Dermoid Ovarian 
Tumors 
BY 
WILLIAM H. BYFQRD, M. D. 
CHICAGO, ILL. 
REPRINT FROM VOLUME III. 
ffipnecologfcal dranaactfons 
1879 DERMOID TUMORS OF THE OVARY. 
BY WILLIAM H. BYFORD, M. D., 
Chicago, III. 
Four cases of ovarian tumors have recently come under 
my observation, presenting features in some respects widely 
different, and yet having sufficient similarity to necessitate 
their classification under the division known as dermoid 
tumors. They have awakened an interest that induces 
me to give a concise account of them, feeling assured that 
their diversity in appearance, from simplicity to great com- 
plexity of structure, would scarcely fail to attract the at- 
tention and excite the reflection of others as well as of 
myself. 
I shall purposely abstain from giving the clinical history 
of each case in such detail as might make the reading of 
them tedious, and shall briefly allude to the salient points 
as an introduction to a description of the tumors themselves. 
I shall not take up the cases in chronological order, but 
with reference to the simplicity and complexity of their 
structure. 
I would apologize to the society for consuming time on a 
subject of so little practical importance if I did not believe 
that they were sufficiently curious to compensate to some 
extent for the time thus occupied. 
Case I. — In the spring of 1874, the patient, a girl eighteen 
years of age, noticed an enlargement in the left iliac region, which 
finally became so great that in October, 1875, s^*e was distressed 
from the distention. At this time she was tapped and about ten 
quarts of fluid evacuated. The physical nature of the fluid was 
somewhat tenacious, of a clear, slightly bluish tinge, and contained 
the ovarian cell. The outline of the tumor could be traced quite 2 
DERMOID TUMORS OF THE OVARY. 
easily after the tapping. It occupied the whole width of the ab- 
domen between the two iliac fossae and extended upwards to 
within two inches of the umbilicus. It was globular and of soft 
consistence. 
After this operation the tumor filled quite rapidly, and on Jan- 
uary i, 1876, the patient was as large as before the fluid was 
evacuated. 
On January 4, ovariotomy was performed. There were no ad- 
hesions or other source of embarrassment to the removal of the 
tumor, and the patient made a good recovery. 
The sac was thin but firm, and presented the peculiarly pearly 
aspect of the ordinary ovarian tumor. When the large Wells’ 
trocar was introduced nothing but serum flowed through the tube. 
Upon being opened the tumor was found to contain about half a 
pound of sebaceous fat. The inner surface was smooth, except a 
small part about the size of the palm of the hand situated at the 
bottom near the pedicle. Here the surface was depressed at 
least an inch below the level of the inner surface, and, although 
not sacculated, had a well defined and pursy margin. The bot- 
tom of this depression was covered with dermic tissue and upon it 
grew an abundant crop of dark brown hair about an inch long. 
It was very fine, and firmly attached. Doubtless the dermic 
patch was the source of the fatty material found floating in the 
cyst which on cooling assumed the consistence and appearance 
of yellow butter. Upon closer inspection of the smooth lining 
of the larger part of the tumor it was found to be studded with 
very minute papillae such as we sometimes see in oligocystic 
ovarian tumors. 
This specimen I regard as not a true dermoid cyst, but 
as a complex dermo-ovarian tumor, a tumor originating in a 
Graaffian follicle in which a tegumentary element had been 
inclosed. It contained no bone or teeth such as are often 
found in the true dermoid tumor, but did contain undoubted 
colloid fluid, diluted with the watery product from the sweat 
glands of the dermic membrane upon which the hair was 
implanted. 
Case II. — Mrs. P., aged forty-three years, the mother of one 
child eighteen years old, became aware of an enlargement of the 
abdomen about ten months before the operation, which was per- WILLIAM H BYFORD. 
3 
formed June 28, 1876. During that time she grew to the size of 
pregnancy at full term. The tumor filled the abdominal cavity 
and extended to the ensiform cartilage. There was no difficulty 
in deciding that it was monocystic and contained a thin fluid. 
The operation was not attended with difficulty in any respect. 
There were no adhesions, and after evacuation the sac passed 
through an incision only three inches long. The patient expe- 
rienced considerable depression from tbe shock of the operation. 
This however lasted but a few hours, no other disagreeable symp- 
toms supervening. The recovery was rapid. The care of the 
case after the operation was undertaken by Dr. S. W. Green of 
Marengo, Illinois. 
The cyst was single, thin, and uniform, except at the part op- 
posite the pedicle, where its wall was about half an inch thick 
and contained a thick layer of adipose tissue. Upon the inner 
surface of this part was a thick tegumentary covering, upon which 
was implanted a dense mass of blonde hair, matted together, and 
nearly the size of an orange. The whole of the inner surface of 
the sac elsewhere was smooth and of a buff color. The external 
surface was of a pearly hue and smooth. There was no evidence 
of bony or dental tissue. The fluid was quite thin, of a slightly 
blue tinge, and floating in it in considerable masses were ten to 
twelve ounces of yellow sebaceous fat. The hairs when straight- 
ened out measured from six to fifteen inches in length. 
This example I regard as a simple dermoid cyst of the ovary, 
there being no signs of follicular papillae upon the inner surface, 
and the fluid not being in the least tenacious or colloid in appear- 
ance ; moreover I was unable to find in it the ovarian cell. I 
think the fluid was the product of the sweat glands in the dermic 
structure at the bottom of the cyst. 
