Secondary disease of the tubes occurs most frequently from gonorrhoeal infection, and from puerperal diseases. Acute inflammations of the uterus and pelvis, acute exanthemata, typhus, cholera, tumors of the ovaries and of the uterus are causes. As regards age it is found during the child-bearing period. Thus Hennig found it: In otherwise healthy women tubal catarrh may often be cured; but not so when it occurs in those having heart lesions, tuberculosis, chlorosis, scrofulosis, kidney disease or amyloid disease. Here the acute catarrh soon assumes a chronic form, which continues until the women die of their other troubles. Hence it is that we so commonly find chronic tubal catarrh and its consequences in the bodies of women who die after the menopause.
Symptoms and is impossible to present a clear picture of tubal catarrh, since disease of the vagina, the uterus, and its neigh borhood, usually accompany it. If prostitutes have frequent attacks of violent colicky pain, bilateral colicky pain, and increasing at menstrua tion, and if we find no explanation for their occurrence in the uterus or ovaries, wo may suspect the existence of tubal catarrh.
In Noeggerath's case, where the catarrh was probably caused by gon orrliceal virus, the twenty-six year old woman fell sick shortly after marriage. The severest pain was in the left lower abdominal region, and
always increased during her scanty menstruation; at the same time the woman had occipital and infra-mammary neuralgia.
It is easy to understand that the catarrhal process should have an un favorable influence upon the life of the zoa-sperm and the progress of the ovum; and we can suspect tubal catarrh though we can not demonstrate it in cases where we find no other cause for sterility.
Since the symptoms are only probably those of tubal catarrh, it has always seemed to us to be hazardous to diagnose the malady positively.
Noeggerath diagnosticatod pelvic peritonitis from catarrh of the left tube in his case. The long-continued suffering caused Noeggerath to make an examination as above described, and he discovered the left tube swollen to the size of a goose-quill. Since he found swelling and soften ing of the left ovary at the same time, it is by no means certain that the symptoms were caused by the tubal catarrh alone. Among the conse quences of tubal catarrh, we must first mention hydrops tulme, and since peculiar symptoms are caused by it in life, we will treat it separately.