DISEASES OF THE OVARIES.

There is an analogy in the reproductive apparatus, running through the whole animal and vegetable kingdoms. The bulb at the lower extremity of the pistil of a flower is called the ovary, and it contains the seed, which in the course of development becomes the fruit.

In the human female, the ovary contains the seed, or germ, which, becoming fertilized, develops into the human embryo, or the fruit of conception.

The seeds of the ovaries are termed ova, or eggs, and the organ or gland in which the germs, or eggs, are prepared is the ovary.

In the human female the ovaries are two follicular glands, about the shape and size of small almonds, situated on each side of the uterus. The follicles, or small sacs, of which the ovaries are composed, are cemented together by delicate fibrillar connective tissue, which is known as the stroma of the ovary, while the follicle is termed Graafian vesicle, after the name of its discoverer. Professor Barry, another investigator, gave the follicles the much better and more appropriate designation of ovisacs, because each of these capsules or follicles contains a single ovule, or little egg.

It is carefully estimated that there are 30,000 Graafian follicles or ovisacs in each ovary, of which only an insignificant number develop and rupture at each menstrual period. It appears, from the researches of Valentine and Pflueger, that the Graafian follicles are formed at a very early period of embryonic life, from a series of minute tubules, that gradually become constricted from surrounding stroma, at regular intervals; the ova are subsequently developed in the interior of the follicles.

Ovarian cysts or tumors cannot be considered in a work for home treatment, but a desire must be awakened in the minds of thoughtful readers, to learn the origin of these growths, and it seems to me quite appropriate at this juncture of the subject, to state that Professor Waldeyer, of Berlin, has discovered that ovarian tumors are developed from the remnants of the little tubules from which the Graafian follicles originate, so that the cause or source of these tumors is already laid before the patient is born; hence cannot be attributed to any fault on the part of the afflicted person. From the earliest period of intra-uterine development up to the age of puberty, the growth of the ovaries is entirely passive, but after that a continuous change takes place in the substance of the ovaries; the contents of the ovaries become active from the period of puberty, from which dates the commencing aptitude for procreation, until the menopause, or final cessation of the menses, which, in popular language, is termed “change of life,” when the aptitude for conception ceases with the proliferation of the ova.

The period of fruitfulness is characterized by the persistence of the menses, and this terminates, on the average, in the forty-fifth year; during all of this time the little ova, or eggs, continually ripen, and at their maturity the ovisacs, or Graafian vesicles, rupture from an increased secretion into their cavities. This ripening of an egg and rupture of a follicle corresponds with the monthly flow. The human ovum is very small; the largest does not measure above 1-120th of an inch in diameter, and very often it measures only half that size.

The situation of the ovary is not fixed in the pelvic cavity with any absolute degree of certainty, but it enjoys a degree of mobility that is even greater than that of the womb itself, to which it is attached by means of the ovarian ligament. Its usual place is about an inch from the uterus and a little backwards. It is partly surrounded by folds of peritoneum, and partly by the tissue that pads out the interspaces between the pelvic organs. If we remember the physiological fact, that at every monthly discharge of blood from the uterus, which is called menstruation, an ovum or egg ripens and an ovisac bursts, we cannot fail to appreciate the importance of the intimate relations that these functions must have, to the health of the individual and the perpetuation of the species.

This process of ovulation has the peculiarity of the first stages of an inflammatory action, because the ovaries become congested whenever an ovisac ruptures.

Through the nervous sympathy existing between the ovaries and uterus, this too becomes congested, so that the network of uterine vessels becomes so engorged that the capillary blood vessels of the mucous membrane of the womb rupture, and the hemorrhage that is the result constitutes the menstrual flow.

There are three physiological processes concerned in the menstrual phenomena: first, irritation and congestion of the ovary, rupturing the ovisac; second, congestion of the Fallopian tubes and uterus; third, consequent rupture of the blood vessels of the mucous membrane of the uterus and probably of the Fallopian tubes.

There may be one or more supernumerary ovaries without disturbing the normal functions; one or both ovaries may be congenitally absent. The entire absence of both ovaries is generally accompanied by deformities of so serious a nature that the newly-born infant is incapable of living.

If the defect is principally limited to congenital absence of the ovaries, then there is an absence of the changes in which puberty is recognized; the mammary glands remain flat; there is not the roundness and fullness of the girl’s figure that signalizes budding maidenhood. The apparently undeveloped form and girlish characteristics are prolonged into the years of adult age, and she remains weakly and small.

