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Related post: muscular fibers of the tubes, enlarging at first, subsequently become markedly thin by stretching from the continued and increasing pressure due to the growth of the ovum, which finally ruptures the tube, usually between the second and third months. According to Mr. Tait the most com- mon seat of rupture is through the surface of the tube into the cavity of the peritoneum, because, as he says, **the pro- portion of the circumference of the tube which is covered by peritoneum is very much greater than the proportion of the circumference of the tube which is related to what is called the cavity of the broad ligament. " As a result of Cheap Generic Topamax such tubal ruptures the placenta is frequently lacerated and the hem- 94 PHYSIOLOGY OF IMPREGNATION OF THE OVUM. orrhage is excessive, which pours into the peritoneal cavity, death being frequently due to shock, hemorrhage, or. if not from either of these, purulent peritonitis is apt to develop. Associated with the rupture in the wall of the tube nnay be that of the ovum, with the escape of the foetus into the peritoneal cavity, or it may be that the ovum remains whole, and in such condition falls into the abdominal cavity ; should the ovum, though, remain in the Buy Topamax Cheap No Prescription tubes, which is rare indeed, and most favorable, the extent of the hemorrhage Topamax Online Buy may be lessened. Spiegelberg mentions three instances where this form of extra-uterine pregnancy advanced to full term, and Hofmeier still another. In all three cases the enormous muscular development in the tubal walls was characteristic. Fatal as this form of ectopic gestation usually is, Can I Order Topamax Online recovery may occur in case of premature death of the foetus before the tubes give way ; and even after rupture has taken place recovery is possible, owing to the formation of inflammatory false membrane around the Topamax Yellow embryo of the entire ovum. Should the tube rupture at any point not involved by the peritoneum, the folds of the broad ligament become sepa- rated by the effused blood, forming a cavity into which the ovum may fall, and either become destroyed, or continue developing up to the fourth, fifth or sixth month, when it usually dies. Then we have, according toTait, Topamax Yellow Pill **a group of cases in which, after suppuration has taken place, the bones of the foetus are discharged through the rectum, through the bladder, or through Douglas* cul-de-sac into the vagina, or sometimes a lithopedion results. The minority proceed to Buy Cheap Topamax the Topamax Prices Pharmacy full time, and are removed, either Purchase Topamax Weight Loss as living or as dead children, from an extra-peritoneal cavity." OVARIAN PREGNANCY. So Topamax Discount Coupons long ago as the latter part of the seventeenth century St. Maurice demonstrated a case of ovarian pregnancy. Since that day a number of cases of this very rare condition are now on record, as that of Granville, Porter, Buy Topamax No Prescription Kammerer, Band!, supported by the tliorougii investigations of Marimus of three preparations found in the Pathological Museum of Wurzberg, which proved unquestionably the presence of gravid ovaries. In Porter's case the woman died from rup- ture at between the sixth and seventh week of gestation in her fourth pregnancy. The autopsy revealed the left ovary greatly enlarged, cofttainiui^ the gravid .sac ; the Fallopian tube on the same side was found * 'floating free and tmpet^ PHYSIOLOGY OF IMPREGNATION OF THE OVUM. 95 vious,** In ovarian foetation, as is usual, the cyst is void of a peritoneal investment, the walls of the Graafian follicle and the stroma of the ovary forming the envelope about the developing ovum. The chorion Topamax Xr is in intimate relation with the interior of the sac. Subsequent to fecundation the Graafian follicle may close, and the ovum continue extra- peritoneal, or the ovum may gradually make Topamax Price Canada its way through the opening occasioned by the escape of the Buy Topamax Cheap Graafian fluid, and thus come to lie eventually, for the most part, within the peritoneal cavity. In either case, rupture of the sac takes place early, though when the sac walls are rein- forced by inflammatory adhesions to the peritoneal cov- erings of adjacent viscera, gestation at full term may be reached. ABDOMINAL PREGNANCY. Primary — Secondary, As was shown in an earlier part of this paper, ova fre- quently, becoming fecundated, drop into the abdominal cavity and perish, the soil being unpropitious for Topamax Price 50 Mg their further development ; occasionally it happens, though, as has Generic Topamax Price been demonstrated, that their death is not so imminent, and that their growth may continue for Topamax Discount Card an indefinite period. Now, the pathological changes occurring in this form of '^primary abdominal" pregnancy must be distinguished from those that take place in that form which is termed **secondary." In the one instance we have so minute, soft, fragile and delicate a corpuscle deposited in the Purchase Topamax No Prescription peritoneal cavity that one Discount Topamax could not well imagine any grave and inflammatory results accruing from its immediate presence. This being the case, then, the contiguous abdominal organs will not Generic Topamax be injured by its ulterior development, because, as Cazeaux remarks, they gradually become habituated to it, and the ovule, having obtained a right of possession, **lives, grows and presents to the smooth, polished surfaces which touch it a Mail Order Topamax surface equally smooth, polished and moistened at their expense, and not having occasion for any other protecting envelope, no cyst is formed," the ovum being simply sur- rounded by the chorion and amnion. On the other hand, in the secondary form of intra- peritoneal pregnancy, we have a voluminous product of con- ception suddenly thrust upon the peritonium, accompanied by large quantities of blood, wounding possibly, irritating certainly, this membrane so unaccustomed to such harsh 96 IS THE FREQUENT USE OF FORCEPS ABUSIVE? intrusion. Here the ovum acts the part of a foreign body, soon determining an acute inflammatory process about Cheap Topamax No Prescription it which possibly may form a cyst-wall made up almost wholly of plastic lymph, which completely isolates it from the rest of the peritonial cavity. If the foetal cyst ruptures, and the contents escape from the amniotic cavity into the midst of the intestinal mass, a renewal of the inflammation occurs, and the cyst just described forms around it. As n rule the foetus perishes at or soon after the time of rupture ; still, there are cases recorded, especially by Bandl, where it con- tinued developing even within the sac formed of prolifera- ting connective tissue. With the death of the child it may be converted into a Hthopedion, or, through the blood- supply of the connective tissue, it may be preserved for
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