A Text-book of Diseases of Women

by Charles B. Penrose

Dr. Beyea and I have found tuberculosis of the tubes present in 18 per cent. of the cases that were subjected to the operation of salpingo-oöphorectomy for inflammatory disease of the tubes.

It may be said, therefore, that tuberculosis is present in from 8 to 18 per cent. of all cases of inflammatory disease of the uterine appendages. It is impossible, however, to say whether or not tuberculosis is the cause of the disease in all cases, or whether tuberculosis has been grafted upon a previous non-tubercular affection. Other organisms, along with the tubercle bacillus, are frequently found in the Fallopian tube.

Tuberculosis of the Fallopian tubes may be primary or secondary.

In primary tuberculosis the tubes are the primary seat of the disease, being affected before other structures of the body.

In secondary tuberculosis the tubes are affected from a tubercular focus in some other part of the body.

Tuberculosis of the tubes is usually secondary.

Infection takes place in a variety of ways. Infection through the blood is the most usual way.

Infection may take place from a tubercular ulcer of the intestine or bladder becoming adherent to the tube. The tube may become involved by extension of tuberculosis of the peritoneum to it. In many cases the reverse order happens: the tube is first involved by the tuberculosis, and the disease extends thence to the peritoneum. In other cases it is the peritoneum that is primarily affected. It seems probable that tubercle bacilli, having gained entrance to the peritoneum from a tuberculous mesenteric gland or from an intestinal ulceration, fall to the pelvis and are drawn into the Fallopian tubes, there producing tuberculous lesions without first affecting the peritoneum.

It seems probable that in a good many cases of tuberculosis of the tubes the infection takes place from without by way of the genital tract. Dirty instruments, syringes, or the examining finger may cause it in this way. Infection may also occur from clothing or bed-sheets soiled by sputum or other tubercular discharge. Coitus with men affected with genito-urinary tuberculosis or any other form of tuberculosis may be an occasional cause. It has been shown that tubercle bacilli may be present in the testes and prostate glands of consumptives without any evidence of genito-urinary tuberculosis being present.

Tubal tuberculosis may occur by way of the genital tract from infection from the discharges from some other tubercular focus in the woman, as in the lungs, bladder, or intestinal tract.