number of ruptured or altered follicles there-
fore will in the first case be less, and in the
second greater, than the number of ova or
foetuses found in the oviducts or uterus.

DEVELOPMENT AND INVOLUTION OF THE
OVARY.

The Origin of the Ovary, and the Alterations
which it undergoes at different Periods of Life.

The ovary takes its origin in a separate
portion of blastema, quite independently of
the Wolffian body, with which it is in close
contact. It is not indeed until after the de-
velopment of the Wolffian bodies has made
considerable progress, and about the time at
which the kidneys first appear, that, according
to the observations of BischofF on the mam-
malian embryos generally, the ovaries are first
perceptible.

In the human embryo the ovary cannot be
discerned earlier than the 5-7th week. Nor
is it possible at the time of its first appear-
ance to distinguish the ovary from the testis.
Hence the term "generative gland " has been
proposed by Kobelt as the most appropriate
designation for a structure which, according
to him, is then capable of being converted into
either organ indifferently. In a human em-
bryo of the fourth week, of which I have
given a description in the Transactions of the



572



UTERUS AND ITS APPENDAGES.



Microscopical Society of London *, no trace
of an ovary or generative gland was discover-
able, but only slight indications of two linear-
shaped bodies occupying the dorsal and lum-
bar regions on either side of the vertebral
column, representing the corpora Wolffiana.
In another embryo measuring 5'" in length, the
generative gland could just be discerned in
front of the supra-renal capsules and kidneys,
but its form could be only indistinctly traced.
In an embryo, however, which measured 8''''
in length, the gland had already assumed dis-
tinctly the elongated figure characteristic of
the early formation of the ovary. It mea-
sured 0*8 /r/ , and its position was oblique, or
intermediate between the perpendicular direc-
tion of the Wolffian body and the horizontal
one of the fully formed ovary. In an embryo
of three months the generative gland or ovary
still retained the oblique direction. Its length
was 2"', and its breadth G'4"'.

From this period the gland, which now be-
gins to assume more decidedly the character
of an ovary, gradually acquires the horizontal
position in which it is found at birth (^g.440.).
In the foetus at term the ovary has usually
attained a length of 4-5"', and a breadth of
H-2'"(/g.441.). Itsfigureisan extended oval,
with flattened sides and base. These meet to
form a triangle, whose basal margins are sinu-
ous and sometimes indented. At the age of
three years, (fig. 442.) the ovary attains a
length of 10-1 2"', still however preserving its
elongated form, with irregular or slightly in-
dented margins. This peculiarity of a foetal con-
dition the ovary gradually loses as the period
of puberty approaches, when it grows more
rapidly and acquires the form and dimensions
already described as characteristic of the ma-
ture organ (fig. 369.). At this period of life,
however, no feature of the ovary is more sub-
ject to variation than its form. Even for some
time after the catamenia have been established,
the elongated figure is often seen to have been
retained, although the rounded or gibbous
outline is more commonly observed by the
time that adult age is attained.

The ovary is now full and plump ; its sur-
face up to the time of puberty has remained
uniformly smooth, even, and shining, and its
investing tunics are unbroken.f But it has

* Vol. iii. part ii. p. 65.

t In reference to the human subject, the univer-
sally received opinion regarding the discharge of ova
by rupture of the ovisac, as an occurrence which com-
mences only at or after puberty, has been called in
question by Dr. Ritchie, who, a'fter detailing a series
of observations upon the condition of the ovary at
various periods of life, asserts that " the Graafian
vesicles contained in the ovaries prior to menstru-
ation are found, as they also are in every other
period of life, in continued progression towards the
circumference of the gland, which they penetrate,
discharging themselves by circular-shaped capillary-
sized pores or openings in the peritoneal coat ; the
presence of the catamenia being thus no indispen-
sable prerequisite to their rupture." l It should be
observed, however, that the facts adduced by Dr.
Ritchie do not appear to bear out very clearly the
conclusions which he has drawn from them.

1 Lond. Med. Gaz., vol. xxxiv. p. 253.



been seen that, from puberty onwards, through
these two tunics of the ovary, the ova pe-
riodically escape by a process of dehiscence,
resulting from an absorption and rupture of
these tunics. The effect of these repeated
lacerations is twofold. The surface becomes
scarred in all directions by the closing up of

Fig. 390.