Case Ilf. — Mrs. P., a small Jewess, thirty-one years of age, the 
mother of four children, the youngest being three years old, 
noticed about nine months before the operation — which was per- 
formed April 7, 1875 —that the abdomen had commenced enlarg- 
ing. The tumor was found to be monocystic and so completely 
filling the abdomen that the patient had great inconvenience from 
distention. 
The removal of this tumor, which originated in the left ovary, 
was easy, as no adhesions or other obstacles were encountered. 
The patient recovered without experiencing any untoward symp- 
toms. 4 
DERMOID TUMORS OF THE OVARY. 
The tumor was composed of a single cyst, of which the wall 
was thin over about three fourths of its circumference and easily 
ruptured. At the bottom or pedicular portion, involving about 
one fourth of the inner surface, was a dense mass of areolar tis- 
sue literally filled with pieces of bone. The greater number of 
these pieces were cylindrical, from half an inch to two inches in 
length, and varying from an eighth to a quarter of an inch in 
thickness. They seemed to be imbedded in loose cellular tissue, 
were not attached to each other, and were easily removed by the 
finger. Other masses of bone, made up of alveolae, were not 
unlike the maxillary processes, and varied in length from one to 
two inches, and in width from one third to one half inch. They 
resembled honey-comb, and were quite firmly attached to the 
cyst wall. The microscope showed their structure to be that of 
true bony tissue. This mass was covered by a tegumentary mem- 
brane to which was attached more than a hundred imperfect 
incisor teeth, distributed over the whole surface, their adhesions 
being so slight that they could easily be scraped from the surface 
with the finger. These dental bodies were all about the same 
size and consisted merely of the crown ; but the enamel and den- 
tine seemed perfect. They had no connection whatever with the 
bony tissue. Interspersed among these teeth was a dense crop 
of blonde hair, averaging an inch in length. 
The fluid, of which there was about ten quarts, sp. gr. 1008, 
was clear, with a slight bluish tinge, and entirely devoid of 
tenacity or other colloid properties. I believed it to be perspira- 
tory serum. There were also several ounces of yellow sebaceous 
fatty matter within the cyst. 
I should class this tumor among the true dermoid cysts 
of the ovary, and believe that it possessed none of the prop- 
erties of the ordinary ovarian tumor. Its structure was 
much more complex than that of the two preceding tumors, 
but much less so than that to which I shall now call atten- 
tion. 
Case IV. — Mrs. B., thirty-five years of age, the mother of four 
children, the last twenty months old, first noticed a tumor in the 
right iliac region nine years before the operation. It was then 
about the size of her fist. It had grown steadily but slowly until 
June 19, 1878, when it was extirpated. The growth did not seem WILLIAM II. BY FORD. 
5 
to be influenced by pregnancy. She had borne three children 
from the time when the tumor was discovered to the time of its 
removal. Her health had been feeble for several years, but from 
the birth of her last child she had been confined to bed half of 
each day, and, for several weeks, all the time. The main incon- 
venience was from the weight and mobility of the tumor. When 
she was in the erect posture it caused dysuria and rectal tenes- 
mus ; when lying on either side it pressed upon the subjacent 
viscera and also dragged upon the upper side ; the only comfort- 
able position was the dorsal. The pulse and temperature were 
decidedly and continuously above the normal standard. She was 
sleepless, had a very poor appetite, and was rapidly becoming 
emaciated. The above very brief history was given me by the 
attending physician, Ur. J. H. Low of Brimfield, Illinois. 
The appearance of the abdomen was very singular. It was 
considerably distended; from its centre, including in fact the 
whole umbilical region, arose a round projection exactly resem- 
bling a ventral hernia, the umbilicus occupying its apex. It 
measured five inches in diameter and protruded three and a half 
inches above the common level. It was fluctuating and dull 
upon percussion. On each side, I could easily distinguish two 
other, apparently larger, cysts not projecting above the surface. 
Percussion over these elicited no resonance, but it was easy to 
detect fluctuation. The tumor could be moved pretty freely in 
all directions without traction upon any part of the abdominal 
walls. By external and internal manipulation I could trace the 
attachment of the mass to the right side of the pelvis and assure 
myself that it was not of uterine origin. It was clear that I had 
to deal with a tumor made up, principally at least, of three cysts, 
and quite certainly originating in the right ovary, but it pre- 
sented so many unusual symptoms and appearances that further 
diagnostic measures were necessary before I would venture to 
remove it. After making preparations for its extirpation, the 
patient being fully etherized, I introduced a small trocar into 
the prominent cyst. A little sebaceous fat flowed through the 
canula and at once made the diagnosis complete. The usual 
small incision exposed the pearly cyst and allowed me to evacu- 
ate the prominent sac of one quart of thin, yellow fat. The other 
two cysts were drawn to the opening and their contents, of a 
similar character, evacuated. By this time the rubber blanket 
was smeared with a sticky grease, the instruments had become 6 
DERMOID TUMORS OF THE OVARY. 
slippery, and my fingers were encumbered with a mass of fat 
which had to be removed before I could proceed with the opera- 
tion. The cysts were drawn through an incision about three 
inches long, and a short slender pedicle — consisting of the right 
ovarian ligament, part of the broad ligament and Fallopian tube — 
was brought up into the wounds, ligated, cut and dropped into the 
pelvic cavity. The left ovary was healthy. As nothing had been 
allowed to pass into the peritoneal cavity the incision was then 
closed. It will have been seen by this description that no adhe- 
sions or other impediment hindered or complicated the operation. 
