The Abdomen 151 



perforating tracts, irrigate the cavity, and establish drainage; in 

 fact, treat such a case exactly as«if it were peritonitis. 



Fetuses. Fetuses may find their way into the cavity through 

 a rent in the wall of the uterus at any stage of their development, 

 but most commonly at the parturition period through operative 

 bungling, or they may pass the whole period of their existence there 

 by reason of the fecundated ova escaping from the ovary at the 

 fimbriated extremity of the Fallopian tube. True ectopic gestation 

 due to implantation of the ovum in the oviduct, which is common 

 in the human female and which is frequently associated with rupture 

 of the tube when the embryo has grown to a certain stage would 

 seem to be an extremely rare condition if the absence of recorded 

 cases is to be taken as indicative. 



When a fetus falls into the cavity during parturition it may or 

 may not carry pathogenic microbes with it, according to whether the 

 uterus is infected or not. If it is aseptic it macerates and is absorbed, 

 though the hard parts take considerably longer to disappear than 

 the soft. This process may have cachectic and even lethal effect by 

 autointoxication. Blanc recorded a case which proved fatal within 

 a month. A septic fetus produces peritonitis. 



In extra-uterine gestation a sac or pseudo-uterus develops around 

 the fetus by formation of fibrous tissue. Such sacs have been found 

 attached to various portions of the peritoneum such as the neigh- 

 borhood of the ovaries, the omentum, and broad ligament. The 

 fetus may continue to develop to full term and then decompose and 

 develop into a suppurative focus, probably by becoming a locus 

 minore resistentiae to the action of microorganisms circulating in 

 the blood, but it usually macerates and is partially absorbed. The 

 internal surface of the sac sometimes undergoes a sort of calcifica- 

 tion. An" animal may conceive in the uterus while having a mace- 

 rated skeleton of a fetus in the peritoneal cavity. Undoubted cases 

 have been recorded by Vemaux and myself. 



Symptoms and Diagnosis. As in the case of perforating in- 

 animate objects, so with fetuses, when they are accompanied by 

 pathogenic microorganisms in their passage from the uterus, the 

 symptoms are those of peritonitis. At the time of parturition the 

 lesion is sometimes discoverable by digital palpation. In Blanc's 

 case referred to above, a fibrinoplastic peritonitis had been pro- 

 voked which had caused an enlarged fluctuating abdomen. 



