

 designation, be regarded as hyperaemia of the 

 follicle, or it might perhaps be more appro- 

 priately termed hypertrophy of the follicle ; 

 but in whatever light it may be regarded, it 

 constitutes one of the early stages of those 

 enormous growths, of which more will be said 

 hereafter. 



A more extensive form of congestion, affect- 

 ing the parenchyma of both ovaries, and as- 

 sociated with a like hyperaemic condition of the 

 uterus, may be sometimes observed about the 

 period of the final cessation of menstruation. 

 The ovaries are then occasionally found of an 

 intense red colour, from the parenchyma, as 

 well as the follicular walls, being deeply loaded 

 with blood. The most marked instances of 

 this I have observed in connection with car- 

 diac disease, and associated with congestion of 

 other organs. 



Inflammation of the Ovary. Ovaritis. 

 Oophoritis. Our knowledge of the patholo- 

 gical changes which the ovary undergoes as 

 the result of inflammation, is chiefly derived 

 from examination of the bodies of women 

 who have died of acute puerperal metro-peri- 

 tonitis. But unquestionably inflammation 

 both in the acute and chronic form may affect 

 the substance of the ovary, independently of 

 the puerperal or pregnant states, and cause 

 various degenerations of the tissues of that 

 organ, as evidenced by those serous, fibrinous, 

 and puriform deposits, or general softening of 

 the ovarian parenchyma, which are occa- 

 sionally found after death. It is probable 

 also, from symptoms displayed during life, that 

 inflammation, especially in a chronic form, 

 not unfrequently attacks the ovary and termi- 

 nates in resolution, or in those milder results 

 of inflammation which consist in temporary 

 induration or enlargement of the organ, unac- 

 companied by serious disintegration of its 

 tissues. 



It must, however, be observed with regard 

 to the evidences of inflammation of the ovary 

 either in the acute or chronic form, which are 

 supposed to be afforded during life, consisting 

 in pain and tenderness referred to the seat of 

 that organ, or in obvious enlargements of the 

 ovarv, as discoverable by various modes of 

 internal or external tactile examination, and 

 conjoined with more or less constitutional dis- 

 turbance, that these signs may and do often 

 in the non-puerperal state, accompany the 

 natural process of ovulation, and that such 

 symptoms, recurring with each menstrual pe- 

 riod, may affect a woman at intervals in a 

 greater or less degree during the whole of that 



period of life in which she is capable of child- 

 bearing. But in the present state of our 

 knowledge of ovarian processes it is perhaps 

 not possible to determine how much of these 

 symptoms may be regarded as evidence of a 

 natural, and how much of a morbid change in 

 the part ; for although in many women the 

 process of ovulation is continually performed 

 without consciousness of local suffering, yet 

 in a great number of instances the act is 

 accompanied by much pain, and there can be 

 no question that the cause of much of this 

 suffering is to be looked for in the changes 

 which the tissues of the ovary undergo in the 

 act of expelling the ova. 



How closely this process in its more ob- 

 vious conditions is allied to inflammation has 

 been already shown. A high degree of vas- 

 cularity of the part, with increased exudation 

 of fluid, and consequent enlargement and ten- 

 sion of the entire organ terminating in spon- 

 taneous laceration of its coats by a process 

 very similar to ulceration, and often accom- 

 panied or preceded by a more or less consi- 

 derable escape of blood : these together form 

 a combination or series of processes closely 

 allied in their nature to inflammation, and 

 frequently evidenced externally by signs usually 

 regarded as characteristic of inflammatory 

 action. 



Nor is it yet known how far these sym- 

 ptoms, which have generally been assumed to 

 indicate ovarian inflammation, especially in a 

 chronic form, may be merely the external evi- 

 dences, not of natural, but of aberrant or dis- 

 appointed ovulation. For just as an abscess 

 is painful generally in exact proportion to the 

 unyielding nature or tension of the parts by 

 which it is surrounded, so it is probable that 

 when the follicle or the entire ovary becomes 

 tense from the effusions which have been 

 shown to have taken place ordinarily within 

 it, and this tension is not relieved because 

 rupture does not occur at the proper time, so 

 that ovulation is disappointed or is aberrant, 

 the symptoms which might be expected to ac- 

 company such an interrupted process would 

 be those which are usually set down as indi- 

 cating inflammation in a part. 



This matter appears hitherto to have been 

 hardly thought of, and yet it is probable 

 that to abortive or interrupted ovulation may 

 be referred the commencement of many of 

 those morbid conditions of the ovary which 

 are not either malignant or the direct results 

 of inflammatory action. Probably many of 

 the cystic diseases of the ovary originate in 

 this way. Of disappointed ovulation, as it 

 may be observed in animals, instances have 

 been given at page .568. Here the follicles, 

 although apparently preparing for rupture, 

 were arrested in their progress from some un- 

 explained cause ; and although it may be con- 

 jectured that such follicles might, under an 

 increase of stimulus, accomplish their final 

 purpose, as Coste has supposed in reference 

 to the instance just quoted, yet it has been 

 shown by the researches of Barry that mul- 

 titudes of ovisacs perish without accomplish- 



