Gynécologie . y. Ceci tient en partie au fait que les opérations conservatrices sont susceptibles d'être suivies d'UNE INFLAMMATION 177 récurrence des symptômes, et en partie au fait que l'endomètre est deuxième impliqué dans un grand pourcentage de cas. Certains cas, où le bassin est rempli d'une masse densément adhérente involutingthe intestins, sont entièrement inutilisables, mais ces cas inutilisables peuvent transformer des remèdes extraordinaires sous un traitement hygiénique approprié, en raison du fait que les chronicadhésions, contrairement à ceux de la gonorrhée, deviennent souvent complètement absorbés et disparaissent spontanément. Comme indiqué,

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Gynecology . y. This isdue partly to the fact that conservative operations are apt to be followed by a INFLAMMATIONS 177 recurrence of symptoms, and partly to the fact that the endometrium is second-arily involved in a large percentage of cases. Some cases, where the pelvis is filled with a densely adherent mass involvingthe intestines, are entirely inoperable, but these inoperable cases may makeextraordinary cures under proper hygienic treatment, due to the fact that chronicadhesions, unlike those from gonorrhea, often become completely absorbed anddisappear spontaneously. As has been shown, the diagnosis of tubercular salpingitis is nearly alwaysmade after the abdomen has been opened. Old shrivelled up fibrous tubercular tubes found incidentally during pelvicoperations may be removed without disturbing other organs. TUBERCULOSIS OF THE UTERUS Tuberculosis of the uterus is usually confined to the endometrium, and this, in turn, is usually associated with and secondary to tuberculosis of the tubes.. Fig. 43.—Tubercular Endometritis.Low power. Around the edges are dilated glands lying in an edematous stroma. The centercontains a tubercle consisting of necrotic tissue infiltrated with round cells and containing severalgiant-cells. The infection takes place by descending extension in the manner mentioned above.It is difficult to say how frequently tubercular endometritis complicates tuber- 12 178 GYNECOLOGY culosis of the tubes, but good authority estimates it as occurring in about one-half of the cases (Kustner). This is a matter of considerable practical impor-tance in deciding the question of a conservative or radical procedure when operat-ing on the tubes. Tuberculosis of the endometrium, as a rule, usually affects onlythe mucous membrane, and usually appears microscopically only as scatteredtubercles in the stroma. It may, however, become more extensive and ulceratethe surface. Rarely the process invades the myometrium, and may even go sofar as to convert the ute

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