FIG. 5.-Pyosalpinx. Longitudinal section through the tube. a, tube with thickened walls and dilated lumen filled with pus; b, cavi'y of the cystic portion of the tube; c, remains of the mucous membrane. The external third of the tube is dilated into an oval shaped cyst measuring 4% by 5 centimetres; its walls are thin and are composed almost entirely of fibrous tissue.

walls thickened, and it becomes twisted into all manner of shapes. The peritubal inflammation is so great that the adhesions and new-formed tissue almost completely obliterate its outlines. The fimbriæ, being extensions of the mucous membrane of the tube, are involved in the inflammatory process at an early stage. They become agglutinated by the exudate, which organ

FIG. 6a.-Bilateral pyo alpinx. A, left tube: a, uterine end of the tube, covered with adhesions; b, longitudinal section of the tube at its middle portion, showing its lumen dilated and its walls thinned; c, cyst of the fimbriated end of the tube. The left tube, A, is dilated into an irregular-shaped cyst measuring 5 by 4 centimetres.

izes and binds them to adjacent organs and finally closes the abdominal ostium, which in time becomes rounded off.

Pyosalpinx is the sequel of a suppurating salpingitis. After the closure of the abdominal ostium, if the inflammatory process progresses, there is an accumulation of pus in the lumen of the

tube. The swelling of the mucous membrane at the uterine end or the complete obliteration of the tube at this point prevents the evacuation of the pus in this direction; the abdominal end being closed, escape is also cut off at this end. The pus accumulating in this now closed sac causes a distention of the tube. This distention generally takes place more rapidly at the outer portion of the tube, so that in the early stages of the lesion it assumes a club shape and in the later stages a pear shape. At

FIG. 6b.-Bilateral pyosalpinx. B, right tube: a, longitudinal section of the uterine end of the tube; b, longitudinal section of the middle portion; c, section of the dilated fimbriated end; d, small cyst on the surface. The right tube, B, is an irregular pear-shaped cyst measuring 11 by 4 centimetres.

times this distention may be uniform throughout the entire length of the tube, when the resulting cyst assumes an elongated cylindrical shape, which may become more or less curved and in advanced cases very tortuous.

The walls of the tube, as a result of this distention, become thinned, and the mucous membrane is replaced by a layer of granulation tissue.

In many cases, however, the perisalpingitis keeps pace with, or even advances more rapidly than, that within the cyst. In such cases the cyst wall becomes very much thickened and firmly adherent to the walls or organs of the pelvic cavity.

Suppurative inflammation of the ovary may occur either as an acute or chronic process ending in the formation of abscesses, or as a suppurative process in pre-existing cysts. The acute process is almost always associated with the puerperal state;

FIG. 7.-Suppurating salpingitis, suppurating cyst of the ovary. a, transverse section of the tube; b, longitudinal section of the portion of the tube attached to the ovary; c, cavity of the cyst of the ovary; d, granulation tissue lining the cyst; e, section through the granulation tissue lining a pocket in the cyst. The cyst measures 16 centimetres in circumference, its walls are composed almost entirely of fibrous tissue, and it is lined internally with a layer of granulation tissue from 3 to 4 millimetres in thickness.

unconnected with this condition it is exceedingly rare. The chronic form is the more common and is almost always the result of the extension of a similar process already existing in the Fallopian tube. In the early stages of the lesion the stroma

a,

FIG. 8.-Suppurating salpingitis, suppurating cyst of the ovary.
enlarged and tortuous tube, its surface covered with adhesions; b,
external surface of the cyst of the ovary; c, wall of the cyst; d, lining
membrane of granulation tissue. This cyst has moderately thick
walls. It is of an oval shape, measuring 5% by 2 centimetres. It is
lined with a thick layer of granulation tissue which is thrown up into
numerous folds.

of the ovary.