In some of these cases, however, there ap pears to have been something more than a mere process of exudative inflammation at work. The parts upon examination appear to have become blended by a conzbined pro cess of absorption of the fimbrim, and at the same time of firm agglutination of the infun dibular base to the surface of the ovary ; so that it may be difficult to find any precise line of demarcation between these parts, except that which a difference of colour may furnish.
Hyperamia or congestion of the tissues of the tube is very commonly- observed. It is apparently a normal state during healthy menstruation, but may be regarded a_s morbid when associated at other times with deep congestion of the uterus and ovaries.
A state of hyperaemia of the tube has been found associated with effusion of blood into its canal, and the escape of a portion of this fluid into the abdomen through the infundi bular orifice.
Hypermmia of the tube occurs as a semi normal condition in cases of tuba! pregnancy.
Inflammatory lesions of the tube may- pre sent the characteristic conditions of acute or of chronic inflammation. The former is com monly seen in cases of puerperal metro-peri tonitis, %%here the inflammation attacking usually the utenzs first has extended to the ovaries and tubes. " The tubes are tumified and infiltrated ; their mucous membrane is variously reddened, discoloured, excoriated, softened and everted at the fimbriated ex tremity. The passage of the tube is dilated, especially at its outer end, and filled with various products, purulent and sanious fluids, and in uterine croup with coagulable lymph, assuming the shape of a tubular concretion, the exudative process having extended from the uterus to the tube."* But more commonly the traces of inflam mation are found in the peritoneal coat, which highly congested and covered by flakes of lymph, partakes in the general inflammatory condition of the adjacent serous surfaces.
In the non-puerperal state, or as a sequel of puerperal affections, inflammation usually takes the form of catarrh or blennorrhcea of the mucous membrane of the tube. The usual evidences of such an affection are, a certain amount of tumefaction of the mucous lining, with thickening of the delicate plicm covering it, and dark congestion of the capil lary vessels. Within the tubal canal are found collections of mucus variously coloured, being sometiznes viscid, or occasionally cream-like, yellow and purulent (fig. 421.).
The chronic inflammations of the serous coat of the tube, which result in various ad hesions of this part to surrounding structures, have been already' noticed.
Collections of fluid within the tube result from a combination of two or more of the foregoing conditions. These fluids consist of blood, menstrual fluid, mucus, serum, or pus, and sometimes or these in various states of ad mixture.
Collections of blood, or of a bloody fluid with in the tube. are occasioned by hypermmia of the tube are patent, the fluid may escape into the uterus, or possibly, by the infundibulum, into the cavity of the abdomen. Of such the tube-walls, whose over-distended ries relieve themselves by sanguineous sion. In such a case, if both the orifices of effusions there are many examples on record. Or should the abdominal end of the tube be closed in the manner already described, and should the uterine end also be temporarily obstructed, as, for example, by slight conges tion of the mucous lining at this point, then the blood, having no outlet, will continue to accumulate within the tube, and a distension of the parietes, more or less considerable, mill result.
But all collections of blood within the tube are not necessarily the result of hmmorrhage. The menstrual fluid has been frequenly ob served to have accumulated here. And these accumulations may occur under various cir cumstances. Thus, in the case of imperforate hymen, when the menstrual function has been established for some time, this fluid, after col lecting behind the obstructed orifice of the vagina, gradually collects in and distends the walls of the uterus, and ultimately mounts up into the Fallopian tubes, distending them also in the same manner as the uterus.
But atresia of the vagina or uterus, causing such accumulations, is not necessarily con genital, but may be consecutive on adhesive inflammation attacking these parts ; as in the instance of a woman, whose case is related in the American "Journal of 'Medical Sciences,"* and who, after her second confinement, had an attack of metritis, terminating in cohesion of the uterine walls and consequent occlusion of the cavity of the uterus. Behind this ob struction the menstrual fluid accumulated until the Fallopian tubes became so enor mously distended that at length one of them burst, and death resulted from the escape of the blood into the abdominal cavity'.