Page images
PDF
EPUB

deposit of cartilage had occurred; cases of this kind have been reported by other writers. Klob states* that the cartilage is found in the form of thin plaques, or in that of granular warty prominences, or, again, the nuclei of cartilage are imbedded here and there in the connective tissue. Other cases show the texture of fibro-cartilage.

In conclusion, it must be remembered that entozoa have been found in the ovary. Treutler states that he saw hexathyridium pinguicola in a fatty cyst of the ovary; Küchenmeister questions this, and says that he probably had a dead linguatula or the scolix of a tænia under observation. O. Petit mentions a case of echinococcus of the ovary, and Freund has observed echinococcus migrate from the omentum into a dermoid ovarian cyst affected with follicular and glandular degeneration. This subject will be more fully considered in section vi.

CHAPTER IV.

NUTRITIVE DISTURBANCES OF THE OVARIES.

1. HYPEREMIA AND HEMORRHAGE.

THE Ovarian congestion which accompanies menstruation may be so greatly increased by external causes that the follicles are often as large as a cherry, or even larger; this apoplexy may affect a number of follicles simultaneously. Fig. 102 represents the right ovary of a servant girl, aged 17 years, who died after severe burns from petroleum. The ovary measured 3.5 centimeters (1.4 in.) in length, 2 centimeters (in.) in breadth, and 1.8 centimeter ( in.) in thickness; upon section not less than 15 cavities, varying in size from the head of a pin to a pea, were found, filled with fluid or coagulated blood. I have observed this condition of both ovaries at three autopsies in which death resulted from petroleum burns. In one instance, the greatest

*Loc. cit., p. 344.

hemorrhagic infarct was equal to a bean in size, shown in fig. 103; in no case was the follicle ruptured, nor was there any extravasation of blood into the stroma. The ovary is usually but little swollen; it may be either soft, or tense and elastic. I have observed analogous follicular hemorrhages twice as a result of phosphorus-poisoning, three times in typhoid fever, and once each in cerebral apoplexy, tuberculosis and disease of the heart, but in none of these was the number of hemorrhagic follicles so great as in the cases of burn above cited. In addition to

[merged small][graphic]

Follicular Hemorrhage of the Ovary, after Death from Extensive Burns.

the degenerated fibrous tissue present, the pulp-like semi-solid contents of the follicles consist of granular pigment, crystals of hematine and, occasionally, cholesterine. When death has not previously resulted from the original affection, the contents gradually become thicker, the pigment changes to a black color, and finally nothing remains but a band-like cicatrix with a pigmented

center.

2. INFLAMMATION OF THE OVARIES. ACUTE AND CHRONIC OOPHORITIS.

Inflammation of the ovary may follow hyperemia and apoplexy of the organ, or may be caused by an extension of inflammatory processes from the vagina, the uterus or tubes, as from gonorrhoeal infection, and especially from acute pyemic or septic infection after labor; it also occurs in conjunction with acute exanthemata, in typhoid fever, phosphorus and arsenical poisoning, and in cholera.

Occurring in the latter disease, there are granular cloudiness, fatty degeneration of the ovules and the follicular epithelium, the follicle becoming sterile and its contents cloudy. In acute inflammation from puerperal infection, the ovary is much swollen,

[merged small][graphic]

Follicular Hemorrhage of Right Ovary (natural size). Follicles about to rupture.

softened and of a doughy consistence; its tissue is reddened, infiltrated with serum and marked by small hemorrhagic points. Yellow points and streaks appear in its interior, the clouded follicular contents become yellowish, and follicular and parenchymatous abscesses are formed. The ovarian abscess may be encapsulated by connective tissue or a granulation membrane and thus remain interfollicular; as the secretion from this membrane accumulates, the cavity of the abscess is enlarged, and it eventually ruptures into the peritoneum, the rectum or some other organ. In more favorable cases, the purulent contents become caseous, calcified, or entirely disappear, leaving a band-like cicatrix.

