In exceptional cases the hypertrophied glands keep heavy and refuse either to go up or to stay up under any treatment whatever. The only known remedy will then be their extirpation—an operation which will be discussed under its appropriate heading.
Hernia of the Ovary.
This is usually a congenital displacement, and, according to Englisch,3 is, when double, almost always so. The ovary is then found either in the inguinal canal or outside of this canal in the corresponding labium majus. The oviduct then accompanies it. When the hernia is acquired, the ovary, with or without the oviduct, makes one of the contents of the sac of an inguinal, a crural, a ventral, or an ischiatic hernia. Of these, the inguinal is by far the most common. Thus, out of 67 cases observed in 9 years by Langlon at the Truss Society, all were inguinal with 1 doubtful exception. Of these 67, 42 were congenital, 25 acquired.
3 New Sydenham Soc.'s Biennial Retrospect, 1871-72, p. 291.
The character of the lesion is told by the peculiar tenderness and nausea following pressure, and by the swelling of the tumor just before the menstrual flux. In one case mentioned by Routh4 pressure on the tumor produced distressing sexual excitement; but this is an unusual symptom, although I have seen it produced by the pressure of hardened feces.5 It is not always easy to decide whether the displaced glands are ovaries or testicles; and repeated mistakes in regard to sex have thus been made.6 So difficult, indeed, is it sometimes that the microscope can alone settle the question.
4 Trans. Royal Medical and Chir. Soc., Lancet, Jan. 28, 1882.
5 Goodell, Lessons in Gynæcology, 2d ed., chap. xxvi. p. 332.
6 Chambers, Trans. London Obstet. Soc., 1881.
TREATMENT.—In a reducible hernia, taxis and an appropriate truss comprise the treatment. If irreducible, a truss with a concave pad may be used to protect the ovary from injury. If the ovary be fixed by adhesions and it give much discomfort, it should be removed by operation.
Öophorectomy; Battey's Operation.