Ovary about the time of cessation of menstruation.
(Ad Nat.)

the lacerated openings, whilst the successive
discharges of the contents of the ovisacs
gradually diminish the bulk of the entire or-
gan (Jig. 390.). In proportion as age advances,
these cicatrices and indentations become still
more numerous, and the once smooth and
plump ovary is converted into a small corru-
gated wrinkled body full of pits and tortuous

Fig. 391.




Ovary in old age.



lines (/g.391.). When sections are made of
the ovary in this condition, it is found that all
traces of the Graafian follicle have disappeared;
or one or two only may be observed, degene-
rated into little masses or sacs of cartilaginous
hardness. More commonly, however, nothing
now remains but a dense parenchyma.

Besides these changes in the form of the
ovary and the condition of its component
parts, great alterations also take place in its
vascular supply. In early life, and especially
from the establishment of puberty up to the
critical age, the organ is abundantly supplied
with blood-vessels, which are seen everywhere
both in the proper parenchyma of the ovary,
and also upon the walls of the ovisacs. These
have been described as undergoing enlarge-
ment, and probably increasing in number in
the neighbourhood of the spot at which the
rupture of the follicle occurs. Not only,
however, is there a local hypersemia in these
situations at each recurrence of the ovipont,
but the entire ovary receives a larger supply
of blood on these occasions. But when the
process of ovulation has entirely ceased, the
tissues begin to suffer the wasting of age, the
ovary partakes in the general state of pallor
of the other pelvic viscera, and the ovarian
vessels carry only as much blood as will suffice
for the bare nutrition of the shrivelled organ.



OVARY (ABNORMAL ANATOMY).



573



ABNORMAL ANATOMY OF THE OVARY.

Effects of extirpating the Oviry. A natural
deficiency of the ovary together with the
oviduct of one side is known to prevail in
the class Aves, but this deficiency, which is oc-
casioned only by a want of development of
one half of the generative organs previously
existing entire in the embryo, does not affect
the reproductive power of birds.

Mr. Hunter, wishing to determine the effect
of extirpating one ovarium upon the number
of young produced in Mammalia, procured
two young sows of the same farrow, and
having removed a single ovarium from one
of them, he kept both animals under the
same circumstances, in order to observe the
comparative effects of breeding upon them.

They commenced breeding when two years
old. The spayed animal took the boar earlier
than the perfect female, and both continued
to breed at nearly the same times.

The spayed animal continued to breed
until she was six years old, and in that time
she had eight farrows, producing in all seventy-
six pigs, but she did not take the boar after-
wards. The perfect sow continued breeding
until she was eight years old, and had thirteen
farrows, yielding one hundred and sixty-two
pigs. She then ceased to breed. The result
therefore of this experiment was, that the
perfect animal continued to breed two years
longer, and produced in all ten more than
double the number of the spayed one, although
she had not double the number of farrows.

But few opportunities have occurred for
observing the effects produced by the removal
of the healthy ovaria upon the human female.
The case in which Mr. Pott removed both
these organs at the same tune constitutes the
best example on record.

A young and healthy woman, twenty-three
years of age, was received into St. Bartho-
lomew's Hospital, on account of two small
swellings, one in each groin, which had for
several months been so painful as to prevent
her from following her occupation as a servant.
The swellings, which were not inflammatory,
were soft, uneven upon their surface, and
moveable. They lay directly upon the out-
side of the tendinous opening of the oblique
muscle through which they appeared to have
passed. The woman was in full health, was
large breasted, and menstruated regularly.
On account of the inconvenience occasioned
by the presence of these tumours in the
groins, Mr. Pott was prevailed upon to re-
move them. They were found upon exami-
nation to be the two ovaria which had de-
scended in the form of a double inguinal
hernia. The woman subsequently enjoyed
good health, but became thinner and more
apparently muscular; her breasts, which were
large, were gone, nor did she ever menstruate
after the operation ; the last observation of
her having been made several years subsequent
to that event.*

Deficiency of the Ovary. Complete con-

* The Chirurgical works of Percival Pott, by Earl,
vol. ii. p. 210.



genital absence of both ovaries, except in the
case of the non-viable foetus, is of extremely
rare occurrence. It is almost always asso-
ciated with deficiency or imperfect formation
of the uterus, and generally with incomplete
development of the vagina, nymphae, clitoris,
and mammae. The sexual appetite in these
cases is wanting. Menstruation is absent ;
the secondary sexual characters are but feebly
expressed, and there is of necessity a total in-
aptitude for reproduction.

