_At the Time of Rupture._--Many cases of tubal pregnancy are first seen at the time of rupture. In such cases celiotomy should be performed without delay. The condition is most urgent in intraperitoneal rupture, but it is the safest rule to operate immediately, whether the rupture be intraperitoneal or extraperitoneal. It is unwise to wait for reaction. The physical depression in such cases is due more to hemorrhage than to shock, and it is in accord with general surgical principles to arrest hemorrhage at once. Rupture usually takes place before the twelfth week, and the whole product of conception, with the tube, may readily be removed. Hemorrhage usually ceases as soon as the proximal and distal ends of the ovarian artery are ligated. The ligatures may be placed about the ovarian artery, at the pelvic wall, and at the uterine cornu, as the first steps of the operation, before any attempt is made to remove the mass. It may be necessary to close the rent in the broad ligament by a series of sutures. _After Rupture._--If the woman survive, and is first seen after primary rupture, one of two conditions will be present--a destroyed or a developing extra-uterine pregnancy. If the fetus has died and gestation has ceased, the woman is exposed to the various dangers that attend the presence of such a foreign body in the abdomen. If the fetus has died during the earlier months, it may have been absorbed and spontaneous cure may take place. Even a dead full-term fetus has been carried in the abdomen for years without producing a fatal result to the mother. It seems safest, however, in all such cases to operate as soon as the condition is recognized. The rules of abdominal and pelvic surgery apply to such cases. The placenta of a dead fetus may be removed without fear of uncontrollable hemorrhage. If the woman is seen after primary rupture, with a developing gestation, the case presents much more serious dangers. These dangers lie in the placenta. If the pregnancy has not advanced beyond the fourth month, it is usually possible to remove the whole of the gestation-sac, the embryo, and the placenta without uncontrollable hemorrhage. The ovarian, and if necessary the uterine, arteries may be ligated, and the placenta may be removed in one mass. The cavity of the broad ligament may be obliterated by buried sutures.