HYDROPS PROFLUENS.
If the ostium uterinum is open, and if behind it there is a fluid con taining tubal sac, and if from a mechanical impetus or from inflammation the amount of its contents are increased, the fluid will from time to time flow into the uterus and be evacuated. This phenomenon has been termed hydrops tuba' profluens.
One of the first reliable cases of fluid accumulation in the tube with periodical outflow is that of P. Frank. " After a sudden fall on the hypogastric region there appeared in a woman a considerable tumor at the place, together with stretching and tearing pains. Then there appeared with the menses a flow of clear watery fluid. Menstruation then ceased while the watery flow lasted daily for half a year, at least a pound being lost every day, until finally the patient died of exhaustion. The necropsy revealed thirty-one pounds of a watery fluid in the left tube." iwisch and Forster distrusted the older observations, though Roki tansky and Klob believed the process to be beyond dispute. Scanzoni described a case where a woman sixty years old died of cardiac disease in whom the right tube was swollen to the size of a goose egg with fluid, while the left was transformed into a sac the size of a chicken's egg, containing only a few drachms of a sanguinolent fluid, which was in open connection with the uterine cavity by means of a canal 1i inches in length and about inch in diameter. Klob found similar lesions often in elderly women, and is much inclined to consider those cases, in which menstruation re-occurs late in life after a long pause, to be instances of hydrops tubarum profluens sanguinolentus: as Heyfelder found in a seventy-eight year old nun in whom menstruation re-occurred after a year absence. Others have described similar cases. Very recently Hausammann has reported a case of hydrops tube profluens in Frankenhauser clinic, which, since it was observed and diagnosticated during life, we will refer to further on.
Not infrequently we find the enlarged abdominal end of a tube ending in the walls of a cavity of the ovary itself. This happens either because an ovarian cyst which had contracted adhesions to the tube had emptied into it, or because the pavilion of the tube had grown to the ovary where a riper Graafian follicle burst. The secretion of these cavities causes enlargement of the tube (Klob). Such tubo-ovarian cysts were first described by Ad. Richard and LabbO; first observed by Rokitansky and Klob; and first demonstrated by Hennig, Beaucamp and others; F.
Winkel found them twice in 500 female bodies.
If the uterine mouth remains open a periodic flow of secretion may take place, which Blasius (1834) described as hydrops ovarii proflnens; in Richard's case the inner third of the tube was dilated, and the secreted fluid flowed freely into the uterine cavity.
One of the first consequences of hydrosalpinx, since it is usually bilateral, is sterility; if the tubes are large they may rupture, and conse quently peritonitis is much to be feared. If there is a stasis of the nor mal or the catarrhal secretion of the tube, a moderate irritant or infec tion, especially at a menstrual epoch, may cause inflammation of the sac wall, and change of the mucous contents into pus. Hydrosalpinx may also end in pyosalpinx with all of its disastrous consequences.
Symptoms and swellings of the tube give no certain symptoms during life, and are usually accidentally found at post mortems. If larger or inflamed there are always symptoms which attract the physi cian's attention.
Hausammann's work, which is based upon five clinical cases, teaches us that menstruation is always irregular; there is amenorrhoea for months and then violent metrorrhagia. He is himself inclined to attribute this to laceration of the uterus, to oophoritis, to chronic metritis, or to chronic peritonitis, than to the tubal disease. Sanger confirms this observation as to cessation of the menses in tumors of the tubes. So also the pains have no such pathognomonic character as Th. Lee claims. According to him there is a deep beating pain in the hypogastric region and pubis, which radiates to the inguinal region and thighs. In the case which Frankenhauser described, the pains were seated principally over the pubis; in the second case, where hydrops tub profluens was diagnos ticated, the pains at first were entirely absent, and only later became severe, when they were similar to uterine expulsive pains, which was when the contents of the tumor began to increase rapidly in amount and to become purulent. Similar attacks of colic and lumbar pain were seen by Dessauer in a case in which the necropsy showed peritonitis and a per forated tube containing pus. If the tubal sacs are adherent to neighbor ing organs, great pressure symptoms, obstipation and dysuria will appear; if inflammation occurs fever will accompany it.