The ovary may, however, be deficient on
one side only, without any of these accom-
panying conditions. There may be nothing
externally to mark the defect, nor is there
necessarily here any impediment to the ex-
ercise of the sexual function.

Arrest of Development. The ovary, like
the uterus, long retains its infantile condition,
but as the period of puberty approaches it
expands and soon attains its full size. This
change, however, may not occur. The ovary
may cease to grow after the third or fourth
year, and, under these circumstances, the
whole organism manifests a corresponding
tardiness of development. An interesting
example of this is preserved in the museum
of King's College. The preparation consists
of the entire internal organs of a young wo-
man who died at the age of nineteen without
having menstruated. The ovaries, as well as
the rest of the organs, are no larger than
those of a child of three years (see^?g. 465.). In
these cases the mammae are small, the ex-
ternal organs only partially developed, and the
whole frame is formed upon a feeble scale.

Atrophy and Hypertrophy. Atrophy has
been shown to be one of the conditions at
which the ovary inevitably arrives when a
certain period of life is passed. It is under
these circumstances a normal condition, just
as the state last described is also a normal
condition when associated with a certain
epoch, but both become abnormal states when
they occur out of their usual course. Thus,
an early atrophy of the ovary on both sides
will of necessity bring with it a premature
failure of procreative power, although an
atrophied state of the organ on one side
only, like atrophy of one testis, will but little,
if at all, affect this power.

Of hypertrophy of the ovary a more par-
ticular account will be given in the descrip-
tion of morbid growths and abnormal deve-
lopments of its special parts.

Displacements of the Ovary. The ovary,
in consequence of its peculiar mode of attach-
ment to surrounding parts, enjoys great free-
dom and range of motion. This is rendered
most conspicuous, when, during the gradual
enlargement of the gravid uterus, the ovary
is carried upwards from the pelvic into the
abdominal cavity. Under these circumstances
the ovary certainly vindicates the character
assigned to it by the older anatomists, of being
an appendage to the uterus, for it necessarily
follows the movements of the larger organ to
which it is attached. Thus, the ovary is
sometimes a pelvic and sometimes an abdo-



574



UTERUS AND ITS APPENDAGES.



minal viscus. But it may be displaced
normal position in either of these



from its

position in either of these cavities
under various circumstances. The causes of
such displacements are chiefly, inflammation
of the surface of the ovary terminating in adhe-
sions, displacements of the uterus, and hernise.

As a result of inflammation of its peritoneal
covering, the ovary may be bound down to
the side of the uterus, or Fallopian tube, to
the recto vaginal pouch, to the brim of the
pelvis, to the colon, to the convolutions of
the ileum, or to the omentum.

The displacements of the uterus which
occasion a dislodgement of the ovary from its
normal position are, retroversion, inversion,
and procidentia, or complete prolapsus.

In retroversion the ovaries are carried
downwards along with the uterus into the
hollow of the sacrum, where they occupy a
position on either side of the principal organ.
In inversion of the uterus, the ovaries, to-
gether with the Fallopian tubes, fill the in-
terior of the artificial pouch, which is formed
by the reversement of the organ ; whilst in
extreme prolapsus the ovaries, together with
the uterus, escape almost entirely from the
pelvis, and occupy the sac which is formed by
the inverted vagina.

But the most remarkable displacements are
those in which the ovary constitutes a true
hernia. Such a hernia may consist of the
ovary only, or may include other organs, as
the Fallopian tubes, uterus, intestine or omen-
tum. A true hernia of the ovary alone is of
comparatively rare occurrence. It may hap-
pen on one or on both sides, and may be
either congenital or acquired. The celebrated
case of Mr. Pott was an example of a double
inguinal ovarian hernia. And this appears to
be the form under which this singular dis-
placement has been most frequently met with.
In these cases the ovary constitutes a solid
tumour of the size of a pigeon's egg, which
may be detained at the ring, or lie within the
inguinal canal, or even descend to the labium.

