—Chronic inflammation is a sequel of the acute and due to the same causes; it is also produced by long-con tinued congestion from excessive sexual intercourse, masturbation, sexual excite ment without gratification, suppressed menstruation, and operations upon the cervix.
consists in the removal of the source of irritation, interruption of marital relations, interdiction of vigorous exercise or long standing, rest in bed dur ing menstruation, extraction of blood by leeches, counter-irritation with iodine or small blisters, and the internal admin istration of potash salts—iodide, or chlorate alone or in combination with bitter tonics. Iehthyol is frequently of service, administered by the mouth, by suppository, or on vaginal tampons; fixa tion of the ovaries may be overcome by judicious pelvic massage; severe attack of pain ameliorated by tincture of pulsa tilla, gtt. x, four times daily, or extract of gelsemium, gtt. v, three or four times daily. The faradic current of tension that is, through a long, fine wire—has been found serviceable in relieving the pain.
Inflammation of the Tubes.
Symptoms.—Tubal disease presents no characteristic symptoms. Patients com plain of pain, tenderness, and more or less induration of the pelvis as a result of the inflammation in the peritoneum. The uterus, ovaries, and tubes are fixed, not infrequently in a mass which cannot be differentiated; so that we are unable to definitely determine the position and relation of the uterus to the inflamma tory collection. The progress of the in flammatory condition, the interference with the nutrition and action of the in testinal canal, and also the absorption of septic matter bring about a lowered state of vitality and a depraved state of health.
Diagnosis.—The history of the patient and course of the disease would indicate the existence of pelvic lesions. Biman ual examination reveals more or less fixation of the uterus, a mass situated upon one or both sides, or in Douglas's pouch, the contents of the pelvis ag glntinated, with a history of pain and tenderness; a recognition of points of softening should enable us to arrive at a diagnosis of pelvic suppuration. In the less severe inflammation, resulting in an hydrosalpinx, we will find upon one or both sides of the pelvis a retort-shaped mass, with its smallest portion directed toward the uterus and the larger extend ing outward into Douglas's pouch, which is movable and differs from an ovarian cyst in shape, having a retort-, or pear-, shape, rather than spherical. Fluctua
tion may be indistinct, according to the of the mass.
Prolapsed intestine and varicose veins have caused difficulties in diagnosis of diseases of the Fallopian tubes. If pa tients are examined in the exaggerated Trendelenburg or exaggerated knee chest position, the tumor disappears. Placing the patient in either of these positions, a little pressure will raise the intestine sufficiently far up to know that it is not a tube, or it will sometimes slip out of the pelvis of its own accord. If there are many adhesions this will not take place, but the contents of the intestine can he pressed up out of the pelvis, so that the distended canal col lapses and shows that it is not a tube. Placing the patient in this knee-chest position or the exaggerated Trendelen burg position, any present disappear, and the differential diagnosis is made in that way. A. J. C. Skene (Brooklyn Med. Jour., Aug., '98).
Etiology.—Tubal disease is most fre quently a result of infection, which may follow an abortion or labor, careless ex amination, or operation upon the cervix or uterine cavity. A more frequent cause is gonorrhoea, which travels through the uterus to the tubes and pel vic peritoneum. Another cause is the tubercular bacillus. This latter disease probably occurs more frequently in the tube than in any other portion of the genital structure. Less frequently it arises as a result of syphilis and mycosis. The most frequent cause of hxmatosalpinx is ruptured ectopic gesta tion with retention of blood in the tube, which subsequently becomes thinned and mixed with mucus. A collection in a tube adherent to an ovary which possibly contains a number of cysts is likely, upon increase in size of the two collections, to have the intervening wall or septum be come so thinned as to break down, the two structures become one, and form a tubo-ovarian cyst or tubo-ovarian abscess according to the character of its con tents. As the sac enlarges, its mucous membrane becomes smooth, and the wall gradually thinned until it forms a tu mor of considerable size. The sac, as it increases in size, may drop into the pelvis, fill up Douglas's pouch, and rupture, or the escape of pus-contents, infecting this portion of the peritoneum, may pro duce a localized peritonitis and the for mation of a large collection in the cal Occasionally two infected tubes may drop down into Douglas's cavity, their ends become united, and a large double pyosalpinx form, the sac consist ing of the two dilated tubes.