are liable to inflammatory affections, tuberculosis, sarcomata, cancer, chorion-epithelioma and tubal pregnancy. Salpingitis (inflammation of the oviducts) is nearly always secondary to septic infection of the genital tract. The chief causes are septic endometritis following labour or abortion, gangrene of a myoma, gonorrhoea, tuberculosis and cancer of the uterus; it sometimes follows the specific fevers. When the pus escapes from the tubes into the coelom it sets up pelvic peritonitis. When the inflammation is adjacent to the ostium it leads to the matting together of the tubal fimbriae and glues them to an adjacent organ. This seals the ostium. The occluded tube may now have an accumulation of pus in it (pyosalpinx). When in consequence of the sealing of the ostium the tube becomes distended with serous fluid it is termed hydrosalpinx. Haematosalpinx is a term applied to the non-gravid tube distended with blood; later the tubes may become sclerosed. Acute septic salpingitis is ushered in by a rigor, the temperature rising to 103°, 104° F., with severe pain and constitutional disturbance. The symptoms may become merged in those of general peritonitis. In chronic disease there is a history of puerperal trouble followed by sterility, with excessive and painful menstruation. Acute salpingitis requires absolute rest, opium suppositories and hot fomentations. With urgent symptoms removal of the inflamed adnexa must be resorted to. Chronic salpingitis often renders a woman an invalid. Permanent relief can only be afforded by surgical intervention. Tuberculous salpingitis is usually secondary to other tuberculous infections. The Fallopian tubes may be the seat of malignant disease. This is rarely primary. By far the most important of the conditions of the Fallopian tubes is tubal pregnancy (or ectopic gestation). It is now known that fertilization of the human ovum by the spermatozoon may take place even when the ovum is in its follicle in the ovary, for oosperms have been found in the ovary and Fallopian tubes as well as in the uterus. Belief in ovarian pregnancy is of old standing, and had been regarded as possible but unproved, no case of an early embryo in its membranes in the sac of an ovary being forthcoming, until the remarkable case published by Dr Catherine van Tussenboek of Amsterdam in 1899 (Bland-Sutton). Tubal pregnancy is most frequent in the left tube; it sometimes complicates uterine pregnancy; rarely both tubes are pregnant. When the oosperm lodges in the ampulla or isthmus it is called tubal gestation; when it is retained in the portion traversing the uterine wall it is called tubo-uterine gestation. Wherever the fertilized ovum remains and implants its villi the tube becomes turgid and swollen, and the abdominal ostium gradually closes. The ovum in this situation is liable to apoplexy, forming tubal mole. When the abdominal ostium remains pervious the ovum may escape into the coelomic cavity (tubal abortion); death from shock and haemorrhage into the abdominal cavity may result. When neither of these occurrences has taken place the ovum continues to grow inside the tube, the rupture of the distended tube usually taking place between the sixth and the tenth week. The rupture of the tube may be intraperitoneal or extraperitoneal. The danger is death from haemorrhage occurring during the rupture, or adhesions may form, the retained blood forming a haematocele. The ovum may be destroyed or may continue to develop. In rare cases rupture may not occur, the tube bulging into the peritoneal cavity; and the foetus may break through the membranes and lie free among the intestines, where it may die, becoming encysted or calcified. The tubal placenta possesses foetal structures, the true decidua forming in the uterus. The signs suggestive of tubal pregnancy before rupture are missed periods, pelvic pains and the presence of an enlarged tube. When rupture takes place it is attended in both varieties with sudden and severe pain and more or less marked collapse, and a tumour may or may not be felt according to the situation of the rupture. There is a general “feeling of something having given way.” If diagnosed before rupture, the sac must be removed by abdominal section. In intraperitoneal rupture immediate operation affords the only chance of saving life. In extraperitoneal rupture the foetus may occasionally remain alive until full term and be rescued by abdominal section, if the condition is recognized, or a false labour may take place, accompanied by death of the foetus.