It was remarkable how extremely greasy everything employed in 
the operation became, and I had more trouble in cleansing the 
instruments from the grease than is usually experienced in get- 
ting rid of the blood and mucoid fluid of the common ovarian 
tumor. The patient had no untoward symptoms, seeming to me 
more like one recovering from the exhaustion and irritation in 
which I had found her than from the hazardous operation for 
the removal of an ovarian tumor. 
Before describing the tumor I wish to call attention to the 
fact that there was no serum evacuated during the operation ; 
no fluid but the soft fat was observed. The tumor proved to be 
a remarkable specimen of the true dermoid variety, nothing in 
its contents seeming to be of ovarian origin. The cyst wall was 
thin, but of firm structure, and divided into three compartments of 
about equal dimensions. The septa were complete and of the 
same consistence and density as the external wall. At the base 
of the tumor the sac was more dense and firm than elsewhere. 
The peculiar formations contained in each cyst were so nearly 
alike that a description of the contents of one will suffice for 
each of the other two. 
On opening the cysts each was found to contain a mass of 
matted hair, the size of a lemon, thoroughly supplied with the 
same fatty substance that had been evacuated from the tumor. 
One of these rolls of hair was red, another blonde, and the other 
gray. The patient’s hair was dark brown. Some of this hair was 
twenty inches long, and it was all attached to tegumentary sub- 
stance closely resembling the scalp. The dermic structure, 
which was about four inches across, rested upon a very uneven 
layer of adipose tissue an inch thick. By the side of the dermic 
patch and not covered by it was a loose layer of areolar tissue, 
an inch and a half thick, containing bones in a great variety of WILLIAM II. BYFORD. 
7 
shapes, — scales, round bones an inch or more in length, alveolar 
nodules, etc. Upon the surface of this part of the tumor in each 
cyst was a half-arch of teeth the shape of one half the superior 
maxilla. In one cyst the crowns of the teeth projected above 
the surface, while in the other two they were thinly covered by 
tissue so soft that it could be pinched'off by the thumb and fin- 
ger. The teeth were not attached to the subjacent bones, but 
were simply imbedded in the loose mass. The teeth in each 
segment very perfectly represented, respectively, an incisor and 
three molars, each having three well-marked fangs. One of the 
molars in each row strongly resembled the wisdom tooth. The 
perfection of their formation will be recognised in the specimens 
which I submit for your examination. The crown with the en- 
amel and eminences, the main body, and roots are as distinctly 
marked as if they had been removed from alveolar cavities. 
Before leaving the description of the tumors and their removal, 
I would call your attention to the great simplicity of the opera- 
tion and the fortunate recovery of all the patients, no adhesions 
or other complications having existed. 
Now what is a dermoid tumor ? This name is given to a 
cyst formed anywhere in the body, the internal or lining 
membrane of which is in part or wholly tegumentary in 
structure. As now understood, the presence of this condi- 
tion alone would justify this nomenclature. The formation 
seems to be no less an error of structure than location. 
Lebert, Paget, Virchow, and most other modern patholo- 
gists agree that the dermic tissue thus located is essentially 
the same in structure as true skin. The products are all 
the same, hair, sebaceous fat, and perspiratory fluid. In 
many of these tumors we find subcutaneous adipose tissue 
very perfectly formed. Less constantly, teeth, bone, mus- 
cular, nervous, and even brain tissues. These latter, except 
the teeth in some instances, are found either beneath the 
dermic membrane, or beneath the portion of the internal 
surface not lined by this cutaneous substance. 
My experience shows that the dermic tissue and its prod- 
ucts characterize one variety of these formations, as in 
Cases II. and III. These constituents are sometimes found 
alone, and may then be regarded as indicative of a more 8 
DERMOID TUMORS OF TI1E OVARY. 
simple formation, while the addition of bone, muscle, etc., 
constitute a more complex order of tumor represented 
by Case IV. The bone and muscle, however, are never 
found in a tumor of this kind without the dermic mem- 
brane, its essential glands, and their products. Another 
thing quite apparent is that the skin and its appendages 
are not only constantly present, but comparatively perfect 
in their organization. The teeth, which are very closely 
associated in embryonic metamorphosis with the formation 
of the skin, stand next ; many being quite perfect in their 
structure. The bony, muscular, and nervous structures, 
although complete in their texture and formation, are never 
developed into complete organs. I am aware that cases 
have been recorded, — as for instance by Blumbach and 
Rokitansky, that would seem to be at variance with this 
assertion, but the bones in these cases lacked the complete- 
ness in structure necessary to entitle them to be classified 
with any of the bones in the human skeleton. When some 
or all of these structures, together with the products of the 
dermic tissue, constitute all the contents of the cyst, the 
specimen should be regarded as a simple dermic tumor, 
even when formed in the ovary, the fact of its having found 
a lodgment in that organ being an accidental rather than 
a necessary condition. When, however, it exists in the 
ovary, and with these substances there is found the col- 
loid or mucoid fluid characteristic of the ordinary ovarian 
tumor, it is not merely a dermoid, but an ovarian dermoid 
tumor. It is a mixed neoplasm, a morbid development of 
the ovarian follicles in connection with the congenital der- 
moid. In my first case this was the character of the tumor, 
and instances of this kind are recorded in the well known 
books of Drs. Atlee, Peaslee, and Mr. Wells. The first 
variety then, although often found in the ovary, differs in 
no essential particular from those found elsewhere, except 
in magnitude and perhaps greater perfection of organized 
development. Possibly this last difference does not exist. 
