Rarely, after spurious labor the gestation-sac ruptures and the fetus is discharged into the peritoneum, the vagina, or the large intestine, whence it is born through the anus. The =symptoms= of tubal pregnancy are in some cases similar in all respects to those of normal uterine pregnancy. In extremely rare cases the woman has reached full term in ignorance of any unusual condition. Usually, however, the early occurrence of some of the accidents of tubal gestation attracts her attention. Before such accidents or complications arise there are most frequently no subjective symptoms to excite any suspicion of the peculiar form of pregnancy. Changes in the skin, in the nipples, in the nervous and circulatory systems, and in the gastro-intestinal tract may resemble those of normal pregnancy, and are subject to the same variations. Mammary changes accompanied by the secretion of milk occur in tubal pregnancy. These changes are, however, less pronounced than in uterine gestation. The vagina may undergo changes similar to those of normal pregnancy; it becomes soft, relaxed, and altered in color, and pulsation of vessels may be felt in the walls. It should always be remembered, however, that tubal pregnancy may occur without the presence of any of the signs of pregnancy. Women in perfect health, thoughtless of pregnancy, have died of acute hemorrhage from a ruptured tubal gestation--the first symptom of this condition. The changes in menstruation vary a great deal. Menstruation usually ceases when tubal pregnancy begins, though not with the same regularity as in normal pregnancy. Sometimes menstruation continues for a few months and then ceases. In other cases menstruation is arrested for the first few months, and occurs with greater or less regularity during the latter months of pregnancy. There may be an irregular discharge of blood throughout the whole course of gestation. In the blood discharged from the uterus there may often be found pieces of decidual tissue of various size. Sometimes the whole decidual membrane of the uterus may be expelled in one mass. In any suspected case the blood should always be carefully examined for such decidual membrane. All shreds of tissue should be submitted to careful microscopic examination. The woman should be questioned in regard to the passage of such tissue before she came under medical supervision. The woman often complains of periodical pains occurring in the hypogastrium and in the pregnant tube. They usually appear after the second month, though they may begin earlier. These pains are thought to be caused by the contractions of the uterus and the gestation-sac. The abdominal enlargement in extra-uterine pregnancy differs in several respects from that of normal pregnancy. It is usually most marked on one side of the abdomen, especially during the first five or six months.