Part 53

Lesions. The inflamed ovary is swollen slightly, or to a great size, in mare or cow like the fist or even an infants’ head. The swelling, however, is unequal throughout, and the surface may bulge in rounded masses at different points. In the early stages the organ is firm, elastic, red and on the cut surface bleeding, with here and there a distended follicle with bloody or gelatinoid liquid contents. The exudate into the fibrous stroma may become coagulated, and later may be organized into fibrous substance giving a hard resistant sensation to the finger (sclerosis). In some cases this may become partly cartilaginous. In other cases the distended follicles may have their contents coagulated and transformed into a caseous mass, while much of the stroma has become liquefied and absorbed. When suppuration has set in, the gland is softened at this point, the parenchyma giving way before the pus. The pus may be in multiple sacs, as if formed in the Graafian vesicles, or it may be in one undivided abscess. In the ovary of a cow, Eléouet counted no less than sixty-three separate abscesses. In cases complicated by ovarian glanders, tuberculosis or actinomycosis, the gross, microscopic, and mycotic characters of the lesions will afford the means of diagnosis.

In chronic forms indurations, cretefactions, cystic degenerations, caseations, and sclerosis may be met with.

Lesions in adjacent structures are common, such as thickening and stenosis of the Fallopian tube; congestion, thickening and puckering of the mucosa in the adjacent part of the womb; peritonitis; adhesions of the ovary to the abdominal walls or to an adjacent organ.

Symptoms. Mare. In many cases the early phenomena are those of excessive genital erethism: the animal is restless, feverish, whinnies to attract other horses, snuffs the males on their approach, contracts the vulvar muscles constantly, exposing the congested mucosa and clitoris, and ejecting a glairy liquid which soils the tail, hips, thighs and hocks. She strains frequently, passing small jets of high colored turbid urine, and rubs the tail and hips against available objects, twisting and breaking the hair and abrading and excoriating the surface. The croup may be alternately drooped and raised and the tail switched. These phenomena are not abated by copulation, nor by time, like ordinary heats, but will last for one or more weeks when a new set of symptoms set in. Meanwhile dull colicy pains cause restless movements, arched back, frequent moving from place to place, crouching by partial bending of the limbs, twisting of the hind parts from side to side. The loins are tender to pressure, and the middle of the flank to pressure or percussion. The mammary glands are usually hot, swollen and tender. The genital erethism may last from four to seven days. Then it subsides, with coincident improvement of the general symptoms and a recovery ensues. Relapses are to be expected sooner or later.

In fatal cases the erethism subsides, but fever, dullness and emaciation continue, the case becomes aggravated at intervals, weakness and exhaustion increase, decubitus may become constant or paralysis ensue. The patient dies in marasmus in one to three months.

In some the genital erethism is absent from the first. There is dullness, prostration, anorexia, fever, hurried breathing, small rapid pulse, colicy pains, tender abdomen, difficult defecation, coated dung, a glairy (perhaps reddish or fœtid) discharge from the vulva, hot, tumid tender mammæ, arched and sensitive loins, and stiffness of the hind limbs.

In all cases alike a rectal examination detects the ovary swollen and exceedingly tender.

Cow. The same general symptoms appear with characteristic modifications. Restlessness, bellowing, pawing, inappetence, arched, tender loins, swollen vulva with discharge, shiny and perhaps fœtid but without contractions, abdomen pendent and flanks hollow and tender, udder turgid, hot and painful, movements of the hind limbs stiff, halting, straddling. There is greater tendency to salacious movements of the croup. The diagnostic feature is palpation of the ovary through the rectum.

In chronic cases more or less of the above symptoms are shown in a greatly mitigated form, but oftentimes there are long intervals of apparent health. Palpation through the rectum is the final test in this as in the more acute cases.

Prognosis. This is very uncertain. Unless complete recovery takes place in a few weeks, the inevitable consequence is sterility, or death from hæmorrhage, peritonitis, pyæmia, or marasmus.

Treatment. In acute cases Trasbot strongly urges bleeding in the larger races and leeching of the flanks in the smaller. Mustard plasters to the loins and abdomen, and cold or damp applications to the croup are in order. Vaginal and rectal injections of mucilaginous liquids, containing anodynes and antiseptics are indicated. Opium, belladonna, hyoscyamus, chloral, borax, acetate of aluminium may serve as examples. If needful to quiet the excitement, morphia, atropia or hyoscyamine may be given subcutem. Or the anodynes may be administered by the mouth. As a last resort, and by far the most radical treatment, castration may be performed. With small ovaries this is best done through the vagina in the larger animals, while with large and adherent ones the flank operation is imperative. If the peritoneum is involved, careful antisepsis of the cavity is desirable. In case of adhesions the operation may be risky, but if successful it will obviate secondary infections and establish a permanent cure. Complications must be treated according to their nature.

