vene at the period of the formation of an abscess | THE OVARIA.-In the human subject, after the behind the ear from the carious perforation of the age of puberty, the ovaria form two oblong flatmastoid process. Should an abscess be discovered in this situation, a very free perpendicular incision is to be made, not only down to the process, but through the carious walls of the process itself into the cells, and relief will be immediately afforded to the cerebral symptoms. The writer was once called to a case of this description, which had been viewed and treated as an idiopathic phrenitis, when he discovered a large abscess presenting behind the ear; it was opened, and discharged a quantity of most offensive pus. The patient was relieved, but she sunk from the copious bloodlettings practised under the erroneous diagnosis of cerebral inflammation.

In one case in which a free opening was made into the mastoid cells by incision, as we have advised, a spontaneous cure of the otorrhoea followed. The administration of injections in the chronic otorrhoea must not be adopted without some precaution; not without first estimating the extent of the carious disorganization; for should this have penetrated the skull, and a fluid be forced into contact with the dura mater, or this being ulcerated, into contact with the brain, a fatal inflammation would be the result. The extent of the disorganization may be determined correctly by the character of the symptoms. While the disease has not extended beyond the ear, the sufferings are referred to this organ by the patient, the pain being deep seated in the ear, and radiating from it over the side of the head; but as soon as the dura mater and brain are involved, the signs of cerebral affection predominate, the complaints now being all referred to the brain. This diagnosis will be a safe guide, and should be borne in mind. The disease being limited to the ear, will be benefited by the use of injections, and further mischief may by them be probably guarded against; but when it has reached the brain, injections are not justifiable.

tened bodies, about an inch and a half in length, which are situated on the sides of the uterus in the posterior duplicatures of the broad ligaments. They are placed a little below the fallopian tubes, near the superior angles of the uterus, to which they are fixed by a short ligament. Their surface, except at the inferior margin where the bloodvessels enter, is smooth and convex. In the fœtus at the full period, the ovaria form long, slender bodies of a prismatic form, and are placed above the brim of the pelvis. In advanced life, they become hard and shrivelled, with deep irregular fissures in their surface.

Each ovarium consists of a peritoneal coat, and a dense fibrous or parenchymatous structure. In this latter texture are imbedded from twelve to twenty vesicular bodies of various sizes, which are named, from their supposed discoverer, the Graafian Vesicles, or Ovula Graafiana. They are composed of a fine membrane, which is separable into two layers, and contain within their cavity a clear coagulable fluid.

Branches of the spermatic arteries and veins are distributed to the ovaria, and they are also abundantly supplied by nerves and absorbents.

The remarkable changes produced in the intellectual and physical constitution of women, at the have been accurately described by Harvey in the age of puberty, by the development of the ovaria, following passage: "nec minus notum est, quanta virgini alteratio contingat, increscente primum et tepefacto utero; pubescet nempe, coloratior evadit, splendent oculi, vox canora, incessus, gestus, sermammæ protuberant, pulchrior vultus renidet,

mo, omnia decora fiunt."

that it is not to the influence of the uterus, but There are certain facts which seem to prove of the ovaria that we are to attribute all the changes which take place in the female pelvis, in the mammæ and uterine system, at the period of puberty; and it seems not improbable from the following facts, that it is also to certain changes in the

all the phenomena of that singular process are to

Graafian vesicles at the time of menstruation, that

be referred.

