TUBAL PREGNANCY.
This is the commonest described variety of extra-uterine pregnancy; out of sixteen preparations in the Vienna Pathological Museum, there are nine with tubal pregnancy, and about two-thirds of the reported cases are described as being of this variety. Hennig found, out of 122 carefully analyzed cases, the seat of the egg to be seventy-seven times in the cen tral part of the tube, and in the remainder of the dues the situation was found to be: If the impregnated egg remains in any part of the tube, the uterine mucous membrane changes, and the tubal mucous membrane becomes increased, surrounds the egg, forms a decidua, and a placenta is developed similarly to that in intrauterine pregnancy. The early changes of the mucous membrane, and the formation of the decidua of tubal pregnancy have been thoroughly described by Rokitansky. According to him the decidua is formed as follows: The tubal mucous membrane becomes softened, covered with numerous elevations and depressions. which anas tomose together and form an areolar layer, which with its depressions receive the villi of the chorion. Until a placenta is formed they are very loosely fastened together. These ideas of Rokitansky are quoted by Lang haus, Leopold, Hennig and others, who have further continued the de • scription. Langhaus says that the changes of the structure of the tubal wall are, strictly speaking, the actual formation of a decidua, which is only completely formed at the placental site. Leopold found that the entire tube, by means of the chorion, was adherent to the ovum, and is so situated that the placental site becomes adherent to the tubal wall, so that from without inward, next to the serosa, is a single muscular layer one twenty-fifth of an inch in thickness, which contains blood cavities through its entire structure. Here a chorion is immediately formed, without the regular mucous membrane divisions, into decidua serotina; it is covered. with epithelium, which is very vascular. The villi on that account, in general, lie loosely next to the musoularis; hut occasionally some are firmly adherent by their expanded extremity to the inner muscular layer, and are surrounded by vessels, even as in the case of the normal serotina.
Recently Hennig noticed that the villi of the chorion are taken into the follicles of the mucous membrane, and in regard to the decidua reflexa, he states that on the thicker parts of the decidua tubas, the layers are sep arated.
The uterine opening of the pregnant tube is occasionally open, and its decidua extends to the mucous membrane of the uterus; usually an extra uterine ovum is shut off from the uterus. Generally tubal pregnancy causes in the beginning no symptoms, and as a rule it is of short duration; it bursts early through the thinnest part of the tubal wall, or at the placental site, and death is caused by internal hemorrhage, or the resulting acute peritonitis.
Ilecker found that rupture took place in 45 collected cases, 26 times during the first two months, 11 times in the third, 7 times in the fourth, and once in the fifth month.
Among the preparations of the Vienna Pathological Museum, was one rupture of a Fallopian'tube the size of a hazel nut, one the size of a pigeon's egg, three the size of a hen's egg, one the size of a goose-egg; in the balance of the tubal pregnancies, there were three with mature foetuses, but owing to the false membranes surrounding the foetal sac, it is impossible to positively diagnosticate the original situation of tile ovum. When an ovum is situated in the outer portion of the tube, it seems as though its duration is shorter, and this is proved by one of Spiegelberg's cases, in which the egg-sac was situated between the layers of the broad ligament, and its walls were strengthened by hyperplasia of the muscular layer of the latter. Recently Litzmann has again drawn attention to this condition, and has stated that such a development of the ovum is of fre quent occurrence, and to it is due the contractility of the sacs.