1. Hyperaemia, Hemorrhage

Hyperemia of the Fallopian tube is almost always a symptom of general congestion of the sexual organs, and especially of the uterus. In rare cases, however, the hyperaemia of the tube predominates, and may lead to hemorrhage of the tube, in which case a larger or smaller quantity of blood is effused into the cavity of the peritoneum.

We have twice had occasion to observe the occurrence of such hemorrhage in the course of abdominal typhus; the left tube was distended, its mucous membrane of a purple tint, and congested. We have once seen it in the body of a female who was attacked, three days previous to her confinement, with pleuritis and hepatitis, and in the fourth instance it was associated with retroversion of the uterus. Barlow has met with this condition in purpura, in consequence of or connected with abortion; and Brodie has observed it in a case of retention of menses in the uterus, owing to occlusion.

2. Inflammation

A. Catarrhal Inflammation

Chronic catarrh, or blennorrhea of the Fallopian tube, is a very common disease; it is frequently a residue of a puerperal affection of the mucous membrane of the tube; or the catarrh may have extended from the vagina and uterus to this point, and is coexistent with vaginal and uterine catarrh, or persists after the cessation of the latter.

At the same time the tube is variously dilated, its course tortuous, its coats thickened; the mucous membrane is tumefied, purple, slate-colored or of a blackish-blue tint; the passage contains a viscid, transparent, milky white or creamy, or a bluish-gray, or yellow, purulent mucus.

Catarrh of the Fallopian tube, by spreading to the fimbriated extremity gives rise to peritoneal inflammation in the vicinity of the orifice, and thus the free termination may become adherent to the neighboring tissues and be closed up, whilst the uterine orifice is obstructed and occluded by the catarrhal tumefaction of the mucous membrane. Catarrhal inflammation in this manner induces sterility.

The chief seat of catarrh is the external distended portion of the channel, and it is here that we find the greatest accumulation of blennor-rhoic secretion.

Under the above-mentioned condition, viz. occlusion of the orifices, catarrh of the tube is very often converted into dropsy of the tube, a condition similar to that which we have already become acquainted with in various other mucous channels and cavities. In consequence of the accumulation of secretion from obstruction of the orifices, the tube, especially towards its fimbriated extremity, becomes so much distended, that that which before represented a tortuous or bent channel, is now converted into a simple sac. At other times, several saccular dilatations form between the separate angles and the projecting duplicatures of the tubal parietes, and give rise to an imperfectly loculated pouch, which, as in the former case, may contain blennorrhoic mucus, a puriform secretion, a true purulent inflammatory product, or, if the mucous membrane has become altered, fluids of another description. It is to be observed, that as the dilatation proceeds, the texture of the mucous mem-brane is changed, and the latter is converted into a serous membrane; its secretion may be a thin, watery, serous, or albuminous synovoid, colorless liquid, giving the tube the appearance of a transparent serofibrous bladder; or it may be variously colored, yellowish, brown, blackish-green, chocolate-colored, inky, and more thick and flocculent, consisting in part of inflammatory products on the internal surface of the membrane.

The hydropic Fallopian tube not unfrequently attains the size of a duck's or goose's egg, or even of a man's fist; although not a usual occurrence, still it is satisfactorily proved that the contents are sometimes discharged into the uterus, and thus carried off.

In extremely rare instances chronic catarrh of the Fallopian tube becomes acute, and passes into suppuration; its contents may then be either poured into a cavity of the peritoneum, which has been circumscribed by adhesive inflammation, or into the perforated intestine, which has been previously agglutinated to the tube.

B. Exudative Processes

An exudative process scarcely occurs on the mucous membrane of the Fallopian tube, except in combination with a similar condition of the internal uterine surface after childbirth. The tubes are tumefied and infiltrated; their mucous membrane is variously reddened, discolored, excoriated, softened, and everted at the fimbriated extremity; the passage of the tube is dilated, especially at its outer end, and filled with various products, purulent and sanious fluids, and in uterine croup with coagulable lymph, assuming the shape of a tubular concretion. The exudative process has extended from the uterus to the tube.

3. Adventitious Growths. A. Cysts

Serous cysts are very often formed at the fimbriated extremity of the tubes, and in its vicinity; and they are generally attached by a pedicle, which sometimes attains a considerable length. They scarcely ever become larger than a bean or hazel-nut.

B. Fibroid Tumors

These are not frequent; they are rarely larger than a pea, and occupy the parenchyma of the tube in the shape of round or discoid tumors.

C. Tubercle

Tubercle of the Fallopian tubes (Fallopian mucous membrane) is generally associated with uterine tubercle; but it is remarkable that it sometimes occurs independently of the latter, or in a condition of higher development. It therefore follows that in many cases of tubercular affection of the internal sexual organs, the mucous membrane of the Fallopian tube is the primary seat of disease.

Tubercle of the tube is almost always presented to us in the dead subject, in the shape of tubercular infiltration and complete disorganization of the mucous membrane; the latter being converted into a softened purulent layer of yellowish-white, cheesy, lardaceous matter, which is cracked and friable, and chokes up the passage. The tube is more or less swollen, its course tortuous, it is hard to the touch, and its parenchymatous coat thickened, and converted into a dense lardaceous tissue.

The fimbriated extremity presents a very peculiar appearance; the mucous membrane, which is infiltrated with tubercular matter, being pushed out in the shape of a cauliflower excrescence, and everted upon the peritoneum.

Opportunities are very rarely afforded of observing the disease at its commencement, which occurs in the shape of a deposit of crude, gray, discrete, or agglomerated tubercular granulations. In the above-described shape, it must doubtless be viewed as the result of a tumultuous localization of the general disease, occurring under symptoms of congestive inflammation. The remarks made in reference to uterine tubercle apply to this affection.

D. Carcinoma

Except when involved in cancer of the peritoneum, the tube is not affected by this disease; and even an extension from the uterus or other adjoining tissues by mere contiguity, after pseudomembranous attachments have been effected, is very rare. Still I have noticed one case of ovarian cancer, in which the tubes, without being agglutinated to the former, were thoroughly diseased; the parietes were very much thickened, callous, contracted in their long diameter, and curled up.