. The diagnosis of diseases of women . gs near thehorn of the uterus are sometimes recognized in a bimanual examina-tion. Few cases have been diagnosed clinically. Hydrosalpinx and hsematosalpinx are recognized clinically bythe pressure they make upon the surrounding structures and bydirect palpation. The patient may be wholly unaware of the exist-ence of the lesion. In a conjoined examination, preferably under anaesthesia, thedistended tube is outlined as a retort-shaped mass, tense, elastic,and often fluctuating. If no adhesions surround the tube thereshould be a free range of motion. The sm
. The diagnosis of diseases of women . gs near thehorn of the uterus are sometimes recognized in a bimanual examina-tion. Few cases have been diagnosed clinically. Hydrosalpinx and hsematosalpinx are recognized clinically bythe pressure they make upon the surrounding structures and bydirect palpation. The patient may be wholly unaware of the exist-ence of the lesion. In a conjoined examination, preferably under anaesthesia, thedistended tube is outlined as a retort-shaped mass, tense, elastic,and often fluctuating. If no adhesions surround the tube thereshould be a free range of motion. The small and firm uterine end,together with the outer, rounded, elastic, and fluctuating portion,gives the impression of an ovarian cyst. The ovary can rarely berecognized apart from the distended tube. There is no way of DIAGNOSIS OF DISEASES OF THE FALLOPIAN TUBES 389 detecting a hydrosalpinx*from a hsematosalpinx except by aspiratingor by an exploratory incision. Tubo-ovarian cysts are only recognized after the cyst is removed. Fig. 162. Right tubo-ovarian abscess and left pyosalpinx. The right tube and ovary are distendedwith pus, as is also the left tube. Adhesions bind the tubes together and the right tube tothe posterior surface of the uterus, rectum, and wall of the pelvis. II. Purulent Salpingitis. Etiology. The causes are essentially those of catarrhal previously stated, catarrhal salpingitis may be followed by sup-puration. On one side may be a catarrhal salpingitis; on the otherside a purulent salpingitis; the two apparently distinct and separatelesions may be dependent upon the same cause. Following are the statistics from the clinic of A. Martin: In2098 cases of purulent salpingitis, 279 were caused by gonorrhoea,374 by puerperal septic infection, 19 by tuberculosis, and 13 bysyphilis. Of this number 1282 were preceded by catarrhal sal-pingitis. From the statistics of Martin, Schauta, Frommel, Char-rier, Wertheim, and Prochowick 376 cases are collected,
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