OVARY, Inflammation of.
Acute ovaritis occurs as a rather rare complication of certain infectious fevers, scarlatina, smallpox and mumps. It is more common as an extension of an inflammatory process in the uterus or tubes, either gonorrhoeal or puerperal. The inflammation may affect the surface of the organ (perioophoritis), leading to the formation of adhesions between it and its surroundings, or may invade the Graafian follicles and result in the formation of an ovarian abscess.
During the acute stage the most prominent symptom is pain, and this is usually referred to the front of the abdomen above Poupart's ligament, the " ovarian spot." For its relief hot applications, poultices or blisters to the lower abdomen may be tried, and absolute rest ordered. The warm applications may be reinforced by the sprinkling of a few drops of Lauda num or of a mixture of equal parts of Lin. Chloroformi and Lin. Bella donna: on the surface, but if the pain is severe Morphine must be given either in -gr. doses hypodermically or in the form of a suppository. A smart saline purge should be given at the onset of the affection, and care should be taken to keep the bowels active during its course. The ovarian trouble is usually an incident in the course of a fairly general pelvic inflammation, and the same treatment that is applicable to the one is indicated for the other. Copious hot vaginal douches, mildly antiseptic (say Tr. Iodi M., Tkxxx. to Oj., or Boracic Acid, half-saturated solution) should be given twice or thrice daily, 4 to 6 quarts of solution at a temperature of to being used on each occasion. This relieves the pain and promotes resolution of the inflammation. As the acute stage subsides, Glycerin of Ichthyol (so per cent.) or Boroglyceride tampons may be introduced into the vagina every other night and allowed to remain for S to 12 hours, the hot douching being resumed on their removal. At the same time measures should he taken to eradicate the infection from the endometrium (see under Endometritis), as there is no doubt that persis tence of the endometritis will tend to perpetuate the ovarian mischief, In a number of eases the ovaritis does not resolve, but terminates in suppuration, and the resulting abscess may form either in the substance of the ovary through infection of a Graafian follicle (ovarian abscess) or in such a position that the ovary forms part of the abscess wall. Such an
abscess causes more or less constant pain and disability, and forms a focus from which a renewal of the acute inflammation may arise. When there is evidence of its presence it is sound practice to evacuate the pus as soon as possible, as full restoration to health cannot be hoped for until this has been done. The abscess may be attacked either from the abdomen or from the vagina. When the pus is encysted in the substance of the ovary, and it is desired to remove the organ entire—the most satisfactory plan—it is best to use the abdominal route, as the adhesions which are certain to be met with can be more easily dealt with from above. On the other hand, where collections of pus exist outside the ovary or tube, the better plan is to incise through the posterior vaginal fornix and to make a blunt dissection with the fingers until all the pockets have been opened up. Gauze drainage should always be provided through the posterior fornix of the vagina; if an abdominal operation has been done, and the peritoneum much soiled, it is well to provide drainage through the lower angle of the abdominal wound as well. (See also Pelvic Inflammation.) Chronic inflammation of the ovary is found as a sequel to acute inflamma tions. It may be associated with a gonorrhceal salpingitis or pyosalpinx; it may be found in connection with a torn and chronically inflamed cervix, or with a retroverted and congested uterus. The affected ovary is enlarged and almost always prolapsed; it gives rise to pain in the back and hip, and is markedly tender on pressure. Considerable relief will be given by adopting measures for the relief of the pelvic congestion and for the treatment of any chronic endometritis that may be present. Thus the uterus should be swabbed with iodised Phenol or Formalin. Boroglyceride or Glycerin of Ichthyol (io per cent.) tampons should be inserted in the vagina twice a week and a daily hot douche instituted. The bowels should he carefully attended to, and benefit will be found from tonics tending to improve the general health. Many of these cases are anomie and run down, and should have a mixture containing Iron. An excellent general tonic is the old-fashioned: R. Decoct. Aloes Co.