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The ovaries may be cystic; there may be chronic inflammation of the womb and possibly the mouth of the womb was injured at last calf birth and the scar prevents its admitting the fertilizing cells. If possible, a veterinarian should make a careful examination of this cow in order to determine what the trouble is.
CLASSIFICATION OF TUMOURS: I. Connective-tissue tumours: Innocent: Lipoma, Xanthoma, Chondroma, Osteoma, Odontoma, Fibroma, Myxoma, Endothelioma, etc.; Malignant: Sarcoma II. Epithelial tumours: Innocent: Papilloma, Adenoma, Cystic Adenoma; Malignant: Epithelioma, Glandular Cancer, Rodent Cancer, Melanotic Cancer III. Dermoids IV. Teratoma.
Cholecystotomy for the relief of the distention of the gall-bladder from obstruction of the common or cystic duct and for the removal of gall-stones was first performed in 1867 by Bobbs of Indianapolis, but it is to Marion Sims, in 1878, that perfection of the operation is due. It has been gradually improved and developed, until today it is a most successful operation.
This is met with chiefly in the breast and ovary, and the tumour resembles the cystic adenoma, but it tends to infect its surroundings and gives rise to secondary growths. It almost never infects the lymph glands. A dermoid is a tumour containing skin or mucous membrane, occurring in a situation where these tissues are not met under normal conditions.
The hepatic and cystic ducts were pervious and the hepatic duct obliterated. There were signs of hepatic cirrhosis and in addition an inguinal hernia. The Gall-Bladder. Harle mentions the case of a man of fifty, in whom he could find no gall-bladder; Patterson has seen a similar instance in a men of twenty-five. Purser describes a double gall-bladder.
On May 3d abdominal section was performed. An incision eight inches long was made in the mid-line of the abdomen. A cystic tumor, formed of small cysts in its upper part and of somewhat larger ones in the lower part, was revealed. It was adherent to the abdominal wall, liver, spleen, and omentum.
These minute ducts gradually unite and form at last one main duct, which carries the bile from the liver. This is known as the hepatic duct. It passes out on the under side of the liver, and as it approaches the intestine, it meets at an acute angle the cystic duct which proceeds from the gall bladder and forms with it the common bile duct.
When it contains myxomatous tissue it is called a myxo-adenoma, and when the gland spaces of the tumour become distended with accumulated secretion, a cystic adenoma, the best examples of which are met with in the mamma and ovary.
Tumours of the thyreoid, enlarged lymph glands, and fatty and sarcomatous tumours can usually be distinguished from aneurysm by the history of the swelling and by physical examination. Cystic tumours and abscesses in the neck are sometimes more difficult to differentiate on account of the apparently expansile character of the pulsation transmitted to them.
The accompanying illustration pictures an extreme ease of cystic goiter shown by Warren. A strange feature of tumors of the thyroid is that pressure-atrophy and flattening of the trachea do not take place in proportion to the size of the tumor.
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