MEDICAL AND PHILOSOPHICAL

Journal and Review.

VOL. I.-No. 2.

For the Medical and Philosophical Journal.

An Account of two Cases of EXTRA-Uterine ConCEPTION; in each of which the Fatus was extracted by an Operation with success. By WILLIAM BAYNHAM, of Virginia, Member of the Royal College of Surgeons, London. Communicated to J. A. SMITH, Professor of Anatomy and Surgery in the University of the State of New-York, and Member of the Royal College of Surgeons, London.

CASE I.

IN the year Mrs. Cocke became pregnant with her third child, and without experiencing any remarkable inconvenience during pregnancy, was seized at the proper period with symptoms of labour. She had her mother with her, who is an old and experienced midwife. The labour pains were regular, but no coloured discharge or waters ever appeared; nor could the child be felt through the os uteri, which was sufficiently dilated, and within the reach of the finger, although its motion was plainly distinguishable by the application of the hand on the belly of the mother. At first the child showed itself to be strong and vigorous, but at length, from the cessation of its former movements, the mother became sensible that it was dead; after which the pains grew gradually weaker, and at the end of the VOL. 1.

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second or third day finally left her, much weakened and exhausted. She remained in a languishing and declining condition, with some, but not much diminution of the tumour in the abdomen, for more than twelve months, when she got better, and gradually recovered a good state of health, which she continued to enjoy uninterruptedly during several years. Two or three physicians attended her during her labour, and at different times subsequent to it, who differed in opinion with regard to her disease; one only believing her to be with child, the others supposing her case to be a dropsy. In the spring of 1786 she consulted me; at which time I received from herself and her mother the relation before stated, together with a minute and circumstantial detail of other particulars; such as her well remembering the time when she quickened, the motion of the child afterwards, the swelling of the breasts, the flow of milk when the labour went off, &c. From all which I did not hesitate to pronounce her case to be that of an extra-uterine con. ception. She was now perfectly well, rather corpulent, and felt no inconvenience from the tumour, except what was naturally to be expected from its size and weight: I therefore told her she must be content to wait the return of a second labour; that at some future day nature, become weary of her burthen, would in some way or other manifest a disposition to rid herself of it, although it was impossible for me to say when or how; that I should then be glad to hear from her; and advised her in the mean time to live as usual, and to think as seldom as possible of her uncommon situation.

In the autumn of 1789 she was seized with the influenza, which was then epidemical in this State; during which, either from the frequency and violence of the cough, or from some other cause, the abdominal tumour became painful, and continued to be a little troublesome to her until the beginning of April, 1790, when she sent for me. The tumour was now more prominent towards the left side than it had been, and was pointed in the middle, where the integuments were inflamed, of a

dusky brown colour, and showing a disposition to gangrene; at the same time I thought I could perceive an obscure fluctuation underneath, although from the thickness of the adipose membrane I could not be certain. On the 18th I made an incision into the tumour where it was most pointed, but no matter issued, although I had gone to the depth of two or three inches. Having neither books to consult on the subject, nor medical friends to advise with, my fears overcame my resolution. I desisted, and concluded that it would be most prudent and safe to wait the further efforts of nature, which evidently pointed towards the expulsion of the child, and which I thought might possibly be effected at no distant period through the opening I had made. I dressed the wound with digestive, directed a plentiful use of the bark (of which she took a very great quantity), and recommended a suitable regimen. By the end of summer the wound was nearly closed, but her health was declining; she afterwards became hectic, her appetite bad, and what little nourishment she did take, the stomach was unable to retain, being almost immediately thrown up again, with high fever, night sweats, and troublesome cough. In this situation, believing her dissolution inevitable, unless the cause could be removed, my fears now gave way to a wish to preserve the life of an amiable woman; and although unsupported by authorities of any kind, and unaided by the presence of any practitioner whose counsel could assist or direct me in the operation, I determined at all hazards on the extraction of the child: accordingly, on the 14th of January, 1791, I made a deep incision through the former opening, sufficient to admit the finger into the cavity of the tumour, and with that as a director, cautiously extended the incision upwards and downwards on the left side, from nearly opposite to the umbilicus, obliquely across the rectus muscle towards its inner edge, and thence almost to the pubes, and in the direction of the linea alba, taking particular care in extending the incision upwards and downwards, not to open the cavity of the peritoneum. Through this opening I happily succeeded

in extracting the fœtus, which, however, could not be done but in parts, in consequence of putrefaction having taken place some time prior to the operation.. This necessarily took up much time, rendering the operation extremely tedious and fatiguing to me, and painful to the patient. Her happy recovery, and the enjoyment of good health ever since, have, however, amply compensated her for the pain of the operation, which she sustained with an uncommon degree of patience and fortitude, and me for my care and attendance, having visited her at the distance of thirty miles every other day for many weeks during the cure. From the different portions of the child, I judged it to have been of the usual size of a full-grown fœtus; and that the putrefaction had not commenced until, by the first incision, air had been admitted into the cavity in which it had been so long quietly lodged. The heart, with a portion of lungs attached to it, was whole and entire, and still retained its natural shape and colour. Some of the bones were denuded of their periosteum; but those which form the basis of the cranium, all the vertebræ, and a few others, were strongly connected by their respective ligaments. The cavity in which the fœtus had lain, apppeared to be, and I have no doubt was separate and distinct from that of the peritoneum. The cyst which formed this artificial uterus was of considerable thickness, very firm, and its internal surface lined with a thin incrustation of os. seous or calcareous matter, which was separated as the cavity gra dually contracted, and was thrown out in small portions at every dressing; together with some of the small bones of the hands and feet, which were occasionally extracted with the forceps, until the wound was nearly healed. After the operation I poured into the cavity a sufficient quantity of the samaritan balsam, luke warm, and well charged with the powder of Peruvian bark; covered the wound and parts adjacent that were in a state of inflammation with a cataplasm of bread and milk, in which was mixed a tea spoonful or two of red bark in powder, and secured it by a broad band carried once round the body,

and pinned in front. I directed wine and bark internally, with an opiate at night, and a light nutritious diet, and ordered injections to be used occasionally, to procure regular alvine discharges. She never vomited after the operation; she rested well, and suffered very little pain from the wound; her fever and cough gradually abated, her appetite returned, and in the course of a few months she was completely recovered.

At the time she became pregnant she had two daughters liv. ing; she was then in her year, and it was upwards of ten

years afterwards when I extracted the child. She is now alive and in good health, but has never bred since.

CASE II.

On the 24th of January, 1799, I was sent for by Mrs. Washington, of Hayfield, in the county of Fairfax, Virginia, to a servant of her's, a young woman who had been with child, as she asserted, eighteen months; she had heard that I delivered a woman who had been with child for ten years, and was willing to submit to any operation that I might think necessary for her relief.

She was taken in labour last March, as she thought; the midwife was sent for; but after being a few hours in great pain, the pains left her; she was at the same time taken with the menses, which continued with her for nine weeks, when they left her, and she has had them regularly every month until the last period. She grew less every day, yet kept tolerably well, though oftentimes in a great deal of pain. About six weeks ago she was taken worse than usual, and has been wearing away ever since, having no stomach to eat any thing, always complaining of so heavy a load at the bottom of her belly, that when she stands up she is obliged to hold it up with her hands. I found her labouring under a hectic fever; she was much emaciated, and confined to her bed.

The abdominal tumour was equal and uniform, reaching half