Diagnosis.—Such a condition should be suspected as the cause of excessive and prolonged menstrual flow near puberty, when the appearance of the patient is characterized by anaemia, complains of weakness, pain, and tenderness within the pelvis, more marked upon the left side, not infrequently associated with pain in the corresponding mammary gland. Follicular apoplexy presents no distinctive symptoms, and is rarely recognized.
Treatment.—The subsequent progress of the patient will depend upon the hygienic management. The patient should be taken away from school, de nied the study of music and the reading of emotional literature. She should be encouraged to take out-door exercise, es pecially horseback- and bicycle- riding and walking. City girls should be sent to the country and sea-shore. The ac tion of the bowels should be carefully supervised and a generous diet given, from which pastries and sweets must be largely excluded. A morning sponge bath followed by friction with a coarse towel is advisable. During and a few days preceding the menstrual period the patient should be confined to bed. If the flow is generally excessive the period should be preceded for a few days by the administration of extract of ergot, f5ss. or ergotin, gr. ij in capsule, or a tablet triturate of hydrastinin, gr. to three times a day; while during the menstrual intervals potassium bromide, gr. xv, should be administered three times daily. Tonics—such as quinine, strychnine, or the bitter tinctures—are serviceable. The antmia may tempt one to resort to the use of iron, but this remedy is better postponed until htemor rhagic symptoms are under control.
Displacements of the Ovary and Tube.
Hernia through the inguinal canal is a rare condition. It is generally found upon the left side. Crural hernia is more frequent, but the ovary has also made its exit through the greater sacro sciatic foramen and the umbilicus. Che nieux reported an ovarian cyst in the right buttock. Most probably the first surgical removal of the ovaries was per formed by Potts for ovarian hernia. The hernia of the ovary is generally second ary, and results from adhesions to the omentum or the intestine. The dis placed organs may readily be mistaken for glands or labial tumors. The con
stant presence of such a tumor; the dull, sickening pain; extreme nausea; and ()Teat tenderness should afford a sus picion as to the diagnosis.
Treatment. — Taxis should be judi ciously and carefully exercised. An ice or sand- bag should be applied, and, when the reduction has been accom plished, a truss should be worn. If the hernia is irreducible, the sac should be opened and the ovary replaced or re Prolapse of the ovary and tube are generally dependent upon the position of the uterus. With a retroflexed or re troverted uterus, the ovary is no longer supported upon the broad ligament, but hangs from it, and generally lies beneath the uterus in Douglas's cul-de-sac. The ovary may be displaced while the uterus retains its normal situation. This more frequently occurs with the left. It is characterized by tenderness, and pain during coition and defecation. Pain during the former may be so great as to preclude its performance. The condi tion is recognized by vaginal and rectal palpation, in which a movable mass is found which can be displaced upward or whose pedicle can be appreciated. The tumor is exceedingly sensitive, and press ure upon it causes a sickening sensation. When the condition is complicated by inflammation, the ovaries and tubes may be found fixed behind the uterus.
Treatment consists of rest, regulation of the bowels, prohibition of the marital relation, and persistent efforts on the part of the patient in the germ-pectoral position to permit the heavy organ to fall out of the pelvis. When the organ is raised up it may be maintained in place by a suitable pessary. Pessaries with heavy posterior bar are most satisfactory, as they fill up the posterior cul-de-sac and afford less opportunity for the down ward displacement of the ovary. When various pessaries have been unsuccess fully tried, if the patient is incapacitated for her duties, an abdominal section should be performed and ovarian fixation effected by restoration of the infundib ulo-pelvic ligaments or suturing the pedicle of the ovary to the anterior pa rietes at a point corresponding to the exit of the round ligaments. Descent of the ovary alone does not justify extirpa tion.