When found in the ovary, either in the single or mixed 
form, the investing membrane seems to be the same in ap WILLIAM II. BYFORD. 
9 
pearance and structure as in ordinary ovarian tumors ; and, 
when first exposed, it is often not easy, if at all possible, to 
distinguish between them until some of their contents are 
evacuated. 
To the more fluid products of the first variety of simple 
dermoid cysts, especially the secretion from the dermic tis- 
sue, such as the serous or perspiratory fluid, we must attrib- 
ute the difference in the size of this form of tumor. The 
sebaceous product is also sometimes quite bulky, as seen 
in Case IV. ; but when the sudoriparous glands are numer- 
ous and active the amount of watery fluid is sometimes enor- 
mous, and consequently the tumor grows to be very large, 
as may be specially noted in the second case. In such in- 
stances, from causes which are not appreciated, the sudo- 
riparous glands seem suddenly to acquire great functional 
activity, and by pouring into the tumor a large supply of 
fluid make it grow with great rapidity. 
As there was no appreciable amount of serum in Case 
IV., the sac being filled with the sebaceous matter, it is 
easily understood why the tumor was a long time in attain- 
ing the dimensions it finally acquired. The solid contents 
of these tumors, as far as I can learn, do not grow to a 
sufficient extent to give them any great bulk, and conse- 
quently when situated in the ovary, such a tumor, apart 
from its fluid contents, would hardly require extirpation. 
The compound variety, or ovarian dermoid, would be 
likely to grow to a great size in consequence of the accu- 
mulation of the colloid secretion, just as they would if the 
dermoid element did not exist. By consulting the litera- 
ture of the subject, I am led to the conclusion that the der- 
moid and colloid contents of these compound cysts are 
usually contained in different compartments of the tumor. 
This was notably the case in some of Mr. Wells’ speci- 
mens. 
There are one or two facts which may have some bear- 
ing upon the production and development of these tumors : 
The dermic membrane is always superficial with reference 
to the inner surface of the tumor ; the hair always, and the 10 
DERMOID TUMORS OF THE OVARY. 
teeth often, grow from its surface ; while the bone and 
other tissues are situated below it, but not always immedi- 
ately under it. In my fourth specimen the bone was im- 
bedded in a mass of cellular substance by the side of the 
cutaneous layer, giving me the idea that it belonged to a 
blastodermic formation deeper than the tegumentary por- 
tion of the surface. 
The question here naturally presents itself, whether the 
simpler forms of these dermoid cysts, in which the dermoid 
structure, with hair, fat, and serum are found without any 
of the deeper tissues, are tumors in the process of develop- 
ment into the more complicated variety. I think not, and 
believe that each tumor receives during its embryonic state 
all the elements of formation it is capable of producing ; 
that the trophic qualities imparted to it then definitely limit 
its possibilities. If so it necessarily follows that the tumor, 
containing all the variety of structure ever found in them, 
should manifest these qualities and structures without gra- 
dation of growth, and possess from the beginning the com- 
plex qualities found in advanced periods of life. 
THEORIES OF THEIR ORIGIN. 
The theories devised to explain the origin and develop- 
ment of ovarian dermoid tumors represent with some de- 
gree of exactness the physiology of the times in which they 
originated. In the earlier ages of medicine physiology was 
the creature of imagination. Definite knowledge of the in- 
ternal organs was wholly wanting ; if possible, even less 
was known of their functions. Pathology also rested upon 
the same unsubstantial basis. As a consequence the theo- 
ries of the origin and development of these curious growths 
were all vague and imaginary. In the latest and most 
plausible explanation yet offered we have the results of the 
present highly cultivated science of physiology ; and if not 
absolutely true there can be fewer rational and scientific 
objections opposed to it than to any of its predecessors. 
It is not my present purpose to do more than give a very 
cursory view of some of the most prominent theories which WILLIAM H BYFORD. 
11 
have at different ages been presented to, and accepted by, 
a large portion of the profession at the time they were 
promulgated. I will classify the theories under three divis- 
ions. I. Those originating in the imagination alone without 
any scientific foundation. II. Those which have for their 
basis the superstitions of the times in which they originated, 
and of the people by whom they were entertained. III. The 
scientific theories. 
I. The most ancient of the imaginative theories is, I be- 
lieve, attributed to Aristotle. It taught that the dermoid 
products of these tumors, — as the hair, teeth, etc., had been 
swallowed and transmitted in some unknown manner to the 
localities occupied by them. This idea is a good match for 
many of the ingenious vagaries of that wise man. 
Belief in virginal pregnancy supplied the basis of another 
and extensively prevalent theory. It assumed several forms. 
One was the abstract possibility of a virgin becoming im- 
pregnated without sexual intercourse, or true parthogenesis. 
