OVARIAN CYSTS IN THE NEGRESS, 
Thomas R. Brown, M. D. 
[Prom The Johns Hopkins Hospital Bulletin, Nos. 94-95-96, Jan.-Feb.-March, 1899.] [From The Johns Hopkins Hospital Bulletin, Nos. 04-95-90, Jan.-Feb.-March, 1899.] 
OVARIAN CYSTS IN THE NEGRESS. 
Thomas R. Brown, M. D. 
Comparatively little has been written concerning ovarian 
cysts in the negress, probably partly because that in most 
hospitals where extensive gynecological operations are per- 
formed the proportion of negro patients is very small, and 
partly because of the comparative rarity of this condition in 
negro women. 
In fact, one frequently hears surgeons say: “The tumor 
before us presents all the features of an ovarian cyst, but inas- 
much as the patient is a negress it is certainly not so, but a 
tumor of different origin (cystic myoma, etc.), as multilocular 
cysts are unknown in the negress.” 
That ovarian cysts are much rarer in negresses than in white 
women no one will deny, but as to the exact numerical rela- 
tionship between the two few if any figures of importance are 
obtainable, and the object of this note is to give definitely and 
numerically this proportion as obtained by an analysis of 
ovarian cysts of various kinds operated upon at the Johns 
Hopkins Hospital. 
In considering ovarian cysts the usual divisions have been 
made into (a) simple retention cysts, including Graafian follicle 
and corpusluteumcysts; (#)unilocular and multilocular ovarian 
cystomata, the two being considered together, as many regard 
the unilocular cysts as originally multilocular; (c) papillary 
cysts and (d) dermoid cysts of the ovary; also for sake of com- 
pleteness parovarian cysts and intraligamentary cysts have 
been considered. 
I shall discuss the frequency of ovarian cysts in the negress 
first (I) from a clinical and macroscopical standpoint, and 
second (II) from a microscopical and pathological standpoint, 
which is much more important. I. 
An analysis is here given of the various kinds of ovarian 
cysts occurring in the white and the colored for a period of six 
years, from January 31st, 1892, until January 31st, 1898, the 
variety of cyst being determined by clinical observation and 
macroscopic appearance. 
3996 
5! 
p* 
Total No. of cases 
of all kinds treat- 
ed in the gyneco- 
logical service. 
oi 
00 
CO 
o 
o 
h-1 
3 
P* 
d 
O fl> 
vj 2 
gp 
CD 0# 
p] 
VARIETIES Ol 
O 
o 
00 
00 
cr 
Simple cysts (Graa- 
fian follicle and 
corpus luteum 
cysts). 
CO 
O 
o 
Cn 
CO 
P* 
Unilocular 
and multi- 
locular 
cysts. 
to 
o 
o 
>—1 
3 
o 
p* 
03 
H 
o 
03 
o 
o 
33 
P* 
o 
-52? 
sa* 
a 
cd ja i 
o 
o 
■3 
Intraligamentary 
o 
cysts. 
o 
a 
It will thus be seen that out of 191 cysts, only 12 were in the 
negress, a proportion of 115, while the proportion of colored 
to white gynecological patients treated during the same period 
was 1 : 6.75 (589 : 3996), i,. e. ovarian cysts were relatively 
2.2 times as frequent in white as compared with colored women. 
When we analyze the proportion in the different varieties of 
cysts, we arrive at some striking results. 
In the case of the dermoid cysts, cysts due to the inclusion 
of some of the embryonic ectoderm in the ovarian tissue, we 
find that 7 of the 24 cases reported were in the negress, i. e. 
1 : 2.5 (7 : 17), which would seem to indicate that the dermoid 
cysts are relatively more than twice as common in the negress 
as in the white woman (the proportion of white to colored 
gynecological patients being 1 : 6.75). 
As regards simple retention cysts, the proportion of 3 to 88 
(i. e. 1 : 29.3) is probably not a fair estimate, due to the fact 
that what to call a Graafian follicle cyst and what to call a 
dilated Graafian follicle depends largely upon the individual 
operator. 
When we consider unilocular and multilocular cysts, how- 
ever, we are struck at once by their remarkable infrequency in 
the negress, of the 55 cases mentioned only 2 being in that 
race, i. e. a proportion of 1 : 26.5. 3 
This is of especial importance, because this form of cyst of 
the ovary grows to the largest size, and it is this variety of 
cyst which many surgeons declare never occurs in the negress. 
No cases were reported of papillary cysts of the ovary, par- 
ovarian or intraligamentary cysts in the negress. 
Thus it will be seen that with the exception of dermoid 
cysts, ovarian cysts are really much less common in the colored 
race, the results, however, being more or less indefinite, due to 
the fact that the diagnosis was made clinically and macro- 
scopically and not microscopically. 
