TUBAL or ectopic pregnancy is mentioned here in connection with womb diseases, because it assumes the symptoms of certain uterine affections, and must be so treated.
When, for any reason, the ovum cannot pass through the Fallopian tube into the womb, where it is normally impregnated by the male germ, but is arrested in the tube, it not infrequently happens that the spermatozoon of the male travels upward through the womb into the Fallopian tube, and there meets the impeded ovum. Fecundation takes place, the ovum swells and grows, the tube stretches more and more till it bursts, and then a hemorrhage occurs into the abdominal cavity, from the leaking tube. A large clot of blood is formed, which generally arrests further hemorrhage and causes the death of the embryo, but not necessarily; after a time, another hemorrhage occurs, with pain, fainting, and even collapse, depending on the severity of the hemorrhage. If allowed to follow its natural course, the hemorrhage finally causes the patient's death. She dies suddenly, as if she were bleeding from a ruptured artery. The cause of all this mischief lies in the diseased tube in which the obstruction occurred. The Fallopian tubes are lined with a beautifully constructed mucous membrane: on the ends of the cells are small rod like processes, which look (under the microscope) like a field of grain swaying with the wind; they move in one direction, from an erect position toward the uterus, and then relax and straighten up again to repeat the process ; thus the ovum which has been grasped by the fimbriated ends of the tube from off the outside of the ovary (see Fig. 136) is carried down into the interior of the womb, where nature meant it should be impregnated. Now, when these tubes become diseased by catarrhal, and especially by purulent inflammation (see Salpingitis), the little rod like extremities of the cells are destroyed, and the ovum finds no ready way of getting into the womb. An unusually active spermatozoon climbs up into the tube, because it has the power of motion so long as it lives; and thus the trouble begins.
Symptoms. A woman misses her menstruation, and goes on a mouth; possibly missing a second or even a third menstruation, without many of the usual accompanying symptoms, till suddenly she is seized with cramp like pains in the lower bowel, and takes her bed she may get up from this first shock of pain (due to hemorrhage), till a second, or even a third still severer attack ensues, when the doctor is called. If he is thoughtful, he at once examines and finds a bunch in the pelvis, on the side of the pain. This bunch is the clot, and the contained sac with the fetus. Not every case is taken alike, but many are crippled at the first onset of pain and hemorrhage; inflammation ensues, and sickness in bed attracts the attention. Usually, there is some slight hemorrhage of blood escaping through the tube into the womb and out into the vagina.
Treatment. This disease, like appendicitis, belongs to modern surgery, as only recently has it been recognized, and treatment on a sound basis been formulated. Death is sure, unless surgical aid comes to the rescue. Laparotomy, or opening of the abdomen, must be performed at once, the clots washed out of the abdomen, of which, usually, there are a quart or more, the sac containing the embryo removed, and the tube tied off. The successes are brilliant, and lives are daily saved. The operation is a grave one, but not as much so as many others performed on the abdomen.
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