The Diagnosis of Malignant Ovarian Tumours and Malignant Peritonitis
Authors: J. Foulis
Journal: BMJ (1878)

a paper before the Medico-Chirurgical Society of Edinburgh, on the Structure of the Ovary in relation to cer- tain Forms of Disease of the Organ.After giving a short account of my observations on the development of the ova and the structure of the ovary, and contrasting them with the recently published views of Waldeyer, I proceeded to give the complete histories of two cases of malignant disease of the ovary which were under my observation during the months of September, October, November, and December 1874.During these months, I made careful drawings of certain cell.groups, which I had discovered in the ascitic fluid surrounding the malignant tumours in both cases; and these drawings were handed round to the gentlemen who were present at the reading of my paper, in order that they might form an idea of the appearances of the cell- groups while I read the description of them.The fluid obtained by tapping the abdomen of the patients was allowed to stand for some hours, and the deposit was carefully exa- mined with the microscope."It contained a number of red blood- corpuscles, and numerous large round cells with bright sharply defined oval nuclei with nucleoli.On placing a drop of the thicker part of the sediment on a glass slip for examination, I saw with my naked eye many small white bodies, varying in size from a pin's head to mere specks; these, under a power of four hundred diameters, were found to consist of groups of cells in all stages of development.Each littlLe body was a mass of cells proliferating in an extraordinary manner.At the margin of each mass, large cells with bright nuiclei were seeis project.ing, and were exactly similar to the large free cells which 1 had noticed first in the sediment.Fromn a minutte solid nucleus invested with proto- plasm up to the large free nucleated cells, all stages of cdl-dtvelopmentt could be seen in each mass.Once seen, such an appearance could not easily be forgotten."I concluded the histories of these two cases with the following remarks."I have given these two cases somewhat in detail, because Irwish to direct attention to these little masses of prolifrating epithelium int ascitic fluid as a mneans of dianptosing malignant peritonitis antd malignant ovarian disease."Dr. Matthews Duncan, the President of the Medico-Chirurgical Society, was present at the reading of the above paper, and, among other things, said as follows."In the pathological aspect of the question, a most important point in the paper was the morbid condition of the connective tissue corpuscles in relation to the peculiar epithelial masses found in the ascitic fluid, which were evidently the product of ruptured cysts.The diag,nosis of malignant ovarian cystoma by find.ing in the fluid, not only of the cysts, but in the ascitic fluid, those beautiJul prol,erating masses had been well shown.These masses were new to Dr. Duncan, and they could not easily be confiused with any other structure.Dr. Foulis's observations were altogether on a different footing from those of most of his predecessors.Hlie had begun the inquiry in the right and only way; viz, by first studying the development of the ovary and ovum.