11. 
An analysis of ovarian cysts from the microscopical stand- 
point was made from all cases operated upon in the Hospital 
from the latter part of 1893 until October, 1898. 
Daring that time there had been microscopically described 
and diagnosed in the Gynecological-Pathological Laboratory 
244 ovarian and parovarian cysts, divided as follows : Dermoid 
cysts 32, Graafian follicle cysts 68, corpus luteum cysts 16, 
unilocular and raultilocular cysts 94, papillary cysts 10, and 
parovarian cysts 24. 
(u) Dermoid cysts. Of the 32 dermoid cysts, 6 were in 
the colored, i. e. the proportion is 1 ; 4.3, showing, as in the 
clinical study above, that these cysts are relatively more 
common in the negro race. 
CASES. 
PATHOLOGICAL REPORT. 
REMARKS. 
(1) S. 
Dermoid cyst of right ovary, 7 cm. 
in diameter 
(2) J. 
Dermoid cyst of ovary, 16 cm. in 
diameter 
(3) I. 
Dermoid cyst of ovary, 7 cm. in 
diameter 
Myomatous uterus. 
(4) S. 
Dermoid cyst of ovary, 8 cm. in 
diameter 
(5) V. 
Dermoid cyst of ovary, 4.5x3.5x3 
cm 
2 intraligamentary myo- 
mata. 
(B) C. 
Dermoid cyst of right ovary, 2.5 cm. 
in diameter. 
Myomata uteri. 
Cases op Dermoid Cyst op the Ovary in the Colored. 4 
(h) Retention cysts. Of the 84 simple retention cysts (68 
Graafian follicle cysts, 16 corpus luteum cysts), 7 were in the 
colored, a proportion of 1 : 11, showing that these cysts are 
relatively less common in the negress than in the white woman 
(as stated before, the proportion of colored to white gyneco- 
logical patients being 1 : 6.75). 
Cases of Simple Retention Cysts in the Colored. 
CASES. 
PATHOLOGICAL REPORT. 
REMARKS. 
(1) s. 
Right unilocular ovarian cyst, prob- 
ably dilated Graafian follicle, in- 
traligamentary, 9 cm. in diameter. 
Double pyosalpinx. 
(2) C. 
Right corpus luteum cyst, 5 cm. in 
diameter. 
Epithelioma of cervix. 
(3) W. 
(4) W. 
Cyst of ovary from corpus luteum 
or Graafian follicle, fix4x4.5 cm. 
Corpus luteum cyst, unilocular, 5 
cm. in diameter. 
Double perisalpingitis 
and perioophoritis. 
(5) B. 
Cyst of left ovary, 5 cm. in d iameter 
(probably of Graafian follicle). 
Myomata uteri. 
(6) B. 
(7) T. 
Graafian follicle cyst of right ovary, 
4 cm. in diameter. 
Right Graafian follicle cyst, 4x3cm. 
Myomata uteri. 
(c) Unilocular and multilocular cysts. Of the 94 uni- 
locular and multilocular ovarian cysts, but 6 were in the 
colored, the proportion thus being but 1 ; 14.7, showing that 
this form of cyst is relatively more than twice as common 
amongst white women. 
It shows, however, that they are by no means so uncommon 
in the negress as popularly supposed. 
Cases op Unilocular and Multilocular Ovarian Cysts 
in the Colored. 
(1) G.—Color, black. 
Pathological Report.—Multilocular ovarian cyst. Myoma uteri. 
(2) H.—Color, black. 
Examination.—Abdomen, especially right side, is distended by a 
firm elastic tumor mass reaching 9 cm. above the umbilicus, its 
longest axis being 23 cm. In left inguinal region is felt a hard, 
irregular mass, the size of a small hen egg. 
Operation.—Cystectomy. Hystero-myo-salpingo-oophorectomy. 
The cyst was thin-walled, filled with bloody fluid ; it was devel- 
oped from the outer pole of the right ovary and was entirely retro- 5 
peritoneal. The uterus was myomatous, and there were many 
adhesions, especially about the cyst. 
Pathological Report.—Multilocular cyst of right ovary 16 cm. in 
diameter, springing from the upper pole ; the cyst wall is 1 mm. 
thick, the fluid is dark reddish-chocolate colored. Myomata uteri. 
Examination.—Abdomen is much distended in its lower half, and 
a large mass of irregular outline can be palpated ; to the right it feels 
elastic ;to the left hard. The upper border of the mass reaches in 
the right parasternal line to within 11 cm. of the costal margin. 
Transversely it measures 29 cm. 
(3) I.—Color, black. 