Another was that the ovaries possessed properties that en- 
abled them to produce to a limited extent the organized 
bodies resembling the parts of a fetus ; or again that cer- 
tain unsatisfied sexual longings of an isolated woman might 
stimulate the ovaries to imperfect generative processes. 
Still another was that certain individuals possessed a sort 
of ovario-cystic diathesis which took this direction. 
It is easy to see that these vagaries — for they ought not 
to be dignified by the term theories — had no physiological 
basis and could be the products of imagination alone. 
II. The superstition of medieval times gave rise to the 
theory that these tumors were visitations of Providence upon 
the subjects of them, on account of particular sins. The 
infliction of this punishment upon males as well as females 
showed Providence to be no respecter of persons. One man 
had a pregnancy in the thigh because he laughed at his 
wife in her suffering during labor. It is said that the prod- 
ucts of these tumors were sometimes baptized in the hope 
of avoiding the perdition in which they would be involved 
without such a ceremony. Hence, it seemed that the priests 12 
DERMOID TUMORS OF THE OVARY. 
believed in their own invention, and that the theory was not 
a mere trick with which they tried to practise upon the 
credulity and ignorance of the people. 
III. As the knowledge of physiology advanced somewhat 
among the profession the theories became more rational, 
and the possibility of natural causes was employed to ex- 
plain the occurrence of these singular tumors. 
They were regarded by many as ovarian pregnancy in 
which the formation of the fetus was imperfect, or after 
having undergone development the fetus had become disin- 
tegrated and, the skin, bones, and teeth being more difficult 
of destruction, had withstood decomposition and remained 
in the sac. Another theory accounted for their peculiari- 
ties by supposing that the ovum had become blighted after 
having been developed to a certain extent. 
Some one else has propagated the doctrine of inclusion, 
or of a fetus in fctu ; believing that somehow one ovum 
had become engulphed in the organization of the other and 
on account of the nature of its nidus could not attain to 
complete organization or development. 
Still later plastic heterology and heterotopy were supposed 
to afford a more rational explanation of their production. 
According to this theory the origin of these tumors in any 
part of the body is no more wonderful than the'growth of 
other forms of heterologous tumors in the same localities. 
In the light of the patient physiological research of our 
own day, and especially from the revelations of the micro- 
scope, a theory of these curious tumors has been developed 
which I regard by far the most satisfactory and scientific. 
This theory is based upon a supposition which is at least 
physiologically plausible. It may be stated thus : — 
In the early period of ovulation or embryonic develop- 
ment, by some accident or imperfection of formation, an 
indentation of the blastoderm is produced. In the won- 
derful trophic energy of that period the minute depression 
is inclosed by the approximation of its blastodermic mar- 
gin and becomes an isolated cavity, and the growth and per- 
fection of the embryo are accomplished notwithstanding WILLIAM H. BYFORD. 
13 
this early accident to the integrity of its envelope. The de- 
pression thus formed involves, perhaps, all the layers of the 
blastodermic membrane, but the external layer becomes the 
lining membrane of the cavity and is completely cut off 
from the rest of the blastodermic surface and invaginated 
with all its essential structures and processes of organiza- 
tion ; all its products therefore, must be retained in the 
cavity. The contents of this cavity correspond in miniature 
with what the formation might have been if the displace- 
ment had not occurred. In the further development of the 
embryo the portion of the blastoderm covering this adventi- 
tious cavity develops its tissues and organs in the ordinary 
way, and thus incloses it in the body by the structures 
usually found to cover it. The internal layer of the blasto- 
derm is doubtless also displaced, but it is not isolated, and 
consequently its products are never found inside the tumor. 
Therefore, in instances where the dermoid patch occupies 
any of the mucous cavities, the neoplasm will always be 
found external to the mucous membrane. This theory 
serves to explain why these hairy tumors are found in the 
fetus, child, virgin, matron, or male, and with equal plausi- 
bility why they may exist in any part of the body. 
Dr. Pauly, in an excellent paper in the “ American Jour- 
nal of Obstetrics,” expresses a doubt whether they exist 
more frequently in the ovary than elsewhere, notwithstand- 
ing the generally received opinion that this is the case, and 
at present it cannot be asserted that they are not as com- 
mon in the male as in the female. This theory would cer- 
tainly not furnish us with reasons for their occurrence more 
frequently in woman than in man. 
If nothing unusual happens the adventitious sac grows 
with the individual in .whom it is situated, and perhaps at- 
tains maturity as the same character of organs mature else- 
where. The sac itself continues to increase in size because 
of the constant secretion of the glands of the dermic struc- 
ture. Growth from this cause would probably be slow if the 
activity of the tegumentary glands were not preternaturally 
quickened by morbific causes. When situated in the ovary, 14 
DERMOID TUMORS OF THE OVARY. 
however, the conditions naturally calculated to impart an 
impetus, exclusive of what is termed pathological states, 
exist. Hence in them they grow more rapidly and larger 
than in other places or organs. The fluctuation of nerve 
force, circulatory supply, and nutritional conditions which 
take place in the ovaries in consequence of the processes of 
menstruation, sexual excitement, and the varied states of 
generation, disturb the states of these otherwise nearly sta- 
tionary neoplasms. 
