582 



UTERUS AND ITS APPENDAGES. 



Fig. 396. 



Part of the thick laminated wall of an ovarian cyst, 

 covered on its inner surface with pyriform vesicles. 

 (After Faget.} 



The Contents of Ovarian Cysts, No cystic 

 formations in any part of the body present 

 such -a variety of contents as those which are 

 found in the ovary. These vary in every de- 

 gree of consistence, from the thinnest fluids 

 to the hardest substances, such as teeth and 

 bones. They may be subdivided according to 

 their densities and different degrees of organi- 

 sation. And first may be considered : 



The Fluid Contents of Cysts. The thinnest 

 fluids are usually obtained from unilocular 

 cysts, which have not been previously tapped. 

 The fluid so procured is commonly of a pale 

 straw colour, and resembles in general charac- 

 ter the ordinary fluid of ascites. It is to 

 these cases that the term " encysted ovarian 

 dropsy " is most commonly applied. The 

 contents of multilocular cysts are often less 

 fluent, presenting every variety of consistence 

 from a thin gelatinous fluid to one of the 

 density of white of egg, of honey, of thin 

 size, or of soft glue. In the latter cases the 

 tenacity of the fluid is often so great that it 

 may be drawn out into long strings, and it is 

 only in this way that it can be extracted 

 through the canula. All these varieties, which 

 commonly retain more or less transparency, 

 may be found enclosed in different cysts within 

 one common investment. 



In other cases the contents, while retaining 

 their fluidity, are rendered turbid or are thick- 

 ened by the admixture of pus or of blood in 

 various degrees. Thus are produced the 

 yellow and green hues as well as the red, 

 reddish-brown, and dark coffee-ground colours 

 which these fluids often present; the turbid 



yellow and green colours being generally 

 caused by the presence of pus, the bright red 

 by the admixture of recent blood, and the 

 dark brown or coffee-ground hue sometimes 

 by the addition of blood which has been 

 effused long enough to have undergone putre- 

 faction, although the brown colour is not al- 

 ways due to this cause. Scales of cholesterine 

 are also found intermixed with those fluids, 

 and in the smaller cysts especially, as already 

 stated, recent blood or the blood clot under- 

 going fibrillation, or breaking down by putre- 

 faction, may be frequently noticed. 



The repeated withdrawal of the contents of 

 ovarian cysts affords the opportunity of ob- 

 serving that the fluid contained in the same 

 sac often undergoes a material change in its 

 composition. Thus, that which is obtained by 

 a first tapping is often of the thin straw-co- 

 loured variety, whilst that which results from 

 subsequent operations has more frequently the 

 turbid muddy or coffee-ground character last 

 described* This can be explained in two ways : 

 the first, by observing that in multilocular cases 

 there is sometimes a natural communication 

 between the walls of the containing and the 

 contained cysts, or an artificial communication 

 may be established by spontaneous rupture, 

 or "by the trocar penetrating through two 

 cysts, and thus the smaller will act as tribu- 

 taries to the larger sac, and pour their varied 

 contents into it; or secondly, inflammation 

 or ulceration may be set up in the walls of a 

 cyst which has been punctured, or the intro- 

 duction of air, or of blood flowing into the 

 cyst from vessels wounded during the opera- 

 tion may so modify the contents as to account 

 for those successive alterations in the fluid 

 which are very commonly observed. In the 

 case of cysts containing pus, rough patches, 

 apparently of ulceration, have been observed 

 upon their internal walls. 



Quantity of Fluids and Rate of Effusion. 

 The structure and situation of the ovary per- 

 mit this organ to suffer a degree of distension 

 which is rarely or never equalled in other 

 parts. Probably the only limit to the increase 

 in size of the morbid ovary, after it has risen 

 out of the pelvis into the abdomen, is occa- 

 sioned by the pressure which the spine, dia- 

 phragm^ and abdominal walls exercise upon 

 the cyst $ for the parietes of an ovarian cyst 

 appear in most cases to possess an unlimited 

 capability of multiplying the fibrous element 

 of which they are principally composed, whilst 

 the power of rapidly replacing the fluid after 

 their contents have been drawn off', proves 

 both the unrestricted capability of secretion 

 inherent in the cyst walls, and at the same 

 time the influence which pressure exerts in 

 keeping that secretion for a time within cer- 

 tain limits. Numerous examples might be 

 quoted in illustration of the immense power 

 of growth and secretion of fluid possessed by 

 ovarian cysts. ImhofF* records a case in 

 which the right ovary contained 42 Ibs. of 

 fluid. Duretf met with 50 pints of water in 



* Acta Helvetica, vol. i., App. p. 1. 

 f Mem. de 1'Acad. de Chir. t. ii. p. 457. 



