A Text-book of Diseases of Women

by Charles B. Penrose

The various forms of glandular and interstitial endometritis that have already been described, and which are due to subinvolution, laceration of the cervix, uterine displacements, fibroid tumors, etc., may exist for a long time without producing any perceptible disease of the tubes. In sepsis and gonorrhea, however, the tubes become very quickly affected after the uterine cavity has been invaded, and for this reason these forms of endometritis excite the greatest apprehension.

Like inflammation of other structures, salpingitis may be either acute or chronic.

Fig. 146.—Acute septic salpingitis: section about the middle of the tube (Beyea).

Acute Salpingitis.—In the first stages of acute salpingitis the disease is confined to the mucous membrane of the tube. It very quickly extends thence, however, to the muscular and peritoneal coats, which become infiltrated with embryonic cells characteristic of the early stages of inflammation ([Fig. 146]).

If the tube is laid open, the mucous membrane is found covered with a muco-purulent secretion. The whole tube is soft, succulent, and friable. The friability is such that the tube may readily be ruptured by bending. The fimbriæ are swollen and congested. A drop of pus is often seen exuding from the ostium abdominale.

In acute salpingitis the tube may become very quickly (in a week or ten days) enlarged to the size of the index finger or the thumb.

The condition that has been described is that found in the severe cases of acute salpingitis, the result of gonorrhea or of sepsis after labor. Opportunity is afforded to examine such cases when the woman has been subjected to celiotomy, or at the post-mortem when the woman has died of acute peritonitis or sepsis.

It is probable that a good many cases of acute salpingitis undergo resolution, and that the tube is restored to its normal condition.

It is also probable that milder forms of acute salpingitis occur—cases in which the disease is limited to the mucous membrane and is merely catarrhal in character, there being no pus, but a hypersecretion of mucus from the tube-lining. Such cases, however, recover or pass into a chronic form of simple catarrhal salpingitis; and the diagnosis made by a study of the subjective and objective symptoms cannot be confirmed by operation or autopsy.