Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects.

Mansell-Moullin, C. W. (Charles William), 1851-1940

Date:: 1893

Credit: Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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$is named the i)aroophoron, while the ovarian tissue i^roper is s])oken of as the oophoron. All remnants of the Wolffian body and its duct give rise, by distention, to cysts, and the great majority of these, according to Doran, contain papillary proliferous growths. They are conveniently classified as— {a) Hilum cysts, which spring from the hilum of the ovary, and are distin- guished from cysts of the oophoron by having a layer of true ovarian tissue si)read over their free surface. They often contain papillary intra-cystic growths. {b) Broad ligament cysts. These arise from the normally persistent vertical tubes or parovarium, and sometimes in Gartner's duct. The cysts lie between the layers of the broad ligament, which is usually evenly expanded. The Fallopian tube courses over their upper surface, and is much stretched if they attain a large size. They contain a clear, watery fluid, but sometimes the contents are discolored by hemorrhages. In larger cysts an epithelial lining rarely exists, but in smaller ones columnar or columnar-ciliated epithelium may be found. 2. Cysts of Mi'iIIer''s Duct.—A small cyst, known as the hydatid of Morgagni, is attached to one of the fimbriae of the Fallopian tube in the female and to the head of the epididymis in the male. It represents the terminal end of Miiller's duct in the female and in the male, but is of no clinical importance. A remarkable instance of persistence of Miiller's duct on one side in its whole length has been described by Dr. Ord. The dilated duct formed an elongated cyst extending from the right kidney to the sinus prostaticus. 3. Cysts from the UracJuis.—Among other rarities, mention may be made of cysts arising in the persistent urachus. Some are lined with ciliated columnar epithelium and others with hair-bearing skin ; they may attain a great size. Cases have been observed in which the cyst communicated with the bladder, and this circumstance has given rise to the passage of hairs with the urine when the cyst was dermoid. Cysts have also been known to develop in Meckel's diverticulum, from the blocking up of the intestinal end. 4. Dermoid Cysts.—These cysts are found in connection both with skin and mucous membrane and in various internal organs. A dermoid cyst must, therefore, be defined as a cyst lined with skin or with mucous membrane and of congenital origin. They may conveniently be divided into : {a) Dermoids derived from epi- blast by enclavement. (Ji) Dermoids of internal organs. {a) The first group comprises dermoid cysts of the skin, mouth, rectum, and nerve-centres, and those situated near the median line in the thoracic and abdom- inal cavities. They are all produced by cutting off of a portion of epiblast {enclave- ment) during the process of closure of branchial fissures of the body walls in the middle line, and in the formation of the membrane bones of the skull and face. They also occur in connection with the involution of epiblast to form the mouth, genito-urinary apertures, rectum, the eye and ear, and the brain and spinal cord. {l>) The second group include dermoids of the ovary and testis, and perhaps may be attributed to exceptional formative powers and tendencies to variation in the structures from which these organs arise. But since the Wolffian duct has recently been shown to be of epiblastic origin, the possibility suggests itself that these cysts may also be derived from the epiblast. Distribution.—On the head and face they are more often situated over the lines of sutures. Their commonest site is beneath or near the eyebrow, especially toward the outer side ; but they are also found at almost any part of the orbital margin. On the skull they are more often observed on the temple near the fronto- maxillary suture, round the anterior fontanelle and over the mastoid process; but they may exist at any part. On the face they occur over the middle line of the nose, the fronto-nasal suture, and rarely on the cheek. On the neck they are placed laterally, viz., over the parotid gland, near the angle of the jaw and along the anterior margin of the sterno-ma.stoid at points corresponding to the lines of the first three branchial fissures. Or they are median, being commonest here beneath$