Lectures on ectopic pregnancy and pelvic haematocele . ta has made for itself visceralattachments wherever it has touched, or where secondary ruptureof a broad ligament cyst has converted an extra-peritonealectopic gestation into one within the peritoneal cavity. Thatthe first of these processes is by far the most common conditionhas been proved to me beyond doubt in my operations, for Ihave seen the ruptured tube within a few days of the catastrophecontaining the great bulk of the placenta, whilst the villi of theextruded portion has been engaged in making epiphytic inroadson intestine, bladd
Lectures on ectopic pregnancy and pelvic haematocele . ta has made for itself visceralattachments wherever it has touched, or where secondary ruptureof a broad ligament cyst has converted an extra-peritonealectopic gestation into one within the peritoneal cavity. Thatthe first of these processes is by far the most common conditionhas been proved to me beyond doubt in my operations, for Ihave seen the ruptured tube within a few days of the catastrophecontaining the great bulk of the placenta, whilst the villi of theextruded portion has been engaged in making epiphytic inroadson intestine, bladder, the back of the uterus and the folds of theomentum. I have pulled these villi out of the living crypts theyhave made, much as one pulls a barnacle out of its bed, leavingbleeding holes behind them. But Berry Hart has proved thisbeyond dispute for he has been able to inject the placenta whichhad come out of its ruptured tube and acquired these strangeand unusual associations, and I here give a drawing of one ofthe preparations showing the Fig. 4.—Actual view of placental villi (c) encroaching upon and causing thinning of themuscular wall (a) of the Fallopian tube; h, maternal blood sinues. (Drawn by E. Tcichelmaunfrom section made by Beriy Hart.) From tlie relations of the outer extremity of the tube I shouldsuppose that a tubo-ovarian pregnancy or one in the pavilion,must of necessity always end by rupture into the peritonealcavity, and I think it would do so within the period whichlimits the existence of the purely tubal ectopic gestations, thatis thirteen or fourteen weeks. Clinically therefore there wouldbe no advantage in multiplying by further sub-divisions thevarieties of tubal gestations. Whatever difference of opinion onthese matters there may be, there can be but a uniform concensus STATISTICS. 15 of belief to this effect, that by far the greater number of casesof ectopic gestations are tubal. I belieA^e that they are reallyall tubal, and in this consis
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