Extra-uterine pregnancy; its causes, species, pathological anatomy, clinical history, diagnosis, prognosis, and treatment.

  • Parry, John S. (John Stubbs), 1843-1876.
Date:
1876
Catalogue details

Licence: Public Domain Mark

Credit: Extra-uterine pregnancy; its causes, species, pathological anatomy, clinical history, diagnosis, prognosis, and treatment. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    some time under the care of a midwife, who asserted that she had felt the head of the child presenting, but that it had sud- denly disappeared in the midst of a severe pain. Moreno diagnosticated rupture of the uterus. A large number of gentlemen were called in consultation, but the error was not corrected until the autopsy was made. The mistake was ascribed to the statements of the midwife, who seems to have been a competent and experienced woman. The narrator appears to infer that she did not find the head presenting, but it is probable that she was perfectly correct in her observa- tion, and that the child suddenly changed its position in the cyst. This error is to be avoided by a careful examination of the uterus, when the os will be found to be displaced in most in- stances, and always to be much less developed than it should be at the full term of pregnancy. In this way the midwife who had charge of Dr. Kelly's patient would have avoided the mistake of opening the retro-uterine tumor in labor, under the impression that it was the bag of waters. Diagnosis after the Death of the Child.—If the patient is not seen until after the death of the child, the diagnosis of an extra-uterine pregnancy may be very difiicult. Many years may have intervened before the woman comes under notice. Of course, if the cyst has opened into the bowels, bladder, or vagina, or a fistule has formed through the abdominal wall, there will be little or no trouble in arriving at a correct con- clusion. Difficulty will arise only when the cyst has not ruptured, or, having opened into the bladder or into the rectum out of reach, it has not discharged any of its solid contents. Under these circumstances, a correct conclusion can be reached by carefully sifting the clinical history. 'No point is too minute for examination. As a rule, it will be found that all such women have a firm conviction that they were pregnant when the abdominal tumor made its appearance. Though more than a score of years may have passed, they will not have abandoned the idea that they still carry a child somewhere in the abdo- minal cavity. Such women will nearly always give the history of labor at or near term, attended with uterine hemorrhage,