These reasons would lead us to expect the dermoids situ- 
ated in the ovaries to become large and to grow more rap- 
idly than in any other organ or locality. When situated in 
these bodies their progress is usually tardy until the age 
of puberty is reached. At this time the tumor is likely to 
be influenced by the increased nervous and vascular activity 
assumed by the ovary, and thenceforward they manifestly 
possess all the conditions necessary to cause copious dermic 
secretions. In the ovaries also, their growth is more likely 
to be influenced by the morbid impressions to which these 
organs are more frequently subjected than almost any other 
part or organ of the body. They are also doubtless espe- 
cially stimulated by the occurrence of the conditions which 
give rise to the colloid tumors. For in connection with 
this form of tumor they are generally found to have as- 
sumed great proportions. 
The condition imparted to dermoid tumors by the ovaries 
would almost necessarily lead to their discovery during the 
lifetime of the patient, and thus favor the idea that they are 
more frequently located in these organs. Situated in organs 
of more unvarying functions they would be likely to remain 
dormant and never attain dimensions that would cause them 
to be discovered ; consequently they are overlooked in the 
general statistics on the subject. Gynecological Transactions. 
NOW READY: 
VOLUME III. 
Being the Transactions of the America?i Gynecological 
" Society for the Year lS/8. 
CONTENTS. 
I. Annual Address on the Relation of Neurasthenia to Diseases of the Womb. By 
the first Vice-President, Dr. William Goodell. 
II. A Case of Rupture of the Perineum without Implication of the Vulva. By Dr. 
J. C. Reeve. 
III. On the Surgical Treatment of Stenosis of the Cervix Uteri. By Dr. J. Marion 
Sims. 
IV. A Case of Extra-uterine Pregnancy, with Discharge of the Fetal Bones through 
the Bladder. By Dr. J. P. White. 
V. A Case of Foot and Head Presentation; Fracture of the Spine in Utero. By 
Dr. J. T. Johnson. 
VI. The Necessity of Early Delivery, as demonstrated by the Analysis of One Hun- 
dred and Sixty-one Cases of Vesico-vaginal Fistula. By Dr. T. A. Emmet. 
VII. The Hand as a Curette in Post Partum Hemorrhage. By Dr. H. P. C. Wilson. 
VIII. The Treatment of Post Partum Hemorrhage. By Dr. R. A. F. Penrose. 
IX. Dermoid Tumors of the Ovary. By Dr. W. H. Byford. 
X. A Contribution to the Study of the Treatment of the Acute Parenchymatous Ne- 
phritis of Pregnancy. By Dr. W. L. Richardson. 
XI. Alternating Anterior and Posterior Version of the Uterus. By Dr. S. C. Busey. 
XII. Remarks on Gastro-elytrotomy. By Dr. H. J. Garrigues. 
XIII. The Pendulum Leverage of the Obstetric Forceps. By Dr. A. H. Smith. 
XIV. Rectal Alimentation in the Nausea and Inanition of Pregnancy; Intestinal 
Inhaustion, an Important Factor and the True Solution of its Efficiency. By Dr. H. F. 
Campbell. 
XV. Three Cases of Rupture of the Uterus. By Dr. T. Parvin. 
XVI. On the Early Delivery of the Placenta when Previa; with the Relation of 
a Case of Spontaneous Detachment of the Placenta without hemorrhage. By Dr. I. E. 
Taylor. 
XVII. Unexpected Narcotism induced suddenly on the Third Day of the Adminis- 
tration of Three-grain Suppositories of Opium. By Dr. J. P. White. 
XVIII. Treatment of Pelvic Indurations and Adhesions. By Dr. E. Van de Warker. 
XIX. On some Points in Connection with the Treatment of Sterility. By Dr. A. 
Reeves Jackson. 
XX. A Case of Extreme Anteversion and Anteflection of the Uterus at the Full 
Term of Pregnancy. By Dr. I. E. Taylor, of New York. 
XXI. Memoir of Edmund Randolph Peaslee, M. D., LL. D. By Dr. Fordyce Bar- 
ker. 
XXII. In Memoriam: Washington Lemuel Atlee. By Dr. T. M. Drysdale. 
XXIII. The Mechanism of Retroversion and Prolapsus of the Uterus considered in 
Relation to the Simple Lacerations of the Cervix Uteri and their Treatment by Bloody 
Operations. By Dr. Nathan Bozeman. 
Index of Obstetric and Gynecological Literature of all Countries for the Year 1877. 
Price of Vol. III., $5.00 ; Vols. I. and II., contents of which will be 
found on the following pages, will be sent to one address by mail or ex- 
press, prepaid, on receipt of $ 10.00 by the publishers. The three volumes 
supplied for $15 00. 
Address HOUGHTON, OSGOOD AND COMPANY, 
WINTHROP SQUARE, BOSTON. TRANSACTIONS 
OF 
The American Gynecological Society. 
VOL. I., FOR THE YEAR 1876. 
400 pages. Many illustrations. 
The Annual Address by the President, Dr. Fordyce Barker, of New 
York, and the following papers : — 
I. Etiology of Uterine Flexures, with the proper mode of treatment indicated. By 
Thomas Addis Emmet, New York. 
II. Cicatrices of the Cervix Uteri and Vagina. By Alexander J. C. Skene, M. D., New 
York. 
III. Extirpation of the Functionally Active Ovaries for the Remedy of otherwise Incur- 
able Diseases. By Robert Battey, Rome, Ga. 
