[Reprinted from the American Gynaecological and Obstetrical Journal 
for April, 1896.] 
CIRRHOSIS OF THE OVARIES.* 
By A. H. Cordier, M. I)., Kansas City, Mo., 
Lecturer on Abdominal Surgery, Kansas City Medical College; Vice-President of the 
American Association of Obstetricians and Gynaecologists. 
The gynaecologist meets with other diseases in the female genital 
organs than pyosalpinx, ovarian abscess, and uterine fibroids that re- 
quire surgical intervention, one of the comparatively infrequent, most 
protracted, and painful diseases of the ovaries being cirrhosis—the 
title of this article. 
The literature on the subject I find to be very meager and unsat- 
isfactory. While the pathology in this condition, in the great majority 
of instances, has its origin in a chronic ovaritis (some claiming the 
exanthematic hardening of the ovaries to be of a non-inflammatory 
origin), its permanency justifies an individuality, and its clinical his- 
tory and pathology a separate chapter in our works on gynaesic dis- 
eases. 
I have within the last year operated for the relief of this, the most 
painful of ovarian diseases, in five subjects. They have all recovered 
from the operation, and four of them have been permanently relieved 
of their sufferings, restored to comfort, and made happy, useful wives 
and mothers. The fifth, operated on a few weeks ago, is convalescent, 
and I feel safe in predicting that the ultimate results in her case will 
be equally as satisfactory. 
The ovaries are sometimes affected with an interstitial sclerosis as 
a result of numerous small follicular dropsies, which are, of course, of 
a non-inflammatory nature. In the post-inflammatory sclerosis or in- 
terstitial ovaritis, like pathological processes in other organs, the 
fibrous tissue predominates and the ovules are either compressed and 
strangled, so to speak, in their normal location, are choked on their 
way to the surface, or perchance, after a painful effort, find their way 
to the surface and rupture. 
Where the ovules fail to reach the surface, owing to the denseness 
* Read before Jackson County Medical Society. 
Copyright, 1896, by J. D. Emmet, M. D. A. H. Cordier, M. D. 
and unyielding character of the fibrous tissue, the condition is one of 
sclero-cystic ovaritis. One of the specimens I have here should be so 
classified. 
Early in the history of this process the ovary looks much like a 
normal organ ; but as the process progresses, as is‘usual, the organs 
contract at the expense of the vascular stroma or medullary substance. 
The true gland structure atrophies, y?t the ovary in some instances is 
larger than normal, owing to the increase of the fibrous elements. 
Battey, of Georgia, in 1872, performed for the first time in the his- 
tory of abdominal surgery what was and is yet called a normal 
oophorectomy. Many of his cases operated on for the relief of pain, 
and supposed to be the removal of normal organs, have, in the light 
of more modern and advanced pathological knowledge, been demon- 
strated as belonging to this classification of ovarian diseases. The 
compression of the delicate and painful nerve filaments in the ovary, 
by the disappearance of at least the greater part of the ovarian struc- 
ture, save the dense, fibrous trabeculae, accounts for the sickening, 
compressing, and almost constant pain in many of these cases, and 
from the same source the reflexes so often manifested where- there 
exists a constant irritation to branches of the ganglionic nervous 
system. 
I would not have my hearers misunderstand me in this matter, for 
I am dealing with diseased and not sound organs. I am not advising 
the removal of any organ where it is not a constant source of trouble 
and a menace to the health and comfort of the patient. Dysmenor- 
rhcea is a term that should be banished from the nomenclature of 
gynsesic diseases, as jaundice has been left out of the classification 
of hepatic diseases, since its source has been definitely traced to well- 
marked pathological processes ; they are both only symptoms. In 
women who cease to menstruate prematurely, often the cessation may 
be traced to cirrhosis (atrophy), the result of a chronic ovaritis or an 
acute exanthematic disease affecting the ovaries, as smallpox, measles, 
or mumps. To this same source may often be traced the irregular, 
scanty, or painful menstrual periods of young girls. 
As a result of the fibrous contractions in a cirrhotic ovary, the sur- 
face of the organ is made to resemble the convolutions of the brain. 
The majority of women suffering from cirrhotic ovaries are sterile, or 
will give a history of a long interval between or since the last birth. 
In many of these cases the Fallopian tubes are also affected, not by a 
suppurative process, but by a form of inflammation that results in an 
obliteration of the tubal caliber—an atrophic salpingitis—the same 
process taking place in the vermiform appendix, as described by Senn Cirrhosis of the Ovaries. 
