704 THE REPRODUCTIVE ORGANS OF THE FEMALE. 



first month or not until much later. In rare cases, -fallen the wall of the tube was ex- 

 tensively involved in the formation of the placenta, the development has gone on until 

 term. The ovum may remain in the tube after the rupture, or may escape into the 

 peritoneal cavity, still enveloped in its membranes ; or the membranes may be ruptured 

 and left in the tube. The rupture is generally attended with fatal haemorrhage. In 

 some cases death is caused by the rupture of a dilated vein while the tube is still intact. 

 Haemorrhage into the sac may occur before its rupture. 



In rare cases death does not take place and the fetus is shut in by adhesions and 

 false membranes. The embryo soon dies. There may be a slow absorption of the soft 

 parts of the fetus, the bones are separated and left embedded in a mass of fibrous tissue, 

 fat, cholesterin, and pigment; or the fetus retains its shape and becomes mummified, 

 and may then be encrusted with the salts of lime (lithopedion). 



On the other hand, degeneration and gangrene of the fetus may take place rapidly, 

 with inflammation and suppuration of the surrounding tissue. There may be perfora- 

 tion and escape of the broken-down fetus through the rectum, vagina, bladder, or ab- 

 dominal wall. The patient may die from peritonitis or exhaustion, or may recover 

 after the escape of the fetus. In some cases the foetus may escape through a rupture 

 of the tube into the space between the folds of the broad ligament. 



In TUBO- ABDOMINAL PREGNANCY the development of the ovum is in the fimbriated 

 extremity of the Fallopian tube. Adhesions are formed, so that the fetus is partly in 

 the end of the tube and partly in the abdomen. 



INTERSTITIAL PREGNANCY. The ovum in these cases is arrested and developed in 

 the portion of the tube which passes through the Avail of the uterus. 



ABDOMINAL PREGNANCY. The ovum, after escaping from the ovary, may not 

 enter the Fallopian tube, but may become fixed to the peritoneum, usually near the 

 ovary, and develops in that position. 



OVARIAN PREGNANCY. The existence of this form of pregnancy is doubtful and 

 difficult to prove, but there are some cases in which it seems probable that the ovum 

 develops in its Graafian follicle. The placenta may be attached to the tube or to the 

 abdominal wall. 



In all forms of extra-uterine pregnancy the uterus becomes enlarged and a sort of 

 decidua is formed on its internal surface. 



The Mamma. 



Malformations . 



Arrest of development of the mammae occurs with arrest of development of the 

 other reproductive organs, and less frequently alone. 



One or both mamma? may be absent. Absence of the nipple is more common. 



Supernumerary mammae and nipples have been observed in a number of cases; the 

 glands may all secrete milk during lactation. 



Too early development of the mammae is sometimes found in young children in 

 connection with abnormal development of the organs of generation. 



HAEMORRHAGE. 



In young women who suffer from amenorrhrea or dysmeuorrhosa, 

 small haemorrhages sometimes occur in the mammae at the time of men- 

 struation. The blood may find its way into the milk ducts and exude in 

 small quantities at the nipple. 



Contusions of the breast may produce extravasations of blood in the 

 mammary gland or the surrounding connective tissue. This may become 

 absorbed, or may remain and be surrounded by fibrous tissue or be con- 

 verted into cysts. 