IV. On Central Rupture of the Perineum. By J. Matthews Duncan, M. D., Edinburgh, 
Scotland. 
V. Viburnum Prunifolium (Black Haw); its Uses in the Treatment of the Diseases of 
Women. By Edward W. Jenks, M. D., Detroit, Mich. 
VI. An Illustration of Xenomenia. By Theophilus Parvin, M. D., Indianapolis, In- 
diana. 
VII. Relations of Pregnancy to General Pathology. By Robert Barnes, M. D., Lon- 
don, Eng. 
VIII. The Spontaneous and Artificial Destruction and Expulsion of Fibrous Tumors of 
the Uterus. By W. H. Byford, Chicago, 111. 
IX. Case of Abdominal Pregnancy, treated by Laparotomy. By T. Gaillard Thomas, 
M. D., New York. 
X. Pneumatic Self-Replacement in Dislocations of the Gravid and Non-gravid Uterus. 
By Henry F. Campbell, M. D., Augusta, Ga. 
XI. Hydrate of Chloral in Obstetrical Practice. By W. L. Richardson, M. D., Boston, 
Mass. 
XII. Labor Complicated with Uterine Fibroids and Placenta Previa. By James R. 
Chadwick, M. D., Boston, Mass. 
XIII. Latent Gonorrhea, with Regard to its Influence on Fertility in Women. By 
Emil Noeggerath, M. D., New York. 
XIV. Death from Urinemia in Certain Cases of Malignant Diseases of the Uterus. By 
Alfred Wiltshire, M. D., London, England. 
XV. Clinical Memoir on some of the Genital Lesions of Childbirth. By William Good- 
ell, M. D., Philadelphia, Pa. 
XVI. Hermaphroditism. By Lawson Tait, F. R. C. S., Birmingham, England. 
XVII. Cases of Cystic Tumors of the Abdomen and Pelvis. By George H. Bixby, 
M. D., Boston, Mass. 
XVIII. Case of Solid Uterus Bipartitus; both ovaries removed for the relief of epileptic 
seizures ascribed to ovarian irritation. By E. Randolph Peaslee, M. D-, New York. 
XIX. The Origin and History of Calculi found in the Bladder after the Cure of Vesico- 
Vaginal Fistula by Operation. By Henry F. Campbell, Augusta, Ga. 
XX. Rare Forms of Umbilical Hernia in the Fetus. By James R Chadwick, M. D , 
Boston, Mass. 
XXL In Memoriam Gustav Simon By Paul F. Mund£, M. D., New York 
Price of Volume I., $5.00. 
As contributions to advanced gynecology they exceed in value anything which we have 
ever before seen collected in any one volume. — N. H. Medical Record. 
This volume of Transactions is certainly superior to any book of the kind that has been 
issued by the American Press.— St. Louis Clinical Record. 
Now we have the first of, we hope, a long row of volumes which will bear comparison 
with the Transactions of European Societies. Indeed, these must look to their laurels in 
this noble emulation. — Edinburg Medical Journal. 
This volume is one of the best collections of gynecological papers that has been published 
this year. —Annales de Gyntcologie. VOLUME IT., FOR 1877. 
650 pages, 12 chromo-lithographs and many other illustrations. 
Contains the following papers, with the discussions to which they gave 
rise : — 
I. Annual Address, on Medical Gynecology. By the President, Dr. Fordyce Barker, of 
New York. 
II. The Functions of the Anal Sphincters, so called. With two wood-cuts. By Dr 
James R. Chadwick, of Boston, Mass. 
III. Excision of the Cervix Uteri; its Indications and Methods. With one wood-cut. 
By Dr. John Byrne, of Brooklyn, N. Y. 
IV. Report on the Corpus Luteum. With twelve chromo-lithograpliic plates. By Dr. 
John C. Dalton, of New York. 
V. The Pathology and Treatment of Puerperal Eclampsia. By Professor Otto Spiegel- 
berg, of Breslau, Prussia. 
VI. Dilatation of the Cervix Uteri for the Arrest of Uterine Hemorrhage. By Dr. 
George H. Lyman, of Boston. 
VII. The Principles of Gynecological Surgery applied to Obstetric Operations. By 
Dr. A. J. C. Skene, of Brooklyn, N. Y. 
VIII. On the Necessity of Caution in the Employment of Chloroform during Labor. 
By Dr. William T. Lusk, of New York. 
IX. The Present Status of the Intra-Uterine Stem in the Treatment of Flexions of the 
Uterus. By Dr. Ely Van de Warker, of Syracuse, N. Y. 
X. Supplement to the report of a case of Xenomenia made at the first Annual Meeting 
in 1876. By Dr. Theophilus Parvin, Indianapolis, Ind. 
XI. A Case of Vaginal Ovariotomy. By Dr. William Goodell, of Philadelphia, Penn. 
XII. Is there a Proper Field for Battey’s Operation? By Dr. Robert Battey, of 
Rome, Ga. 
XIII. Subsulphate of Iron as an Antiseptic in the Surgery of the Pelvis. By Dr. H 
P. C. Wilson, of Baltimore, Md. 
XIV. Tetanus after Ovariotomy. By Dr. Theophilus Parvin, of Indianapolis, Ind. 
XV. Sarcoma of the Ovaries. By Dr. Washington L. Atlee, of Philadelphia, Penn. 
XVI. The Value of Electrolysis in the Treatment of Ovarian Tumors, as seen in the 
Light of Recent Experience. By Dr. Paul F. Mundd, of New York. 
