doses, deafness and singing in the ears come on, the action of the heart is lowered, and the symptoms of peritonitis are said to abate. Such are the remedial measures suitable to all types of sub-acute ovaritis, but the patient should be warned that nature, by subjecting her to a periodical return of pain and congestion of the ovaries, renders her liable to returns of a low inflammatory action in the same organs, and that therefore it may be necessary to continue the treatment month after month, to use sedative rectal injections a few days before the return of menstruation, and during the flow, if there be much pain, though at that time warm water should be injected instead of cold. PREVENTIVE TREATMENT OF SUB-ACUTE OVARITIS. This it is no less the practitioner's duty to enforce, even though he may not be questioned on it by patients or relatives, ever anxious to throw off the trammels of medicine when they are once relieved from pain. This essential part of practice should be planned so as to fortify the nervous system by diet, exercise, amusements, and tonic medicines; to ensure the avoidance of such causes as I have shown are the most likely to give rise to menstrual disorders in general, and in particular to sub-acute ovaritis-such as cold, emotional stimuli, and in the married, sexual indulgence. The reader will easily deduce the means of successfully preventing the development of ovarian and uterine disease from a careful study of my long chapter on the causes of sub-acute ovaritis, or, if he wishes to see the subject treated at a length proportionate to its importance, I refer him to my Elements of Health, and Principles of Female Hygiene. CHAPTER XXX. ACUTE SYN.-Oopboritis.-Dugès. OVARIT IS. Vesiculite suppurée-Inflammation of the uterine appendages-Ovarian abscess-Abscess of the broad ligaments-Pelvic tumour. DEF.-Considerable painful swelling of the ovaria, and of the surrounding cellular tissue, with formation of pus, which is either disseminated or encysted. It is necessary to class and to separate, so as to take stock of what one possesses, but there is no abrupt transition from the acute to the chronic; and if I consider ovarian abscess separately, it is because it has many peculiarities, and requires surgical as well as medical treatment. A pelvic tumour may be the result of inflammation communicated from the cæcum to the surrounding cellular tissue; it may be constituted by the inflamed ovaria and its surrounding cellular tissue, or, on the contrary, it may be formed by an abscess in the cellular tissue subsequent to child-bearing. It may also be sanguineous. The term Vesiculite suppurée can only be correct when it is possible to distinguish the three envelopes proper to the vesicle from those of the ovary, which seldom occurs. Although much has been published on most of these varieties of disease, the whole of our information requires to be tested and increased, by numerous cases exhibiting each variety unadulterated by complications. Large maternity hospitals afford an excellent opportunity for doing this, both for puerperal ovaritis, and for pelvic cellulitis. Idiopathic acute ovaritis is a rare disease, and every pathologist must build its history on cases derived from many sources. cluding those incompletely given, or on which doubts could be entertained, and all those of chronic ovarian tumours, in which suppuration supervened in structures totally different from those of the healthy ovary-cases which have been Ex erroneously classed with ovarian abscesses-I have collected twenty-four published cases of idiopathic ovarian abscess, capable of being used for this purpose, and adding to them two, which occurred in my own practice, I shall qualify the assertions of authors by the analysis of these twenty-six cases. In twelve out of the twenty-six, a post-mortem examination showed that the ovary was transformed into an abscess, the great probability of this having been the case with many of the other fourteen, rests on the testimony of competent observers. Following the example of the best authorities, I have not separately considered idiopathic and puerperal ovaritis, because the nature, symptoms, and terminations of both diseases are similar, however much the danger of ovaritis may be increased when it arises in the midst of puerperal fever. PATHOLOGICAL ANATOMY OF ACUTE OVARITIS. When describing the anatomical lesions of acute ovaritis, one treads on less disputable ground than when speaking of those of the sub-acute form. These lesions are, in themselves, more apparent, and similar to those produced by acute inflammation in other organs. If the inflammatory process has been sufficiently intense, or has not been actively treated, the ovaria in the course of a few days swell to a considerable bulk; and if, by chance, an opportunity be afforded of examining them, the peritoneal covering of the ovaria may be found acutely inflamed, red, vascular, the lymphatics full of pus, and the surface covered with false membranes, or imbedded in lymph, as may be seen in the beautiful delineations of Carswell and Cruveilhier. The ovaria themselves are swollen to three or four times their usual