An example of this kind of hernia, in which
the left ovary has for many years occupied
the inguinal canal, has recently come under
my notice. Deneux*, who was at the pains
to search out all the cases on record up to
his time, has collected examples also of crural,
ischiatic, umbilical, ventral, and vaginal hernia
of the ovary, and to these Kiwisch has added
a case of hernia through the foramen ovale.

Diseases of the Tunics.

Inflammation of the ovarian tunics, and parti-
cularly of the peritoneal coat, is most commonly
associated with acute puerperal metritis. But
inflammation, both in the acute and chronic
form, may affect the ovary independently of the
puerperal state. The resulting anatomical
changes in the coats of the organ are vascular
congestion in various degrees ; fibrinous exu-
dations upon their surface, followed occa-
sionally by the formation of artificial bands
or adhesions with surrounding parts ; and

* L. C. Deneux, Recherches sur la Hernie de
1'Ovaire. 1813.



chronic thickening of these coats, whereby the
original smooth and even surface, (Jigs 368. &
369.) characteristic of the ovary in early life, is
lost. When inflammation of the ovary has ad-
vanced to the suppurative stage, and this organ
is converted into a bag of pus, the coats may
have become so attenuated and softened as to
burst when the attempt is made to lift the
parts from the body after death.

Ulceration. Rupture. In the case of
large collections of fluid within the ovary, as
for example in large abscesses or in ordinary
ovarian dropsy, the surface of the ovary fre-
quently inflames and contracts extensive
adhesions with surrounding parts, and if the
latter happen to be hollow viscera, such as
the intestines, uterus, or bladder, a fistulous
communication may be established between
them and the sac of the ovary, through a
process of ulceration or absorption of the
common partition wall, and the contents of
the ovary may become discharged externally.
Or it may happen that by a similar attenua-
tion and rupture, or by a process of ulceration
and absorption of these tissues, the ovarian
walls give way, in some parts of their free
surface, and their contents escape into the
abdominal cavity.

Hypertrophy of the ovarian tunics is almost
constantly observed in considerable enlarge-
ments of the organ, from whatever cause they
may arise. In the case of large ovarian cysts,
before adhesions have been occasioned by the
pressure of surrounding parts, the peritoneal
coat of the ovary, though much thickened,
retains its smooth, shining, external surface.
It may be generally stripped off with ease,
and displayed as a dense white membrane of
unequal thickness, but having undergone no
further change than that of a generaf hyper-
trophy of its ordinary component tissues.
The tunica albuginea in like manner becomes
thickened by simple increase of its ordinary
constituents, but in the case of very large,
and particularly of unilocular cysts, the cyst
wall becomes so intimately blended with the
common ovarian investment, that it is impos-
sible to determine how much of the now
united membranes was originally furnished
by the tunica albuginea, or ovarian stroma,
and how much by the proper wall of the cyst.
The hypertrophy in these cases is often so con-
siderable that the boundary walls of a large
ovarian cyst may measure one or two inches
or even more in thickness in some places.

Ossification. Patches of ossific matter
more or less extensive are occasionally found
scattered over the surface of ovarian cysts.
It is probable, however, that these are de-
posited in the first instance upon the inner
surface, or in the proper walls of enlarged
cysts, and subsequently extend to the proper
coverings of the ovary, and that the fibro-
cartilaginous degeneration which these cyst
walls sometimes exhibit, also commence in
the original cyst, and proceed from within
outwards.

Diseases of the Tissues,

Hypercemia of the ovary may be limited to



OVARY (ABNORMAL ANATOMY).



575



the parenchyma, or to the walls of particular
follicles, or may affect all these parts together.

Hyperaemia of particular follicles, with con-
siderable enlargement of the sac and effusion
of blood into the cavity of the follicle, is not
unfrequently observed as an abnormal condi-
tion. But hyperaemia of single follicles with
effusion of blood into the cavity has been
already described, as being also a natural state
of the Graafian follicle, which is preparing for
dehiscence and discharge of an ovum.*

