DISEASES OF THE OVARIES - adverting to classes of disease peculiar to the female sex, it must be remembered that they are often mixed up with hysteria, and while that unde fined malady may give rise to symptoms in any organ of the body, and may simulate any form of disease, the practitioner must be on his guard against assuming symptoms to be merely hysterical when they depend on some obscure cause which he has been unable to trace. The early changes in the ovaries, as they cannot be recognized, must therefore be borne in mind, as affording a possible explanation of symptoms otherwise unintelligible : but this is very different from the views which we cannot but regret to see advocated by any claiming for themselves a respectable position in the profession, who would refer to some undefined local changes all the anomalous characters which hysteria so constantly presents. If medicine is to be ranked as a science, we cannot ignore the clear and accurate teachings of pathological anatomy; we may not assign to any disease a cause which post-mortem examination proves to have no existence; we may not assume ovaritis, as it has been called, to be a common condition in the living, when we know that it is seldom met with in the dead body. Pathological anatomy does not teach us what hysteria is, but it teaches us in unmistakable language what it is not, and if we learn the lesson it conveys, no truth will come home with more force of demonstra tion than this, that neither ovarian changes nor ulcers of the os uteri have anything to do with its occurrence, except as they figure in the opinion of the practitioner, or engross the thoughts of the patient: more than this—it also teaches that disease of the ovaries, though not uncommon, is not of such a kind as can be traced to "inflammation" in any of the multifarious forms assigned to it. All that can be said of ovaritis is, that were it present its symptoms would be undistingaishable from local peritonitis confined to the region of the ovary.
The earlier history of ovarian growths is quite unknown to us. The first symptom is generally the patient's consciousness of enlargement of the abdomen : as an indication of disease this is classed among " alterations of size ;" and it is worthy of observa tion that, in external form, the abdomen is liable to be unequally prominent on one side. The tumor may possibly be recognized by the practitioner before its existence is known to the patient herself—as, for example, in pressing the abdomen during fever, with bowel ailment. More rarely the growth is found out in
searching for the causes of constipation; but such a condition is so common among females in this country that it can scarcely lead to the discovery of the disease. Among early symptoms, pains in the groins, and a sensation of weight and bearing down in the pelvic viscera are mentioned, and may be of service in leading to more careful examination, but they are not in any way characteristic. When enlargement has a,ctually taken place, it is not unimportant to notice in how many instances there is no dis turbance of the general health.
§ 1. Ovarian Dropsy.—In the greater number of cases cysts are developed containing fluid—ovarian dropsy as it has been termed. By percussion over the prominent part of the abdomen, want of resonance is discovered, and fluctuation will be made out more or less readily in the same situation, according to the stage which the disease has reached ; but at its very commencement this must be imperceptible. In speaking of ascites (Chap. VII., Div. I., § 2) the signs derived from these sources by which that disease is characterized were pointed out ; we have now to notice the indications which the same means of investigation afford in cases of encysted dropsy.
A cyst developed from the ovary commences to one side of the mesian line, and consequently for a long period during the con tinuance of the ca,se, the dulness on percussion occupies one side of the abdomen much more than the other : fluctuation extends upwards on that side, and can be readily traced so long as one hand does not pass far beyond the umbilicus, but becomes at once obscure when it is placed towards the flank on the resonant side. When these two observations correspond, the evidence is more satisfactory than that derived from any other source ; some times it is even more striking when the fluid is contained in several cysts, and the tumor is multilocular. In such cases fluc tuation may be most clearly perceptible while the hands are placed only a few inches apart, but becomes obscure as soon as the bound ary between two cysts is passed ; indeed the position of the septa, as they reach the surface of the abdomen, is sometimes distinctly defined. Occasionally the enlarged ovary very early assumes a central position with reference to other viscera, pushing them aside into both lumbar regions pretty equally, and approaching the anterior wall of the abdomen in the hypogastrium ; and then the diagnosis requires more care.