In the discussion of the secondary changes, the clinical history, and the treatment of cysts, the oöphoritic, paroöphoritic, and parovarian cysts will be considered together under the general heading of ovarian cysts. SECONDARY CHANGES OR ACCIDENTS OF OVARIAN CYSTS. There are various accidents which may happen to an ovarian cyst which have an important bearing on the clinical course of the disease. These accidents are: inflammation and suppuration; torsion of the pedicle; rupture of the cyst. =Inflammation and Suppuration.=--Inflammation of an ovarian cyst is of very common occurrence. It seems especially liable to happen in the small cysts of pelvic growth. Ovarian dermoids are very often inflamed. The inflammation may result in but a few peritoneal adhesions between the outer surface of the cyst and some of the contiguous structures, as a loop of intestine, the bladder, the anterior abdominal wall, the omentum, etc., or the whole cyst may be universally adherent, so that its removal is rendered most difficult, and in some cases impossible. The operator should always remember the possibility of these adhesions in removing an ovarian cyst. Its surface should be carefully examined as it is dragged slowly through the abdominal incision, in order that slight adhesions to delicate structures like the omentum and the vermiform appendix may not be recklessly or unknowingly torn. The sources of inflammatory infection of an ovarian cyst are the intestinal tract, the urinary bladder, and the Fallopian tube. Perhaps salpingitis is the most frequent cause of such inflammation. Infection often comes from the vermiform appendix, which is frequently found adherent to the surface of the tumor. Old adhesions usually contain blood-vessels, which may be of large size, especially if they arise from the intestine, the omentum, or the uterus. In some cases in which the tumor has become detached from the pedicle by rotation or traction the adhesions have been sufficiently vascular to maintain the vitality of the tumor. Suppuration of ovarian cysts is sometimes seen. It was more frequent in the period when these tumors were treated by tapping, as infection occurred in this way. Suppuration is most common in ovarian dermoids. The tumor may become adherent to surrounding structures, and may discharge its contents through the bladder, the vagina, the rectum, or the abdominal wall. A tooth thus discharged into the bladder from a suppurating dermoid has in several instances formed the nucleus of a vesical calculus. A suppurating ovarian cyst sometimes contains gas, either from communication with the intestine or from decomposition of its contents. In such a case the usual tumor-dulness is replaced by a tympanitic note.