Mare, cow, ewe, sow, bitch, hen. Forms. Histogenesis. Dilated
vesicles, egg tubes, blood obstruction. Lesions: Ovary large, smooth,
lobulated, vascular, size, connective tissue, epithelium, liquid
contents. Abscess. Symptoms: impaired portal circulation,
muco-enteritis, piles, intestinal torpor, impaction, constriction,
obstruction, congestions, inflammation. Urinary disorder.
Strangulation. Sterility. Abortion. Dystokia. Indigestion. Anorexia.
Colic. Genital erethism. Straining. Altered Urine. Peritonitis. Septic
infection. Collapse. Rectal palpation, enlarged, sensitive ovary.
_Treatment_: Castration. Tapping cyst. Rupturing cyst by compression.
These have been met with in all races of domestic animals, mare, cow,
ewe, sow, bitch and hen. They vary greatly in their characters, being
unilocular, multilocular, rounded or lobulated, serous, albuminous,
colloid or hæmorrhagic, strictly ovarian or parovarian (in broad
ligaments), in one ovary or in both.
_Histogenesis._ The source of these cysts has been much debated. Many
have held with Spencer Wells that they have their origin in dilated
Graafian vesicles, and the discovery of an ovum in the contents, by
Rokitansky and Ritchie showed at least that this follicle had formed
part of the cyst. On the other hand Foster, Rivolta, Klebs, Malassez and
others, constantly failed to find ova or other distinct elements of the
Graafian follicles, but did find epithelial elements, and note that the
cysts are at an early stage connected with the surface of the ovary like
the egg tubes. These embryonic tubules of Pflueger are therefore held to
be the starting point for the cysts, which because of their mixed
epithelial as well as liquid contents, seem allied to adenoma. From
observations on the ovarian cysts of the lower animals Galtier, attaches
great importance to vascular obstructions. Obstruction by pressure or
otherwise led to hæmorrhages and transudation of blood, and the cavities
formed in this way became the seats of epithelial growth, and liquid
effusion. The blood remained for a time as distinct clots, and was later
indicated by the pigmentation of the walls of the cyst.
_Lesions._ The enlarged ovary may be uniformly rounded and smooth, or it
may be marked by irregular bosses, giving it a lobulated appearance. It
is very vascular, and is often covered by a thickening of peritoneum.
When multiple they are usually closely adherent and may even be included
one within another. The individual cysts may be of the most varied
sizes. The cystic ovary has at times reached enormous dimensions: in the
mare 46 lbs. (Bouley, Rivolta, Thiernesse): in the cow 250 lbs.
(Reynolds, Meyer): in the ewe 7 lbs. (Willis): in the sow 7 lbs.
(Reyer): in the bitch 15 lbs. (Bovett). The walls of the cyst are formed
of connective tissue more or less perfectly organized, arranged it may
be in several superposed layers (Galtier) and lined or not by epithelial
cells (cylindroid, nucleated, or of various forms). They may be reddened
by hæmorrhages or pigmented from former blood extravasations. The liquid
contents may be clear and watery, white, straw yellow, or of a deeper
yellow, brown or red. Among other constituents there are alkaline
chlorides and sulphates, albumen in solution or flakes, mucin, fibrine,
fatty granules and cholesterine crystals. In some instances they contain
pus cells (chronic abscess).
