DISEASES OF THE TUBES AND EXTRA-UTERINE PREGNANCY.
At the eighth week of embryonic life those parts of the ducts of Miiller which form the uterus and vagina coalesce, whilst the upper part out of which the tubes are formed remains separated. Thus the tubes are composed of tissue similar to that of the uterus. At puberty they are from 3-1 to n inches in length. Their outer covering is the peritoneum; under this is the thicker tubal layer, the muscularis, which is separated from the peritoneum by a delicate layer of subserous connective tissue. We can distinguish an outer layer of longitudinal fibres and an inner of thicker transverse fibres, both of which connect with corresponding layers of uterine muscle. Under the mus cularis is the submucous layer, composed of wide-meshed tissue which is in contact with the inner wall of the tube. The latter is a movable folded mucosa, provided with ciliated cells, and is continuous with the peritoneum at the fimbriated extremity. The well•developed eilim generate a stream from the ostium abdominale towards the ostium uterinum, and will assist the transit of the ovum rather than that of the spermatozoa.
Here we will mention that Lawson Tait says that the tubes play a more important part in menstruation than the ovaries. He was led to this conclusion by the fact that the menopause was brought about when only the tubes were extirpated, and also because during ovariotomy at the time of menstruation he found no swollen follicles in the healthy ovary, which he did find during the interval. Sanger thinks that very likely this opinion of Lawson Tait is further fortified by the fact that tumors of the tube frequently cause a prolonged cessation of the menses.
The mucosa lies in numerous longitudinal folds that run parallel with one another and encroach on the lumen of the tube. Hennig says that there are from three to five large folds and about twice as many smaller ones. The tubal mucus usually forms a thin grayish covering of the sur face.
Hennig describes and figures tubal glands, which are probably the same that Bowman saw. Biker could not prove the existence of the
glands, and Luschka, Henle and Blob considered them to be simply folds of the mucous membrane.
The muscularis of the tube is thicker at the inner than at the outer half, and forms a sphincter tub at the uterine opening. The folds in the mucosa are most marked in the outer half of the tube (ampulla of Henle) and gradually diminish towards the uterine end, so that in the in terstitial part they can no longer be recognized with the naked eye. The tubal end terminates in from four to five larger and eight to ten smaller fimbrite, one of which (fimbria ovarica, Henle) usually extends to the vicinity of the ovary. The fimbria3 are so thin and delicate that they readily contract adhesions with neighboring organs and with one another; they are so commonly found post-mortem that we must conclude that adhesions often occur during life without any special disease. It, is easy to understand why the tubes so often participate in diseases of the uterus and ovaries since their physiological and histological relationship is so close.
An especially favorable opportunity is given for the extension of catarrhal processes from the uterus, and these then easily cause the above mentioned adhesions between the fimbrise and the folds of mucous mem brane, forming the commonest cause of the most frequent disease of the tubes, hydrops tubas.
Even to-day there is no doubt that the pathological anatomy of dis eases of the Fallopian tubes has far exceeded our clinical insight. We find post-mortem anomalies and catarrhs of the tube with a varying amount of mucus, nay even strictures and malformations and even tumors of the existence of which we had no suspicion during life; yet the influence of which on the woman's health and fecundity must have been unmistakable.
In more than half the uteri of female bodies, according to Hennig in three fourths of the cases, according to Winckel 205 times in 500 cases, we find morbid changes and signs of catarrh in the tubes.