The treatment of the otalgia does not call for any particular measures further than such as are appropriate to the relief of the inflammation, be it subacute or acute, of which the otalgia is a sign. The remarks it is of consequence here to make are, that the otalgia, or ear-ach, is indicative of an inflammatory congestion of the tympanum, which The case of a young woman who died at the should not be neglected however trivial it may ap- age of twenty-nine, in whom the ovaria were pear. Though the patient may not estimate the wanting, was published by Mr. Charles Pears, in importance of an ear-ach, the practitioner should the second part of the Transactions of the Royal do so, and not be content until he has removed it Society of London for 1805, and the following by the application of leeches to the mastoid pro- appearances have been recorded. Having ceased cess, by aperients and so forth; not trusting to to grow at ten years of age, she was in stature popular remedies placed in the meatus, but reject- not more than four feet six inches high. The ing them; and taking a proper pathological view breadth across the shoulders was as much as of the nature of the affection, of the dependence fourteen inches, but her pelvis measured only nine of otalgia on inflammation of the tympanum, he inches from the ossa ilia to the sacrum. Her should combat it by appropriate remedies accord-breasts and nipples never enlarged more than in ingly, and so preserve the patient from impair- the male subject. She never menstruated; there ment of the sense of hearing, or from that disor- was no appearance of hair on the pubis, nor were ganization of the ear of which even a very sub-there any indications of puberty in mind or body acute otitis may be the unsuspected forerunner. at twenty-nine years of age."

JOHN BURNE.

In the young woman, whose ovaria were extirpated by Mr. Pott in an operation for inguinal hernia, menstruation ceased, the voice became I OF THE STRUCTURE AND FUNCTIONS OF hoarse, the mamma shrunk, and hair appeared on

OVARIA, DISEASES OF THE.

the chin and upper lip. Before this period this | Paddington, we had an opportunity in 1831 of female was stout, large breasted, and menstruated regularly. (Pott's Works, vol. ii. p. 210.)

different depths, were found imbedded in it. The left ovarium presented a natural appearance. The free extremities of the fallopian tubes were gorged with blood. Their cavities were filled with a red coloured fluid. The uterus was not enlarged, but the parietes were gorged with blood, and the lining membrane of the fundus was coated with menstrual fluid. A small coagulum of blood likewise adhered to the upper part of the uterus.

period is the cause of menstruation, which he has defined to be “an imperfect or disappointed action of the uterus in the formation of the membrane (decidua,) which is requisite for its connection with the impregnated ovum." (An Essay on the Periodical Discharge of the Human Female, by J. Power, M. D. 1832.) This hypothesis does not appear to have been formed from actual observations on the ovaria during menstruation, as Dr. Power has made no allusion to these in his work, and does not state that he has ever examined the body of any individual who died with the menses upon her. That an ovum, by which is usually meant an embryo enveloped in membranes, does not pass from the ovarium during menstruation, is evident from the fact that an ovum is never formed but as a consequence of impregnation, and that conception does not take place at the menstrual period. The facts which have now been related render it, however, ex

On the 2d of July, 1832, Sir Astley Cooper, to whom the writer had mentioned these cases, sent him the ovarium of a woman who died from cholera while menstruating. The ovarium was much larger than natural, and at one point there was a small irregular aperture in its peritoneal coat, through which a portion of a slender coagulum of blood was suspended. On cutting into the substance of the ovarium, it was found to be occupied by three small cavities or cysts, one of which was filled with a clear ropy fluid, another with semi-fluid blood, and the third, which com-tremely probable that all the phenomena of menmunicated with the opening in the peritoneal coat of the ovarium, with a firm coagulum.

On the 18th of November, 1832, the uterine organs were removed by Messrs. Girdwood and Webster, from the body of a young woman who had died suddenly the preceding day when the catamenia were flowing. Both ovaria were remarkably large, and both fallopian tubes were red and turgid. The peritoneal coat of the left ovarium was perforated at that extremity which was nearest to the uterus by a circular opening, around which aperture for several lines the surface of the ovarium was elevated and of a bright scarlet colour, like extravasated injection. The margin of this opening was thin and smooth, and did not appear to have been produced by laceration.. Its centre was slightly depressed below the level of the edges, but there was scarcely the appearance of a cavity beneath. The right ovarium was much larger than the left; and when cut into, a cavity or cyst was found which was filled with half coagulated blood. The peritoneal coat of

this ovarium was entire.