It may be asked, therefore, in what respect
does the normal differ from the abnormal
state, and by what characteristics may the one
be distinguished from the other ? It appears
to me that Rokitansky, in the account which
he has given of hyperaemia of the Graafian
follicle f, has included under one head both
the natural and the morbid condition ; for
his description will very well apply to the
rising follicle, in its second stage, when the
escape of blood into the cavity has been
shown to be a normal, and in some animals a
constant occurrence. The presence, therefore,
of blood within the follicle, for the reasons al-
ready fully given (p. 556.), must not be regarded
as necessarily affording evidence of a morbid
state. There are, however, certain pecu-
liarities in the condition of the unhealthy fol-
licle, by which it may be distinguished from
that which is natural. The natural follicle,
when preparing for dehiscence, is always near
the surface, and often projects considerably
above the level of the ovary (J?g.380.). Its coats
are unequally thick ; the thinnest portion being
always found at the most prominent point of
the follicle. There is considerable vascularity
about this point, plainly visible externally,
and here the process of attenuation and ab-
sorption continues to be progressive until the
sac spontaneously ruptures. The walls of the
follicle are at this stage of a bright yellow
colour. The liquor folliculi is either clear and
limpid or intermixed with blood, or the centre
of the sac is filled by a coagulum, which is at
first bright red, and afterwards becomes pale,
and at length nearly white. The coagulum may
adhere to the walls, and undergo fibrillation
and subsequent conversion into a solid body,
or into a dense white membrane, or it may be
rapidly absorbed.

On the other hand, the morbid follicle, al-
though it may not exceed nor even equal in
size that which is passing through its normal
changes, may yet be distinguished by many
characters which are the converse of those
just described. The morbid follicle is often
not peripheral, but is more or less central in
its position in the ovary. It may attain to
the size of or of the ovary, without ne-
cessarily causing any distinct prominence above
the surface (especially when occurring singly).
The walls are equally thick, and exhibit at no
part any evidence of attenuation or absorp-
tion. No preparation for rupture is indicated
externally by any peculiar arrangement of ves-

* P. 556.

t Manual of Pathological Anatomy. Sydenham
Society. Vol. ii. p. 328.



sel, or by any marked increase of vascularity.
The walls do not exhibit the remarkable yellow
colour nor the cerebral foldings characteristic
of the advancing normal ovisac, but the tis-
sues of which they are composed are simply
those of the undeveloped Graafian follicle.
The contents of the sac are neither the clear
liquori folliculi, nor the bright clot, nor the
decolorised fibrin, but generally a collection of
dark coffee-ground matter, resulting from the
admixture of a quantity of decomposing blood-
corpuscles and fragments of membrana gra-
nulosa intermixed with a dirty fluid. On
washing out these contents, the walls of the
cyst, if the ovary has been injected, are seen
to carry numerous vessels, irregularly arranged,
but never presenting that rich network of
capillaries which are visible after a successful
injection of a healthy ovisac progressing to-
wards rupture, especially in those cases where
the quantity of yellow oil is not so great as
to obscure these vessels altogether.

By these characteristics the morbid ovisacs
may generally be distinguished from those
which are healthy. There is enough of simi-
larity between them to prove their identity of
origin, and enough of dissimilarity to show
their divergence from a common starting point ;
the healthy follicle proceeding onward through
a course of different changes, which have been
already fully described ; the morbid follicle
exhibiting an apparently unlimited power of
growth and deformity, "such as will be pre-
sently more fully noticed.

Fig. 392. exhibits the morbid follicle in one
of its earliest stages of growth. It may be con-
trasted viiihjigs. 381. and 385., for the purpose
of showing the points of difference which have
just been described. In Jig. 392. the morbid
follicle occurs as a single cyst in the midst of

Fig. 392.




Ovary containing a morbidly distended Graafian
follicle in an incipient stage. The rest of the organ
'is healthy. (A



otherwise healthy tissues. Although occupy-
ing more than of the entire ovary, it scarcely
disturbs the even outline of that organ. Its
coats are of uniform thickness throughout.
There is no attenuation nor preparation for
dehiscence at any particular spot, nor external
sign of increased vascularity in one point.
But the walls of the follicle contain nume-
rous vessels, distributed nearly equally over
their surface. The cavity is filled with loose
flocculi of a dark chocolate colour, consisting
of decomposing blood clot mixed with patches



576



UTERUS AND ITS APPENDAGES.



of membrana granulosa. The walls of the
follicle are not yellow, and contain no oil
globules. They * are slightly thicker than
those of the healthy follicle. Their compo-