XVII. Congenital Absence and Accidental Atresia of'the Vagina; Mode of Operation 
to Establish the Canal, and to Evacuate retained Menstrual Blood. With three wood- 
cuts. By Dr. Thomas Addis Emmet, of New York. 
XVIII. Case of Sarcoma of the Kidney in a negro child. With Heliotype. By Dr. 
W. H. Geddings, Aiken, S. C. 
XIX. The Hystero-Neuroses. By Dr. George J. Engelmann, of St. Louis, Mo. 
XX. Cases illustrating Important Points connected with Ovariotomy. By Dr. Gilman 
Kimball, of Lowell, Mass. 
XXL The Radical Treatment of Dysmenorrhea and Sterility by Rapid Dilatation of the 
Canal of the Neck of the Uterus With one wood-cut. By Dr. Ellwood Wilson, of Phil- 
adelphia, Penn. 
XXII. Dr. Uvedale West’s Views of Rotation, as illustrated by the Contrast between 
the Mechanism of Simple Occipito-Posterior Positions and those of the Bregmato-Coty- 
loid Variety. By Dr. John P. Reynolds, of Boston, Mass. 
XXIII. Vascular Tumors of the Female Urethra; with the Description of an Instru- 
ment devised to Facilitate their Removal. By Dr. A. Reeves Jackson, of Chicago, 111. 
XXIV. Lying-in Hospitals; especially those in New York. By Dr Henry J. Gar- 
rigues, of Brooklyn, N. Y 
XXV. The Simpler Varieties of Perineal Laceration; their Consequences and Treat- 
ment. By Dr. Thaddeus A. Reamy, of Cincinnati, Ohio. 
XXVI. The Cyclical Theory of Menstruation By Dr. John Goodman, of Louisville, 
Ky. 
XXVII. In Memoriam Charles E. Buckingham With a Heliotype Portrait By Dr. 
George H. Lyman, of Boston, Mass. 
Index of Obstetric and Gynecological Literature of all Countries, from July i, 1876, to 
January i, 1877. 
The price of Volume II. is $6.50. Vols. I. and II. will be sent by mail 
or express, post-paid, for $10.00. Address, 
HOUGHTON, OSGOOD & CO., Boston. OPINIONS OF THE PRESS. 
As contributions to advanced gynecology they exceed in value any- 
thing which we have ever before seen collected in any one volume. With- 
out exception, every paper has an interest and value attached to it which 
is intrinsic, and which reflects the best efforts of the respective authors. 
.... The work is elegantly printed, neatly and tastefully bound. — If. Y. 
Medical Record. 
This volume of Transactions is certainly superior to any book of the 
kind that has been issued by the American press. The papers read and 
here presented are well written and well digested ; and the discussions re- 
ported have almost as much value as the papers themselves. — St. Louis 
Clinical Record. 
We think that never before was such a number of excellent monographs 
collected together in one volume of Transactions. It is a model in every 
respect. It is a volume that should be in the hands of every general prac- 
titioner as well as specialist, as in it may be found most useful suggestions 
for every day practice. We cannot commend the work too highly, and it 
is our earnest hope that future meetings of the society will give origin to 
volumes of Transactions equal to the one before us. — The Hospital Ga- 
zette. 
In conclusion, we cannot but regard this volume as a fitting monument 
of the progress of this most progressive department of medicine. The 
discussions are rich, and are full of such epitomized good sense well ex- 
pressed, as is rarely found in any volume of Transactions, while the whole 
contents exhibit the most careful supervision of the editor. — Toledo Medi- 
cal and Surgical Journal. 
Organized amid the whirl and bustle of last summer, the American 
Gynecological Society bids fair to realize the brightest hopes of its found- 
ers. Its first volume of Transactions, now before us, will bear the closest 
scrutiny, and safely challenge the severest criticisms, so superior is it in its 
breadth of thought and observation, scientific worth, and literary excel- 
lence ; the writers of the papers in these Transactions being no mere 
novices, but men skilled in the profession they represent, and experts in 
the branch of study and practice which they especially call their own. — 
Philadelphia Medical Times. 
It is not a trifling matter to be able to say of this volume that it is the 
handsomest of the kind anywhere produced. .... But this is not only an 
elegant volume, it is a good one ; creditable to the authors, creditable to 
the great republic Now we have the first of, we hope, a long row 
of volumes which will bear comparison with the Transactions of European 
Societies. Indeed, these must look to their laurels in this noble emula- 
tion. — Edinburgh Medical Journal. 
This book of nearly 400 pages contains a series of excellent articles 
upon gynecological topics, written by the most prominent gynecologists of 
America and England. — Allg. Wiener Med. Zeitung. 
This volume is one of the best collections of gynecological papers that 
has been published this year We do not doubt that it will confer 
the greatest honor upon the medical literature of America. — Annales de 
Gynlcologie. 
Few volumes that have recently come under our notice have been so ex- 
tremely interesting and instructive. The papers reach a very high order 
of excellence, and some indeed are superlatively good. — American Jour- 
nal of Obstetrics.