The uterus was large, and when cut into, the parietes appeared to contain an unusual quantity of blood. The inner membrane was of a bright red colour, and coated with a thin layer of catamenial fluid. Both fallopian tubes were red and turgid, and the interior of the left was filled with menstrual fluid, but nothing in the form of a Graafian vesicle could be detected in the tube. The appearances now described have been accurately represented in a drawing made from the parts within two hours after they came into the author's possession.

In a paper by Mr. Cruikshanks, published in 1797, there is an account of similar appearances having been observed by him in a young woman who had died at the monthly period. "I have also," he says, "in my possession the uterus and ovaria of a young woman who died with the menses upon her. The external membranes of the ovary were burst at one place, from whence I suspect an ovum escaped, descended through the tube to the uterus, and was washed off by the menstrual blood."

Dr. Power has likewise conjectured that an ovum escaping from the ovarium at every monthly

struation depend upon or are connected with some peculiar changes in the Graafian vesicles, in consequence of which an opening is formed in their peritoneal and proper coats. Whether an entire vesicle, or only the fluid it contains, escapes through this opening at the period of menstruation, further observations may hereafter determine. There is no proof whatever that an ovum passes along the fallopian tube into the uterus during menstruation, and it is not clearly established that this takes place even subsequent to conception.

[The opinion that menstruation is connected with periodical changes in the ovary is now embraced by most obstetrical physiologists, and especially by Négrier, Gendrin, and Raciborski. (See the author's Human Physiology, 5th edit. ii. 348: Philad. 1844.)]

Menstruation probably does not take place during infancy, because the ovaria are not then developed, and it is absent during pregnancy and lactation, because at these periods they are in a quiescent state. After the age of forty-six the catamenia cease, because the parenchymatous structure of the ovaria has partially disappeared, and the Graafian vesicles have degenerated into thick opaque cysts.

In many cases of disordered menstruation, chlorosis, and hysteria, which we have observed, the symptoms have been clearly referable to certain morbid states of the uterine appendages, and decided benefit has resulted from the application of those local remedies which were employed with the view of subduing the irritation, congestion, or inflammation, which appeared to be present in these parts of the uterine system.

II. DISEASES OF THE OVARIA.

1. Inflammation and its consequences.— In the unimpregnated state, the ovaria are not very subject to those severe attacks of inflammation which produce an alteration in their structure. In most cases of puerperal fever, the peritoneal and parenchymatous textures of the ovaria become inflamed, and not unfrequently their structure becomes completely disorganized. In the article PUERPERAL FEVER in this work, a full account has been given of these morbid changes,

and of the varied symptoms to which they give rise during life. The adhesions between the ovaria and fallopian tubes which are so frequently met with in examining the bodies of women of different ages and conditions of life, prove that slight attacks of inflammation of the peritoneal coat of the ovaria are not of rare occurrence, and that their presence is seldom discovered during life. Abscess of the ovarium from chronic inflammation of the parenchymatous structure, though a rare disease, does sometimes occur, as the following cases will show :

Inflammation of the ovary, both acute and chronic, may terminate by resolution, by tumefaction and induration or softening, by suppuration, the formation of serous cysts, fibrous tumours, &c., and when both ovaries are affected, the menstrual function is interfered with, generally, indeed, suspended. Sterility is a common consequence of the ovarian changes.