3 
and others, as appendicitis obliterans. A few of these cases cease to 
menstruate altogether, and thus Nature cures the case, unless there 
exists firm surrounding adhesions, the remains of old inflammatory 
processes ; these, of course, are to be dealt with in the usual surgical 
manner if there exist indications for a surgical procedure. 
The all-important question to the patient is what can be done for 
the relief of her suffering. 
Case.—Mrs. B., aged forty-two, mother ; last child eleven years 
old. Menstruation regular in time, normal duration three to five 
days, and free from pain. Not a dysmenorrhcea or painful menstrua- 
tion. Her best days during her menstrual month are those during 
and for several days following her flow. Nine or ten days before her 
expected menstrual period a pain of a sickening, throbbing, and com- 
pressing character developed, and lasted with unremitting severity up 
to the day preceding the flow, ceasing with its development, to return 
again at the beginning of the usual painful period. This pain has 
made her an invalid by its protractedness. She has not acquired the 
morphine habit, because she is the wife of an intelligent practitioner, 
who foresaw the dangers attending the prolonged occasional adminis- 
tration of an opiate, and used other analgesics. 
This is a short history, but it is all there is to say about the case, 
save to assure you that all other symptoms inquired for were nega- 
tive. 
An examination revealed small, tender ovaries ; no evidence of 
old, purulent tubal disease. The case was diagnosed as one of cir- 
rhotic ovaries ; the correctness of this opinion was fully established at 
the operation, and the justifiability of the operative procedure has 
been thoroughly proved by the results in the case. The pain has not 
returned, and I feel safe in predicting a permanent cure in the case. 
There are some features in this case worthy of comment. 
The absence of any history of an exanthematic disease demon- 
strates that a cirrhotic ovaritis may take place without this cause ; 
the absence of any evidence of old tubal disease shows that the pro- 
cess did not originate from this source. The left ovary had the cir- 
rhotic process the most marked, and it must be remembered that it is 
the left testicle that is oftenest found atrophied, one of the most fre- 
quent causes in the male being a varicosity of the spermatic veins. 
It was noticed in this case that the pampiniform plexus on the left side 
was very greatly enlarged and tortuous. It might be claimed that 
this disease of the blood-vessels was the source of the pain, but the 
character, time, and duration of the pain would negative this deduc- 
tion. A. H. Cordier, M. D. 
4 
That this atrophy of the ovaries was of a post-climacteric charac- 
ter was disproved by the regularity of the menstrual function and by 
the microscopical as well as macroscopical appearance of the structure 
of the organ. 
This woman being forty-two years of age and menstruating regu- 
larly would not warrant waiting for a natural menopause to occur, for 
many women continue menstruating for six years beyond this age. 
this would imply six years more of continued suffering and invalidism. 
I know of nothing to relieve this suffering save the removal of the 
cause. The results of this cause, be they what they may, are of a per- 
manent character, and in an organ not essential to comfortable exis- 
tence the only remedy for the relief of suffering produced by its pres- 
ence is the removal of the diseased organ. 
Many of these patients will present the usual uterine syndrome, 
and a diagnosis is arrived at by exclusion of other conditions giving 
rise to these pelvic manifestations. 
It is with no certainty that the patient can tell when her symptoms 
began, as the process is a gradual one. Arrested involution is re- 
sponsible for many cases of this disease. The all-important point in 
these cases to the gynaecologist and the patient is the present condi- 
tion and the methods of relief. 
The pain in the cases I have had under my care has been of a 
sharp, darting, sickening, or throbbing character, in one or both 
ovarian regions, but most frequently and of severer character in the 
left ovary. This pain has its greatest intensity from a few days to two 
weeks prior to the menstrual period, and is usually accompanied with 
the usual nervous reflexes, as hysterical manifestations, backache, etc. 
In many of the cases, owing to the intimate nerve connection with 
the lumbar ganglia of the spinal nerves, the pain will be found run- 
ning down the front and inner side of the thigh, genito-crural and 
anterior crural, and in the hip joint through the obturator nerve con- 
nections with the sympathetic. Dyspareunia is in many cases absent, 
owing to the fact that the ovaries are small and are not prolapsed, 
and may not be very tender. 
Early in the history of these cases they may be treated, with some 
relief of the pain, by electricity, but the results from this agent have 
not been at all satisfactory. All cirrhotic ovaries do not require re- 
moval. It is in cases where other means have failed, and where the 
woman has been made an invalid or her suffering becomes almost 
intolerable, that the removal becomes imperative. Each case is an 
individual one, and should be studied and treated as such.