ADDENDUM. 



Since writing the above I have had an opportunity to examine 29 new speci- 

 mens of tubal pregnancy; and this was done in such a way so as to test thoroughly 

 the condition of the tube wall in each specimen. Most of the specimens came to me 

 unopened and many of them were preserved in an approved manner in our laboratory. 



As far as possible careful examination was made of the tube wall near its uterine 

 end, in the neighborhood of the pregnancy, and at its fimbriated end. Examina- 

 tions of the fimbriated end were not often possible, but in several instances they gave 

 data of great value as regards the condition of the tube lumen (e. g., Nos. 928, 939, 

 and 967a). 



Twelve of the 29 specimens came from the Philippine Islands, and in these the 

 inflammatory reaction in the tube lumen would appear to be more extensive than 

 in those obtained from the United States. In two-thirds of these the accompanying 

 clinical histories show that there had been an infection and that adhesions were 

 found at the time of the operation. In only one of the 12 cases (No. 938) is it stated 

 that the patient's condition was normal, and in this case no change was found within 

 the mucous membrane of the tube. The same condition of the tube was found in 

 2 other specimens (Nos. 911 and 953). In all of the rest of the specimens follicular 

 salpingitis, outpocketings of the epithelial lining into the muscular wall, or both, 

 were found in some position of the tube lumen. This pathological condition was 

 found 17 times in the uterine end of the tube, 14 times in the region of the pregnancy, 

 and 6 times in the fimbriated end, and, as stated above, in some portion of the tube 

 in 25 of the 28 specimens. The twenty-ninth specimen consisted only of a normal 

 embryo, the tube not having been sent with it. 



It is evident, then, that the changes within the tube lumen are frequently cir- 

 cumscribed; sometimes it was necessary to examine a second block from the uterine 

 end before a pathological change was found in it. In one case this difference was 

 most pronounced, the tube at its entrance into the uterus being normal, whereas 

 one centimeter nearer the point of pregnancy a most pronounced follicular salpin- 

 gitis was found. 



In specimens Nos. 900/, 908, and 939, both tubes were examined. In the first 

 and second there were outpocketings or follicular salpingitis in the uterine end of 

 the pregnant tube, similar conditions being present in the same region of the non- 

 pregnant tube. In No. 939 follicular salpingitis was found at the point of preg- 

 nancy and in the fimbriated end of the non-pregnant tube. A more detailed study, 

 with the utilization of serial sections, would no doubt show pathological changes in 

 the mucous membrane of the tube in every case, but at present such a study is 

 entirely out of the question. For practical purposes the examination as recorded 

 in table 14 is most satisfactory. 



To make the causal study of tubal pregnancy complete, it will be necessary 

 to determine with greater accuracy the norm of the mucous membrane of the 

 Fallopian tube for various periods in its history up to the menopause, and numerous 

 specimens for a study of this kind have already been collected. Furthermore, it 

 will be necessary to make complete bacterial examinations from tubal pregnancies 

 in order to determine their relation to venereal diseases. 



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