DISEASES OF THE FALLOPIAN TUBES.

The Fallopian tubes are the ovi ducts, along which the spermatozoids pass from the womb to fertilize the ovum, and along which the fertilized or non-fertilized ovum, as the case may be, is carried to the cavity of the uterus.

They are two small canals, between three and a half and four inches in length, and constitute the only means of communication between the womb and ovaries; their caliber is exceedingly small and lined with a delicate mucous membrane.

The diseases which affect the Fallopian tubes are inflammation, stricture, distention and displacements.

The inflammation is distinguished as salpingitis, from salpinx, Fallopian tube, and itis, in composition, inflammation; this consists of a catarrhal inflammation of the lining membrane of the tubes, which rarely if ever originates in the tubes themselves, but is secondary to an inflammatory process in the neighboring organs.

Chronic endometritis or catarrh of the womb is undoubtedly the most fruitful cause of salpingitis, although this is not absolutely the rule, for there are some women who have had uterine catarrh for years without its affecting the tubes in the least. But there is a type of uterine catarrh that has a special tendency to spread from the womb to the lining membrane of the tubes, and this is the infectious endometritis. An infectious inflammation of the womb may be due to many different sources of infection; the retained products of conception after an abortion may become putrescent and furnish one source; carrying putrefactive germs into the uterine cavity from the vaginal canal by means of probes or instruments, that are in themselves defiled by not having been thoroughly cleansed and purified since their last employment, is another source of infection; the latter is perhaps the commoner cause of blood poisoning in criminal abortions by the abortionists. Gonorrhoeal infection seems to have a greater tendency than any other to spread itself from the uterus to the tubes; this has been the subject of special inquiry, and has been thoroughly confirmed, and this may arise many months after the infected male has imagined himself entirely cured.

The diseases of the tubes that I have enumerated are in the relation of cause and effect; a catarrhal inflammation is quite likely to induce a stricture or an occlusion, and this causes a distention from retention of the secretions, whether the secretions are a natural or an inflammatory product. If the inflammation has an infectious origin, then the retained secretion becomes purulent, or it may be a muco-pus secretion from the commencement. The dilated tube may also contain blood or serum; the latter constitutes tubal dropsy; or it may contain a fertilized ovum; this gives rise to tubal pregnancy.

Tubal dropsy may be a distention of the tubes when both ends are sealed by inflammatory adhesions; these distentions vary in size from the thickness of a finger to a large ovarian tumor, from which it is not an easy matter to distinguish it.

The most dangerous form of tubal obstruction and distention is where the contents are pus or purulent matter; this is liable to be poured into the peritoneal cavity from ulceration or rupture of the sac, and excites fatal peritonitis.

Salpingitis can only be viewed as a complication of some prior inflammatory process in some of the adjacent organs and tissues; these are the uterus and ovaries and the pelvic peritoneum and pelvic cellular tissue.

The symptoms of inflammation of the tubes are not so clearly defined as to indicate the nature of the affection, because it is hardly ever limited to the tubes alone, the surrounding tissue being always more or less involved. These patients are so seldom free from pain that their lives are a constant suffering. If the pain subsides, it is only for a few days, and the slightest exertion brings about a relapse, so that walking or standing must be avoided. During menstruation the pain always increases, and the menses may be excessive at one period and scant at another; these harassing pains make powerful inroads on the patient’s strength; she becomes pale and debilitated, while her emaciated form and careworn expression give us a picture of the typical invalid. Fortunately, this complication is not as frequent as one might expect from the intimate relation of the tubes to the womb and ovaries, but the possibility of the Fallopian tubes becoming inflamed should admonish women against taking any chances by neglecting the rules of hygiene, that I have laid down in another chapter, for the old saying that “prevention is better than cure” is only too true of this malady.

TREATMENT.

The curative measures for inflammatory diseases or abscesses of the tubes have not been, on the whole, until within a comparatively recent period, very satisfactory.

When this affection complicates uterine or vaginal catarrh, then the treatment that is recommended elsewhere for the relief of these complaints should be adopted; quietude is of paramount importance, and total continence must be practiced by the sufferer. Hot sitz baths and warm fomentations are important auxiliaries in the treatment. Vaginal irrigations of hot water, night and morning, relieve the congestion and stimulate the absorbents of the pelvic glands. Femina vaginal capsules are a great assistance towards accomplishing the same end; one capsule introduced into the vagina at bedtime should be combined with the other treatment.

If these measures fail to accomplish a cure, then a surgical operation may be required as a last resort, which consists in extirpating the diseased tubes and ovaries.

This operation has given some brilliant results, but it has also hurried a great many to an untimely grave. Fool-hardy surgeons or operators are the rule; doctors of only mediocre talent worm themselves into positions that give them prestige in the community. Where nature refuses a capacity for the acquirement of solid wisdom, she seems to compensate her creatures by endowing them with faculties for cunning and intrigue, that galvanize the spurious into the apparently genuine. They have charge of hospitals and are professors in colleges, and are ambitious to imitate the operations of the European masters. On the other hand are the statistics of able surgeons, who seem to have an inborn genius for a special line of operations; such a one is Lawson Tait, of Birmingham, and Martin, of Berlin. Tait has had phenomenal success in cutting open the abdomen and removing diseased tubes and ovaries. He possesses the faculty and skill to select only those cases that are especially suited for an operation, and those that are not adapted for the knife are excluded. In the exercise of this judgment the danger of the operation is reduced to a, minimum. The tubes and ovaries are often so matted and tied down with inflammatory adhesions, that their removal means sure death, and does the average surgeon know this? To have the genius of a Tait is to be one in ten thousand, and for this reason his statistics should be neither a guide nor an excuse for the other nine thousand nine hundred and ninety-nine, to attempt to do as he does. To assume that they can, is as absurd as to admit that our indigenous colonels of the State militia can plan or execute the campaigns of Napoleon.

Galvanism or electricity has come to the rescue of this class of cases, as a safe and reliable method of treatment; of course it takes more time and patience. Should not this outweigh the selfish ambition of the unscrupulous surgeon who desires to boast of the number of times he has opened the abdomen, with little compunction of the confiding lives that he has sacrificed?

I have myself had abundant experience to be convinced of the usefulness of electricity as a curative agent in this class of diseases, but I prefer to illustrate the treatment by quoting from a paper on “The Value of Electricity as a Substitute for Laparotomy,” by Augustin H. Goelet, M. D., in the New York Medical Journal. He says:—

“Mrs. T., aged twenty-six. Severe pelvic pain referred to left side; profuse leucorrhoea; prolonged and painful menstruation. Diagnosis: Pyosalpinx (or pus) in the left tube. Laparotomy (opening the abdomen) advised at Woman’s Hospital. Treatment: Tube emptied into the uterus by applications of positive galvanism to the left horn of the cavity of the uterus. Intravaginal applications afterwards, completed the cure. Duration of treatment, four months Complete relief of pain followed the removal of the pus from the tube. At the end of the treatment she had completely regained her health. Menstruation was normal, and symptoms relieved.”