Genital Tuberculosis in Women

REVIEWS AND ABSTRACTS

343

Driessen: Genital Tuberculosis in Women. N" ederlandsche Tij dschrift voor Geneeskunde, 1920, ii, 1652. In investigating the final outcome of cases of adnexal tuberculosis, Driessen finds that in the afebrile cases the patients were alive and in splendid health up to ten years after treatment, which was not necessarily surgical. The patients with fever and night sweats, however, usually succumbed earlier. Driessen places great hope in the development of the use of the R. E. vVOBUS. roentgen and violet rays for these cases. Stephan: Special Indications for Roentgen Treatment in Peritoneal and Genital Tuberculosis. Monatsscbrift fiir Geburtshiilfe und Gynakologie, 1921, liv, 314. Stephan discusses the treatment of tuberculous lesions of the peritoneum and internal genitalia and outlines the general principles of such procedures at present in use in the Clinic at Greifswald. The clinic does not advocate x-rays in all cases to the exclusion of radical operation and never attempts to employ the latter when an .exploratory laparotomy reveals dense adhesions between the loops of :intestines and the internal genital organs. Each case must be individualized and treated accordingly. ~{"'j "'l"X1l-....-. ...... +h.r.-wr. Ll.U::.L c:; lh'

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the intestines matted together but without ascites, the x-ray is used exclusively; it is immaterial whether or not there is an accompanying infection of the genital organs. ~foreover, this treatment is employed in all patients who refuse operation, and in all others who exhibit general cachexia or other primary manifestations which contraindicate operation. In the miliary form of tuberculons peritonitis with ascites, the abdomen is opened so that the diagnosis may be established by inspection and by the examination of some of the excised tissues. The fluid is drained off at the same time and the condition of the internal genitalia is carefully determined. If the pelvic organs show only a serous reaction to the infection, the entire abdomen is x-rayed during the convalescent period, both through the front and the back, with the small pelvis screened off, so that the pelvic organs are subjected to a dose too small to effect cessation of ovarian function. It is well-known that the hyperemia and round-cell infiltration resulting from the raying of the mmer nortion of the neritoneal cavity affects the whole serous cavity:everi" though all COl'llers are not rea~hed primarily by the rays. In young patients, even when the adnexa are severely involved, it i'l P!':i~Pnt.iRl t.o hv to nrPRPl"VP H fnndionatin1r ovarv. This is onlv nos~bl~- ~;h-~~~ :th~-~x~~( ~~~ditio;~~ -~~~ d~te;~in~d ;t laparotomy." The process is never of equal severity on the two sides and the better of the two ovaries is conserved if possible. If, for example, one side shows the tube alone affected, it is removed completely while the ovary is left in situ, and the other side which shows more extensive involvement is not disturbed, but is intensively rayed after operation, the normal ovary being protected so that menstruation will not be stopped. In the cases most advanced, with involvement of the whole genital tract and with broken-down foci in the pelvis, the abscesses are opened