Section Iii. the Ovaries and Fallopian Tubes.

1. The Ovaries.

=Malformations and Malpositions.= The absence or arrest of development of one or both ovaries is occasionally met with.

The ovaries may be found in the labia majora as a congenital defect, or in the inguinal or crural canal, or in the foramen ovale, as congenital or acquired herniæ.

=Inflammation= is but rarely met with in post-mortem examinations in an isolated form. It generally is associated with affections of the uterus or its appendages, in connection with the puerperal condition. It does, however, occur as an idiopathic disease, and then generally attacks but one ovary. In the congestive stage there is more or less engorgement with blood, even amounting to extravasation, enlargement and softening of the organ.

=Abscesses.= As a result of acute inflammation, abscesses may form in the substance of the ovary. These may reach considerable size, and may burst into the peritoneal cavity, resulting in death; or they may discharge into the rectum, vagina or bladder, and end in recovery.

Morbid Growths.

=Ovarian Tumors= or Ovarian Dropsy, are generic terms for a class of affections characterized by the formation of cysts, which have a tendency to excessive development. The disease affects married females more frequently than the single, and the age from thirty to forty years is that most subject to it. According to statistics, the right ovary is more frequently the seat of the malady. Various forms of the disease are met with. The cysts may be simple or unilocular, compound or multilocular, or cancerous.

Simple cysts have but a single, undivided cavity, containing fluid, and enclosed within the ovary or external to it. We may find one or more, varying greatly in size, some being no larger than a pin’s head or pea, while others contain several gallons of fluid. The contained fluid also, presents great varieties; it may be clear, straw-colored, highly albuminous, or present a viscid, glairy, more or less opaque character; or we may find it of a coffee color, or greenish, with a large quantity of oily matter floating on the surface. In the latter cases the appearance is due, as shown by the microscope, to the presence of blood corpuscles and cholesterine plates.

These simple cysts may acquire an enormous size, filling the abdominal cavity, and crowding the viscera from their position. In a case examined for Dr. B. Berens, in 1855, a free incision was made through what appeared to be the abdominal walls alone, when the cavity was found filled with a straw-colored, slightly gelatinous fluid, of which several gallons were removed.

Upon extending the incisions and looking into the cavity, it presented the appearance of an entire absence of all the abdominal viscera; the spinal column projected at the posterior portion, while above was seen what appeared to be the concave, under surface of the diaphragm, with no trace of liver, stomach, or other viscus. A careful examination of the edges of the incision disclosed the divided walls of the cyst, closely adhered to the abdominal parietes at all points. With a little care, these were gradually torn away, when, behind the tumor, was found the atrophied viscera, crowded and displaced upwards and backward into the smallest possible space.

Pilo-cystic or Dermoid cysts may be found containing hair and fatty matters. These appear, in many cases, to be the remains of blighted ova enclosed in the body. They are congenital in their origin, and usually contain some fœtal debris, such as portions of bone, teeth, etc.

CASE.—Ovarian Cystic Disease—fatal termination. Autopsy revealing presence of bone and teeth in small cyst.

The following interesting case occurred in the practice of Dr. William A. Read, of this city, from whom the appended statement has been received:

Miss ——, aged 42 years, after having been treated by several physicians, came under the care of Dr. Read for the treatment of what was diagnosed as an ovarian tumor. Paracentesis was resorted to, with the result of drawing off a considerable quantity of gelatinous fluid, but without any permanent benefit. The disease pursued the usual course, and the patient finally died of exhaustion.

The autopsy revealed a large multilocular tumor, filling a large portion of the abdominal cavity. Upon removing the same from its pelvic attachments, and opening one of the smaller cysts within the broad ligament, the latter was found filled with a quantity of highly offensive fluid, and containing one large, irregular mass of bone, in which were imbedded two well-formed teeth, a smaller piece with one tooth, and nine detached teeth found in the same sac, making twelve in all.

The first impression upon the discovery of such remains would naturally be, that the case was one of extra-uterine pregnancy; but in this instance, the well known character of the lady was such as to preclude such a theory; while the presence of the unbroken hymen was further evidence of virginity. From the impossibility of conception having been the source of the bony and dental remains found in this and similar cases, the problem can only be solved, by supposing that, two ova had been impregnated when this woman was conceived, one of which, in some manner, became imbedded within the other, so that at her birth this lady had within her abdomen the remains of her undeveloped twin. These became encapsulated within the pelvis, and finally induced the local disease, which resulted in death.

That this is the correct explanation of such cases, is confirmed by the fact that similar remains have been found within the bodies of males.

Multilocular cysts disclose, instead of a single cavity, numerous chambers, containing secondary, and even tertiary cystic growths, either sessile or pedunculated, and with varying contents.

By the complicated form, we understand that in which, to some other diseased state of the organ—as hypertrophy, fibrous tumors, or carcinomatous growths—the cyst formation is superadded.

Fibrous growths. These are developed in the tissue of the ovary, and present a globular form, with well defined outline. They may attain an enormous size; the largest one on record, occurred in the practice of Dr. Simpson, and weighed fifty-six pounds. We occasionally meet with proofs of a tendency to so-called ossification, in the presence of calcareous matter, into which a portion of the tissue has been converted.

Malignant disease of the ovary, is by no means a rare affection. It is generally limited to one side, and appears as scirrhus, encephaloid, hæmatoid, melanotic, or alveolar cancer, either as an isolated growth, or in the infiltrated form, and generally as an addition to some other morbid formation. It runs a rapid course, although it has been met with even before puberty; forty-one years was the average age at death according to the statistics collected by Dr. Walshe.

Cartilaginous tumors are extremely rare in the ovaries.

Tubercles are occasionally found as small, cheesy deposits.

2. The Fallopian Tubes.

=Congenital Anomalies.= One or both of the tubes may be imperfectly developed, in connection with an unsymmetrical development or total absence of the uterus. The tubes may be occluded by the closure of one or both ends, and the point of insertion into the uterus may be abnormal.

=Inflammation.= Catarrhal inflammation is of not unfrequent occurrence, and may lead to partial or total, temporary or permanent closure of the channel of the tubes. Thus the fimbriated extremities may become agglutinated to the ovaries, the broad ligament, or the uterus itself; or obliteration may occur at one or more points within the passage.

The continued accumulation of the secretion of the mucous membrane will cause distension, either simulating a cyst formation, or presenting the appearance of several saccular dilatations. The dilatations, containing mucus matter of a more or less purulent character, or fluid of an heterogeneous constitution, are rarely of large size, although an instance is on record in which the distension amounted to five inches in diameter. The morbid contents may be poured into the uterus, or in less favorable cases the sac is ruptured, and the contents are effused into the abdominal cavity.

Morbid Growths.

Cysts of small size frequently affect the fimbriated extremities of the tubes.

We may also find fibroid growths, carcinoma and tubercle; the two latter commonly, although not invariably, secondary to similar diseases of the uterus.