OF TRUE PREGNANCY. 141 



364. Every species of extra-uterine pregnancy may terminate by 

 the laceration of the ovum, and of the sac which serves in place of a 

 womb; examples of this kind, if we may credit M. Mesniere, have 

 been noticed both in instertitial and abdominal pregnancy; but tubal 

 pregnancy most frequently terminates in this way: although very 

 extensible, the parietes of the tube are, nevertheless, too thin to ad- 

 mit of the enlargement of the cyst beyond the third or fourth month. 

 In some instances the rupture occurs suddenly and seems to be 

 occasioned by some exertion, or fall, &c.; sometimes, on the other 

 hand, it is effected and prepared for by slow degrees, by the mecha- 

 nical thinning, the softening, or some other change of a portion of 

 the foetal sac. In all cases where no conservative adhesions have 

 been formed, the water of the amnios, the fostus, and the blood that 

 flows from the lacerated surfaces, pass into the cavity of the perito- 

 neum; iipothymia, syncope, convulsions incessantly repeated, and 

 intolerable pains, often carry off the sufferer in a few hours; in other 

 instances vital resistance does not so readily yield; a violent perito- 

 nitis comes on, and death succeeds on the second, third, or fourth 

 day. Finally, in some rare cases, nature, with proper assistance, 

 resists the first dangers of this redoubtable tempest, and a protracted 

 inflammation permits the effused matters to accumulate in a more 

 circumscribed space, and give birth to a real abscess, which may 

 still leave some chance of saving the patient. 



365. Treatment. The impossibility of <;ertainly recognising the 

 nature of extra-uterine pregnancy in the 5rst months of its existence, 

 is the reason why attempts to remec'y it are scarcely ever made until 

 the occurrence of symptoms, apiiouncing the death of the foetus or 

 rupture of its coverings: besiJes, the powers of art are so limited in 

 these circumstances, that the only assistance which it is possible to 

 afford would be almost as dangerous, in itself considered, as the na- 

 tural terminations of the affection. Gastrotomy, the only remedy 

 that has been proposed, can boast of no successes as yet; in one case, 

 published by M. De Bouillon, the woman survived eighteen days; 

 nature, on the contrary, when left to her own resource, has several 

 times succeeded in triumphing over all obstacles. Nevertheless, the 

 fears of Levret and Sabattier, in regard to hemorrhage, suppuration, 

 and wounds of the peritoneum, are evidently exaggerated; it would 

 seem, a priori, that gastrotomy ought to be much less frequently 

 fatal than is commonly supposed. 



366. On the other hand, although we have no right to invoke past 

 experience in its favor, we should not forget that, having been 

 hitherto performed in despair of all other assistance, we have no 

 reason to be surprised at its not having prevented death from taking 



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