. The diagnosis of diseases of women . s espe-cially susceptible to tuberculous infection. Inflammatory lesions of the tubes are likely to have tuberculosisengrafted upon them. In this manner we have mixed infections ofthe tubercle bacillus with the gonococcus, staphylococcus, strepto-coccus, and colon bacillus. 400 SPECIAL DIAGNOSIS Anatomical Diagnosis. As in other forms of salpingitis werecognize an acute and a chronic stage. Acute tuberculous salpingitis is very rare. The tube resemblesthe catarrhal form. There is a slight increase in the size of thetube together with marked congestion; th
. The diagnosis of diseases of women . s espe-cially susceptible to tuberculous infection. Inflammatory lesions of the tubes are likely to have tuberculosisengrafted upon them. In this manner we have mixed infections ofthe tubercle bacillus with the gonococcus, staphylococcus, strepto-coccus, and colon bacillus. 400 SPECIAL DIAGNOSIS Anatomical Diagnosis. As in other forms of salpingitis werecognize an acute and a chronic stage. Acute tuberculous salpingitis is very rare. The tube resemblesthe catarrhal form. There is a slight increase in the size of thetube together with marked congestion; the mucosa is swollen andthe secretion increased. The entire wall of the tube is infiltratedwith small round cells, and in addition to these changes, which arethose of acute catarrhal salpingitis, giant cells, tubercles, andtubercle bacilli are found in the mucosa and, to a lesser degree,in the muscularis. The lesion is more pronounced in the fimbriatedend. The secretion collected in the lumen may be serous, bloody,or purulent. Fig. 166. Tuberculosis of the uterus, tubes, and ovaries. The surface of the uterus, tubes, andovaries is covered with miliary tubercles by direct extension from the peritoneum. Theappendages are matted and enlarged (tuberculous salpingitis and ovaritis). From the acute the lesion may merge into a chronic stage closelyresembling chronic catarrhal or chronic suppurative a rule, there is no acute stage. INIiliary tubercles may aggregate to form large tubercles andnodules, which in turn may undergo caseous degeneration. Thelumen of the tube may be filled with caseous material. A tuber-culous pyosalpinx may form after the closure of either end of thetube. There is no way of distinguishing tuberculosis of the tubes eitherin the acute or chronic stage from catarrhal or suppurative salpin-gitis except by the discovery of tubercles, giant cells, or tuberclebacilli. For this reason tuberculosis in a tube is often over-looked. DIAGNOSIS OF DISEASES OF
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