On the right side a multi! ocular ovarian cyst posterior to the uterus, 
filling the cul-de-sac and rising above the pelvic brim, with its 
walls intimately adherent to the intestines. Myomatous uterus, 
size of foetal head. 
Operation.—Cystectomy. Hystero-myo-salpingo-oophorectomy. 
Pathological Report.—Ovarian cyst (either multi- or unilocular, 
probably the latter) ; fluid is clear, limpid and yellowish. Myomata 
uteri. 
Examination.—Abdomen is irregularly distended. On palpation 
a mass, divisible into two separate masses, can be made out, one 
occupying the lower portion of the abdomen, with irregular outline 
and nodular surface, the other reaching as high as the costal mar- 
gin on the left, measuring 9xl2}£ cm. with smooth surface and elastic 
feel. 
(4) C.—Color, black. 
The cyst was punctured and the fluid withdrawn before the enu- 
cleation was started. 
Operation.—Hystero-myomectomy. Cystectomy. 
Pathological Report.—Left unilocular ovarian cyst, 7 cm. in diam- 
eter. 
Examination.—The body of the uterus is apparently of normal 
size and is pressed backwards by a large abdominal tumor, which 
is firm, elastic, tense, of smooth surface and gives a distinct wave 
of fluctuation. Corona of resonance is well marked. 
(5) F—Color, black. 
Operation.—Cystectomy (left). Eight salpingo oophorectomy. 
The cyst-wall was punctured, the fluid obtained therefrom being 
of a muddy brown color. The cyst sprang from the left ovary and 
was adherent to the omentum. The right tube and broad ligament 
were plastered over the surface of the cyst. Right salpingitis. The 
uterus contained a few myomatous nodules. 
Pathological Report.—Large multilocular cyst of left ovary, 19x18 
cm., containing 1800 c. cm. of dark brown fluid containing much 
albumen. 6 
(6) H.—Color, black. 
Pathological Report.—Bight multilocular ovarian cyst, 6 cm. in 
diameter, dense adhesions, cyst of left ovary 5 cm. in diameter, con- 
taining blood and debris. 
Thus it will be seen that, although these cysts are less 
common in the negro race, nevertheless they do sometimes 
occur, and reach as large a size in some cases as the corres- 
ponding cysts in the white race, and thus the possibility of their 
being present should always be seriously considered when the 
physical examination points in that direction. 
(.d) Papillary cysts. No case of this kind was found in the 
negress in the cases analyzed. 
(e) Parovarian cysts. Of the 24 parovarian cysts, only 1 
was in the negress, showing the extreme rarity of this variety 
of cyst in this race. 
(1) A.—Pathological Report. Right parovarian cyst. Myoma 
uteri. Left salpingitis. 
Thus, of the 344 cases of ovarian and parovarian cysts, but 
20 were in the colored race, i. e. the proportion is 1:11.2, 
showing that the relative frequency of these cysts is 1.66 times 
as great in the white as in the colored race. 
If we exclude the parovarian cysts, of the remaining 230 true 
ovarian cysts 19 were in the negress, a proportion of 1 ; 10.6, 
i. e. the relative frequency is 1.57 times as great in the white 
as in the colored race. 
If we exclude the dermoid cysts, cysts which owe their origin 
to some defect in embryonic development, of the remaining 188 
ovarian cysts (corpus luteum, Graafian follicle, multilocular, 
unilocular and papillary cysts), but 13 were in the colored, i. e. 
a proportion of 1 : 13.4, showing that these cysts are relatively 
exactly twice as frequent in white women as in colored. 
Perhaps the thing that strikes one most in studying these 
cases is the extreme frequency with which the ovarian cysts in 
the colored are associated with other pathological conditions, 
especially with a myomatous condition of the uterus. 
In 10 of the 20 cases reported, uterine myomata were also 
found. These were distributed as follows: In 3of .the 6 
cases of dermoid cysts; 2of the 7 cases of Graafian follicle and 7 
corpus luteum cysts; 4 of the 6 cases of unilocular and multi- 
locular cysts; and in the 1 case of parovarian cyst reported. 
In 3 of the 20 cases salpingitis, perisalpingitis or pyosalpinx 
was reported, i. e. evidences of inflammatory trouble, dis- 
tributed as follows: In 2of the 7 cases of corpus luteum and 
Graafian follicle cysts, and in the 1 case of parovarian cyst. 
Thus, to summarize our results, while the simple retention 
cysts and the unilocular and multilocular ovarian cysts are 
seen relatively much less frequently in the negress than in the 
white woman, they are present relatively much more frequently 
than is universally supposed; while from both a clinical and 
pathological study the dermoid ovarian cyst seems to be rela- 
tively more frequent in the negro race.