2000 HUMAN ANATOMY. 



The chief causes of tubal pregnancy are pathological or abnormal conditions of 

 the tube. The more important of these are: {a) congenital, such as exaggerated con- 

 volutions, diverticula, and atresias ; (d) sagging and attachments by adhesions dis- 

 torting the tube ; (c) pressure from surrounding structures ; (d ) thickening of the 

 tubal walls, interfering with peristalsis ; and (e) destruction of the cilia or narrowing 

 of the tube following salpingitis. Complete occlusion of the tubes of both sides 

 would result in sterility. 



The great danger of ectopic gestation is that of hemorrhage following riipture 

 of the tube by the growing foetus. This will occur some time prior to the fourth 

 month, and may be intraperiiojieal, — i.e., directly into the peritoneal cavity ; or 

 extraperitoneal, — i.e., downward, cleaving the layers of the broad ligament, and 

 finally rupturing the tube within the layers of the Hgament ; or, in case the pregnancy 

 is "interstitial," the rupture may be intrauterine. The intraperitoneal rupture 

 usually takes place before the seventh week ; the extraperitoneal usually from the 

 seventh to the twelfth week. If the foetus should survive the primary rupture in the 

 extraperitoneal variety, secondary rupture into the general peritoneal cavity may 

 occur later, and the ovum may go on to full term within the abdominal cavity. 



The Fallopian tube offers a passageway in tHe opposite direction for the entrance 

 of infections, especially gonorrhoeal, from the vagina and uterus into the peritoneal 

 cavity. When inflammation involves the tube, it is followed soon by a closure of 

 the fimbriated extremity, the fimbriae adhering to each other, to the ovary, or to 

 some adjacent peritoneal surface. Later the uterine end of the tube also closes, and 

 the pus which results from the infection now accumulates within the tube {pyo- 

 saipinx) and may greatly distend it. If the infection is gonorrhoeal, such a pus-tube 

 without rupture is frequently unaccompanied by acute symptoms. Slight ruptures 

 with leakage into the peritoneal cavity followed by sharp attacks of localized pelvic 

 peritonitis often occur. A large rupture may give rise to a diffuse septic peritonitis, 

 although the danger of this result in a case of chronic pyosalpinx, even if of enormous 

 size, is far less than after acute gangrene of the appendix with escape of a relatively 

 minute portion of its contents. In the former case a certain degree of immunity has 

 probably been established during the slow formation of the pyosalpinx (Binnie) ; and 

 moreover, in many such cases (6i per cent., Penrose) the contained pus has become 

 sterile. 



When the inflammation is of a mild grade the accumulation may be of a serous 

 character {hydrosalpinx), and may become so large as to reach half-way to the 

 umbilicus. If hemorrhage occurs into the tube it is called an l?^?natosalpinx. 



The proximity of the right Fallopian tube to the appendix should be recalled, as 

 salpingitis on that side has not infrequently been mistaken for appendicitis, and vice 

 versa. The right ovary is often connected with the meso-appendix by a fold of peri- 

 toneum, — the appendiculo-ovarian ligament ; and it is stated that the fact that this 

 fold often contains a small artery which gives an additional blood-supply to the ap- 

 pendix helps to account for the relative infrequency of appendicitis in females. 



RUDIMENTARY ORGANS REPRESENTING FOETAL REMAINS. 



The development of the reproductive organs (page 2042) emphasizes the fact 

 that whereas, in the male, the Wolffian body and its duct play a very important role 

 in the production of the excretory canals for the sexual gland, the MuUerian duct 

 remains rudimentary ; in the female, the converse is true, the Miillerian ducts forming 

 the excretory canals — the tubes, the uterus, and the vagina — while the Wolffian 

 ■structures are secondary in importance and give rise to only rudimentary and func- 

 tionless organs, situated chiefly in the vicinity of the ovary and Fallopian tube between 

 the layers of the broad ligament. These foetal remains include the epoophoron, 

 Gartner s duct, the paroophoron, and the vesicular appendages, which may be appro- 

 priately described in this place. 



The Epoophoron. — This rudimentary organ, parovarium or organ of 

 Rosenmiiller^ lies between the layers of the broad ligament (mesosalpinx) in front 

 of the ovarian vessels, in the area bounded by the ampulla of the oviduct, the 

 ovarian fimbria and the tubal pole of the ovary. It is quite flat, triangular, or 



