The causes of ovarian dropsy are not to be very definitely stated; except that they may arise from a great variety of influences in persons of a general dropsical diathesis. These are stated by Leadam to be injury during parturition, blows, falls, strains, fright, sudden applications of cold, undue excitement, & c. Hence in general, next to a careful consideration of the constitution, symptoms, and indications, it may be important to bear in mind those things which may have resulted in such abnormal developments. For so powerful is the influence of the mind over the body, that even in structural disorders which have thus resulted from such influences as terror, fright, but little progress will be made towards a cure so long as we neglect to take such circumstances into consideration.
Ovarian dropsies may also arise in connection with suppression of the menses, – as is the case with all forms of ovarian tumors. And in the former, as in the latter case, it may not always be possible to determine which is the primary and which the secondary affection; at least where both ovaries are at the same time affected, -which however is not common. In ordinary instances one ovary will become diseased, and the other still perform its function of ovulation, and conception itself may result. This may be the case until the larger size of the ovarian tumor interferes with the proper action of the other ovary.
Complications.– Dropsies of the ovaries are very often complicated with malignant disease, either of the scirrhous or of the medullary or colloid variety; and during life it is sometimes impossible to distinguish between those which are simple and those which are thus seriously complicated. In some such obscure cases nothing but a careful attention to the constitutional indications and symptoms will guide the physician aright. he may know of no remedies capable of curing the form of dropsical tumor before him, but he may be able to select remedies which shall greatly benefit, and even finally cure his patient. Ascites or even hydrothorax and general anasarca may become complications of ovarian dropsy, especially in its advanced stages–thus greatly aggravating the sufferings of the patient, and hastening the fatal result. Inflammation may arise in the dropsical tumor which may led to suppuration and a fatal termination,– especially after the operation of paracentesis has been performed.
Diagnosis.– It is important, though not always easy, to be able to distinguish dropsical from other ovarian tumors; particularly with reference to prognosis.
From pregnancy, inter-pelvic, ovarian dropsy may be distinguished by internal examination, by means of which this tumor may be separately felt apart from the fundus uteri. And in a similar manner, by examination per rectum, as well as per vaginam, this dropsy, while yet within the pelvic cavity, may be distinguished from dropsy of Fallopian tubes. From retroversion of the uterus it may be distinguished by its slow growth, as compared with the frequent suddenly formed tumor which arises from this displacement of the uterus; by the greater mildness of the symptoms, the bowel not being at once affected; and by examination per rectum.
After the dropsical tumor has so increased in size as to have ascended into the abdomen, it may be distinguished from pregnancy by auscultation; by its being one-sided sometimes; by examination per rectum and per vaginam showing the uterus not to be enlarged. In those instances in which pregnancy does exist in connection with ovarian dropsy, it may not be possible to determine the facts of the case until the ear can catch the sound of the foetal circulation; and even then, there may be some obscurity. Still, even here, the constitutional affections, the sensational symptoms, will lead infallibly to the right remedies, and thus the very best that can be done will be done. From ascites, ovarian dropsy may be distinguished by the well-defined form of the tumor; by its original or permanent inclination to one side; by its maintaining its situation, even while the patient is in the recumbent position; by the more obscure fluctuations; by examinations per rectum and per vaginam, which will also enable it to be distinguished from dropsy of the uterus; and by the absence of oedema of the feet and ankles which almost invariably attend ascites, but which are less apt to accompany encysted dropsy, except in the last stages. The constitutional symptoms are less strongly marked in this encysted form of dropsy, than in ascites. From solid ovarian tumors, ovarian dropsies are to be distinguished by the fluctuation; and by their more rapid growth. It must be borne in mind, however, that there are cases of true ovarian dropsy, which come on very slowly; which may remain dormant and stationary for a number of years.
The prognosis in a case of ovarian dropsy will be favorable or the reverse, according to the rapidity or its growth, the severity of the attendant symptoms, the period of life, and the conclusion we can form as to the mild or malignant character if the affection itself. In almost all cases of confirmed, encysted dropsy, even if uncomplicated with scirrhus, it is merely a question of time. But that time may not necessarily be short. For cases have been recorded, even under Old School treatment, in which the patients have lived for many years with ovarian dropsy of considerable size, without being tapped. While under the Homoeopathic regime, there is reason to hope that the progress of the disease may be entirely arrested, in many cases, and the patient may be considered curd, if the enlargement remain. But those dropsies which occur towards the change of life; which are accompanied by total loss of menstruation; which appear to give rise to severe constitutional symptoms, to great debility or to a general cachectic condition, may well occasion serious anxiety.
Treatment.– Under this head may be considered both the internal medication and operative interference. The latter may be more readily disposed of first.
Operations for dropsical tumors are of two kinds; those which are intended to entirely remover the disease by expiration of the tumor itself, and those which attempt merely to relieve the patient by drawing off the accumulated fluids. The removal of ovarian tumors, of all kinds, was formerly far more generally practiced than now, in the ranks of allopathic surgery. The well- known fact that persons may live a long time with such encumberances; and that they are very apt to die within a few months, if not within a few days or hours, after suffering their removal, renders people less willing to submit to the operation. Out of a considerable number of cases of ovarian tumors removed by a celebrated surgeon of this city, and by him reported as illustrations of successful operations, not a single patient survived more than nine months! And even so long ago as 1844, Ashwell very earnestly cautioned against the operation. And partly from the great uncertainty of determining that here is no scirrhous complication, partly from the impossibility of ascertaining in advance that there are no such adhesions as would, by giving rise to subsequent peritonitis, render the operation almost necessarily a fatal one, and partly from a consciousness of the existence of important “organic disease, of which the dropsical affection may be but an outgrowth, many eminent allopathic authorities, such as Hamilton, Churchill, and Lea, caution against performing this operation. professor Hodge says: The terrible operation of gastrotomy for the removal of such solid tumors (enlarged ovaries) is, we think indefensible: inasmuch as in itself it is very dangerous and often fatal. but in cases where there are collections of watery, gelatinous, purulent or other fluids in the ovaries, he considers the question of ovariotomy to be different, since such cases, after the lapse of months or years, are generally fatal. And he thinks that the decision may occasionally be in favor of the operation. But with the experience of many able allopathic surgeons before us, and remembering the excellent results which have been obtained by the use of Homoeopathic remedies, we think the cases are few indeed in which the operation for the extirpation of cystic tumors of the ovaries would be justifiable. And this conclusion, which coincides with Homoeopathic principles, is confirmed by the very great danger that the dropsical tumor may prove complicated with scirrhus, and so become all the more rapidly fatal for being interfered with; by the danger of death from the extension of the original disease, even where it was not malignant, which, disturbed in its primary and preferred form of development, is apt to find another and less salutary one; and by the imminent danger from peritoneal and general inflammation, inseparable from such extensive openings into the abdomen.
Paracentesis. Tapping is the operation resorted to in some instances, for relief of the patient, but not with the expectation of obtaining a radical cure of the disease. And it will be recommended by the Homoeopathic physician, principally in those cases of the unilocular form of ovarian dropsy, in which fluctuation can be distinctly felt; and in which the patient experiences a great deal of suffering in locomotion and respiration, from the large quantity of water accumulated in the tumor. “It should not, as a general rule, be performed so long as the patient is comparatively comfortable, experience having shown that when it has once been done, it will usually have to be done soon again.
