The =diagnosis= of uncomplicated tubal tuberculosis is difficult, and in many cases impossible. If the peritoneal covering of the tube is involved, the small tubercles may sometimes be felt by vaginal or rectal palpation. Or, if the condition has extended to the posterior aspect of the uterus, the tubercles may be felt here, by dragging the cervix down with a tenaculum and palpating the posterior uterine surface with a finger in the vagina or the rectum. The association of salpingitis with pulmonary tuberculosis would lead the physician to suspect that the salpingitis might be tubercular. If the woman has tuberculosis of the peritoneum, and the tubes are found enlarged, it is most probable that they are tubercular. A knowledge of a genito-urinary lesion of tubercular nature in the husband should lead us to fear tubal tuberculosis in the wife. =Prognosis.=--Tubal tuberculosis is a dangerous disease. There are several methods of termination. It very often leads to tuberculosis of the peritoneum. For this reason peritoneal tuberculosis is more common in women than in men. A tubercular abscess may be formed in the pelvis, and the woman may die as the result of prolonged discharge and suppuration, as in the case of non-tubercular pyosalpinx. General tubercular infection may arise from the tubercular focus in the tubes. Tuberculosis of the tubes may, and probably often does, undergo spontaneous cure. The fibroid changes that have been described lead to this end. In some cases calcification occurs, as in tuberculosis elsewhere, and the disease is cured in this way. Fig. 154 represents an old tubercular pyosalpinx that was filled with calcified plates. Even though these conservative changes take place and all danger from the tuberculosis has disappeared, the woman will continue to suffer pain and dysmenorrhea from the tubal and ovarian adhesions. =Treatment.=--The treatment of tubal tuberculosis is celiotomy, with removal of the tubes and ovaries. If the uterus is involved, it should also be removed. Removal of the tubes, however, is the important feature of the operation. I have seen perfect and permanent recovery occur after removing the tubes, even though the disease had extended into the uterine cornua. As the disease very rarely extends below the internal os, the uterus may be amputated at any convenient point of the cervix. [Illustration: FIG. 154.--A tubercular pyosalpinx. To the left are three calcified plates that were found in the tube.] Tuberculosis of the peritoneum is an indication for, rather than a contraindication to, the operation. The most extensive cases of peritoneal tuberculosis have been cured by opening and draining the abdomen. If the tubes are rendered inaccessible from the involvement of surrounding structures, the operator must content himself with opening and draining the abdomen.