Puerperal inflammation of the ovaries frequently becomes chronic, although chronic inflammatory infiltration of the ovarian connective tissue may also result from non-puerperal inflamma

tion of the ovaries. Hemorrhages into the stroma lead to obliteration of the follicles and to indurations; the ovary becomes adherent to neighboring tissues, to the uterus or to the tubes. The adhesions may be thin and delicate, membranous, narrow or broad, so that the ovary is often dislocated, and may even be imbedded in them, in which case there is chronic oöphoritis with perioöphoritis. There are numerous small cicatricial contractions upon the surface of the ovary, giving it the appearance of the surface of a walnut; such changes in form result from atrophy of the tissues and premature rupture of the follicles. In addition to these cicatrices, we find large follicles which have undergone cystic degeneration, the follicular membrane being thickened, and the albugineous covering transformed into a firm, fibrous connective tissue. Ziegler had directed attention to the fact that true cicatricial tissue can rarely be found; it seems, therefore, that the ovarian stroma has great power of regeneration, resulting in the disappearance of traces of the inflammation. In these conditions of chronic inflammation the ovary is but little enlarged by proliferation of the connective tissue. Fibrous hyperplasia of the ovary is found in fibroma and fibro-sarcoma. In chronic oöphoritis the ovary may become as large as an apple or a billiard ball.

Symptoms. As acute oöphoritis usually appears subsequent to infection manifested by a severe attack of disease in neighboring organs, its symptoms are at first masked by those of the constitutional affection and the peritonitis. In some cases of puerperal infection it is possible to palpate the enlarged ovary in the early stages of the disease, and to recognize the source of the pains which radiate from that organ into the thigh and into the bladder, rectum and other pelvic organs. In a case of puerperal ovarian abscess under my care for almost two months, the patient suffered from severe and frequent rigors, which could only be controlled by quinine; the case terminated fatally from sudden perforation. Acute oōphoritis, parenchymatous or interstitial, may terminate in cicatricial contraction, or in the constriction of the gland or tubes, with which hematoma and chronic inflammation may be

* Patholog. Anatomie, 1885, pp. 1483–4.

associated. A. Martin has repeatedly found hematomata of the ovary as large as a fist, and enclosed in a firm, thick layer of connective tissue.

The symptoms of chronic oöphoritis have generally associated those of chronic pelviperitonitis; at other times they are obscured by retroflexion or prolapse of the uterus, these dislocations being a frequent cause of chronic oöphoritis; in a third variety of cases they form part of the symptoms characteristic of peritonitis from gonorrhoeal infection.

Amenorrhoea is a symptom of premature destruction of the follicles, and of chronic thickening of the albugineous tunic. In patients in whom I have been able to confirm this diagnosis by an autopsy, I have observed the menopause as early as the thirtieth year caused by chronic oõphoritis; this is due to the fact that both acute and chronic inflammations are seldom unilateral, but usually affect both ovaries. In nineteen cases of extirpation of the ovary for chronic oöphoritis, A. Martin has seen the second ovary diseased in three instances, and subsequent extirpation was necessary. Conception is very infrequent in unilateral disease of the ovary, and the cause of the sterility is probably catarrh of the uterus resulting from gonorrhoeal infection, the most frequent cause of chronic oöphoritis.

Cohabitation is usually painful and increases the severity of the symptoms.

There are cases of oöphoritis in which we observe profuse and protracted menstruation; as a rule, the symptoms are aggravated during the menses, and the pain is much more severe. What has been said concerning menstruation and the inflammatory symptoms of dermoid cysts, is applicable in this affection.

Diagnosis. An acute oöphoritis can be diagnosticated only when the enlarged and extremely sensitive organ can be directly felt. I have several times succeeded, by this method, in recognizing the affection without especial difficulty. Inflammation of a cystoma may be diagnosticated by the fever and by examination of the purulent contents. Other coexisting diseases, such as urethritis and colpo-endometritis, will often lead to the discovery of the tubo-ovarian affection. The symptoms characteristic of chronic oōphoritis are the swelling, sensitiveness and

« PreviousContinue »