Diseases of the Ovaries and Parovarium.—The ovaries undergo striking changes at puberty, and again at the menopause, after which there is a gradual shrinkage. One or both may be absent or malformed, or they are subject to displacements, being either undescended, contained in a hernia or prolapsed. Either of these conditions, if a source of pain, may necessitate their removal. The ovary is also subject to haemorrhage or apoplexy. Acute inflammations (oöphorites) are constantly associated with salpingitis or other septic conditions of the genital tract or with an attack of mumps. The relation of oöphoritis to mumps is at present unknown. Acute oöphoritis may culminate in abscess but more usually adhesions are formed. The surgical treatment is that of pyosalpinx. Chronic inflammation may follow acute or be consequent on pelvic cellulitis. Its constant features are more or less pain followed by sterility. The ovary may be the seat of tuberculosis, which is generally secondary to other lesions. Suppuration and abscess of the ovary also occur. Perioöphoritis, or chronic inflammation in the neighbourhood, may also involve the gland. The cause of cirrhosis of the ovaries is unknown, though it may be associated with cirrhotic liver. The change is met with in women between 20 and 40 years of age, the ovaries being in a shrunken, hard, wrinkled condition. Under ovarian neuralgia are grouped indefinite painful symptoms occurring frequently in neurotic and alcoholic subjects, and often worse during menstruation. The treatment, whether local or operative, is usually unsatisfactory. The ovary is frequently the seat of tumours, dermoids and cysts. Cysts may be simple, unilocular or multilocular, and may attain an enormous size. The largest on record was removed by Dr Elizabeth Reifsnyder of Shanghai, and contained 100 litres of fluid, and the patient recovered. The operation is termed ovariotomy. Dermoid cysts containing skin, bones, teeth and hair, are of frequent growth in the ovary, and have attained the weight of from 20 to 40 kilogrammes. In one case a girl weighed 27 kilogrammes and her tumour 44 kilogrammes (Keen). Papillomatous cysts also occur in the ovary. Parovarian and Gärtnerian cysts are found, and adenomata form 20% of all ovarian cysts. Occasionally the tunic of peritoneum surrounding the ovary becomes distended with serous fluid. This is termed ovarian hydrocele. Ovarian fibroids occur, and malignant disease (sarcoma and carcinoma) is fairly frequent, sarcoma being the most usual ovarian tumour occurring before puberty. Carcinoma of the ovary is rarely primary, but it is a common situation for secondary cancer to that of the breast, gall-bladder or gastro-intestinal tract. The treatment of all rapidly-growing tumours of the ovary is removal.
Diseases of the Pelvic Peritoneum and Connective Tissue.—Women are excessively liable to peritoneal infections. (1) Septic infection often follows acute salpingitis and may give rise to pelvic peritonitis (perimetritis), which may be adhesive, serous or purulent. It may follow the rupture of ovarian or dermoid cysts, rupture of the uterus, extra uterine pregnancy or extension from pyosalpinx. The symptoms are severe pain, fever, 103° F. and higher, marked constitutional disturbances, vomiting, restlessness, even delirium. The abdomen is fixed and tympanitic. Its results are the formation of adhesions causing abnormal positions of the organs, or chronic peritonitis may follow. The treatment is rest in bed, opium, hot stupes to the abdomen and quinine. (2) Epithelial infections take place in the peritoneum in connexion with other malignant growths. (3) Hydroperitoneum, a collection of free fluid in the abdominal cavity, may be due to tumours of the abdominal viscera or to tuberculosis of the peritoneum. (4) Pelvic cellulitis (parametritis) signifies the inflammation of the connective tissue between the folds of the broad ligament (mesometrium). The general causes are septic changes following abortion, delivery at term (especially instrumental delivery), following operations on the uterus or salpingitis. The symptoms are chill followed by severe intrapelvic pain and tension, fever 100° to 102° F. There may be nausea and vomiting, diarrhoea, rectal tenseness and dysuria. If consequent on parturition the lochia cease or become offensive. On examination there is tenderness and swelling in one flank and the uterus becomes fixed and immovable in the exudate as if embedded in plaster of Paris. The illness may go to resolution if treated by rest, opium, hot stupes or icebags and glycerine tampons, or may go on to suppuration forming pelvic abscess, which signifies a collection of pus between the layers of the broad ligament. The pus in a pelvic abscess may point and escape through the walls of the vagina, rectum or bladder. It occasionally points in the groin. If the pus can be localized an incision should be made and the abscess drained. The tumours which arise in the broad ligament are haematocele, solid tumours (as myomata, lipomata and sarcomata), and echinnococcus colonies (hydatids).
Bibliography.—Albutt, Playfair and Eden, System of Gynaecology (1906); McNaughton Jones, Manual of Diseases of Women (1904); Bland-Sutton and Giles, Diseases of Women (1906); C. Lockyer, “Lutein Cysts in association with Chorio-Epithelioma,” Journal of Obstetrics and Gynaecology (January, 1905); W. Stewart McKay, History of Ancient Gynaecology; Hart and Barbour, Diseases of Women; Howard Kelly, Operative Gynaecology. (H. L. H.)
GYÖNGYÖSI, ISTVÁN [Stephen] (1620–1704), Hungarian poet, was born of poor but noble parents in 1620. His abilities early attracted the notice of Count Ferencz Wesselényi, who in 1640 appointed him to a post of confidence in Fülek castle. Here he remained till 1653, when he married and became an assessor of the judicial board. In 1681 he was elected as a representative of his county at the diet held at Soprony (Oedenburg). From 1686 to 1693, and again from 1700 to his death in 1704, he was deputy lord-lieutenant of the county of Gömör. Of his literary works the most famous is the epic poem Murányi Venus (Caschau, 1664), in honour of his benefactor’s wife Maria Szécsi, the heroine of Murány. Among his later productions the best known are Rózsa-Koszorú, or Rose-Wreath (1690), Kemény-János (1693), Cupidó (1695), Palinodia (1695) and Chariklia (1700).
The earliest edition of his collected poetical works is by Dugonics (Pressburg and Pest, 1796); the best modern selection is that of Toldy, entitled Gyöngyösi István válogatott poétai munkái (Select poetical works of Stephen Gyöngyösi, 2 vols., 1864–1865).
GYÖR (Ger. Raab), a town of Hungary, capital of a county of the same name, 88 m. W. of Budapest by rail. Pop. (1900)