Ovaritis would seem to have been most frequently induced by sudden suppression of the catamenia, or by irregular exposure during the menstrual period. Most frequently, however, it A woman, æt. 17, of the lowest and most un- follows labour, and has often been observed fortunate class of females, was a patient of Guy's amongst the morbid appearances in puerperal Hospital, under the care of Dr. Bright, in the fever. It has been affirmed, that females affected autumn of 1823. She was greatly emaciated, with gonorrhoea are liable to it, in the same had a very quick and feeble pulse, a shining red manner as males, affected with the same disease, tongue, and constant watchfulness. She suffered are liable to orchitis. Dr. Simpson, however, from constant and irresistible diarrhoea, and for (Tweedie's Library of Medicine, 2d Amer. edit., many successive days vomited both food and iii. 342, Philad. 1842,) states, that he has watched medicine the catamenia were absent. : After diligently for its occurrence in some hundreds of having been in the hospital about two months, cases of gonorrhea, which have been under his care she suddenly complained of most acute pain over in the Lock Hospital of Edinburgh, but that he the abdomen, and in a few hours expired. On has only met with one, and that a doubtful inopening the abdomen, death appeared to have stance. In two cases, recorded by M. Leroy been produced by the effusion of a large quantity d'Etiolles, the disease supervened on the use of of pus into the peritoneal cavity, which escaped uterine injections. The injections were sent with from an abscess in the right ovarium, which ab- moderate force into the uterus by the aid of a gumscess appeared to arise from suppuration in the elastic tube. In one, the quantity of marsh mallows substance of the viscus, similar in every respect to was ten drachms; and in both cases, the liquid phlegmonous abscess in any part of the body, and had scarcely reached the cavity of the uterus, benot connected with any cyst, or change or addi-fore the patients complained of acute pain in the tion of structure, the product of morbid growth. (Dr. Seymour's Illustrations, p. 41.) A woman, whose case has been recorded by Dr. Taylor, of Philadelphia, had an abdominal tumour, which was considered to be an encysted dropsy of the Ovary. On inspecting the body after death, the tumour, which occupied the whole abdominal cavity, and weighed seventeen pounds, was found to be formed by one of the ovaries, but in no respect did it resemble ovarian dropsy, being a large cyst, containing twenty pints of pus. (North American Med. and Surg. Journ., 1826.)

side.

The treatment differs in no respect from that which is adapted for inflammation of the uterus.]

2. Cysts and Tumours of the Ovaria. ——— There are perhaps no organs in the human body in which cysts containing a fluid are so frequently found developed as in the appendages of the uterus, and particularly in the ovaria. These sacs or cysts, which have not unfrequently been confounded with hydatids, constitute the disease termed encysted or ovarian dropsy; and it scarcely admits of a doubt, from the progressive enlarge[When acute inflammation of the ovary is ac- ment observed in the Graafian vesicles, that these companied by metritis or peritonitis, it may be cysts often originate in a morbid distension of difficult, if not impracticable, to detect the ovarian these bodies. In other cases, ovarian dropsy phlegmasia. When the ovary is affected alone, arises from the development of a solitary serous burning pain will be experienced deep in the side cyst in the neighbourhood of the uterus, in the of the pelvis in which it is situate, accompanied folds of the broad ligaments, or connected with by the ordinary general symptoms that belong the ovaria, if not imbedded in their substance. to acute inflammation of the internal viscera. The whole substance of the ovarium is converted Usually, however, the constitutional affection is into a large bag containing a fluid, or into a connot severe. Not much information can be ob-geries of cysts of different sizes, which have no tained by examination per vaginam. A recent writer, however, (Leroy d'Etiolles,) speaks of having detected the ovarian tumour-owing to its sinking down-by the finger in the vagina. The finger, passed into the reetum, according to M. Löwenhardt, can reach the situation of the ovary, and may discover any tumefaction of the organ, or unusual tenderness on pressure. Pain is likewise experienced by the pressure of the distended rectum during defecation.

In the chronic form of ovaritis, the local phenomena are of the same character as in the acute, but less in degree, and it must be diagnosticated by the same mode of exploration. The disease is, however, necessarily more obscure.

communication with each other. These cysts, which differ considerably in the density of their coats, contain fluids which vary in colour and consistence. In some it is serous, mixed with a slimy, ropy fluid, like jelly; in others it is a purulent fluid, or dark-coloured like coffee-grounds, and in two instances observed by us, the matter contained in these cysts resembled custard or soft cheese. A small ovarian cyst contained a thick dark-brown fluid like treacle, which did not become decomposed by pressure.

Dr. Hodgkin has recently investigated the structure and mode of formation of some of the more complicated varieties of ovarian cysts and tumours. He has given the following description of the

compound serous cyst, which is often complicated | nature, and have no tendency to degenerate into with malignant disease of the ovaria :