We shall first discuss the anomalies presented in the attachments of the ovum, i. e. its attachment and development at a point external to the uterine cavity, extra-uterine pregnancy and the degeneration of the ovum. We shall then examine the abnormities occurring in the separate parts of the ovum, the membranes, the placenta, the funiculus umbilicalis, and the foetus.

1. Extra-Uterine Pregnancy

Extra-uterine pregnancy may take place at different points; in the order of frequency these points are, the Fallopian tube, the parietes of the uterus, the ovary, and the vagina. We proceed to state the more important matters connected with each of these occurrences.

1. Pregnancy In The Fallopian Tube

Pregnancy In The Fallopian Tube (graviditas tubaria) is the most frequent of all; the ovum attaches itself either near the fimbriated extremity, or more towards the uterus; this part of the tube becomes dilated into an oval sac, with eccentric development. This variety of pregnancy generally proves fatal in the third or fourth month by hemorrhage into the peritoneal cavity, from rupture of the sac either with or without an escape of the foetus. We have however observed this occurrence in one case at the sixth week, and in another a fortnight after conception. On the other hand, an old preparation existing in the Viennese Museum, appears to prove that pregnancy may continue to the sixth or seventh month. Of six cases of tubal pregnancy preserved in the same collection, five are on the right side.

2. Pregnancy In The Parietes Of The Uterus

This kind of pregnancy, which has also received the name of interstitial pregnancy, and about the seat of which various opinions have been promulgated, is probably nothing more than a pregnancy of the Fallopian tube, i. e. a pregnancy occurring in that portion of the tube which traverses the uterine tissue. It is, consequently, in a close relation with the uterus, and necessarily involves the uterine parenchyma in such a manner that the cavity which contains the foetus with its membranes, appears to have been developed within the tissue of the uterus. It will consequently be most appropriate to consider it as tubo-uterine pregnancy. The pregnant sac consists of uterine tissue, its walls are of considerable thickness, and are in direct connection with the uterus; the sac is more or less distinctly seated at the side of the fundus uteri, and uterine fibres are traceable into it.

This pregnancy generally proves rapidly fatal by rupture; however, it is evident, both from our own observations and those of other morbid anatomists, that it may terminate in a different manner. At various periods of the normal progress of pregnancy, the sac, probably in consequence of the traction exerted upon it, becomes the seat of chronic inflammation, which passes into suppuration and gangrene; after causing the death of the foetus, this either proves fatal by itself or by inducing peritonitis. The sac may suppurate chiefly in one direction, and thus involve the adjoining viscera; so that, after their destruction, it may discharge its contents externally or into the cavities of neighboring organs; this is generally ejected slowly and piecemeal. In other cases, pregnancy not only attains, but even extends beyond the full period. The parietes of the sac in this case are of considerable substance and thickness; the sac itself is capacious, and contains a mature or even an overripe hypertrophied foetus. In one case of this description the pregnancy lasted sixteen months, and the over-ripe foetus, which had died some time previously, was extracted by opening the abdominal cavity and the sac.

3. Peritoneal Pregnancy

Peritoneal Pregnancy, graviditas peritonealis, occurs within the cavity of the peritoneum; the foetus with its membranes is surrounded by an organic exudation attached to the peritoneum, and the placenta is found connected with the most different parts of the parietal and visceral laminag of the peritoneum. This form of pregnancy generally terminates fatally at various periods by peritoneal inflammation; sometimes the peritonitis ends in suppuration, which may cause the effete foetus, together with the formative organs, to be discharged by various passages.

4. Ovarian Pregnancy

Ovarian Pregnancy is the most unfrequent form of the extra-uterine pregnancy; it either terminates in laceration, which is at once fatal, or in inflammation and suppuration of the sac, which in their turn prove fatal, or cause a diminution of the foetus.

5. Vaginal Pregnancy

Vaginal Pregnancy is not only the rarest of all, but altogether problematical.

Although we have given an anatomical account of the chief terminations occurring in extra-uterine pregnancy, we will add a comparative analysis, and also subjoin one that we have not yet mentioned.

Interstitial, ovarian, and tubal pregnancy terminate by laceration; the last two at an early period, the first much later, and even after the usual duration of pregnancy.

All the varieties of extra-uterine pregnancy may terminate in inflammation with consequent suppuration, owing to the decomposition of the defunct foetus, and the putrescence of its involucra. Inflammation may, in advanced interstitial pregnancy, doubtless arise in the sac primarily, from the traction exerted upon its tissue and upon the peritoneal investment, and thus induce the death of the foetus. If the suppurative process attacks the organs adjoining and adherent to the sac, the latter may discharge itself externally through the abdominal parietes or into the cavity of an adjoining organ; the foetus may thus be eliminated entire or piecemeal, in a state of maceration, saponification, or putrefaction. This has been observed repeatedly; single bones belonging to the foetus having been seen to pass through the navel, at different parts of the hypogastric region, and still more frequently by the anus or the urinary passages. It is stated that, after this has taken place, a cure may follow; but death from exhaustion is a more common consequence. The discharge may occur long after the usual period of pregnancy has terminated.

Besides the above-mentioned modes of termination there is another, which must be viewed as the most favorable one; in this case the foetus dies before or after it has attained maturity, and, after the surrounding fluids have been removed by absorption, becomes mummefied and indurated; or if the soft tissues have already undergone a certain degree of decomposition, it may become incrusted by a greasy, chalky substance (lithopaedion), and in this shape be borne for a long time in the contracted sac, without much inconvenience. This termination occurs chiefly in peritoneal pregnancy, it has however also been observed in pregnancy in the Fallopian tube.

In all extra-uterine pregnancies we commonly observe the formation of a deciduous membrane on the inner surface of the uterus; and the latter undergoes, up to a certain period, the same changes that it would present if it contained the foetus. It scarcely ever exceeds the dimensions which it exhibits about the first and second month of normal pregnancy. This development of the uterus is undoubtedly more considerable in interstitial and tubal pregnancy, than in the other varieties of extra-uterine pregnancy, and may be considered as analogous to the development of the unimpregnated half of the uterus bicornis or bilocu-laris.

2. Degeneration Of The Ovum

We here but allude to those cases of degeneration of the ovum which are called moles, and which are distinguished according to their external appearance, structure, and density as carneous, vesicular moles, etc. We exclude all abnormities in the formation of the foetus, and remark that moles generally contain no foetus, as the degeneration of the membranes and the placenta mostly occurs at a very early period of pregnancy, in consequence of which the embryo dies and disappears, the cavity of the amnios remaining persistent or becoming obliterated. The diseases in which the moles of which we speak originate, will be adverted to in the following pages, and we shall take care to point out the connection.

3. Abnormities Of The Separate Parts Of The Ovum