4OO The Ovary 



has to be distinguished from abdominal ascites. When several 

 follicles are dropsical, mullilocular cystic tumours occur. 



Both in ovarian and abdominal dropsy there is a rounded swelling 

 giving a wave of fluctuation on palpation. But as the patient lies 

 supine the ovarian tumour bulges more on one side, the area of 

 dulness on percussion varying little with change of position (v. p. 316). 

 If the tumour extend across the middle line, it pushes away the 

 intestine and renders the area absolutely dull ; whereas, in ascites, 

 there is generally some inflated bowel floating up under the umbilicus, 

 rendering percussion resonant. The finger in the vagina makes out 

 the semi-elastic tumour, and probably finds the cervix uteri swung 

 over to that side by the body of the uterus having been pushed over 

 to the opposite side by the tumour ; the uterine sound also shows lateral 

 deflection of the uterus ; but let it be remembered that miscarriage 

 is apt to follow the careless use of the sound. It should not be 

 introduced if there be the least chance of pregnancy existing I kn< 

 of an instance in which a physician was spared the operation of ovari( 

 tomy itself by the patient giving birth to twins very early on 

 morning of the proposed operation. 



When the diagnosis is between ovarian disease and pregnant 

 bimanual examination should be resorted to, the. os uteri and the 

 breasts should be examined, and the fcetal heart-sounds should be 

 listened for. If still there were doubt, time would certainly clear 

 it up. 



A large ovarian tumour presses upon the bladder and irritates it ; 

 upon the rectum and obstructs it, producing haemorrhoids ; upon 

 the iliac veins, causing cedema of one lower limb. It may also irritate 

 the stomach, and, by pushing up the diaphragm, impede the action of 

 the heart and lungs. If it compress the ureter there will be renal pains 

 and albuminuria. The legs may be painful and greatly swollen. At 

 first the tumour occupies only one side of the false pelvis, but as it 

 ascends into the abdomen it passes to the middle line and evenly 

 occupies the cavity. By pressing upon the bladder it may entirely 

 efface that cavity, so that the urine runs away by the urethra as quickly 

 as it flows from the ureters. 



Ovaritis, acute or chronic, may follow sexual and other irritations 

 of the vagina and uterus, just as epididymitis is caused by irritation of 

 the prostatic urethra. It is especially apt to follow specific (gonor- 

 rhceal) inflammation which has extended up the Fallopian tube. There 

 is pain in the back and down the inner side of the thigh, as inorchitis 

 and tenderness deep in the iliac region. 



Ovariotomy. The bowels should be empty, and a catheter should 

 be introduced into the bladder just before operating. The incision, 

 which need not measure more than a few inches, should be made in 

 the median line from an inch or so below the umbilicus. The parietal 

 peritoneum is then opened, and the cyst is seen and tapped ; and when 



