584 



UTERUS AND ITS APPENDAGES. 



So far, therefore, as these analyses may be 

 taken to represent the ordinary composition 

 of the more fluid contents of ovarian cysts, it 

 may be concluded that the action performed 

 in these cases by the walls of the cyst is the 

 separation from the blood chiefly of the watery 

 and saline ingredients, with the exception of 

 alkaline phosphates, whilst the albumen is only 

 in part removed, and none of the fibrine. 



Examined by the microscope, the more 

 fluid contents of ovarian cysts frequently ex- 

 hibit flocculi, composed of patches of epi- 

 thelium, more or less united together by gra- 

 nular matter. When gelatiniform they often 

 contain faint oval corpuscles, or a few primi- 

 tive corpuscles. Occasionally an opalescent 

 or opaque creamy appearance is communicated 

 to the jelly by the formation of pus corpuscles 

 or minute granules, and sometimes the con- 

 tents are wholly filamentous, and mixed with 

 granular cells and other products of inflam- 

 mation. This jelly-like matter, when consist- 

 ent, presents all the characters of coagulated 

 liquor sanguinis, which has not yet passed into 

 organisation. Acetic acid develops in it, or 

 causes to be precipitated a white membrane 

 having all the characters of fibrous tissue. 

 Frequently granules, cells, and filaments may 

 be observed in it in various stages, as is the 

 case with recent exudations from the serous 

 membranes, or in other simple forms of hya- 

 line blastema.* 



Hydatids contained in Ovarian Cysts. A 

 very perfect example of this rare affection 

 of the ovary (originally in the possession of 

 Dr. Hooper) is contained in the Pathological 

 Museum of King's College. It is the largest 

 specimen of ovarian disease in that collection, 

 and consists of an immense aggregation of 

 compound thin-walled cysts, of the second 

 and third order, many of the latter being 

 stuffed full of hydatids. Several of these 

 have fallen out of the cysts, and lie loosely at 

 the bottom of the glass. They are of the form 

 and average size of pigeons' eggs, and possess 

 the usual characteristics of Acephalocysts. 

 (Barren echinococcus vesicles?) Compara- 

 tively few cases of this form of ovarian disease 

 are on record. 



The solid Contents of Ovarian Cysts. These 

 consist of fatty matter, hair, teeth, and bones. 

 Cysts containing such materials are termed 

 dermoid cysts. They rarely grow with the 

 rapidity, or attain the enormous bulk com- 

 monly observed in those with fluid or hydatid 

 contents. That such cysts may, however, 

 sometimes equal in size those of a more sim- 

 ple character, is shown by a remarkable ex- 

 ample described by Blumenbach. j- A girl 

 aged 17 had a swelling of the left ovary, which 

 after 21 years' growth measured four ells in 

 circumference, and reached below the knees. 

 Death occurred at the age of 38, when the 

 sac of the ovary alone weighed 14lbs., and 

 contained also 40 Ibs. of a thick, fatty, honey- 

 like substance, mixed with short and long 



* Dr. J. II. Bennett on Encysted Tumours of the 

 Ovary and Pelvis, Edin. Med. and Surg. Journ. No. 

 1G7. 



t Medicin. Biblioth. bd. i. s. 152. 



hairs, some two feet in length, and matted 

 together in locks. Besides these the sac con- 

 tained several irregular portions of bone, some 

 of large size. In one of these were fixed six 

 molars and one incisor tooth, completely 

 formed. The inner surface of the sac was 

 beset with short hairs. 



The composition of these cysts, and espe- 

 cially of their lining membrane, will in a great 

 measure account for the differences which are 

 observable in their progress and mode of 

 growth. The dropsical cysts are closely allied 

 in their nature to serous membranes, and, like 

 these in a morbid condition, they possess the 

 power of separating and collecting into their 

 cavities the thinner constituents of the blood. 

 And as the only apparent limit to this process 

 is the resistance offered by the walls of the 

 sac, and the parts external to them, so the 

 distensibility of these, and the capacity of the 

 walls of the cyst to meet the increasing pres- 

 sure by a correlative hypertrophy of its tis- 

 sues, will determine the form, size, and general 

 condition of the tumour. But the non-malig- 

 nant cysts, whose contents are of a more solid 

 nature, and possess a higher organisation, are 

 tegumentary in their character. Their con- 

 tents are chiefly tegumental products, which, 

 once formed, have attained the limit of their 

 growth. Such cysts, therefore, are more sta- 

 tionary in their character ; or if occasionally 

 they approach in bulk the watery cysts, as in 

 the example just quoted, this arises mainly 

 from the addition of a fluid secretion, and 

 the necessity for circumscribing it by hyper- 

 trophy of the walls. But more often the 

 cysts with solid contents, if they do not re- 

 main passive, contract adhesions with sur- 

 rounding viscera, and by the aid of fistulous 

 openings discharge their harder parts, such 

 as bones, through the nearest natural orifice. 



The tegumentary character of these cysts 

 has been clearly shown by Cruveilhier*, Kohl- 

 rauschf, Lebert j, and Paget. "Upon their 

 inner surface is produced a growth of skin, 

 with its layer of cutis, subcutaneous fat, epi- 

 dermis, and all the minute appended organs of 

 the proper hairy integument of the body ; " 

 whence the term " dermoid cysts." It is pos- 

 sible that at the commencement of their for- 

 mation such cysts may have a general tegu- 

 mentary lining, a part or the whole of which 

 may afterwards become obliterated. For in the 

 condition in which they generally come under 

 our notice, the tegumentary structure is con- 

 fined to patches of the lining membrane, while 

 in many the hair is found entirely detached 

 and lying in the form of a loose ball in the 

 centre of a smooth-walled sac. 



Sebaceous and Sudoriparous Glands have 

 been shown by Kohlrausch and Heschl to be 

 present in these cysts, where they have the 

 same general arrangement as in the skin 

 Ofc.397.c). 



Fatty Matter. This occurs under two 

 forms : first, as a loose granular fatty sub- 



* Anat. Pathol. torn. i. livr. xviii. 

 t Muller's Archiv. 1843, p. 365. 

 j Traite d'Anat. Pathol. 

 Lectures, vol. ii. p. 83. 



