578 



UTERUS AND ITS APPENDAGES. 



Hooper* " met with only two instances of 

 abscess" of this organ. "The one was the 

 size of a child's head at hirth, the other not 

 larger than an orange. There was nothing in 

 these different from common abscesses ; the 

 whole of the internal substance of the ovaries 

 was gone, and the walls were formed of a 

 thick and mther ligamentous cyst, covered by 

 peritoneum." Suppuration occurs also occa- 

 sionally in those cysts of the ovary which con- 

 tain hair and teeth, together with other im- 

 perfectly formed products. To the same class 

 of suppurative diseases should also probably 

 be referred that singular morbid condition of 

 the part in which the entire ovary is reduced 

 to the state of a diffluent pulp, of a yellow or 

 brownish-green colour, of the consistence, and 

 having somewhat the appearance of very soft 

 putty, immiscible with water, and retaining 

 sufficient tenacity to preserve its semifluid 

 character, and yet not having firmness enough 

 to admit of the part being preserved as a pre- 

 paration. Of this morbid condition of the 

 ovary, which, however, may possibly be can- 

 cerous, I met with a striking example in a 

 case of sudden death occurring in the seventh 

 month of pregnancy. Both ovaries were of 

 the size and form of a bullock's kidney, their 

 natural structure was entirely destroyed, and 

 was replaced by the soft substance just de- 

 scribed. The circumstance that both ovaries 

 were thus affected renders it evident that the 

 disease could not have existed in any great 

 degree at the time of impregnation, or that it 

 certainly must have been then limited to one 

 organ. 



From the comparatively scanty materials 

 extant relating to ovarian abscess it may be 

 concluded, that suppuration may either com- 

 mence at separate parts of the parenchyma, 

 forming small collections of matter, which 

 gradually coalesce, or it may be set up through- 

 out the whole of the stroma at once. In these 

 cases the parenchyma of the ovary is gradually 

 consumed, and the organ is converted into a 

 purulent cyst.f Whilst in other cases the 

 Graafian follicle appears to be the seat of the 

 suppurative action, which may either com- 

 mence originally in the walls of one or more 

 follicles constituting circumscribed abscesses 

 of moderate size, or the suppurative stage of 

 inflammation may be established in the walls 

 of a follicle already considerably enlarged, and 

 thus an ordinary ovarian cyst, with simple 

 transparent contents, may be gradually con- 

 verted into an abscess of enormous magnitude. 



Cysts. A complete anatomical description 

 of the numerous forms of cystic disease which 

 affect the ovary would occupy a far larger 

 space than the limits of this article will per- 

 mit. On this account the more important 

 varieties only can be noticed. These are 

 chiefly Simple cysts, Compound cysts, Hy- 

 datid cysts, Demoid cysts, or those contain- 



* The Morbid Anatomy of the Human Uterus 

 and its Appendages, p. 3. 



t Rokitansky, Path. Anat. vol. ii. p. 331. Syd. 

 Soc. edit. 



ing fat, hair, teeth, and bones, and Colloid 

 cysts. 



Simple Cysts. The simple, barren, or uni- 

 locular ovarian cysts are composed, as their 

 name implies, of a single sac, which, accord- 

 ing to its size, occupies the interior of the 

 ovary, whilst the rest of the organ retains its 

 normal condition ; or else the cyst, by en- 

 larging, presses aside and distends the paren- 

 chyma and tunics of the ovary, which thus 

 form a common boundary to the sac, or the 

 cyst, having originated in one extremity of the 

 ovary, grows at the expense of that portion 

 of the organ, whilst the rest, retaining its 

 natural structure, becomes by degrees a mere 

 appendage of the sac, and may be seen pro- 

 jecting in the form of a small button-like pro- 

 minence from its outer surface. 



These cysts vary in size from that of a pea 

 to the bulk of the adult head ; they rarely, 

 however, attain the latter dimensions without 

 becoming proliferous or multilocular, and they 

 appear never to acquire as single cysts the 

 enormous bulk which the compound cysts not 

 unfrequently exhibit. This more moderate 

 size of the single cyst is less frequently pro- 

 ductive of those adhesions with surrounding 

 parts which the pressure of the larger com- 

 pound cysts so commonly occasions. Hence 

 the precise locality of the single cyst, and its 

 origin in the substance of the ovary, can 

 generally be determined without difficulty. 

 The distended sac is found hanging as an ap- 

 pendage to the ovarian ligament, whilst the 

 Fallopian tube is often seen partly spread out 

 over its surface, one of the fimbriae being 

 always closely adherent to the sac, and con- 

 ducting the observer infallibly to any portion 

 of the original ovarian structure which may 

 have remained yet unchanged. 



The coats of these cysts vary much in density 

 and thickness. Those of the single kind are 

 more uniform throughout ; they are generally 

 thickest towards the base or seat of their vas- 

 cular supply. Here they vary in thickness 

 from 2'" to 12'", but become much thinner in 

 other parts, so as at times to be nearly trans- 

 parent. The outer coat always consists of 

 peritoneum, which is smooth and shining upon 

 its surface, except when adhesions have been 

 formed with surrounding parts, or when fatal 

 peritonitis has occurred, as from bursting of 

 the sac. The condition of this coat has been 

 already described under the head of morbid 

 states of the ovarian tunics. The variations 

 in its thickness are not generally so consider- 

 able as materially to affect the bulk of the 

 sac. 



The middle or intermediate coat is that ge- 

 nerally upon which the greater or less density 

 of the cyst wall depends. This coat is usually 

 of a brownish-yellow colour, and firm fleshy 

 texture. It is with difficulty split into a 

 number of rough -surfaced laminae, exhibiting 

 to the naked eye a coarse fibrous arrangement 

 of their constituent parts, which, under the 

 microscope, are seen to consist of inelastic 

 fibrous tissue, mingled with granules, and 

 undeveloped fibre cells in varying proportions. 



