1. Defect Of Formation

It is very unusual for one of the ovaries to be wanting, if the sexual apparatus is otherwise normal.

The ovaries often appear, together with the other portions of the sexual organs, in a state of imperfect development, and small; and, on account of the depth at which the Graafian follicles are placed, of uniform density and hardness, and with an even and smooth surface.

2. Deviations Of Size

We find various enlargements occurring in the ovaries, which form a contrast with the just-mentioned smallness of the ovaries and their diminution at the decline of life; the latter affection only comes within the domains of pathology if it occurs prematurely. We shall have occasion to notice them all under the head of textural disease, and therefore do not here enter into a more minute examination of the subject. We here merely allude to that form of ovarian dropsy which results from the excessive development or hypertrophy of one or more Graafian vesicles, as a subject coming under the above denomination; but it will be more practical to consider it fully when we speak of the formation of ovarian cysts.

3. Diseases Of The Tissues

These diseases affect either the cellulo-fibrous substance (stroma) and the fibrous capsule of the ovary, or the follicles, or both together, as we shall have occasion to explain in the subsequent sections that relate more particularly to this point. We confine ourselves to the most important and conspicuous affections of the follicles and their contents.

1. Hyperemia, Apoplexy

Hyperemia of the ovary, affecting both its stroma and the external layer of the follicle, occurs physiologically in menstruation; but it also accompanies numerous pathological processes in the sexual apparatus, and is sometimes permanent. Its characters are tumefaction of the ovary, softening of its tissue, vascularity, and darker color; permanent hyperemia gives rise to a gradual increase of size, to hypertrophy of the stroma, and enlargement of the ovary.

Hyperaemia affecting the more developed follicles that are seated at the surface of the ovary often induces effusion of blood into the cavity of the follicle or apoplexy. One or more cysts, varying in size from a pea to a hazel-nut, are found in the ovary; they project more or less above its surface, after having perforated the fibrous sheath of the ovary, and are at once recognized by their contents being visible through the parietes of the follicle. If seen shortly after the occurrence of extravasation, they are tense: but more commonly a certain amount of coagulation has been effected in their contents, and they then appear slightly collapsed, and present fluctuation. They now contain a dark-red loose coagulum, which is invested by a white or colored fibrinous coa-gulum varying in thickness. In the course of time the coagulum assumes a rusty or yellow color, is converted into a pulp which gradually becomes inspissated, and yields the above-mentioned fibrinous coagulum and serosity, the latter being in its turn removed by exosmose and absorption. The entire cyst contracts, retaining traces of the original lining coagulum of fibrine and of its yellow deposit, and, perhaps, also, a yellow, indurated, friable, chalky residue of the coagulated blood; it may become reduced to less than the normal size of the follicle, and from drawing in the fibrous sheath of the ovary, cause the appearance of a cicatrix. The contents and parietes of the apoplectic cyst consequently present an appearance which varies according to the length of time that has elapsed. We very often find cysts of different dates in one or both ovaries.

It is evident that this effusion of blood must induce a destruction of the germ, and, at last, cause an entire obliteration of the follicle. The cicatrix naturally always presents a greater or less resemblance to the corpus luteum. Although the amount of effusion is often very considerable, rupture of the follicle and hemorrhage into the peritoneal cavity is of very rare occurrence.

The most common cause of this affection is excessive menstrual congestion, and it undoubtedly comes within the sphere of pathological inquiry (vide Negrier).