NEW GROWTHS OF THE TUBES.
Connective rare cases the tubes are the seat of fibroid or fibro-muscular tumors, which in structure resemble the same varieties of tumors that often appear in the uterus. Rokitansky describes them as the size of peas or beans; glob saw such tumors projecting from the outer surface of the tubes, or they were pediculated; Simpson described a fibroma of the tube the size of a child's head.
In chronic catarrh are occasionally found on the inner surface warts and panillomata. Ilennig found in 200 cadavers two small polypi of the Fallopian tube. By proliferation and thickening, the flmbrire often form small tumors of the connective tissue, which are of the consistency of cartilage, and at the same places also are often found on the peritoneum covering of the tubes fringe-like projections that form the groundwork for small cysts.
In rare instances lipomas from the size of a bean to a walnut, develop in the outer third of the tube.
separates them into outer and inner. The outer are the more numerous. Hennig found them in 115 cadavers, and, after their discoverer, they were called Morgagni's hydatids. They are the remains of the upper ends of MUller's ducts, and usually develop into pea-sized cysts with thin pedicles one half to an inch long. glob saw one seven and a half inches long, extending from the anterior surface. In rare in stances these formations develop to the size of a walnut, in which case they may separate the opening of the tube from the ovary, and so prevent fecundation. Furthermore, in advanced age cysts, from the size of a to a pea, develop on the broad ligaments or Fallopian tubes and contain a colloid fluid; on the fimbriated ends they often take the form of smaller stationary cysts.
The inner cysts are as follows: They are usually flat, a line in diame ter, formed in rows on the inner surface of the funnel-shaped extremity of the tube; in rare instances they also extend to the inner third of the tube. The diseased and dilated parts of the Fallopian tubes appear as sago-like bodies, at the top of which often is seen a dark spot, which was very likely a follicle of the mucous membrane. Also larger cysts are found in this neighborhood. Kiwisch found cysts from the size of a pea to a walnut under the mucous membrane.
of the tubes often follows tuberculosis of the genitals, but as frequently developes simultaneously with the latter; it may develop at any age, rarely before puberty, is most common during menstrual life, and often developes during the puerperal state. In most instances both tubes are affected at the same time. In many instances tuberculosis of the tubes developes secondarily to tuberculosis of other organs, the lungs, rectum and peritoneum. Rokitansky and Kiwisch, in forty deaths from tuberculosis, found one with tuberculosis of the uterus; F. Winckel found tubal and genital tuberculosis in 1 per cent. of necrop sies.
When the uterus and tubes are simultaneously affected,, the latter is more markedly diseased, and many authors, Blob, Foster, Wernich and others, believe that probably the tubes are the prime centre of the disease.
The disease begins in the mucous membrane of the abdominal extremities of the tubes, and extends along the organ towards the uterus.
The appearances of the mucous membrane at the beginning are simi lar to those of catarrh, with slender projecting points the size of a millet seed, of a gray or yellow grayish color; usually the tube is distended with a muco-purulent mass. Later in the disease these tubercular nodules break down and form abscesses in the mucous membrane with extension of inflammation to the walls of the tube, and the organ becomes filled with a soft cheesy mass. The tube wall itself has been perforated by the breaking down of a tubercular nodule. By preceding disease the tubes are frequently extensively dilated, markedly distorted, and occasionally become twisted, and so resist degeneration to the neighboring canals. In very rare cases Kiwisch and Rokitansky have observed the changing of the tubercular mass into a chalky and fatty mass. Klob adds to these statements the idea that these cases are easily mistaken on account of the shrinking which occasionally occurs in a tube that is distended with calcareous matter, or thick pus, such as follows catarrhal inflammation.
elder Chiari, of Vienna, has taught that under favor able circumstances, with thin abdominal walls and large vagina, tubercular disease of the tubes can be felt from the vagina or rectum as irregular tumors, externally to the uterus. Also we can say from our own more extended experience, that under favorable circumstances the tubes can, by hi-manual examination, be very plainly mapped out; but in other ex tensive disease, as chronic catarrh, the canal will b•found distended and its walls thickened so that the diagnosis of tuberculosis of the tubes is more or less uncertain. It seems possible that by examining the uterine secretion, and finding the tubercular bacillus, that the diagnosis can be made positive.
of the tubes rarely developes primarily, but is usually secondary to carcinoma of the uterus, ovary or peritoneum. Scanzoni saw a colloid cancer, the size of the fist, of the right ovary with cancerous deposit in the left tube, which was eillarged to the size of the thu nib.
The tubes are often found hardened similarly to those in tuberculosis, the size of the finger and markedly degenerated, and are adherent to the similarly diseased neighboring organs, which together form an agglutinated mass; often they are contained in the diseased mass, but still are found to be in a normal condition. By tearing up the cancerous mass, parts of the tube will be found affected. As the disease advances the tubes play a most important part, even though carcinoma originates it the neighbor ing organs. There are no certain symptoms of this disease, and on that account its diagnosis is uncertain. Very rarely can a degenerated tumor of the tube burst and empty its cancer contents into the abdominal cavity. Kiwisch saw a case of this kind that ended in fatal peritonitis. Likewise death occurred in Scanzoni's famous case, after bursting of a softened carcinoma of the ovary.