590 



UTERUS AND ITS APPENDAGES. 



It becomes a question whether this law, 

 which has been established by ample tes- 

 timony, admits of the exception that the 

 ovum may be impregnated before quitting the 

 follicle, and therefore whilst still contained 

 within the ovary. 



The records of various cases, in which the 

 fetus is apparently contained within the 

 ovary, raise this question. For if the foetus 

 is found strictly contained within structures 

 properly ovarian, then the ovum must have 

 been impregnated within the ovary, and the 

 seminal fluid must have entered the Graafian 

 follicle*, for it cannot be supposed possible 

 that the ovum, having quitted the follicle 

 unimpregnated, should again enter it after 

 being impregnated. 



The cases, however, which have been re- 

 corded as examples of ovarian gestation do 

 not suffice to demonstrate that the sac con- 

 taining the embryo or foetus and its mem- 

 branes is strictly within the ovary, and is com- 

 posed of structures strictly ovarian ; and until 

 such demonstration has been given, ovarian 

 gestation, in the most liberal view that can be 

 accorded to it, cannot be held to have any 

 other signification than that of the develop- 

 ment of the embryo or foetus in a sac con- 

 nected with or occupying the usual seat of the 

 ovary, but not yet proved to be developed 

 within the proper structures of that gland. 



Origin of Ovarian Cysts in general. It has 

 been often asserted, and as frequently doubted 

 or denied, that these cysts derive their origin 

 from an unnatural enlargement or dilatation 

 of Graafian follicles. Such a contrariety of 

 views is observable equally with general 

 pathologists, as with those who have studied 

 the special histology of this subject. Of the 

 latter both Rokitansky and Wedl may be 

 considered as still holding uncertain opinions ; 

 for Rokitansky, who regards it as probable 

 that the simple cysts are in many cases 

 developed from the follicles, doubts that such 

 is their origin in those instances in which 

 their number far exceeds the usual number of 

 Graafian vesicles, holding them to be new 

 formations ; and Wedl says that of the cysts 

 in the parenchyma of the ovary no direct 

 proof has ever been given that they originate 

 in the Graafian follicles; and with respect 

 to those which contain hair and teeth, he re- 

 gards their origin in this way as "extremely 

 doubtful." 



It is obvious that a question of this kind 

 cannot be definitively settled except by mi- 

 nute examination of the morbid cyst in all 

 the early stages of its growth; an exami- 

 nation for which opportunities cannot very 

 frequently arise. The choice lies between 

 the classing of such cysts with those, on the 

 one hand, which originate in the dilatation of 



* There is nothing in this supposition incompa- 

 tible with the known facts relative to the spon- 

 taneous opening of the follicle, and the power of 

 penetration of the spermatozoa occasionally as far 

 as the distal extremity of the oviduct, or even to the 

 surface of the ovary. 



natural sacculi and ducts, or with such as 

 have their commencement in the enlarging of 

 areolar spaces, or in the growth of primary 

 cells or nuclei into cysts. 



In the case of the ovary, it happens that 

 the settlement of this question is more diffi- 

 cult than in that of most other organs ; for 

 with regard to the formation of cysts upon 

 the latter plans, whether the views of Wedl 

 be adopted, that they consist in an excessive 

 augmentation of volume of the areolae of 

 the areolar tissue, or those of Rokitansky, 

 that a cyst proceeds from an elementary 

 granule which grows, by intus-susception,into 

 a nucleus, and this into a structureless vesicle, 

 in both views such cysts come to be com- 

 posed ultimately of a cell-wall compounded 

 of fibrous tissue and lined by epithelium a 

 structure which is, in fact, identical in com- 

 position with the Graafian vesicle itself. 



With regard to any doubts as to the origin 

 of cysts in Graafian follicles, which may be 

 founded upon their number exceeding the 

 average number of healthy follicles in an 

 ovary, it need only be observed that the 

 latter have been shown by the microscope to 

 be innumerable ; and with respect to secon- 

 dary cysts, springing from the walls of pri- 

 mary ones, numerous observations prove that 

 the impulse to cystic formation once given in 

 an organ, even by the primitive enlargement 

 of normal cavities, a marked tendency to the 

 antogenous formation of cysts follows.* But 

 even if no other explanation could be offered, 

 the discovery of Barry, that the walls of a 

 Graafian follicle in a natural state often con- 

 tain numerous follicles of a second order, 

 would sufficiently demonstrate the capacity 

 of these for secondary cell-growth. 



In giving the preference to that view which 

 regards the cystic diseases of the ovary as 

 originating in a dilatation of the Graafian 

 vesicles, I have been guided chiefly by the 

 following considerations. 



In those cases where I have been able to 

 discover cysts in the ovary in a stage of early 

 formation, these have not been of less size 

 than the average dimensions of the developed 

 Graafian follicle. 



They occur intermixed with healthy fol- 

 licles, and exhibit with them the same histo- 

 logical formation ; their tissues being altered 

 sometimes only in such slight degrees as still 

 to admit of their common origin with the 

 Graafian follicle being shown. 



There is sometimes exhibited in the same 

 ovary, or in the ovaries of both sides together, 

 a sufficient number of grades of enlargement 

 to constitute a series of cysts, evidently com- 

 posed of similar parts and tissues in various 

 stages of growth. 



Beginning with the smaller cysts, still con- 

 tained in part or entirely within the ovary, 

 there may be traced cysts of precisely similar 

 formation and structure in every gradation of 

 size up to those examples in which the ovary 

 itself comes to be a mere appendage of the 



* Lebert, loc. cit. p. 244. 



