Similar infection may rarely occur from the escape into the peritoneum of the colloid contents of a ruptured glandular cyst. After such an accident the peritoneum has been found covered with tough gelatinous masses, of a gray or yellow color, which reached the size of a hickory-nut. This condition has been called _myxoma peritonæi_. Very rare cases of similar metastasis from rupture of dermoid cysts have been reported. In one case yellow nodules the size of a pea, containing light-colored hair, were found scattered upon the peritoneum. It is probable that when the walls of an ovarian cyst are very thin, slow transudation of the fluid into the peritoneum takes place. THE CLINICAL HISTORY OF OVARIAN CYSTS. The symptoms produced by ovarian cysts depend upon their size, their position, and the accidents that may arise. If the tumor be intra-peritoneal in its development, the woman’s attention is usually first directed to the pathological condition when the growth has attained sufficient size to extend above the pelvis. The time of the perception of the tumor depends upon the intelligence and powers of observation of the woman and the thickness of the abdominal wall. A cyst often attains a large size and reaches well up into the abdomen before the woman is aware of its existence. In the papillomatous cysts sometimes the first symptoms that attract the woman’s attention appear after the cyst has become perforated and the peritoneum has become invaded by the papillomata. Pain, except that due to pressure or inflammation or some other accident, is not at all characteristic of ovarian cysts. If the cyst be intra-ligamentous in development, or if it be wedged in the pelvis, the first symptoms of the disease appear at an earlier date. The intra-ligamentous tumors first separate the layers of the broad ligament; they push the uterus to one side, and press upon the bladder, ureters, and rectum. The disposition of the peritoneum may be altered in a variety of ways by these growths. They may grow altogether behind this membrane, becoming retro-peritoneal, coming into immediate relationship with the rectum; or they may pass behind the cecum and the ascending colon, growing between the layers of the mesocolon. They sometimes develop more especially under the anterior layer of the broad ligament, strip off the peritoneal covering of the bladder, and come into immediate relationship with the anterior abdominal wall; so that if laparotomy is performed, the operator will enter the cavity of the cyst before he has opened the general peritoneum. It is of the greatest importance that the surgeon should be familiar with such unusual ways of development of these tumors, as the operative difficulties that are encountered are most embarrassing.