The dislocations of the tubes are yet to be mentioned; they are caused by a aeries of pathological processes which we have already become acquainted with, and which we shall meet with again; processes, most of which are themselves capable of producing sterility. We only have to add the herniw of the tubes. But here as a rule the ovary is also situated in the'hernial sac, thus neutralizing the disadvantage of malposition.
Of much greater importance in regard to the production of sterility, are the inflammatory processes in the tube and around this organ. Sal pingitis, or catarrh of the tubes, is of considerable importance, because of its frequency and especially by its bi-lateral occurrence. We need not here discuss its etiology, in which gonorrhceal infection and puerperal processes play a very important role; we are only concerned with the sequelse of the inflammation. It has already been mentioned that tubal catarrh may extend to the peritoneum and give rise to exudation. The consequences of this process have already been spoken of. Often, however, the inflammation remains confined to the neighborhood of the ostium abdominale, whereby the fimbriated extremity becomes fixed, removed from the ovaries, and incapable of undergoing changes of form resem bling erections. A further consequence of such an inflammation that is confined to the ostium abdominale, is stenosis and atresia of that open ing, a condition not infrequently found in the =lavers of sterile women. It is easily comprehensible that the chances for the reception of the ovum are much less in case of stenosis than when the wide, funnel-shaped in fundibulum is open; when there is double atresia, sterility of course is absolute.
This atresia with its results is also found among our domestic mam mals. If then by a collection of secretion and pus, those tubal saes known as hydro-and pyosalpinx are formed, the obstacle to conception comes into the foreground in a palpable form. It is not necessary, how ever, for a salpingitis to develop so far as this in order to produce sterility. Even a considerable swelling of the mucous membrane of the canal, which in the normal condition is extremely narrow where it penetrates the wall of the uterus, may prevent the passage of sperma or OVUM. As a rule,
in the above-named tubal sacs. only the abdominal end of the tube is found closed, the uterine extremity being merely plugged, but this plug ging closes the lumen of the canal BO efficiently that the strong pressure of the fluid within the sac is not able to free the uterine end of the tube. Small polyps that close the lumen of the tube may retain the ovum in a similar manner; some cases of tubal pregnancy are even ascribed to them. Since, however, these formations are to be regarded merely as the expres sion of an intense catarrh, it would be difficult, in any given ca.se, to as cribe the cause of sterility to them alone. Whether strictures or atresite may occur in the lumen of the tubes, and like stenoses of the cervix may favor sterility, has not been ascertained by pathological anatomy. Gen erally, however, the ovum can scarcely get so far into the tubes; the secretion which has collected in the wider portion of the tube, and which even according to the anatomical position of the tube can not empty itself into the uterus, alone is able to prevent the onward movement of the ovum, which is not capable of spontaneous motion. It is not im probable that the aecretion may exert an unfavorable influence also by virtue of its chemical qualities, or by a specific character, as in gonorrucea. Whether the ovum may also suffer by this is uncertain. It is highly probable that conception is essentially interfered with by the removal of the epithelium, the movement of whose cilise is mainly active in effecting the onward movement of the ovum, and in chroniC inflammations, by the fact that it is replaced by cells that are in no way equal to this task. We are not unjustified in the belief that the muscular tissue of the tube is obstructed in its movements by serous infiltration and swelling, as well as by the onset of further changes when the trouble is of longer duration, thus again interfering with the onward movement of the ovum. Each of these factors alone may disturb the normal course. A combination of them, and such occurs often enough, would the more certainly obstruct the passage of ovum and sperma.