For the elucidation of the important question of the possibility of the entrance of fluid into the tubes, Hourmann performed certain experiments on the cadaver which Klemm repeated under Hennig's guidance. It appeared, 1, that if a tube is thoroughly wedged into the cervix uteri, and if with more force than is necessary for the washing out of the organ a large volume of fluid is injected, a portion of it will in many cases pene trate through the tube into the abdominal cavity while another portion will enter the uterine body through the vessels ; 2, if a more moderate force be used the fluid will very seldom penetrate further than a line into the uterine ends of the tubes, more often going into the vessels; 3, if we inject gently through a tube which does not entirely fill the cervical canal, fluid will enter neither the tubes nor the uterine vessels.
These experiments show us proximately the manner in which injury is done, namely by fluid entering the tubes. The opinions as to the ease or difficulty of penetration of fluids injected into the uterus are even to day so divided that a large number of gynecologists will only permit the injection of the uterus after dilatation of the cervix, indeed they regard this danger as so great that they look upon failure to previously dilate the cervix as an error of technique.
In this division of opinion it seems proper for us to relate our own experience with intrauterine injections.
We were accustomed to inject the non-puerperal uterus usually with out dilatation of the cervix, in many hundred cases of obstinately bleed ing mucous membranes; we do it here and there in suitable cases to-day; and we have never noticed penetration of fluid into the tubes or any other dangerous occurrence. The reason for the safety when Braun's syringe is used, comes from the fact that it is held firmly, so that only the walls of the organ can be brought into contact with the trickling fluid, and usually only from one to five drops are necessary. Under careful snper vision we even permit physicians to give these injections to dispensary patients.
One important precaution with these injections, as with every medical intrauterine application, is to watch the contraction of the organ while it is being done. Strange to say we do not know that any one has empha sized the importance of this precaution; and yet a careful observation of it will give assurance to the whole procedure. Many a bleeding uterus grasps the tube of the syringe, as soon as the first drop of the solution of the chloride of iron is thrown in, so that it can only be moved by the exertion of considerable force. In another case it may take five or ten drops to produce the same effect. If the procedure has caused a power ful contraction we have done all the good that we can by injecting; every extra drop only does harm, for the body of the uterus firmly grasps the tube of the syringe. The resistance of the lower parts of the uterus may during contraction be greater than that of the uterine openings of the tubes, and thus the fluid is forced into them and most serious accidents are caused.
The most important congenital anomalies of the tube are mentioned under the subject of the faulty development of the uterus.
Abnormalities of Length.—F. Winckel found in 500 female bodies, three pairs of exceptionally long tubes, four and a half to five inches, while in twenty-five cases they were of unequal length.
Abnormalities of the Ostia of the Tubes.—Blob has called attention to the very varying form of the ends of the tubes. Occasionally we find on the inner wall of the outer third of the tube, small hernial dilatations. These occur from the mucous membrane insinuating itself between two separate muscular layers of the organ. Very often these little hernia] have a slit at their apex, and thus form supplementary openings of the tube. Rokitansky and Blob believe that these dilatations can occur from diseases of the tubes, such as a chronic catarrh.
It happens in some cases that in a single tube, a second and even a third fully developed and fimbriated ostium is present. (The accessory tubal mouths of Rokitansky.) In 500 female bodies F. Winckel found accessory tubal ostia twice. Hennig in 100 female subjects found an ac cessory tube three times.
All these abnorrnaiities are of developmental rather than practical in terest. It has not been proved that they have-any influence either on conception or upon the course of an extra-uterine pregnancy.
These are partly congenital and partly acquired.
Congenital abnormalities of position are due to faulty development of the uterus, or congenital or false position of that organ or of the ovaries.
In these cases the tubes are often placed more perpendicularly, and in certain abnormal developments of the uterus we find them displaced to wards the pelvic wall. Often in consequence the peritoneal duplication is shortened.
At times we find the ovaries changing their position as the testicles do, approaching the internal inguinal ring, and even reaching the labia, when there exists a processus vaginalis peritonei. In this way congenital ovarian tubal inguinal hernias are caused, which under certain circum stances may drag the uterus also after them. (glob.) In the Berlin Obstetrical and Gynecological Society, Lomer described the genitals of a well-developed girl of twenty-one years of age, in which the left ovary and left tube had passed into a peritoneal pouch.
The acquired Anomalies of Position. --These must accompany all mal positions of the uterus and ovaries. During life we often find them in Douglas's cul-de-sac.
Most commonly they are felt during life in cases of retroflexion and version, with a moderately enlarged and descended uterus; it is less easy to appreciate the tubes in other positions and axial changes of the uterus. In cases of hydrops tube, or when the tube is in any other way increased, it is frequently dislocated into Douglas's pouch. Even a pediculated or non-pediculated hydatid oan separate the fimbriated end from the ovary.
Important changes of position must occur in the tubes when there is prolapse and inversion of the uterus. In the latter case, when the inver sion is of long standing, their lumen becomes contracted here and there, as Wilde has proved in a case of extirpated uterus.