Menorrhagia will sooner or later induce ovarian irritation, in consequence of the nervous weakness of the sexual organs and of the whole system, which follows such exhausting discharges. In all the abnormal varieties of menstruation, – in profuse as well as in suppressed menstruation, -the ovaries are often the organs most severely affected. And even where the profuse flow originates in a morbid condition of these organs, the reflex influence of such flow is capable of greatly aggravating the original morbid condition. In some instances ovarian irritation seems to be the result of erosion or congestion of the cervix uteri; in others the irritability appears only on the repression of such organic diseases by the barbarous, surgical treatment of the allopathic school.
The relation of amenorrhoea to ovarian irritation has already been explained; and in those forms of dysmenorrhoea which are due to imperfect or difficult ovulation, it is easy to see that the ovaries must be in an irritable condition. Thus the entire absence of sexual intercourse; its imperfect performance, or excessive indulgence in coition may, in different ways, lead to the same state of ovarian irritation. And in many cases of sterility, the only assignable cause will be found in a similar irritability of the ovaries. Hysteria is a no less invariable attendant upon this form of irritation; but it must be regarded rather as the consequence than as the cause of the irritability. Since, as already stated, in a previous chapter, hysterical paroxysms may sometimes be immediately produced by pressure of the fingers upon the ovaries. For treatment of Ovarian Irritation, see Remedies for Inflammation of the Ovaries.
ACUTE INFLAMMATION OF THE OVARIES.
ACUTE OVARITIS may be idiopathic or puerperal, according as it arises directly from local or constitutional influences peculiar to the ovaries,- or result from peritoneal inflammation succeeding to abortion or parturition.
Description and symptoms. – Idiopathic Ovaritis is comparatively rare; except where it is the consequence of external injury. It is most apt to occur just previous to, during or immediately after the menses. The ovaries themselves swell to three or four times the natural size, and their peritoneal covering usually become tender and inflamed. Scattered through the substance of the inflamed ovaries will be found purulent matter, contained in cysts which have been supposed to be the Graafian cells filled with pus of their own secreting. The patient suffers with severe, deep-seated pain in the pelvic cavity; the pain is accompanied by a burning sensation and is made much worse by motion.
If the peritoneal covering becomes involved, the pain is rendered much more acute and lancinating, – aggravated by pressure and by suddenly assuming the upright position; while the former tenderness on pressure, instead of being confined to the ovarian regions, will be found to have extended over the whole surface of the abdomen. In the severer forms of ovaritis, the fever and other symptoms will greatly resemble those constituting peritonitis; “the skin is hot, the pulse quick and concentrated; the stomach becomes disordered, and nausea and vomiting occur. The inflammation usually does thus extend more or less over the adjacent peritoneal membranes; causing dysuria and very frequent and painful micturition; or the inflammation may be directed more posteriorly and the rectum rather than the bladder become principally affected. In this latter case there may be frequent and ineffectual calls to evacuate the bowel, -even with distressing tenesmus. “In the earlier stages of idiopathic ovaritis, nausea, sickness, and sometimes constipation are frequent accompaniments, depending at first on the irritation of visceral peritoneum, and on the temporary paralysis of the muscular coat of the intestines. When the tumor has increased, and rests on the rectum, the patient is troubled by a more constant constipation and by tenesmus. The pressure on the rectum is sometimes so great that the feces are moulded into the form of a ribband. Sometimes constipation is so great that the case is said to be one of ileus. – Tilt.
Acute ovaritis may give rise to nymphomania: “the mind is more evidently affected in the sanguine, the irritable, and the plethoric; the desires are inordinately excited, so as almost to amount to uteromania. But this exaltation of the sexual feeling can only arise in the earlier stages of the ovarian inflammation. And on the other hand, “inflammation of the ovaries decidedly occurs, not only without the slightest approach to nymphomania, but it is frequently attended by a directly opposite state of feeling on the part of the patient. – Lowenardt.
