. Gynecology : . escending infection originates from a tuberculosis of the peritoneum or in-testines above the tubes. The descending disease may affect either the peri-salpinx or the endosalpinx, or both. When only the perisalpinx is involved, thesurface of the tube merely takes part in a general tubercular salpingitis. Whenthe endosalpinx is involved the disease becomes specialized. The hematogenous mode of infection in the tubes implies a metastatic growthof tubercle bacilli which have come by the blood circulation from some distant INFLAMMATIONS 217 focus, usually in the In this cas
. Gynecology : . escending infection originates from a tuberculosis of the peritoneum or in-testines above the tubes. The descending disease may affect either the peri-salpinx or the endosalpinx, or both. When only the perisalpinx is involved, thesurface of the tube merely takes part in a general tubercular salpingitis. Whenthe endosalpinx is involved the disease becomes specialized. The hematogenous mode of infection in the tubes implies a metastatic growthof tubercle bacilli which have come by the blood circulation from some distant INFLAMMATIONS 217 focus, usually in the In this case the original focus may become entirelyhealed, while the new growth of bacteria may continue to flourish. The infec-tion may, therefore, appear to be primary in the tubes, whereas it is, in reality,secondary. Except when the tubes take part in an acute general miliary tuberculosis,tubercular salpingitis is always chronic. As we have seen, the disease may beeither an endosalpingitis or a perisalpingitis, or Fig. 44—Tubekcular power to show giant-cells. The gland-like spaces are follicles formed by fusion of the the center of the drawing are four giant-cells which are characteristic of tuberculosis. The tissuearound them has become necrotic and is infiltrated with round cells, mostly of the mononuclearvariety. Tubercular endosalpingitis somewhat resembles in its processes a gonorrhealinfection. The first stage is catarrhal, in that it involves only a superficial inflam-mation of the mucous lining. The tubal ostium tends to close early and the dis-ease may progress to a tubercular pyosalpinx. The contents of a tubercular pus-tube consist of a white, mushy, cheesy material if the infection is exclusivelytubercular, but a mixed infection in these tubes is common. If the latter takesplace the pus-tube is then exactly like that originating from gonorrhea. In fact, 218 GYNECOLOGY tuberculosis and gonorrhea may exist together. In pus tubes of this kin
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