Report on Obstetrics and Diseases of Women

W. L. Richardson
1874 Boston Medical and Surgical Journal  
Diseases of Women Subacute Ovaritis.-E. J. Tilt, M.D. (Transactions of the London Obstetrical Society, xv. 1874.)-The difficulty of correctly diagnosticating ovaritis arises chiefly from the fact that peritonitis obscures the diagnosis by embedding the pelvic organs in a mass which forms, only too often, a hard pathological puzzle. The symptoms may be divided into thoso known as catamenial and objective. Although subacute ovaritis may be met with during the whole period of ovarian activity, it
more » ... arian activity, it is most likely to occur in young unmarried women, from fifteen to twenty years of age, particularly in those who are delicate in body, sensitive in mind, and with proclivities to tubercular disease. When met with in women presenting none of these peculiarities, the patients will be found to have suffered all their lives from menstrual irregularities. Women, suffering from this trouble, complain of habitual pelvic and mammary pain, and especially of a marked aggravation of the nervous symptoms of menstruation, the menstrual How being usually too abundant, or, as occasionally happens, too scanty. The pain of subacute ovaritis is deep seated, persistent, moderate, bearable, extending from the ovarian region to the knee, and sometimes accompanied by numbness, coldness and anassthesia of the anterior part of the thigh. Tho pftin gives rise to a certain degree of hesitation in the patient's movements, since she has learned to know that a sudden motion will increase it. Firm pressure on the ovarian region increases tho pain and the peculiar nausea which not unfrcquently accompanies it. The pain sometimes subsides soon after menstruation, only to reappear, however, a few days before the next period. It is not relieved by a free flow of tho menses. Menstruation is preceded and accompanied by a marked aggravation of the usual mammary symptoms of that period, the breasts being swollen, painful and hot. Hysterical phenomena may also be present. A vaginal examination will often throw a great deal of light on the case, even if it does not finally settle the diagnosis. The left hand should forcibly depress tho ovarian region, while the two first lingers of tho right hand examine, per vaginam, both sides of the body of the uterus. A forcible inclination of the cervix uteri to the side on which the disease is supposed to exist, stretches tho connections of the fundus uteri and the ovary to such a degree as greatly to increase the pain. Sometimes the ovary descends into Douglass's pouch, where it can be felt as an ovoid body, about two inches long, either more or less fixed by peritonitis, or fleeing from tho finger, only, however, to return, as by a kind of ballottement. This body, when seized, will be found to bo semi-elastic aud peculiarly sensitive to pressure. A combined rectal and vaginal examination will often be found of great service in making out the diagnosis. As regards treatment, a well-appointed hygienic course for menstrual
doi:10.1056/nejm187408270910902 fatcat:hhaseglnrbf4tp6tssjtm2qjhy