Inflammation of the Fallopian Tubes.
To speak of this disease means to review the growth of gynecological science within the last fifteen years.
The operation of laparoscopy, or opening the abdomen, is now performed so successfully by almost every surgeon, that it has taken its place among the every day measures for relief, and frequent opportunities have of course been presented to the profession, of corroborating or refuting some old time theories. Many a notion of inflammation of the bowels, or peritonitis, has become a thing of the past; many an unexplained death has been made clear, and many, many lives have been saved by a timely recognition of the true state of affairs within the pelvis.
Many cases of what formerly was regarded as peritonitis are now known to have been either salpingitis, ovarian abscess, appendicitis, etc. Of these diseases the most prolific of trouble, as well as the most common, is salpingitis, or inflammation of the tubes which conduct the ovum to the interior of the womb, where it is fructified by the male germ.
These tubes are lined with a mucous membrane like that of the interior of the womb, and continuous with it, so that whenever inflammation from whatever source is present in the cavity of the womb, it is extremely liable to travel up the tubes, even to the ovaries and peritoneum. This inflammation may be merely catarrhal, and only become bothersome by its chronicity, or it may become purulent and suddenly cause violent illness.
The catarrhal form begins very slowly and gradually from some old neglected uterine disorder, or it may follow a labor where there was some septicemia or blood poisoning; it may spring from venereal disease, either contracted by the woman illicitly or given her by her husband; and it may come in several ways not of general interest to the reader. At all events, it is essentially a germ disease, and when anyways severe has a tendency to spread and become worse.
Symptoms. These little tubes, which are normally about the size of a slate pencil, become swollen, and very painful and tender, causing inability on the woman's part to do a full day's work, and even confining her to bed. The temperature is raised, the belly bloated, the urine often being frequently passed; the bowels are constipated, appetite poor, and digestion bad; sleep is disturbed and the nerves weakened.
On examination, the trained finger in the vagina feels a large, swollen, tender tube on the affected side, and often a bulging of the roof of the vagina.
Treatment. Rest in bed, hot douches, painting the side with tincture of iodine, and the using in the vagina, every night and morning, of a suppository of five grains of ichthyol, with laxative ~s and nerve sedatives, will do much toward reducing a slight and even moderate attack. The disease, however, does not usually exist alone, and therefore much time is generally necessary in eradicating it.
When the catarrhal form, however, gets worse, and pus forms, we then have the so called purulent salpingitis, or pus tube. Pus gathers here as elsewhere, stretching the tube more and more; finally the pus germs work through the tube and out of the end, where they set up an active inflammation, and new tissue forms about the tube, shutting it off from the general cavity. Everything in the neighborhood becomes glued together, fixing the womb in an immovable position. The tube goes on stretching more and more, It finally it becomes one large abscess cavity. It may then, at times, be punctured through the vagina and thus drained; but generally an operation is required, either to remove the womb and its appendages through the vagina, or else to open the abdomen and take away the large mass of exudation, in the centre of which is the pus cavity. When matters have reached this stage, the patient is of course in a very grave condition. There is a high fever, with sweats and perhaps chills, loss of appetite, pallor, pain, and all the evidences of being extremely sick. The patient either dies shortly or becomes bed ridden, unless an operation can relieve her. This latter variety of the disease is called pyosalpinx.
Acute Salpingitis is best treated by rest in bed, douches, saline purgatives, and a liquid diet. It gradually subsides without serious results.
Chronic Salpinitgis is the more common variety, is very protracted in its course, and rarely ends in spontaneous recovery. It requires great patience on the part of both physician and patient, and often can only be cured by the removal of the offending organ by laparotomy.
It must be remembered that all these various forms of tubal disease are produced by one form or another of bacteria or disease germs, and that in their treatment strict cleansing of the vagina by antiseptics is necessary.
Salpingitis is always preceded by some form of metritis or endometritis, as, for instance b, the gonorrheal metritis, that caused by septicemia or blood poisoning, the metritis following labor, etc.
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