OVARIAN CYSTS.

Mare, cow, ewe, sow, bitch, hen. Forms. Histogenesis. Dilated vesicles, egg tubes, blood obstruction. Lesions: Ovary large, smooth, lobulated, vascular, size, connective tissue, epithelium, liquid contents. Abscess. Symptoms: impaired portal circulation, muco-enteritis, piles, intestinal torpor, impaction, constriction, obstruction, congestions, inflammation. Urinary disorder. Strangulation. Sterility. Abortion. Dystokia. Indigestion. Anorexia. Colic. Genital erethism. Straining. Altered Urine. Peritonitis. Septic infection. Collapse. Rectal palpation, enlarged, sensitive ovary. Treatment: Castration. Tapping cyst. Rupturing cyst by compression.

These have been met with in all races of domestic animals, mare, cow, ewe, sow, bitch and hen. They vary greatly in their characters, being unilocular, multilocular, rounded or lobulated, serous, albuminous, colloid or hæmorrhagic, strictly ovarian or parovarian (in broad ligaments), in one ovary or in both.

Histogenesis. The source of these cysts has been much debated. Many have held with Spencer Wells that they have their origin in dilated Graafian vesicles, and the discovery of an ovum in the contents, by Rokitansky and Ritchie showed at least that this follicle had formed part of the cyst. On the other hand Foster, Rivolta, Klebs, Malassez and others, constantly failed to find ova or other distinct elements of the Graafian follicles, but did find epithelial elements, and note that the cysts are at an early stage connected with the surface of the ovary like the egg tubes. These embryonic tubules of Pflueger are therefore held to be the starting point for the cysts, which because of their mixed epithelial as well as liquid contents, seem allied to adenoma. From observations on the ovarian cysts of the lower animals Galtier, attaches great importance to vascular obstructions. Obstruction by pressure or otherwise led to hæmorrhages and transudation of blood, and the cavities formed in this way became the seats of epithelial growth, and liquid effusion. The blood remained for a time as distinct clots, and was later indicated by the pigmentation of the walls of the cyst.

Lesions. The enlarged ovary may be uniformly rounded and smooth, or it may be marked by irregular bosses, giving it a lobulated appearance. It is very vascular, and is often covered by a thickening of peritoneum. When multiple they are usually closely adherent and may even be included one within another. The individual cysts may be of the most varied sizes. The cystic ovary has at times reached enormous dimensions: in the mare 46 lbs. (Bouley, Rivolta, Thiernesse): in the cow 250 lbs. (Reynolds, Meyer): in the ewe 7 lbs. (Willis): in the sow 7 lbs. (Reyer): in the bitch 15 lbs. (Bovett). The walls of the cyst are formed of connective tissue more or less perfectly organized, arranged it may be in several superposed layers (Galtier) and lined or not by epithelial cells (cylindroid, nucleated, or of various forms). They may be reddened by hæmorrhages or pigmented from former blood extravasations. The liquid contents may be clear and watery, white, straw yellow, or of a deeper yellow, brown or red. Among other constituents there are alkaline chlorides and sulphates, albumen in solution or flakes, mucin, fibrine, fatty granules and cholesterine crystals. In some instances they contain pus cells (chronic abscess).

Symptoms. Small, tardily growing cysts may cause no appreciable symptoms. The larger ones or those that increase rapidly are liable to cause disorders of circulation, innervation and digestion. The mere pressure of a considerable cystic ovary may interfere with portal circulation so as to entail muco-enteritis, rectal congestion, piles, or intestinal torpor or impaction. Adhesions of the diseased ovary to adjacent intestinal viscera, tend to produce constrictions, obstructions and local congestions or inflammation. In adhesions to the womb or bladder, ureter or kidney, the symptoms will indicate disorder of these respective parts. The weight of the enlarged ovary causing extension of its ligamentous connections will allow of its winding around a loop of intestine and producing strangulation. In those unusual cases in which pregnancy occurs it may interfere with its completion, causing abortion or, failing in this, with parturition, by becoming imbedded in the pelvis. In the line of innervation, disorder is especially common in the digestive organs, anorexia, nausea, impaired rumination, and colicy pains resulting. Again, in many subjects the genesic instinct is stimulated, the patient is more or less constantly in heat, cows become bullers, and mares switchers, they cannot be impregnated, and under the continuous excitement undergo rapid emaciation. There is often urinary disturbance, frequent straining with the passage of a small quantity only of turbid or glairy liquid, colored, it may be, by blood, or fœtid. The colics are liable to be dull and slight, the patient moving uneasily, switching the tail, moving the weight from one hind foot to the other, pawing, looking at the flank, but seldom lying down or rolling. In other cases, with adhesions, impactions, obstructions, and congestions, all the violent motions of the most intense spasmodic colic may be shown. Where there has been rupture of the obstructed bowel, these symptoms may merge into those of peritonitis, septic infection, or collapse. When with these symptoms of intestinal disorder, there are tender loins and flank, abdominal plenitude and tension, genital excitement, frequent straining to pass urine, the discharge of a glairy or fœtid liquid, and when all these symptoms have increased slowly for weeks or months in a female, the ovaries may be suspected and a rectal examination should be made. Usually the outline of the womb can be made out with the enlarged and irregularly shaped ovary anteriorly and adherent to it through one of the broad ligaments; it may be sensitive to touch, tense, or even fluctuating. Difficulty may be encountered when the enlarged ovary is so great as to fill the whole region, or when adherent to or wound round the rectum, thus hindering the advance of the hand or the movement of the gut, or when it has become pediculated and displaced to a distant part of the abdomen. Even the obstructed and distended intestine, may prevent a satisfactory diagnosis. Yet in the great majority of cases rectal examination gives conclusive results.

