An Address on Chronic Disease of the Uterine Appendages. with a Table of Thirty Consecutive Cases Treated by Abdominal Section
Authors: W. Duncan
Journal: BMJ (1891)

TGENTTLEM-N1EN,-When asked by our e(ner- geti( semnior Secretary to mea(l a paper before thiis Society it occurred to mile, after somie consideration, that this subijet wvou(ld be a good one, immasunluch as it is of the greatest illiportance, and one about icelh-especially wvithi regard to diagno- sis ani(l treatnenit--tlhr is at the presemnt nomieilmit mIu hli (lifference of opiniionl.1Orp coMnIvenience of reference I hiave arranged all the cases in a tabular forium (see next page):--Let us con-sider, seriatim, tIe different diseases of thfe uterinie appenidages included iimider tlie title of this p,aper.It is obviously unneces;sary to toucelh upon large tumours whic rise up out of the pelvic c(avity, as nowadays aliiost everyone agrees that their prolper treatment is by abdoninial section.Suchl, however, is unfortunately not the case wvitli disetises which give rise eitlher to smiiall pelvic tumours or to none at all, but whichl often entail intense suffering, which are somne- times overlooke(l and( about tlhe treatmemnt of which there is (uniluckily for tIme stufferer) a great diversity of opiiiomil.CIHRONIC SALPINGITIS.Clhronic salpinigitis is in the majoritv of cases (Ie to extension of catarrhal or piuirulent endomnetritis; sometimes, however, it is doubtless secondary to a pelvic peritoniitis.Each1 Fallopian tulbe coilsists, as is w%,ell kIiiownv], froIm wvith1out miiwards of p)eritoneuin, circulair an(d lon1gitu(in1ial muscular fibres, with1 a, aiiucous miemibr-1ane which is liined by a layer of columnar ciliated epithieliuni, and1I thirowvii ;i1to niue11( rous lonigitudinal folds or p1icaC.Glanids hlave been (descrihbe(l as presemit, but thiere-is a complete absence of themn; probably the folde(I appearance of tIme mlucous membrane led to the error.Time chlanges whuich take place ii tIme tubes when sub- ject to chronic inflam11mation1 are well shiowni in a drawing takeni froni the beautifuil plates of AWvyd(er, of Berlin.The muncous and 1n uscuilfar 1avers areW hypertrophii(e.TIme fol(Is (of the mnuco0uIs niembrane (l1w;1(1 not show thle ormIal complpicate(l appearancee.Single papillary elevations are seen separated froini omme another by glandlike invaginations oif tIme iiimucous memi-branie, some shiallow, some (heel).The papilke are comn- plletely-bared of epitheliumiii, liut it may still be seen in the recesses l)etween thu f ,(Is.On the surface of the ituolueols niemibrane is, a zi nie of closely packedi roIud ce ((118 likw g)ramnu- lation tissue, whllilst blleeath this tIle deeper p)ortioln of tiwe inueous meninbrane is specially characterised by the prmsince of a lar-ge numnber oif spindlhe cells.Tlhiek alled vessels are presenit in great numbres in tIme wall of tlIe, tube.I believe a ssalpingitis imiay exist like this for aim indefinite period, tlle fluid exuded gradually making its wa-tlmrouglh the pa1'tent uterine end inlto the uterine cavity-but what happenis far more often is this-tIme inflamimation extends to tile fimbri- ated end, a little (of the fluid escapes inito tIme perit(oiieal cavity, ald sets up a pelvic peritonitis(of varyinlg degrees of severity according to the virulenice of the exuidation, tthen Ilme ostiumn gets closed by adlliesiomns, aldi tlme tube becomles transformed into a slhuit sac b)y tIme uterine enld also becoming elosed.TIme furthler changes in the tube (tepen(d omi tlme character of the primary inflammation ; if it be catarrhal or (lue to extenision of a peritoinitis, then serous fluid collects in the tube, the coats of w-hich gradually get thinned out, and finally we have a hydrosalpinx with a very thin transparent cyst wall.When the inflammation lhas 'been purulent (as in extension upwards of a gonorrhoea), then the same changes take place, with the important difference that the cysts con- tenits consist of pus, forming a pyosalpinx.In other cases the capillaries of the diseased mucous membrane become enigorged with blood, thleni some of them ruptuire, and blood gets extravasated into the tube forming a lne-matosalpinx.This conditioni is slhowin in some of the specimens on thle