Some Points in the Investigation, Prognosis and Treatment of Tubal Conditions, with Special Reference to Insufflation and X-Ray Examination after Injection with Lipiodol *Read before the Edinburgh Obstetrical Society, 11th May 1932.

The two procedures, namely, testing the tubes for patency by insufflation and X-ray examination of the uterus and adnexa after the injection of lipiodol, have made intelligent and practical much which has hitherto been speculative and empirical. Insufflation has its chief scope in cases of sterility. The routine operation of a dilatation and possibly a curetting, if performed without the additional information obtained by insufflation, is done on a speculative basis. It is obviously futile to render the cervical canal and the uterus itself more patent if some inflammatory lesion has blocked the fairway along the tubes. The percentage of such tubal lesions must of necessity be a variable factor, but whatever percentage is accepted it must be sufficiently large to be reckoned with. 15 to 20 per cent, of cases of sterility of the hospital class have sealed tubes. When investigating cases of sterility a history of cervical adenitis or appendicitis, or the operative scars for such conditions, or a history of inflammation of the bowels in childhood, make it imperative that the tubes should be tested regarding their patency. A history of a septic puerperium would also make for special care in cases of one-child sterility. Cases with gross evidence of pelvic mischief usually complain of other symptoms, and sterility is purely a secondary matter. The type of case under consideration complains of sterility and does not give any pelvic symptoms. The examination may reveal some of the finer evidences of mischief, such as peritoneal thickening, a cystic ovary, or one lacking mobility,