If both ovaries are involved in the disease, inasmuch as they are generally affected successively, and one is less enlarged than the other, the smaller one remains in the pelvis, and its retention is proportionate to the obstacles offered to its ascent by its fellow. It is wedged in between the uterus and the rectum, even if there are no adhesions. If we find the above-mentioned irregularity in the uterus and the vagina, and at the same time discover an immovable tumor in the pelvis, which weighs upon the posterior walls of the vagina, and pushes it, together with the uterus, forwards, it may be assumed, if there are no contraindications, that both ovaries are diseased.

The cysts very frequently become the seat of inflammation. This either attacks at different periods the peritoneum, investing the diseased ovary, and causes its adhesions and fixation in the abdominal cavity, or the fibro-serous parietes of the cysts themselves inflame, and the resulting products are deposited upon their internal surface or in their cavity. Thus we find not only all the exudations with their metamorphoses, that occur on the normal serous membranes, at this place, but also all the further effects of this variety of inflammation. Our observations, however, lead us to except the tubercular metamorphosis of the inflammatory product; we, at least, have never met with it, in spite of very extensive and various opportunities.

As the dropsical ovary enlarges, it occupies more and more of the abdominal cavity; it distends the belly to an enormous extent, pushes the intestine into the inguinal regions, forces the epigastric viscera, together with the diaphragm, into the thorax, and causes universal emaciation, proportionate to the increase of the tumor. The adventitious growth enters into combination with fibroid and carcinomatous products, and especially with medullary cancer, in the manner which we shall have occasion to explain further on. It is the less frequently complicated with tubercle, the more it approaches the character of areolar cancer, and the more it compresses the thorax by its increase of size.

There are a few cases on record in which the dropsical ovary is said to have discharged its contents into the Fallopian tube, and thus into the uterus, and externally.

d. The simple cyst, or the cyst with secondary endogenous formations, also occurs in the shape of cystosarcoma of the ovary; this, however, is much rarer than any of the above-mentioned three varieties, and scarcely ever attains the extreme size to which these are developed.

e. Finally, we observe that cysts with anomalous contents, viz. encysted fatty tumors, occur nowhere so frequently as in the ovary; either, and most commonly, as a simple cyst, or as the composite cyst, in which one of the cysts of the secondary formation is distinguished from the rest by its adipose contents, or, though rarely, in the shape of a compound adipose cyst. We often find the fat associated with a formation of hair, frequently, too, of teeth, and sometimes with the formation of bone. Like the serous cysts, the adipose cysts are undoubtedly often formed from a Graafian vesicle; they occur most frequently in the prime of life, rarely at the period of puberty, and still less frequently in childhood. We have, however, one case of adipose cyst of the ovary in the museum of Vienna, belonging to a child of six years. They grow very slowly, and rarely exceed the size of a child's head. There generally is but one adipose cyst in one of the ovaries; the two are rarely affected at the same time.

The inflammation to which this variety is equally subject with the other cysts, gives rise to a dilatation of the cyst, as well as to an essential alteration in its contents by means of the exudation. It occasionally terminates in suppuration, and discharge of the contents externally at the navel, in the hypogastric, or inguinal regions; the contents consist chiefly of pus mixed up with hairs. Under certain circumstances, which will be explained in the sequel, the partially liquefied contents of an adipose cyst assume a peculiar form. In a female, 46 years of age, who died of internal hernia, the right ovary was found converted into an ellipsoid fibrous sac of the size of a man's head, and nine inches in its long diameter; it had mounted above the pelvis, and lay obliquely in the left iliac . Its inferior apex was attached to the ovarian ligament; the other, which was directed upwards and outwards, was attached to the anterior surface of the middle portion of the jejunum, by means of a cellular band of an inch in breadth. The sac had been twice turned upon its axis; it contained a brown, fatty, gelatinous fluid, in which, besides a ball of the size of a walnut, composed of hairs that were matted together, there floated seventy-two bodies of the size of a filbert, and a much larger number of smaller bodies of the size of a pea, consisting of a greasy fat. They were of a yellowish color, and from mutual pressure had a polyhedral surface, and presented concentric layers. The cyst was not only surrounded by coils of the small intestine, but two portions of intestine also passed underneath it. It may therefore be said to have represented a capsule, which both from its form and attachment, and from the circumstances of its having been found rotated upon its axis, resembled a dredging-box (granulirbiichse), the rotations of which had converted the contained fat into the globular bodies above described.

b. Anomalous production of fibrous and osseous tissue. a. Fibrous tissue is formed:

In the shape of fibroid exudation on the internal surface of the simple cysts, but more especially on that of the composite and areolar cysts.

As a subperitoneal (subserous) new growth (so-called cartilaginescence) in the cystic parietes.

As a fibroid tumor; this rarely attains a larger size than that of a hemp seed or pea. We must except those cases in which the tumor has formed in the parietes of a compound cyst.

As a dirty white or yellow, plicated, curled, soft concretion, within which, not unfrequently, a cavity may be traced. These concretions appear to be Graafian follicles which, after having undergone inflammatory thickening, shrivel up and become obliterated; after puerperal processes we find them occasionally in the shape of soft, collapsed, friable sacculi, whilst under other circumstances they appear as solid, dense, coriaceous cysts.

As a cicatrix, presenting a rounded, nodulated wheal, with a yellow, rusty, or black nucleus, resulting from follicular apoplexy of the ovary.

3. A formation of bone occurs:

In the shape of so-called ossification (earthy concretion) in the majority of the just-mentioned fibroid growths, and more particularly in the fibroid exudation, and in the subserous fibroid formations of the dropsical ovary.

As genuine bone, in various forms that offer but a weak analogy to one another, and in the adipose cysts.

C. Tubercle

The occurrence of tubercle in the ovaries is at least doubtful; so far as our own investigations and observations go, we must deny it altogether.