In an incomplete or rudimentary development, from an arrested or imperfect evolution of the ovaries, there is often a condition that resembles the above very much; neither are these cases nearly so infrequent as those whose organs are entirely absent. The ovaries may persist in their fetal state, or their growth may be arrested at any time before the expected period of puberty. The diagnosis of this pathological condition must be inferred from the undeveloped state of the different organs and from the absence of those signs which the approach of the menses communicate.

Displacements of the ovaries are often the cause of suffering and disease, that may excite symptoms quite remote from the seat of trouble. I remember the case of a young woman, who had suffered from obstinate dyspepsia, which subsided at once after the removal of the prolapsed ovary. It has been already alluded to, that these glands are naturally very movable. Anything which increases their weight, whether inflammatory enlargement or a dragging in connection with some inflammatory adhesion to a neighboring organ, may cause their displacement in various directions. It happens that the ovary may form the contents of a hernia or rupture. A prolapse or descent is the most common form of an ovarian displacement. We often find one or the other ovary resting in the pouch between the uterus and rectum, and if the patient should be troubled with constipation, the hardened feces may give rise to painful symptoms in the ovaries, and pain in the rectum, while it also is one of the causes of painful sexual relations. The irritation to which the dislocated ovary is exposed gives rise to inflammatory affections, that may be the cause of continual suffering.

INFLAMMATION OF THE OVARIES, OR ACUTE OVARITIS.

What inflammation is elsewhere, it is again here in these glandular structures.

I endeavored to point out in the beginning of these articles, that the difference of inflammatory diseases was not due to any difference in the inflammatory processes, these are identical, but the modification of the processes are due to the nature of the structure of the tissues that are involved.

If the intelligent reader will bear this in mind, she will form a clear idea of all the inflammatory diseases that come under consideration.

Pathological microscopists have recognized two forms of ovaritis, the follicular or parenchymatous, in which the Graafian follicles or ovisacs are the seat of the inflammatory process, and the interstitial, in which the intervening or interstitial connective tissue, the stroma, between the follicles is inflamed. This distinction has only a scientific interest because it is impossible to distinguish one variety from the other in the living subject; this can only be done with the aid of a powerful microscope after the suspected ovary is removed from the body. Whether the inflammation is follicular or interstitial or both combined, it is liable to destroy all the follicles or ovisacs which contain the ova, that are essential to procreation, and the consequence will be sterility.

The great functional activity to which the ovaries are subjected at each menstrual period, make them extremely liable to an inflammatory process, so that women cannot be too careful of themselves at this precarious period. It is during menstruation that the ovaries become periodically congested, and this alone offers an excellent predisposition for inflammation. As a complication of other inflammatory diseases, ovaritis is very common; it seems hardly probable that there can be an inflammation of a pelvic peritoneal fold or of the pelvic cellular tissue in close proximity to or surrounded by it, without involving the corresponding ovary. There cannot be a serious inflammation of the womb or of the Fallopian tubes without being communicated to the ovaries, and this is always true of the infectious catarrhs, especially the gonorrhoeal form.

There is a great tendency in inflammation of the ovaries to suppurate and change the entire tissue of the ovary into an abscess. Ovarian abscesses are not much different in their behavior from abscesses in the Fallopian tubes or cellular tissue. It is claimed that they have a greater tendency to break into the bladder than other pelvic abscesses; this may be due to a displacement of the ovary, which locates the gland near or between the bladder and uterus, before the advent of the inflammation. There are no infallible signs that point to the existence of acute inflammation of the ovaries, owing to the complication of other inflammatory processes in the majority of cases. The characteristic pain of an inflamed ovary is of a throbbing or pulsating nature.

I cannot imagine an ovaritis without at least a circumscribed peritonitis, and one can hardly suppose a pelvic peritonitis to exist without in a certain degree compromising the ovary.

If the ovary has once become inflamed, whether alone or as a complication of other diseases, then the most important question to decide is the existence of an abscess. This can only be recognized by an experienced and careful specialist, who has trained his sense of touch, so that he can feel the abscess between the fingers of one hand in the vagina, and the other making counter pressure on the abdomen. The history of each case must in a measure decide the nature of the fluctuating tumor, whether it may not be an ovarian cyst instead of an abscess, although an abscess may have been a small cyst.