_Symptoms._ Small, tardily growing cysts may cause no appreciable
symptoms. The larger ones or those that increase rapidly are liable to
cause disorders of circulation, innervation and digestion. The mere
pressure of a considerable cystic ovary may interfere with portal
circulation so as to entail muco-enteritis, rectal congestion, piles, or
intestinal torpor or impaction. Adhesions of the diseased ovary to
adjacent intestinal viscera, tend to produce constrictions, obstructions
and local congestions or inflammation. In adhesions to the womb or
bladder, ureter or kidney, the symptoms will indicate disorder of these
respective parts. The weight of the enlarged ovary causing extension of
its ligamentous connections will allow of its winding around a loop of
intestine and producing strangulation. In those unusual cases in which
pregnancy occurs it may interfere with its completion, causing abortion
or, failing in this, with parturition, by becoming imbedded in the
pelvis. In the line of innervation, disorder is especially common in the
digestive organs, anorexia, nausea, impaired rumination, and colicy
pains resulting. Again, in many subjects the genesic instinct is
stimulated, the patient is more or less constantly in heat, cows become
_bullers_, and mares _switchers_, they cannot be impregnated, and under
the continuous excitement undergo rapid emaciation. There is often
urinary disturbance, frequent straining with the passage of a small
quantity only of turbid or glairy liquid, colored, it may be, by blood,
or fœtid. The colics are liable to be dull and slight, the patient
moving uneasily, switching the tail, moving the weight from one hind
foot to the other, pawing, looking at the flank, but seldom lying down
or rolling. In other cases, with adhesions, impactions, obstructions,
and congestions, all the violent motions of the most intense spasmodic
colic may be shown. Where there has been rupture of the obstructed
bowel, these symptoms may merge into those of peritonitis, septic
infection, or collapse. When with these symptoms of intestinal disorder,
there are tender loins and flank, abdominal plenitude and tension,
genital excitement, frequent straining to pass urine, the discharge of a
glairy or fœtid liquid, and when all these symptoms have increased
slowly for weeks or months in a female, the ovaries may be suspected and
a rectal examination should be made. Usually the outline of the womb can
be made out with the enlarged and irregularly shaped ovary anteriorly
and adherent to it through one of the broad ligaments; it may be
sensitive to touch, tense, or even fluctuating. Difficulty may be
encountered when the enlarged ovary is so great as to fill the whole
region, or when adherent to or wound round the rectum, thus hindering
the advance of the hand or the movement of the gut, or when it has
become pediculated and displaced to a distant part of the abdomen. Even
the obstructed and distended intestine, may prevent a satisfactory
diagnosis. Yet in the great majority of cases rectal examination gives
conclusive results.
_Treatment._ Medicinal measures are useless: surgical alone are of any
avail. Castration is the natural resort, and in all recent cases,
uncomplicated by adhesions, is to be preferred. In the large females it
may often be performed through the vagina, but if the ovary is very
large the flank operation becomes imperative. Sometimes the evacuation
through a cannula of the contents of one or more large cysts will so
reduce the mass as to allow of the safer vaginal operation.
A less radical measure is the evacuation of the cyst with cannula and
trochar and the injection of tincture of iodine. With a hand in the
rectum the ovary may be held against the abdominal wall to facilitate
the operation. The results, however, are not satisfactory, for, although
re-accumulation of the liquid is delayed, it is not entirely prevented.
Moreover, when the cysts are multiple, the punctures also must be
numerous, or remain ineffective. Nor is the operation unattended by
danger as deaths often occur from resulting inflammation, infection, or
iodine poisoning.
Zannger, in 1860, introduced the method of rupturing the cyst without
incision, and met with considerable success. With the hand in the rectum
the cystic ovary is pressed against the wall of the pelvis or abdomen,
until the attenuated wall of the cyst gives way, the fluid is left in
the abdominal cavity, to be absorbed and many animals will afterward
become pregnant. In a large proportion of cases in which the symptoms
are marked, the walls of the cyst are sufficiently attenuated to allow
of rupture by pressure, and, if the escaping contents are free from
infecting microbes, no immediate harm comes to the peritoneum. It should
be avoided in case of abscess, following perhaps on a shivering fit and
constitutional febrile reaction, and when there is a fœtid discharge
from the vulva, suggesting microbian infection likely to dangerously
infect the serosa. In appropriate cases it is a resort of very great
value, in restoring to use animals that are especially valuable for
their progeny and which become utterly useless when rendered barren.
According to different observers an average of 70 per cent. can be
restored to usefulness in this way. Friedberger and Fröhner claim 90 per
cent. Some febrile reaction may be noted for twenty-four hours,
demanding rest, restricted, cooling, laxative food and sometimes
laxatives and anodynes.