From these various observations it is doubtful whether a tube has been sounded, and it is certain that the greatest care is necessary in such an undertaking.
In opposition are the following observations, where it is claimed that during life one or the other tube was sounded: Duncan, Veit, Hilde brandt and others believe in the possibility of passing a sound into the uterus and tube, and under certain abnormal circumstances they are more or less sustained by pathological conditions, Bischoff having described and proved by necropsy a case where in life without doubt a tube was sounded. Following is a short description of the case: In a woman aet. sixty-five, suffering from ovarian tumor, a sound was passed with little force 64, inches into the uterus without the occurrence of reaction; the point could not be felt through the abdominal wall. The ovarian tumor disappeared and seven days later the woman died. At the necropsy it was found that the uterus was pushed very much to the right and bent. The highest point was at the left tube. The uterine cavity measured inches and the thick walls gave no signs of injury. In the fundus was found a pigeon-egg sized interstitial fibroma. The uterine opening of the left tube was funnel-shaped, with the point outwards; the tube itself was so patent that there was sufficient room for more than one sound. The sounding of the tube on the cadaver in this case was very easy; as the uterus was so far bent to the right that the dilated left tube extended directly upwards, so that the uterine opening could not have been missed. But from pathological reasons the sounding of the tubes is surrounded by numerous difficulties. Frankenhituser unsuccessfully attempted to sound the diseased tube in cases of hydrops tubas profluens after pressing out the fluid.
On account of the possibility of easily perforating the uterus we hold that it is not rational to attempt sounding the tubes.
Treatment.—Frankenhauser has often successfully pressed out the secretion of tubal sacs, and we also have observed, in women who suffer from severe uterine colic and similar signs that accompany obscure tumors next to the uterus, that after thorough bi-manual examination large masses of secretion were discharged, upon which the pains always ceased. Such undertakings should only be resorted to when there is no danger of bursting the tubes.
Friction of the abdomen with different anodyne medicines—chloro form with oil to which morphine has been added, warmed before use—is often of service; it appears that by friction of the uterus and diseased tubes the collected secretion is dissipated. Poultices are often of service.
Puncture of Tumors of the Tube.—Simpson claims to have cured many cases by puncture provided they can be reached from the vagina or abdominal wall, are not large and are movable. Care must be taken not to perforate the intestine, which is apt to lie in the way.
If the tube-sacs are adherent to the abdominal wall or rectum it is often impossible to differentiate them from other tumors; but their treat ment is similar, for both a small ovarian cyst and hydrops tube that can be reached from the vagina are treated in about the same manner. The
character of the tumors is determined by their fluctuation, percussion note and principally by their situation, also by passing a medium-sized trocar into them from the vagina. The contents spontaneously flows out through the trocar; if it is thick you can apply a closed syringe to the trocar and aspirate or use a modern aspirating apparatus. Satisfy your self that the tumor is entirely emptied and it will not always refill. We have seen small fluid-containing tumors remain unfilled for many years after puncture through the vagina; of coarse we were not positive that these were only the tubes. If the tumor refills at the second tapping, the cane la of the trocar can be left in for several days, until thick pus discharges from the wall of the tumor. In case of decomposition of the secretion it is necessary to irrigate with antiseptics. By these means we have seen many women cured of pelvic tumors without knowing whether they belonged to the tubes. In larger tumors, especially when they con tain pus, a larger trocar can be used so that the secretion can be washed out through a double catheter; or where we are positive that the tumor is entirely shut off from the peritoneal cavity a free incision can be made into it, and drainage and washing out with a sublimate solution 1 to 2000 'from the vagina, may be resorted to. Tapping of smaller tumors through the abdominal wall is seldom possible, and puncture from the rectum we consider dangerous. Frankenhauser, in a case of hydrops tuba; profluens, after it was impossible to press any more fluid out of the tumor and after he had attempted to pass a sound into the tube, found it necessary to tap three times in quick succession; the sac continued to fill and hectic fever appeared. At the last puncture a trocar of an inch in thickness was used, a double current' catheter was passed into the tumor, and allowed to remain for seventeen days, through which he often injected a weak solution of permanganate of potash. After removal of the catheter the opening would at times close and the retained pus caused fever; but the pus always burrowed its way out, so that at the end of seven months after the first puncture the woman had entirely recovered. We have had no trouble after tapping cysts that could easily be reached from the vagina. It must be remembered that large cysts of the broad ligament usually develop downward from their starting-point and can be punctured with out fear. If the tumors are not easily reached and lie in the front part of the pelvis it is necessary to bear in mind the situation of the bladder. It can easily be injured with a trocar; twice we have seen the bladder emptied with an exploratory trocar, instead of a small ovarian tumor, but fortunately with no bad result. In both cases the punctures closed with out treatment and without damage to the women Before tapping from the vagina it is necessary to empty and thoroughly examine the bladder and its surroundings.