618 



UTERUS AND ITS APPENDAGES. 



the tube- walls, whose over-distended capilla- the tube are patent, the fluid may escape into 

 ries relieve themselves by sanguineous effu- the uterus, or possibly, by the infundibulum, 

 sion. In such a case, if both the orifices of into the cavity of the abdomen. Of such 



Fig. 421. 



The Fallopian tubes thickened by inflammation, and distended by collection of fluid. (After Hooper.) 

 a, uterus ; b, distended tubes ; c, thickened lining of the same ; d, round ligament. 



effusions there are many examples on record. 

 Or should the abdominal end of the tube be 

 closed in the manner already described, and 

 should the uterine end also be temporarily 

 obstructed, as, for example, by slight conges- 

 tion of the mucous lining at this point, then 

 the blood, having no outlet, will continue to 

 accumulate within the tube, and a distension 

 of the parietes, more or less considerable, will 

 result. 



But all collections of blood within the tube 

 are not necessarily the result of haemorrhage. 

 The menstrual fluid has been frequenly ob- 

 served to have accumulated here. And these 

 accumulations may occur under various cir- 

 cumstances. Thus, in the case of imperforate 

 hymen, when the menstrual function has been 

 established for some time, this fluid, after col- 

 lecting behind the obstructed orifice of the 

 vagina, gradually collects in and distends the 

 walls of the uterus, and ultimately mounts up 

 into the Fallopian tubes, distending them also 

 in the same manner as the uterus. 



But atresia of the vagina or uterus, causing 

 such accumulations, is not necessarily con- 

 genital, but may be consecutive on adhesive 

 inflammation attacking these parts ; as in the 

 instance of a woman, whose case is related in 

 the American "Journal of Medical Sciences,"* 

 and who, after her second confinement, had 

 an attack of metritis, terminating in cohesion 

 of the uterine walls and consequent occlusion 

 * No. XXXV. 



of the cavity of the uterus. Behind this ob- 

 struction the menstrual fluid accumulated 

 until the Fallopian tubes became so enor- 

 mously distended that at length one of them 

 burst, and death resulted from the escape of 

 the blood into the abdominal cavity. 



Or lastly, the menstrual fluid may collect 

 in the tube after the manner of the blood in 

 the case just described, where both the ori- 

 fices of the tube are obstructed. Of such 

 accumulations I have met with many ex- 

 amples ; and it is interesting to observe that 

 here, as under many like circumstances, the 

 walls of the tube usually become hypertro- 

 phied in proportion to the degree of pressure 

 caused by the accumulations of fluid which 

 they are called upon to resist. 



These collections of menstrual fluid within 

 the tube, which I have found to be consider- 

 able in some instances, where I have ascer- 

 tained beyond question that death had taken 

 place during a menstrual period, are instruc- 

 tive, as showing, upon strong probable evi- 

 dence, that the menstrual fluid is supplied in 

 part by the walls of the Fallopian tube as well 

 as by those of the uterus itself. For I have 

 seen it in cases where both orifices of the tube 

 were obstructed ; and therefore in cases where 

 it was not probable that the fluid could have 

 regurgitated from the uterus into the tube. 



Collections of serous fluid. Hydrops tuba; 

 Hydrusalpinx . In catarrhal inflammation of 

 the mucous lining of the tube, whether oc- 



