Prolapse of the ovary and tube are very common, where these organs have become considerably enlarged; so that it is not unusual to find tubal and ovarian enlargements behind the uterus.
Inflammations of the Ovary.
Oophoritis.—Inflammation of the ovary is known as oophoritis and peri oophoritis. It may be either acute or chronic. We find distinctions of paren chymatous, follicular, and interstitial in flammation, but such conditions are not recognized clinically.
Acute Oophoritis.— SYMPTOMS AND ETIOLOGY.—The patient complains of intense lancinating pain, generally in the left inguinal region, with marked tenderness, elevated temperature, rapid pulse, and frequent chills. In peri oophoritis symptoms are less marked than in mild peritonitis.
Acute inflammation is generally caused by injury, septic poisoning after parturition or abortion, gonorrhoea, ar senic or phosphorus poisoning, or the exanthemata, acute rheumatism, mumps, and long-continued endometritis. The most frequent cause is sepsis, next gonor rhon. Sepsis is prone to result in ab scess. Gonorrhoea produces periapho ritis, with fixation of the ovary.
Acute inflammation may terminate in resolution and disappearance of abnor mal symptoms, or in the development of an abscess, its rupture, the occurrence of rapidly fatal infective peritonitis; or the disease may become chronic; most fre quently is associated with disease of the tube.
PATHOLOGY.—In an acute inflamma tion of the ovary the organ is enlarged, oedematous, filled with cysts and the lat ter with cloudy serum resembling pus. It rapidly attains to three or four times its normal size; is filled with serous fluid, and in the more severe grades with pus; can attain the size of a man's head, but generally is not larger than a hen's egg. When inflammation results in the forma tion of an abscess, its watery contents can be absorbed, and leave a cheesy mass. In the milder forms resolution occurs. An acute inflammation may be followed by cirrhosis of the ovary from the retrac tion of the increased connective tissue. The ovary may be reduced to the size of a hazel-nut. This form of inflammation involves both ovaries, while abscess usually involves but one. In perioopho
ritis the capsule of the ovary becomes thickened, and the entire organ fixed by perimetric bands of adhesion. Thicken ing of the capsule renders it less likely to rupture when the mature follicle and a cyst remains. A large number of such follicles form a cystic ovary. The par titions between these break down and considerable sized cysts are formed.
TREATMENT.—Absolute rest in bed; free purgation by salines; tincture of aconite, gtt. i-ij every hour; leeches to the perineum; an ice-bag over the scat of the pain; morphine by the rectum or hypodermically, only to control the se vere pain.
Chronic Oophoritis.—Chronic inflam mation is much more common than the acute. It occurs during the period of sexual activity and more frequently in the married. If the ovary is large, con tains a number of cysts, with increased fibrous tissue, it is followed by an atrophy known as cirrhosis. It may be fixed in the pelvis by an extensive infiltrate, ren dering it immovable, and its situation difficult to discover.
—Pain, with its greatest in tensity in the groin, and most frequently upon the left side. It is persistent, in creased by locomotion, misstep, or jolt ing, and exaggerated as the menstrual period approaches. With free menstrual flow the pain is relieved or disappears. When slight, it increases. Pain extends down the thighs over the sacrum; not infrequently it is experienced in one or both mammary glands. Pain in the groin and symptoms of spinal irritation are frequently present during the men strual periods. Pain, hysteria, and hys tero-epilepsy are associated. Sterility is a constant result. The ovaries—tender to pressure—are not much enlarged. When they are prolapsed, the symptoms are increased. Physical examination must be conducted with care. When pro lapsed and fixed by inflammatory exu date, a careless observer may mistake it for retroflexion of the uterus.
Diagnosis is determined by finding large sensitive ovaries, increased distress for a week or ten days prior to menstrua tion, mammary pain, and painful defeca tion and coition. Rectal examination will be found of service.