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. Gonorrhœal 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 leucorrhœa; 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.”