Syphilis manifests itself in the vagina and vulva in the form of the hard chancre, which may even occur at the os uteri. It does not present in these situations any peculiarities distinguishing it from chancre, as already described. Condylomata of considerable size also occur in the vulva and vagina, often forming warty projections.

Tuberculosis of Fallopian tubes seen from behind, a, uterus; 6,6, fimbriated extremities of the tubes; c, left ovary.

Fig. 451. - Tuberculosis of Fallopian tubes seen from behind, a, uterus; 6,6, fimbriated extremities of the tubes; c, left ovary. The right tube is seen to be very greatly dilated and convoluted. The dilatation disappears just before the uterine termination of the tube. The left tube is much less affected, being most dilated at its distal part. There was also tuberculosis of the lungs ana mesenteric glands.

Tuberculosis Of The Tubes And Uterus

This commonly begins in the Fallopian tubes. As the fimbriated extremities open into the peritoneum they absorb any such virus as that of tuberculosis which may be present. Hence it is a regular result of tubercular peritonitis in the female, and also sometimes occurs in tubercular ulceration of the intestine. It is stated by Schramm that it is met with in three per cent, of all females dying of tubercular disease.

Tuberculosis of the Fallopian tubes begins at the distal end, and this part is generally found most affected. The mucous membrane is destroyed and replaced by caseous matter which accumulates in the calibre of the tube. The wall is also thickened and infiltrated with the tubercular new-formation. These two conditions lead to a great distension of the tube (Fig. 451) so as to resemble some of the conditions resulting from salpingitis. The condition is sometimes called Tubercular salpingitis. This condition is probably of great frequency, and we believe, from observation, that a large proportion of cases which are simply designated salpingitis really belong to the tubercular form. There is not generally much adhesion to parts around, but there may be, especially when the condition coincides with tuberculosis of the peritoneum.

The tuberculosis frequently extends to the Uterus, where ulcers form, and there may be extensive destruction of the mucous membrane. The whole internal sufface is sometimes involved.

Tuberculosis of the Ovaries is exceedingly rare. It occurs in the form of caseous masses.

Literature

Mosler, Tuberkulose der weibl. Geschlechtsorgane, 1883; Schramm, Arch. f. Gynacol., xix.; Steven, Glasg. Med. Jour., xix., 1883; Williams, Johns Hopkins Hosp. Reports, iii., Nos. 1, 2, 3, 1892.