The development and course of different cases, present various aspects for consideration. The enlargement may become obstinate to the ordinary methods of treatment and assume the chronic form of subacute inflammation. The inflammation may spread from the ovary to the peritoneal membrane that partly covers it; these are the broad ligaments of the uterus. This may be the means through which the organ may grow to the surrounding tissue and adjacent organs, so that it becomes utterly impossible to move it or even successfully extirpate it from its intimate attachments.

In other cases the ovary remains entirely free from attachments or complications, and while it can be generally felt lower down pressing perhaps on the rectum, it is readily movable or replaced. In the majority of cases only one ovary is involved, but in these cases there is a predisposition which in a large proportion sooner or later compromises also the other ovary in a similar diseased process.

TREATMENT.

The treatment of this affection is greatly modified or influenced by a knowledge of the causation of the inflammation. In every case, however, the patient should take to her bed. If there is a profuse vaginal secretion it should be ascertained if the disease is of infectious origin, and where this is suspected, the vaginal canal should be thoroughly rinsed with an antiseptic solution of corrosive chloride of mercury in the proportion of one grain of the sublimate to two thousand grains or parts of water, or about fifteen grains to the half gallon of water. There are tablets to be had at the drug stores which contain the requisite amount of corrosive when added to a given quantity of water; these are preferable and more convenient than the crude drug, and as they are a deadly poison they should be kept under lock and key. There is nothing to equal the corrosive for an offensive vaginal discharge, for it is the most reliable disinfectant there is in the entire pharmacopoea. Half a gallon of this solution should be used at a time, and after the vaginal canal has been thoroughly disinfected, about a pint of the same solution must be passed through the uterine cavity by means of a double catheter, that has a reverse flow and is especially made for the purpose. To insure against mercurial poisoning I am in the habit of following mercurial irrigations with warm water, that was previously sterilized by boiling. One pint of the simple water is generally sufficient to displace all the mercurial water that might have remained in the uterine or vaginal cavities. These medicated irrigations should have an average temperature of 105 degrees Fahr. and be repeated daily for about a week.

If the vaginal secretion is not of a specific nature, then the Femina antiseptic uterine lotion is a safer remedy.

Ice bags applied over the regions of the painful ovaries check the acute inflammation from going into suppuration and forming an abscess. Should the latter be found to exist, it should be opened by means of a trocar or aspirator. The bowels should be kept free by taking a daily dose of Femina laxative tablets.

CHRONIC OVARITIS.

If an acute inflammation does not terminate in prompt recovery or an abscess it may lose its fiery nature and tone down into a low grade of prolonged congestion which does not go on to the production of suppuration. This would constitute the chronic form of inflammation.

It does not follow that all chronic inflammations are preceded by the acute form, for there are inflammations that are subacute from the beginning, that is, that there is not the heat nor feverishness in the tissues which is one of the principal features of the acute process.

Chronic inflammation of the ovaries is much more frequent as an original or individual affection, than the preceding form. A peculiar feature of this affection is a gradual growth or enlargement of the ovary, all the way from a moderate swelling to a good-sized orange. There has been some discussion as to the particular tissue of the ovaries that is involved in the inflammatory process, whether it is the interfollicular structure or the follicules or ovisacs themselves; practically the solution of this question has no bearing on the treatment, although it may have an influence on the function of the organ, which may be more injuriously affected by the latter than the former variety. The disease occurs almost exclusively after the age of puberty and during the period of sexual activity. It is not as often met in the unmarried as in the married, and with the latter it is more prevalent in the first years of married life. Inordinate sexual indulgence is a frequent exciting cause, and when this is coupled with pernicious means that are employed for preventing conception, it becomes still more frequent.

Chronic inflammation of the vagina, womb, and of the Fallopian tubes is often transferred to the ovaries.

The infectious catarrh to which the genital tract of the female is more or less exposed from a lack of proper cleanliness of her own person, or a gonorrhoeal infection from her male companion, show a peculiar tendency to gradually spread the inflammatory processes to the ovaries. Some careful observation has established the fact that an apparently cured gonorrhoeal infection in the male may, after a year or two, excite a gonorrhoeal catarrh in the genitals of the female; a great many diseases of the ovaries have been traced to this source of infection.

As gonorrhoea is not an uncommon affection among the male portion of the community, it is not sufficient for the intelligent members of the medical profession to know of these dangers of infection, but every man and woman should be apprised of the great danger there is of infecting the marital chamber with the pollution of the brothel.

The symptoms of chronic ovaritis are more or less dependent on the causation of each individual case.

