The blood in case of rupture of the ovisac may form a hematocele be hind or to one side of the uterus, and undergoes the same changes as will be described later on.
In case early rupture of the sac, with fatal termination—as is usually the case in tubal pregnancy, of which we have seen and diagnosticated a number of instances—does not occur, then at the third to fourth month, pressure symptoms are caused, even as in case of tumors of other na ture, when they have attained the same size. These are the more marked the deeper the position of the ovisac, and the more the uterus is pressed upwards, or to one or another side.
The most prominent symptoms are due to pressure on the bladder and rectum. Compression of the urethra results in difficult micturition, and later there may be atony of the bladder, as sometimes occurs in retroflexion of the gravid uterus; pressure on the rectum causes constipation, at times so severe that the woman is unable to have a passage without enemata.
Later in the development, added to the pressure symptoms, are in flammatory troubles, which are caused by successive ruptures and blood extravasations and the reformation of pseudo-membranes. From time to time pains occur in the abdomen, usually in the neighborhood of the developing ovum, accompanied by recurring febrile symptoms and tym panites, which often cause the woman to remain in bed during her abnor mill pregnancy, until finally a fatal or favorable termination occurs.
In addition to the above symptoms of stretching and pressure, appear others from the side of the uterus. This organ, which goes through the same development as in pregnancy, and in which a decidua is usually formed, endeavors from time to time to discharge its con tents, and this is the explanation of the watery discharges and pieces of decidua. The contractions of the organ in the beginning are not marked, and cause but little pain; they increase, however, generally after an irregular manner, and towards the end of the gestation they assume the character of true labor pains. In two women we have seen the pains so severe that it was necessary to apply an abdominal compress. These
pains last for days, and are often the beginning of a favorable or fatal end, the latter being more frequent, and being due to rupture of the eac or to peritonitis.
If the ovum developes above the pelvic inlet, as occurred in one of our own cases, the pressure-symptoms are usually absent, and there are cases described where the fully developed foetus was found covered only by decidua, there being no pseudo-membrane; the inflammatory symp toms may be absent, and the abnormal pregnancy in rare instances can progress to full term, or even longer without causing special symptoms.
Termination of Extra-uterine Pregnancy.—Not all extra-uterine pregnancies lead to death, but a very small percentage run a favorable course. In literature there are recorded a large number of cases where the foetus either died in the ovisac, or where after rupture it was carried in the abdominal cavity for a number of years, until it finally caused death, or the patient succumbed to some other disease.
Recovery may ensue in case there is only rupture of the outer layers, when either the ovum degenerates or the fcetus dies, forming a so-called mole, as G. Blasius found even in a tube. Inflammation of or hemorrhage from the decidua, or lack of development of the villi of the chorion, will re tard the development of the foetus, or when developed prevents its further gro .vth; the foetus mummified becomes calcified within the intact sac.
Though the kindness of Professor Heschl I received a remarkable preparation of this variety, No. 3315 in the catalogue of the Vienna Pathological Museum, which was not contained in Rokitansky's collec tion, or described by any other writer. It came from a thirty-five year old woman who died from heart disease. The outer half of the right tube was swollen, and contained a bloody, slimy liquid, and in its cavity was a round hazel-nut-sized body, which was attached by tender threads from the villi of the chorion to the tubal wall. In the left ovary was a nut-sized cyst.