size, are pulpy, of a bright red colour, very vascular, and with a collection of pus in some portions of their tissue. These purulent deposits, scattered through the ovaries, have been described by Négrier, and considered as inflamed Graafian cells, filled with pus of their own secreting. He has given an interesting case, where the rupture of one of these very small purulent cavities, and the diffusion of its contents into the peritoneal cavity, terminated in death. These small cavities may communicate, or the central part of the ovary may be broken, nothing being left but the ovarian shell, filled with pus; and if well protected by false membranes, the pus may remain there, without giving signs of its existence. In twelve out of twenty-six cases of idiopathic ovaritis, a post-mortem examination was made. In seven out of the twelve, the pus was found in the unbroken ovarian shell; in three, its contents had been emptied into the peritoneum, and had caused general peritonitis; and in three out of the seven cases, both ovaries contained pus. Haller, Portal, Montault, and Cruveilhier, have related instances of the ovarian abscess containing several pints of pus; and in the North American Journal, 1826, Mr. Taylor has published a case, where it was said to have contained twenty pints; but I consider this, and similar cases, to be suppurated ovarian cysts, and not ovarian abscesses. Acute inflammation often supervenes on chronic ovarian tumours; this evidently occurred in Portal's case: the tumour is described as still containing steatomatous matter. These collections of pus, if not artificially opened, have a tendency to empty themselves into the neighbouring organs, for they will be found to communicate, by fistulous passages, with various parts of the intestinal canal, with the bladder, the vagina, or the peritoneal cavity. T. Bonnet, Shenkius, Merat, and Dr. Seymour, have related cases, wherein the ovaries were found in a state of gangrene. It is said, and Dr. H. Bennet has lately repeated the assertion, that inflammatory action generally extends to the cellular tissue contained within the folds of the lateral ligaments. This is only true for puerperal ovaritis, and partly explains the gravity of the disease, but in idiopathic ovaritis, inflammation often remains confined to the ovary; in seven out of the twelve cases, in which a post-mortem examination was made, the pus was in an unbroken ovarian shell, and it is not mentioned that the surrounding cellular tissue was much implicated in the other five. The coincidence of abscesses in the ovary and the corresponding oviduct, was noticed by Morgagni, and afterwards by Andral, Dalmas, and Hasse. In a post-mortem examination, Cruveilhier found both the ovary and the corresponding Fallopian tube distended with pus, the tube being adherent, and the ovary so softened in The the vicinity of the adhesion, that it would soon have allowed its contents to pass through the tube to the uterus. ovary is often found partially destroyed, and sometimes entirely so. The pathological lesions of puerperal ovaritis are sometimes similar to those described. Pus may be found in the ovarian veins, though not so frequently as in the uterine. Cruveilhier considers the lymphatics to be more commonly distended with the pus they have absorbed; and in several of his plates he has shown the deep and superficial lymphatics of the ovaries and broad ligaments replete with purulent fluid. These vessels have been sometimes mistaken for veins; but when the pus is removed from the lymphatics, those structures appear perfectly healthy; whereas, when veins are inflamed, their tissues are thickened, are more fragile, and are lined with false membranes. The change produced by pregnancy in the structure of the ovaries accounts for some other changes frequently found in those of puerperal women; for if the ovaria, when already softened and swollen by that physiological process which had not escaped the notice of Bichât and Roux, are attacked by acute puerperal inflammation, it need not excite wonder if their whole substance should be dissolved into a jelly-like substance without admixture of pus. Morgagni was one of the first to notice this peculiarity— Epis. 46. In a woman who died on the thirtieth day after her confinement, he found an abscess formed between the right ovary and the colon, which was the cause of death. The left ovary, although, in size and colour, not differing from one in a healthy condition, was softer than usual, and on being opened was found to consist of a sort of jelly. The same appearance has been since observed by Collins and Cruveilhier. The size of the tumour is often more considerable, and the stroma loses all trace of organization, being changed into a milky sero-purulent magma, into a greyish sanious matter, or into a vascular pulp, which is almost diffluent, and approaches very nearly to the condition of gangrenous decomposition, since it indicates the total disorganization of the ovarian tissue. In some cases of puerperal metro-peritonitis, Cruveilhier, Boivin, Dugès, and Seymour, have found the diffluent ovaries ruptured, without its being possible to ascribe the |