HYDROPS TULE, IIYDROSALPINX.
Catarrh and inflammation of the tubes themselves, as also a partial peritonitis of their ostia, may cause closure of the abdominal ends of the tubes, adhesions to surrounding objects, and stricture and closure of the ostium internum.
A total or partial closure of a tube hinders the flow of secretion, which normally only trickles into the uterus or peritoneal cavity in very small quantity; the histological composition of the inner surface and its secre • tion becomes pathological. If the ostia now become closed, there occur the above-mentioned sacculated swelling of the tubes, which have the most varied contents.
This is sometimes similar to the serum of blood, or it may be .a more or less thick bloody or purulent mucus. Often the fimbriEe enter the lumen of the tube, and grow to one another by their peritoneal surfaces, so that each fimbria is projected forward by the pressure of secretion, and the end of the tube assumes a peculiar roseleaf-like appearance. (Schroder.) Often the hydrops begins as a hemorrhage, as in hEematometra and hEemotocolpos. We then find within the sac the remains of the blood.
Hydrops tubas can reach a considerable size. Rokitansky, Klob, Froriep and others have seen it the size of a child's head; Bonnet found thirteen pounds of fluid in the left tube, and Peaslee of New York described a case in which the abdominal tumor was punctured three times as a cystovarium. Necropsy showed a right ovarian cyst, while the left tube was transformed into a sac containing thirty-three ounces of a thin fluid. The uterine mouth of the diseased tube was closed. These large tubal sacs, however, when they are not tubo-ovarian cysts, are very rare; they are usually sausage-shaped swellings with two or throe constrictions two to four inches long, one to three inches wide.
The older cases were probably ovarian cysts, which were adherent to a lengthened tube. Thus Harder found in one 140 pounds, Merklin 40 measures, Cyprianus 150 pounds, van Swieten 112 pounds of fluid The shape of the smaller tumor is usually club-shaped, with its point turned toward the uterus; sometimes it is large at its beginning, but it is almost always divided by a furrow a finger's breadth from the uterus; sometimes a pigeon's-egg-sized swelling is situated at the end of the tube.
Dropsy of the tube is frequently bilateral. The cysts are often sunken behind the ovaries in the cavum recto-uterinum; only seldom do we see the larger tumors of the tube situated at the brim of the pelvis. Pseudo membranes are almost always attached to them from all parts of the pelvic peritoneum, and give them the most varied position and shape.
If both mouths are open but strictnred, there can probably be but a small accumulation of secretion; yet absolute closure of the ostia is not necessary for the formation of hydrops tubie.
Froriep, therefore, distinguishes two forms of tubal hydropsy, the hydrops fallopii, occluscs, where both ostia are closed, and hydrops apertce, where the ostium uterinum is open.
The naturally narrow ostium uterinum has its lumen further en croached upon by the swelling of the mucous membrane, which thus hinders the free outflow of the secretion.