Excerpt from The British Gynaecological Journal, Vol. 2: Being the Journal of the British Gynaecological Society; November 1886

The left ovary is somewhat swollen its surface is covered by a shaggy layer of purulent lymph. The substance con tains a corpus luteum of pregnancy. On the right side of the pelvis, firmly adherent, by its external aspect, to the osseous framework of the pelvis, is a tumour, ovoid in shape, and about the size of the closed fist. On its internal aspect it is adherent to the uterus from the Fallopian tube downwards. On incision, the tumour was found to be a cyst with a very irregular cavity, lined by a pyogenic membrane, for the most part of a dark purple colour. The cyst contained smaller cysts filled with pus. The wall of the cyst at its upper and inner aspect is thin elsewhere it is very thick, being composed of tough, white, fibrous tissue. The right ovary (one? Ovary) is absent, but on following down the Fallopian tube a flattened mass of fibrous tissue, covered with what had been apparently peritoneum, could be stripped off the postero superior aspect of the tumour. This probably represents the right ovary. The other organs are healthy.

The woman on admission was evidently suffering from peritonitis, due either to being kept too long in labour (four hours) or to the frequent manipulations of the attendant medical men. She does not, however, seem to have had very strong labour-pains during all this period some force appears to have been used to reduce the tumour. It is a question whether this pressure on the tumour might not have caused a rupture of some of the cyst-walls and the infiltration of pus into the surrounding tissues, which pus afterwards became absorbed into the system, giving rise to acute septicaemia. I am inclined to think that the large amount of purulent fluid found in the peritoneal sac was due to some septic absorption. In this case death was clearly and emphatically due to disease of the right ovary, which could have been removed without great difficulty for although the tumour was firmly adherent to the posterior wall of the pelvis, it was not more so than one ordinarily meets with in such cases. Dr. Hebb readily sepa rated the cyst from the pelvic walls in the post-mortem theatre.

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