Solid ovarian tumors may be considered as the indurations which occur in chronic inflammation of these organs. These are mostly fibrous tumors; and are either external and attached to the ovary, or imbedded within its substance. They are similar in situation, structure and in variety to tumors of the uterus, and often occur in the ovaries at the same times that they do in the womb, -but are less intensely painful. The solid ovarian tumors of a non-malignant character are comparatively rare; they may be quite small, or vary from the size of a goose’s egg to that of a man’s head. One of this mentioned by Scanzoni, – which, however, gave some traces of a cancerous nature,-was found to weigh nineteen pounds, -the patient having died of Bright’s disease. In their general appearance these tumors are correctly described in the words of Dr. Baillie, – “The ovarium is much enlarged in size, and consists of a very solid substance, intersected by membranes which run in various directions. It resembles in its texture the tumors which grow from the outside of the uterus, and I believe has very little tendency to inflame or suppurate.
In many instances the induration partakes of the nature of an enchondroma, in which the sub-peritoneal fibrous membrane of the ovary itself assumes an osseous or cartilaginous hardness. Thus in two examples, mentioned by Kiwisch: (*Scanzoni, p.418) “Once these cartilaginous concretions surrounded the ovary in the form of numerous plates or of rounded protuberances, more or less large, which gave to the entire organ an aspect altogether tuberous. At another time the right ovary was entirely transformed into a tumor of the size of the fist, surrounded with numerous false membranes whose exterior layers contained large, hard, cartilaginous nodules, while the interior of the tumor resembled a cartilaginous hyaline mass of very great hardness.
Very rarely the induration partakes of the calcareous or cretaceous nature. Or from the presence of a peculiar dyscrasia in the system, which may be termed tuberculous, tubercles may be deposited in the substance of the enlarged, hardened and inflamed ovary, – as in pulmonary tuberculosis. In such cases the adjacent organs will also show traces of similar tuberculous deposits. And thus, by almost insensible gradations, the non- malignant may be seen to run into the malignant form of ovarian induration. The reciprocal relation of the constitutional dyscrasia which produces tubercles, to that which results in genuine cancer, has already been explained in a previous chapter, on cancer of the uterus, -to which the reader is here referred.
The diagnosis of fibrous, non-malignant tumor of the ovary, will be assisted by examination per rectum, – by which such a tumor can be distinguished from tumor of the uterus; and by the consideration of the general health of the patient, and the less poignant and lancinating character of the pains, – by which such a tumor may be distinguished form fibrous cancer of the ovary. But this is of consequence rather for the comfort and encouragement of the patient, than for our own guidance in prescribing; since the medicine must always be selected from a careful study of the totality of the symptoms and conditions, – never from our pathological theories or conclusions. The symptoms will surely lead us right; while our pathological theories, – by persuading us to generalize instead of individualizing, – will assuredly preclude us from the success we might attain.
Apis m. Stinging pains, like bee-stings, occurring occasionally.
Arnica m. If developed from a bruise, – the Arnica symptoms remaining, – a sore, bruised sensation.
Belladonna. The pains coming and going suddenly. Downward pressure, as if all would issue through the genital organs.
Conium. Much nausea and vomiting. Vertigo whist in a recumbent position, particularly on attempting to turn over. The urine intermits in its flow.
Graphites. She has itching blotches here and there over her person. Getting her feet a little damp aggravates her sufferings. Obstinate constipation of large, knotty feces, with varices.
Lachesis. Especially in cases where the left ovary was first affected, with tendency towards the right. Worse after sleeping. The pain is often relieved by a discharge of blood from the vagina.
Lycopodium. The right ovary is first affected, – and inclines to the left. Aggravation after four P.M. Much borborygmus, particularly in the left hypochondria. An abundance of red sand in the urine. Much pain in the back before urinating, – which is relieved as soon as the urine flows.
Zincum met. The sufferings are entirely relieved during the catamenial flow. A sensation of as boring in the tumor, which requires pressure and shaking of the part for relief.
See also Ovaritis.
CANCER OF THE OVARIES.
The malignant and the non-malignant may be stated to comprehend all the varieties of solid ovarian tumors; of these the latter, – principally fibrous tumors, – have just been described: the various forms of scirrhus, cancer, and fungus haematodes make up the former.
The fibrous cancer, or true scirrhus, is the one which are more properly belongs to the class of solid tumors of the ovaries. This form of ovarian cancer is usually very moderate in size; very slow in its growth and development; and as a primary affection comparatively rare in its occurrence. The more frequent form of cancer of the ovaries, however, is not the scirrhous, but the cerebriform variety, the cystocarcinoma which appears in connection with encysted rather than with solid ovarian tumors. Both varieties, for the sake of simplicity and conciseness, will be considered in the present section.
Cancer of the ovaries is less common than that of the breasts, and not nearly as frequently as cancer of the uterus. It appears to attack principally the unmarried female at the middle period of her life; while cancer of the uterus more frequently occurs in those of a more advanced age.
The fibrous cancer or scirrhus of the ovary, presents the characteristic stony hardness of this affection in general; it is uneven in its surface, and nearly homogeneous in its substance. Its coexistence with cancer of other organs, especially in the breast, greatly aids in determining the nature of the difficulty. In other respects the reader is referred to the symptoms as described under cancer of the uterus. The examination per rectum will enable the tumor to be distinguished from that of the uterus.
The more common form of ovarian cancer is the cerebriform; which is also much more rapid in its growth. “We have the ovaries or Graafian vesicles, swelled out into cysts whose walls are like scirrhus, or we have them converted into those bags of gelatiniform substance, which have obtained the name of colloid. We see also here those proliferous cystic growths classed by some authors among the non-malignant tumors, but which are, I believe, true cancer. It appears from the results of operation, that the diagnosis of these tumors from the simple cystic formations is very difficult; and also, that very unfavorable results have ensued whenever the ovarian tumor which has been removed proved to be cancerous. – Cooke. As neither in malignant nor in non-malignant tumors of the ovaries, do the principles of the Homoeopathic school approve of operations whose subject is the extirpation of such tumors, – so neither will the Homoeopathic physician be led into the fatal error of attempting the removal of a cancerous enlargement of the ovary. Still it is desirable as above stated to be able to distinguish at an early a period as possible, a scirrhous growth from an ordinary and comparatively innoccuous induration. And so also to distinguish a fibrous from a cerebriform or colloid cancer of the ovary; since while the former may occupy years in its development, and even then attain to but a moderate size, the latter runs a very rapid course and may acquire an enormous volume in a few months.
As fibrous cancer of the ovary may become a softened, ulcerated cancer; so these two forms of the cancerous affection, which arise in connection with encysted dropsy, either present at different periods of their development great differences of consistence, or they combine in one and the same tumor and at the same time the most opposite constituents. An ovarian tumor was dissected by Veter, weighing fifty-six pounds, and of a consistence, almost cartilaginous; in three parts, however, it was softened, and resembled the substance of the brain. The encephaloid substance was more distinctly characterized in a case of enormous cancer, of seventy-five pounds’ weight, which occupied the left ovarium, and contained within a fibrous and a fleshy mass and a fatty tissue. It is this encephaloid disease which has been termed cephaloma, when it is whitish, – and haematoma when it is vesicular and saturated with blood; the same that by others has been denominated malignant, or fungoid tumor of the ovarium. (*Boivin and Duges, page 479) A similar, fungous or cancerous cauliflower excrescence, has been described, in which, in connection with dropsy, both ovaries were changed into a mass infinitely ramified with vessels in its substance, and granulous at its surface.
