The autopsy showed general peritonitis with sero-purulent exudation, with slight adhesions of the intestinal coils, which were also bound to the left groin. After these adhesions had been separated, a deep-seated tumor was found on the left side of the uterus in the neighborhood of the rectum. On the inner side of the rectum was found a perforation the size of a quill, which communicated with the described tumor, on press ing which pus could be forced into the rectum. This perforation was at a level with the brim of the pelvis near the sacroiliac symphysis. The tumor was soft, shrivelled, and no opening could be found excepting the one communicating with the rectum; it occupied about a quarter of the true pelvis, to the left side and behind the rectum, which it displaced upwards and to the right. On close examination it could be seen that this swelling was formed from the left tube, part of which lay against the left side of the uterus, and could easily be traced; an inch outwards it could not be traced On opening the tumor, that part of the tube situated next to the uterus was found expanded into a sac, beyond which the tube could not be followed. Behind this large pus-centre a second tumor was situated about the size of a walnut, which was the ovary that was also found to contain pus, although it was not connected with the sur roundings. The left side gave the appearance of generally altered rela tions; also here the outer end of the tube was expanded and contained a small amount of pus. The ovary was markedly diseased, forming a tumor about the size of a hen's egg. Furthermore, the rectum was found constricted at two places with follicular ulceration of the gut.
In favorable cases a pus-containing tube forms adhesions with the abdominal wall or vagina, through which it perforates externally.
In a more favorable case the pus is easily absorbed, or undergoes fatty, calcareous or cheesy degeneration, in which case the tube is partially or totally obliterated (Blob.) Rarely is a healthy Fallopian tube contained in the wall of a peri Uterine abscess. Koberle described in the Strasburg Medical Society one of these rare occurrences. The patient, a woman aged sixty, for twen ty years had had symptoms of pus formation in the pelvis. Every two or three weeks occurred the discharge of a large amount of pus through the vagina, which lasted for two or three days. On the posterior surface of the uterus there was a cyst about the size of a child's head, in which was incorporated the left ovary and tube, with its plainly seen fimbrite. From time to time during life the collected pus discharged through the tube.
On the Possibility of Sounding the Tubes.—In hydrops tubte are collec tions of pus in the tube, and it is natural to think of probing and catheterizing the Fallopian tube. The idea occurred to Dr. Tuchman, of London, of the possibility of finding the mouths of the ureters in men, and to Simon the possibility of sounding and catheterizing the ureters from the bladder, and Dr. Pawlik has described the sounding of the same in women without dilatation of the urethra. Tyler Smith (1849) claimed
that he had many times successfully sounded and catheterized the Fallo pian tube for sterility. At the same time Robert Froriep (1850) proposed to bring about closure of the Fallopian tubes by passing a sound into the uterus with its point armed with caustic, and by this means, in women with markedly contracted pelvis, to bring about organic closure of the tubes, and to cause sterility so as to obviate the necessity of performing Caesarean section. For this purpose Froriep has devised a special instru ment—a hollow Uterine sound through which a whalebone bougie can be passed. The hollow sound is to be passed to the fundus of the uterus, and then should be so turned that its opening lies against the uterine opening of the tube; through it is then passed the whalebone bougie, which is to find its way through the intrauterine portion of the tube.
When we undertake to sound a diseased tube, we must take into con sideration the fact that in the cadaver, under normal conditions, the tubes of married or unmarried women cannot be sounded by large or small sounds, as has been proved by Albers, Hennig, Wegner, and my self. Also during life, with wide uterine cavities, the dilatation may give rise to the idea that possibly the situation of the tubes, which has never occurred to me, may be found and the sound passed. We must always take into consideration the fact that the sound can be passed through the uterine substance near the opening of the tube. This easily happens when the uterus is still in the condition of puerperal involution, as was observed by Rabl-Ruckhard and .Lehmus, that on the thirty-fourth day after delivery it is easy to pass a sound through the uterine wall into the abdominal cavity, and Wegner demonstrated by necropsy the presence of perforation of the muscularis of a dilated and partly fatty uterus. In the same manner the sound was easily passed through the uterus in four other cases. Honig describes perforation of the uterus, and Alt two cases where the sound was passed from six to seven inches into the uterus of a recently delivered woman, causing perforation; Tait also described such cases in the Lancet of 1872-3. Perforation of the uterus with the sound can very easily occur in extra- uterine pregnancy, a case of which we have ourselves observed and described. In this case by very light pressure the sound was passed nine inches, perforated the uterus and produced the impression that the tube had been sounded; but the necropsy showed a perforation close to the uterine opening of the right tube. It is in teresting to notice that in almost all described perforations of the uterus reaction did not occur. It was so in four cases of Rabl-Riickhard and Lehmus, in three cases of L. Tait's, in our own, and also by Zini, who could in seven cases in the first six weeks after involution pass his sound eight inches into the uterus, and often felt the knob of the sound through the abdomen to one side of the median line without reaction.