FIG. I.—TURAL CATARRH WITH ROSARY FORM or THE TUBE AND PERISALPLNGITIC REMNANTS (Reit:mann.) tions. Ilennig says that the microscope shows the epithelium enlarged and filled with particles of fat. Transparent drops go from the base of the ciliated cylindrical cells to the free surface, and there are arranged in mosaic-like figures; in the spaces between are the remains of the broad cells of the reddish shimmering mucus, which to the naked eye appears yellowish or greenish white.
This thin mucus is not alkaline like norma, tuoa. mucus, but is neu tral or acid. It consists in a small part of mucin, but mostly of an al buminous mucoid matter, which Ilennig has called hyalin.
There are usually also adhesions of the mucous membrane and of the fimbrife to each other or to the ovary; and in consequence of the ever present peri-salpingitis, the tubes are bent, drawn out of place and sealed to various places on the uterus, Douglas's pouch, the intestines or even to one another. The outer half of the tube is usually most affected, and the delicate and movable abdominal extremity is often closed. This hap pens less commonly at the ostium uterinum, though it is often swollen and constricted.
The chronic catarrh almost always proceeds from the acute, since the conditions in the tube are most unfavorable for the healing of a catarrhal process. Acute exacerbations occur from insignificant injuries. Both tubes are usually affected in chronic catarrh, the abdominal and some times the uterine end being closed. F. Winckel, in 205 cases of tubal disease, found atresia of the tubes 38 times, tumors of the tube with a larger or smaller collection of secretion, 28 times, and adhesions to sur rounding parts 93 times; one tube being affected in 47 cases and both in 46 cases. Albers found the ostium abdominale closed in 35 cases, and the ostium uterinum only in 9 cases. In consequence of the closure of the ostia, and the subsequent accumulation of mucus, the tubes are length ened, swollen and sacculated in several places; hence the tubes acquire rose-wreath forms, which Rokitansky calls hydrops tubm saccatus. The
mucous membrane is thickened, or may be thinned if there is much fluid; according to Hennig, there is increase of the little folds and often poly poid growths. The color is reddish or bluish, the small veins are often injected, while the tubal mucus often contains the remains of hemor rhages. This mucus is abundant and of varying color and consistency; a moderate pressure will cause it to flow into the abdominal cavity. Hen nig, to whom we owe the more minute study of tubal catarrh, found indican present. It reacts alkaline or acid, that is on both red and blue litmus paper. The microscopic components are non-ciliated epithelial cells, changed in old cases to pavement and spindle cells, sometimes abundant blood corpuscles and fatty granular cells.
In more advanced cases the deeper layers of the tube are changed. The mnscularis is thinned or absent, the peritoneal coat shows cloudy places, and the swollen tubes are sealed or united to neighboring parts.
El iology.—Catarrh of the tube is seldom primary. From increased physiological activity the uterus and the adnexa are more disposed to disease. Thus we see that a menstruating or puerperal woman is espec Tally susceptible to injury. Intercourse, drink, exercise, chilling of the ab domen and feet while menstruating, cause catarrh of the tubes. Do we not see during that time other congestions and inflammations of the uterus and vicinity arise ? I refer to parametritis and hcematocele. Hennig found one case due to acute phosphorous poisoning. Gravidity in one tube causes catarrh of both (Siwisch) or of the other tube (Kussmaul.) It would be hard to believe that traumatisms would cause tubal catarrh and subsequent hydrops (P. Frank); but it is easily comprehensible how irritant medibines injected into the uterine cavity may cause catarrhal in flammation of the tubes.