RUPTURE OF CYSTIC TUMORS.—The rupture may occur suddenly as a result of a fall or blow, or gradually from changes in the cyst-wall. In papillary growths the pressure of the vegetation causes thinning of the cyst-wall, and finally rupture, or the growths extend through the wall of the cyst and on its external surface. Rupture of the cyst can occur into the surrounding viscera, but more frequently into the peritoneal cavity; in thin-walled cyst occurs easily under manipulation to determine the diagnosis, change of position in bed, the act of coition, or vomiting, and occa sionally occurs without assignable cause. The effect of the accident will depend upon the character of the cyst-contents. In unilocular cysts no untoward symp tom occurs beyond excessive flow of pale urine. In single parovarian cysts recov ery may follow the rupture. Generally, however, the opening closes and the fluid reaccumulates. In rare cases it is lowed by high temperature, rapid pulse, vomiting, pressure at stool, and diar rhcea, which indicate the condition of the contents: a kind of autointoxication. In multilocular and dermoid growths rupture into the peritoneal cavity is often followed by infection, rapidly developing peritonitis, and finally death. Rupture of papillary cysts results in infection of the peritoneum and the formation of as cites. Vegetations spring up over the entire cavity. Sometimes an artery is torn in the rupture, and marked hmmor rhage with profound anemia follows. The occurrence of rupture is recognized by disappearance of the tumor, diminu tion of its size, recognition of free fluid in the peritoneal cavity, peritonitis, col lapse, diarrhoea. and diuresis.
Rupture of ovarian cysts divided into spontaneous and traumatic. One hun dred and eight collected cases of the latter variety may be further subdivided into ruptures—due to movements of the body as a whole, 30 per cent.; and due to direct trauma, 70 per cent. Cases the result of torsion or parturition are not included.
Of the 70 caused by direct traumatic in fluences, 34 were the result of falls and 10 occurred during examination. Fate of the patient in 75 eases unoperated upon shows a mortality of 32 per cent., S of these being immediate, probably as the result of shock or hemorrhage, while in 10 others the ultimate death from peri tonitis was the result of the rupture. Mortality from traumatic rupture is somewhat lower than the average of mixed spontaneous and traumatic rupt ures (41 per cent.), the spontaneous be ing specially prone to give rise to peri tonitis, from their more complex con tents. Twenty-six per cent. of cases re covered after more or less peritonitis, while 44 per cent. showed absolutely no symptoms of peritonitis; many of these were probably parovarian.
Clinical difference between traumatic and spontaneous rupture is chiefly to be found in the sudden outpouring of a much larger quantity of fluid into the peritoneal cavity. The initial pain varies from agony to such slight dis comfort that the patient is almost un aware of the injury. The subsequent fate depends greatly on the character of the escaped fluid. In 9 instances the tumor did not return. Fatal hemor rhage was found to be rare, though doubtless, from the symptoms so closely resembling shock, this may have been overlooked. Recently several cases have been reported, in which the urine showed the presence of peptones after a rupture. Storer (Boston Med. and Surg. Jour., vol. cxxxv, No. 21).
Ovarian tumor may be complicated with PREGNANCY. It is more frequent in the one-sided, though it may occur in the double-sided ovarian tumor. It can occur with any variety of tumor, though more likely to complicate the slow-grow ing formations. Numerous cases are recorded where the person carrying an ovarian tumor has run successfully the gauntlet of several pregnancies. The ovarian tumor does not grow so rapidly in pregnancy as does the fibroid. The occurrence of pregnancy will depend upon the size of the tumor. Very large tumors may, with increased size from pregnancy, cause marked dyspncea, re quiring interference. The influence upon the labor will depend upon the situation of the growth. The very large growths interfere with uterine contrac tion, and especially the voluntary assist ance. If the tumor rests above the uterus and presses it down in a position of retroversion, or retroflexion, it may cause impaction and finally abortion. A tumor situated in the pelvis below the uterus interferes with delivery, and un less it can be displaced its size must be reduced.
Case of a woman subjected to double o6phorectomy who soon after the oper ation began to menstruate and con tinued to do so regularly and painlessly for four months. Fourteen months after the operation she was delivered of a healthy girl, who (lied, however, three weeks later. Soon after this the patient again menstruated and has continued to do so regularly since. M. A. Morris (Boston Med. and Surg. Jour., Jan. 24, 1901).
An investigation on the relationship between ovulation and menstruation has shown that menstruation is no in tegral part of ovulation, nor an abso lute factor of conception, though these two conditions are usually concurrent and attendant. There may, however, be ovulation without menstruation, and menstruation without ovulation, and conception without menstruation. C. C. Thayer (Jour. Amer. Med. Assoc., Feb. 9, 1901).