Sometimes it is traced to the fiery stage of the acute affection, while in other instances it can be laid to some indiscretion during the menstrual flow, then, again, it may have developed itself so stealthily that the greatest acumen and skill are required to detect its origin. The most important and constant sign is a steady pain in one or both ovaries. When this pain is violent, it shoots toward the back and rectum and down the thighs. The pain becomes heightened from an accumulation of feces in the rectum, which a habitual constipation entails. Marital excesses near the approach of the menstrual period or shortly after the disappearance of the menses are quite likely to precipitate the painful symptoms. The bladder sympathizes in a certain proportion of cases, so that there is a frequent desire to pass water. In the course of time the distressful symptoms that have been enumerated derange the digestive apparatus; the patients lose their appetite and decline into a debilitated and nervous state, so that one or the other hysterical phenomenon become more or less prominent in persons of a nervous temperament.

Sterility is a rule with this class of women, even if there is only one ovary affected; this would indicate that the apparently healthy one sympathizes with the other, or an accompanying catarrh of the uterus or tubes may prevent the passage of the fertilizing germ. If both ovaries are inflamed, then it is quite natural to suppose that the delicate follicles and their contents, the ova, become destroyed or so altered that they no longer answer the purpose of reproduction. It is seldom that one meets a chronic ovaritis without a uterine catarrh, and how much this contributes to the sterility is not easy to tell.

TREATMENT.

The course of this affection in the majority of cases is favorable. If the treatment is intelligently administered, the pain and congestion gradually subside, and as this class of patients have generally learned from sad experience that negligence or indiscretion on their part will excite a relapse, they soon learn to avoid these, so that they enjoy comparative immunity from suffering for a considerable length of time.

There is a smaller proportion of cases whose unfortunate surroundings or lack of intelligence makes remedial measures of no avail. These poor women have neither respite from physical labor nor freedom from the animal passions of their husbands, and thus living in constant pain they become drooped in spirit and reduced in vigor, so that they fall an easy victim to any intercurrent affection that may attack them.

In proportion as the patients can give their diseased ovaries freedom from irritating influences are the chances for their complete recovery increased.

To accomplish this object, quietude in the recumbent posture, sexual abstinence and a free daily stool form the basis for recovery. If there is much pelvic pain, this is best controlled by means of the ice bag, 4x6 inches in size, of which one on each side, wrapped in one thickness of flannel, should be applied to the groin or region of the ovaries; cold-water compresses, thoroughly wrung, so as not to drip, and covered with flannel so as to keep the bed covering dry, are also advisable, but only a poor substitute for the ice.

Iodoform suppositories greatly stimulate the absorption of the inflammatory exudation; one of these should be introduced into the vaginal canal each day. If the patient can get up without any painful symptoms, she should take the hot sitz bath for ten or fifteen minutes daily, and as a general tonic, this is a useful prescription.

NO. XI.

Mix. A tablespoonful three times a day.

There is no affection in the entire category of diseases of women, in which the confidence of women has been more abused by specialists, than by meddlesome surgical invasions, for the extirpation of one or both ovaries, to cure real or imaginary diseases of these glands. There is a veritable mania among surgeons for this operation, but the conservative portion of the profession are awakening to a conviction that this is entirely wrong, and a presumption on professional license that is altogether unpardonable.

If these castrations were confined to the removal of ovaries that are unmistakably degenerated or diseased, and that had resisted intelligent treatment for some time, there would not be the same objection, but when ovaries are removed that are apparently healthy, but through ignorance or incompetency are supposed to be the offending members, then, I say, that is an outrage.

There are a great many women who have been subjected to the dangers of a so-called normal ovariotomy, without being in the least benefited by the operation. The symptoms which the extirpation of their ovaries was to relieve, persisted as before, and they discovered, when it was too late, that spaying is not a panacea for the ills that suffering women are heir to.

The ovaries are in delicate sympathy with all the other pelvic organs, and when these are affected there may be more or less pain in one or both of these glands. They may be even the seat of a neuralgic affection without any structural change in the organ or in the neighboring organs. This would be simply a reflex sign of a general debilitated condition, and to mistake all these for ovarian disease and to make it an excuse for their removal, is not warranted by careful observation. Electricity is now coming to the front as one of the most valuable remedies for just this class of affections, and I will give a detailed account of the nature of this remedy and the requirements for its successful application, which persons who speak lightly of its virtue, never acquire nor take the pains to possess.