TUBERCULOSIS OF THE GENITAL ORGANS. 193 



in the same way as we have explained the occurrence, for instance, 

 of primary tuberculosis of joints and peritoneum. We can only 

 safely assume that tubercular infection of the tube often, if not 

 always, takes place upon the basis of preexisting pathological con- 

 ditions, taking it for granted that the healthy tubes do not present 

 favorable conditions for the localization of the tubercle bacilli. A 

 catarrhal condition of the lining membrane of the tubes, as in other 

 organs, undoubtedly acts, in many instances, as a predisposing cause 

 to localization of preexisting microorganisms in the circulation. 



Barbier (G-az. M6d., 1888, No. 39) believes that a woman can be 

 infected by a tuberculous man during coitus. Bacilli have been 

 demonstrated in the semen, as well as in the discharge attending 

 tuberculous epididymitis, The uterus may be infected by extru- 

 sion from tuberculous growth in the vulva, without any inter- 

 mediate trace of infection in the vagina. The writer even admits 

 the possibility that tubercular infection may be transmitted by the 

 finger of the attendant, by unclean instruments, or even through 

 the medium of the air. 



Primary Tuberculosis of the Fallopian Tube. Kotschau (Arehiv. 

 /. G-ynakologie, B. xxxi. Heft 2) gives a full description of a case 

 of primary tuberculosis of the Fallopian tube. The patient was 

 forty-five years old, having a good family history, and had suffered 

 for a year with pains in the abdomen, profuse metrorrhagia, and 

 diverse nervous disturbances, She was treated for retroflexion ; 

 and subsequently had an attack of pelvio- peritonitis. Vaginal 

 examination disclosed a firm, smooth movable tumor as large as 

 an apple, to the right of the uterus ; this was taken for a malig- 

 nant ovarian growth, and laparotomy was done for its removal. 

 On opening the abdominal cavity a quantity of turbid, purulent 

 fluid escaped. The tumor, of oblong shape, was found lying appa- 

 rently in a bed of pus ; on account of its intimate adhesions it could 

 not be removed. The patient died from shock. The autopsy 

 showed the uterus enlarged and retro verted. The right tube was 

 tortuous and generally thickened ; near its distal end it was dilated 

 into a swelling the size of a hen's egg, in the centre of which was 

 a cavity containing cheesy material. Other smaller caseous deposits 

 were found in the tubal wall in close proximity to the large swell- 

 ing. The ovary on the same side was enlarged and transformed 

 into a caseous mass ; the left tube and ovary showed similar changes, 

 though less extensive. The microscopical examination of the patho- 

 logical products confirmed the diagnosis of tuberculosis. 



Werth (Centralblatt /. G-ynakologie, July 20, 1889) in a recent 

 paper on the subject of tuberculous disease of the Fallopian tubes, 

 recognizes an acute and chronic form ; in the former both the mus- 

 cular and serous coats undergo caseous degeneration, numerous 



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