It must be remembered that amenorrhea is not as general in tubal as in uterine pregnancy. The woman often gives the history of irregular bleeding, or of arrest for a few periods and then recurrence of menstruation. Such experience may lead her to seek medical advice even before rupture. The intermitting attacks of pain that are sometimes felt in the affected tube may also cause her to seek medical advice. A history of the discharge of membrane or of shreds of membrane is of great value. If opportunity is afforded for examination of such shreds, and decidual cells are found, and if uterine pregnancy may be excluded, there is very strong evidence that any mass in the pelvis is an extra-uterine gestation. It has been advised to curette the uterus for diagnosis in order to determine the decidual character of the lining membrane. This is good advice if the operation is performed with great care and if we can with certainty exclude the possibility of uterine pregnancy. If followed indiscriminately, numbers of abortions would be produced. Uterine pregnancy has often been mistaken for tubal pregnancy. The mistake is likely to occur when the fundus is drawn to one side or is retroflexed. Uterine pregnancy may occur with tubal enlargement from other cause than tubal pregnancy. In conclusion, the diagnosis of tubal pregnancy before the presence of a fetus can be ascertained is based on the following considerations: The symptoms of pregnancy; a tubal or pelvic tumor; a slightly enlarged though not pregnant uterus; discharge of decidual tissue from the uterus; the history of the woman pointing to menstrual irregularity, uterine discharge of shreds, history of previous tubal rupture. =Treatment.=--The treatment of tubal pregnancy is operative. It may be considered under the following heads: Before primary rupture; At the time of rupture; After rupture. _Before Primary Rupture._--If the physician is so fortunate as to recognize a tubal pregnancy before primary rupture, he should without delay remove the affected tube and the contained ovum. The operation is simple, is attended by no more danger than that accompanying an ordinary salpingo-oöphorectomy, and the woman is saved the imminent dangers associated with a developing tubal pregnancy. There are no circumstances under which it is proper to follow an expectant treatment. Most of the cases of unruptured tubal pregnancy that have been operated upon were not recognized until the abdomen had been opened. The operation was performed under the diagnosis of pyosalpinx, hematosalpinx, or some other tubal disease. The cases show the value of the general rule to operate without delay for all gross diseases of the tubes.