Treatment. Medicinal measures are useless: surgical alone are of any avail. Castration is the natural resort, and in all recent cases, uncomplicated by adhesions, is to be preferred. In the large females it may often be performed through the vagina, but if the ovary is very large the flank operation becomes imperative. Sometimes the evacuation through a cannula of the contents of one or more large cysts will so reduce the mass as to allow of the safer vaginal operation.

A less radical measure is the evacuation of the cyst with cannula and trochar and the injection of tincture of iodine. With a hand in the rectum the ovary may be held against the abdominal wall to facilitate the operation. The results, however, are not satisfactory, for, although re-accumulation of the liquid is delayed, it is not entirely prevented. Moreover, when the cysts are multiple, the punctures also must be numerous, or remain ineffective. Nor is the operation unattended by danger as deaths often occur from resulting inflammation, infection, or iodine poisoning.

Zannger, in 1860, introduced the method of rupturing the cyst without incision, and met with considerable success. With the hand in the rectum the cystic ovary is pressed against the wall of the pelvis or abdomen, until the attenuated wall of the cyst gives way, the fluid is left in the abdominal cavity, to be absorbed and many animals will afterward become pregnant. In a large proportion of cases in which the symptoms are marked, the walls of the cyst are sufficiently attenuated to allow of rupture by pressure, and, if the escaping contents are free from infecting microbes, no immediate harm comes to the peritoneum. It should be avoided in case of abscess, following perhaps on a shivering fit and constitutional febrile reaction, and when there is a fœtid discharge from the vulva, suggesting microbian infection likely to dangerously infect the serosa. In appropriate cases it is a resort of very great value, in restoring to use animals that are especially valuable for their progeny and which become utterly useless when rendered barren. According to different observers an average of 70 per cent. can be restored to usefulness in this way. Friedberger and Fröhner claim 90 per cent. Some febrile reaction may be noted for twenty-four hours, demanding rest, restricted, cooling, laxative food and sometimes laxatives and anodynes.

DERMOID CYSTS OF THE OVARY. PILOUS CYSTS.

Closed cutaneous sacs, with hair and sebum. Causes: enclosure of dermoid tissue in embryo: aborted ovum: virgin gestation. Symptoms. Treatment: Castration.

These are much less common than are simple cysts. They are closed sacs, lined by a tissue essentially representing skin, and containing sebaceous matter and hairs, some growing from the dermoid surface, and others detached and formed into a loose mass.

Causes. These cysts have been attributed to the enclosure, in the forming embryo, of the formative elements of dermoid tissue, which may or may not remain latent and inactive until maturity, or until the ovary becomes physiologically active.

Another theory is that an impregnated ovum has remained imperfect, developing only the elements of the skin, instead of the whole fœtal body. Many cases cannot by any possibility be included under this head, seeing that the cyst is found at much too early an age, and its bearer has never had sexual intercourse.

Another doctrine is that the dermoid cyst is derived from the normal plastic or formative powers of the ovary, and the product becomes suggestive of parthenogenesis or virgin gestation. The fact that these cysts are not confined to the production of skin and hair, but at times form bone, teeth, nervous and other tissues as well, corroborates this view. On the other hand we must bear in mind that dermoid cysts are much more common in other tissues than they are in the ovaries. Thus they are common in the subcutaneous connective tissue and between the muscles.

The symptoms do not differ essentially from those of simple cysts and treatment is mainly by castration. As the escape of the contents into the peritoneal cavity is especially provocative of infection, the greatest care must be taken to extract the mass whole, or to use the most thorough antiseptic precautions.

SOLID OVARIAN TUMORS.