424 Diseases of the Genital Organs 



it is ordinarily held too far forward to permit it to be car- 

 ried back above the vagina, dislodgment must be attempted 

 by compression per rectum. The ovarian tissue more or 

 less completely surrounds it with firm tissue which can be 

 ruptured only with great force. 



Whenever possible, the dislodgment of the corpus luteum 

 should be made per vaginam. In pyometra the uterine con- 

 tents should first be siphoned out, when ordinarily the ovary, 

 containing the yellow body, may be brought back over the 

 vagina and the dislodgment undertaken from there with 

 safety. The mechanism of dislodgment is essentially that 

 of rupturing cysts. The compression should be concentrated 

 upon the base of the ovary by its ligament, leaving the con- 

 vex border free to break and permit the escape of the yel- 

 low body. Care should be taken to get all of the lutein tis- 

 sue, that the body may not reform without ovulation. In 

 one instance, where fortunately the ovary could be brought 

 back over the vagina, I could not dislodge the yellow body 

 by compression and was forced in the end to stab the ovary, 

 as described in connection with the cysts of nymphomania. 

 When the ovarian capsule and overlying ovarian tissue are 

 incised, although the stab is very narrow, the incision 

 weakens the structure, the cut extends under compression, 

 and the yellow body is forced out. 



Although I have not met such cases, it probably occurs 

 in some instances that the operation cannot be carried out 

 per rectum or per vaginam. Then, especially in desiccated 

 fetus, laparotomy is indicated when the ovary can be acted 

 upon directly. 



10. Abscess of Ovary 



I have not observed primary ovarian abscess. In connection with 

 tubal infections, tubo-ovarian abscesses are not rare. Where trace- 

 able, they originate secondarily from pyosalpinx subsequent to mar- 

 ginal adhesion of the pavilion of the tube to the gland. The lesion 

 is consequently one of pyosalpinx, in which the pus first surrounds 

 the ovary and then destroys it. This will be considered later under 

 tubal infections. 



