Or lastly, the menstrual fluid may collect in the tube after the manner of the blood in the case just described, where both the ori fices of the tube are obstructed. Of such accumulations I have met with many ex amples ; and it is interesting to observe that here, as under many like circumstances, the walls of the tube usually become hypertro phied in proportion to the degree of pressure caused by the accumulations of fluid which they are called upon to resist.
These collections of menstrual fluid within the tube, which I have found to be consider able in some instances, where I have ascer tained beyond question that death had taken place during a menstrual period, are instruc tive, as showing, upon strong probable evi dence, that the menstrual fluid is supplied in part by the walls of the Fallopian tube as well as by those of the uterus itself. For I have seen it in cases where both orifices of the tube were obstructed ; and therefore in cases where it was not probable that the fluid could have regurgitated from the uterus into the tube.
Collections of serous fluiel. Hydrops tubee Hydrosalpinx.—In catarrhal inflammation of the mncous lining of the tube, whether oc curring in the acute or chronic form, the fluid, secreted more abundantly than in a state of health, may find vent by either or both of the tubal orifices, so long as these re main pervious.
It is probable that in this affection the superabundant fluid flows generally by the lower orifice into the uterus, and so escapes per vaginam, constituting one of the numer ous forms of "leucorrhcea." But if both ex tremities of the tube are closed, then, as in the case of hmmorrhage or menstruation oc curring under like circumstances, the fluid collects within the tube and mechanically distends its walls.
The pressure producing this distension, when operating in only a slight degree, causes a nearly equable enlargement of the tube, so that its natural conical shape is still preserved. But as the quantity of fluid increases, the thin ner and less resisting portions of the walls, which lie towards the distal extremity, give way more rapidly than those at the proximal end; and the tube, after becoming irregularly tortuous, is at length converted into a series of sacculi, the largest of which, usually- of a pyriform shape, occupies the extremity of the tube (fig. 422. d).
From the irregularity with which different portions of the tube walls dilate under the pressure of the accumulated fluid, it often happens that several angles are formed by the sudden bending of the parietes, and at these points the tube walls, extending innards, con stitute so many valvular projections which partition the tube into several irregular cham bers, communicating together by narrow ori fices. Such a condition of parts may be
frequently observed upon both sides of the body, as in fig. 422., where both tubes are affected in the same manner although in un equal degrees.
When these dilatations have attained to any considerable size the condition of the lining membrane of the tube becomes altered, so that the mucous gradually acquires the cha racter of a serous surface, and the fluids collected within these sacculi present the ordinary condition of the fluids of serous dropsies.
The more simple of these fluids are thin, serous, and nearly colourless, and may be more or less albuminous. Not infrequently, however, they contain flocculi, or are thick ened by- the admixture of various yellow, brown, or chocolate coloured denser fluids, consisting chiefly of pus and disintegrated blood, The quantity of fluid does not commonly exceed a few drachms, and in ordinary ex perience six or eight ounces would be a rather large accumulation. Yet it is certain that sometimes a much more considerable collec tion has been observed.
Thus in " Bonnet's Sepulchreturn Anato micum*," a ca.se is given in which one of the tubes held thirteen pounds of fluid ; and De Haent mentions an instance in which the hypertrophied tube weighed seven pounds, while the quantity of fluid contained in it amounted to thirty-two pints.
Other cases, of more or less authority, have been recorded, in which the collection of fluid has been estimated at 112, 140 and 150 lbs. But it is exceedingly doubtful if the tube walls are capable of dilating to the extent that would be necessary to support so large an amount of fluid without laceration. For it is very well known that in tubal pregnancy rupture of the tube almost always occurs before the middle period of gestation is reached ; and even in those cases where the reports are founded upon post-mortem ex_ amination it is very possible that a part of the fluid was contained in the ovary, for a concomitant enlargement of both tube and ovary is a very common occurrence, as in the case represented in fig. 422.; and on this account no record of any very considerable dropsy of the Fallopian tube should be con sidered as complete, unless the condition of the corresponding ovary is also mentioned.