Diagnosis. In inflammation and in irritation of the ovaries, an examination per rectum may be found requisite. “Without the aid of examination per rectum, it would be exceedingly difficult to form a certain diagnosis; the finger per anum, easily reaches to the side of the uterus, where the swollen and generally painful ovary may be distinctly felt. Examination per vaginam leads to little or no certain results. And by such exploration per anum, ovaritis may be distinguished from all other affections; because in no other affection is the ovary necessarily enlarged. A careful study of all the symptoms and conditions will remove any remaining obscurity in these cases. The history of the case; the previous condition of the patient; the nature of the pain as sharp, lancinating, aggravated by motion, will all aid to determine the origin and extent of the ovarian affection. This must also be distinguished from simple ovarian irritation, by that symptom of aggravation on pressure, which is common to acute inflammation but not to nervous or neuralgic conditions.
Termination. The natural course of ovaritis, like that of other acute inflammations, is to terminate in suppuration unless its progress is arrested. In the latter case, whether the result be brought about by art or by unaided nature, the termination is in resolution. This is but another name for the subsidence of the inflammation itself. But a partial resolution or subsidence of the more violent inflammatory symptoms may be supposed to have taken place where the chronic ovaritis replaces the acute. Here we have the commencement of an ovarian tumor, for the enlargement of the ovary which appeared is generally diffused throughout the substance of the ovary. This pus, – whose formation may be indicated by rigors, softness of the pulse, and mitigation of the general symptoms with an increased sense of local weight and throbbing,-may be reabsorbed into the system; and thus a form of resolution may succeed, even after suppuration. Or the abscess may bust and discharge its contents, either externally; through vagina; into the intestine; into the bladder, or into the cavity of the peritoneum. The discharge of the matter through the vagina is the most favorable of all; whether it be transmitted through the Fallopian tubes and uterus, or, as is more frequently the case, directly into the vagina itself. The discharge of the product of ovarian suppression through an intestinal or a vesical opening may result favorably or unfavorably, according to the other circumstances of the case. But the effusion of ovarian pus in quantity, as of any other purulent matters into the peritoneum is almost necessarily fatal. In many milder cases of ovaritis, in which no structural disorganization, as suppuration or tumor appears, the organ may none the less effectually become incapable of ovulation, by the condensation of its tissues; -or adhesions may occur which may indirectly, but no less certainly, occasion sterility.
Causes. Idiopathic ovaritis may result from external injury; and it has been known to follow sudden suppression of the menstruation. It has also supervened on the suppression of gonorrhoea by astringent injections; and it has occasionally occurred in connection with variola, and in pneumonia. “A cold taken during menstruation, the suppression of the courses, coitus during or immediately after this epoch, the use of violent emenagogues, pediluvia or hot baths at the same period, are the principal causes likely to produce ovaritis in the absence of the gravid or puerperal state. – Scanzoni.
The Puerperal Ovaritis is much more common and is often merely an extension of inflammation from the uterus, or broad ligaments to the ovaries. As this is rather the consequence of another morbid condition of which it forms a complication, we refer the reader to Puerperal peritonitis for a fuller description.
CHRONIC INFLAMMATION OF THE OVARIES.
Chronic Ovaritis as already explained, is often but the continuation of the acute in a less active form, in other instances, it is the result of a corresponding inflammation of the uterus and its appendages; or it may arise, as it were, originally and spontaneously, in the individual follicles. In either case there is more or less enlargement of these organs; their contour becomes irregular, their surface roughened and their entire substance indurated. This enlargement and induration usually affects but one of the ovaries, in the first instance; the other retaining its natural size, or only becoming affected subsequently. The enlarged ovary remains within the pelvis either freely movable or adherent, – until its increasing size causes it (if movable) to pass into the abdomen entirely, – or to extend its growth in the same direction, where from the formation of false membranes adhesions have bound the original tumor within the pelvic cavity. Having risen up into the abdomen, the enlarged ovary may still remain freely movable,-or become fixed, by means of adhesions to the adjoining viscera, or by completely occupying the cavity of the abdomen itself. In this general manner do what are called ovarian tumors spring from chronic inflammation of the ovaries.
