way from the umbilicus to the scrobiculus cordis, but more prominent in the umbilical region, where the head of the fœtus was plainly to be distinguished by the hardness of the feel.

I performed the operation on the 6th of February, 1799. I carefully made an incision through the integuments and muscles in the most prominent part of the tumour, thereby exposing the head of the child, and cautiously extended it upwards and downwards by the direction of the finger introduced into the cavity, so as to reach from a little above the umbilicus nearly to the pubes, on the left side, close to and in the direction of the linea alba; by which a sufficient opening was made to extract the child with ease. It was of the common size, and sound, except on the head, where a small portion of the scalp was in an incipient state of putrefaction. A large branch of the internal mammary artery was divided; but it was readily secured by the needle and ligature. No liquor amnii or other fluid was found in the cavity, which closely embraced the fœtus, and to which it was attached and glued, as it were, by a sort of cement of a greyish cast, of the nature of that kind of mucus which is found on the surface of the bodies of new-born infants; so that I was obliged to insinuate my hand, and with my fingers carefully separate the head, body, and arms from their attachments. The funis was small and short, connecting the child with the mother by three or four ramifications, inserted low down in the anterior part of the cavity in which it was lodged. The adhesion was so strong that I did not think it adviseable to use any force to separate it; choosing rather to leave it to nature to dislodge it. Some pieces were thrown off at almost every dressing; but it was upwards of a fortnight before the string came away; some days after which I left the patient to the management of the family, as the wound was by that time healing, the cavity filling up and closing fast. The same dressings were used in this case as in the first. An anodyne was given immediately after the operation, repeated again that evening, and for three or four nights afterwards; it was then

discontinued, and the Peruvian bark given three or four times a day. The bowels were carefully kept open from the second day after the operation, first by emollient injections, afterwards by the occasional use of an infusion of senna, manna, and salts. The diet was at first light and slender, but afterwards changed for one more generous and liberal. She soon got perfectly well, and is now alive and in good health. I believe she has not been again pregnant.

I am inclined to think cases of extra-uterine conception are not so rare as is generally supposed, although I find no account of any operation for the extraction of the fœtus in all my reading; nor did I ever meet with a case where the fœtus had grown to full size and maturity, until that of Mrs. Cocke presented itself. They are, I am apt to believe, often mistaken for other diseases; and, being treated accordingly, the patients fall victims to the ignorance, obstinacy, or incredulity of the practitioners attending them, as has already been mentioned in the case of Mrs. Cocke. In the case of Mrs. Washington's servant, the physician, an old experienced practitioner of great respectability in his profession, who attended her for several months, declared it to be a case of schirrous uterus, and gave it up as incurable. Here the poor woman's life was saved by her having heard of my first operation on Mrs. Cocke; and firmly believing herself to be in the same situation, declared she was confident I could relieve her if sent for. Fortunately for the woman, her mistress had humanity and liberality enough to listen to her repeated declarations of this kind, and sent for me to attend her at the distance of nearly an hundred miles.

I was called to another woman in the Northern Neck some years ago, who was then afflicted with an ascites, and much emaciated with hectic fever; but who also declared that she was pregnant, and had overgone her time several months. I tapt her, and drew off a large quantity of thick purulent fluid. After emptying the cavity, I could plainly distinguish within it an irregular moveable tumour low down on the right side.

This was very probably a fœtus of an extra-uterine conception burst forth from the sac or cyst in which it was originally contained, lying loose among the abdominal viscera, and perhaps in a state of decay and putrefaction; which latter circumstance would, in all probability, commence from the date of the child's emancipation from its artificial uterus, and might be the cause of the woman's subsequent pain and ill health, and the collection of purulent fluid in the abdomen.-It is very possible, indeed I think it more than probable, that another lady for whom I was consulted laboured under a case of this latter kind also; and the reason why I did not propose nor consent to her being tapt when mentioned in consultation, was the unsuccessful result of this operation in the last case; from which the woman found no relief, but gradually declined, and died in a few weeks after the operation. In the course of last summer I was applied to by a woman whose situation, I am almost positive, will eventuate in another proof of such cases being more frequent than has been generally supposed, and of the propriety of medical practitioners directing their attention to this subject.

In performing the operation for the extraction of an extrauterine fœtus, the first and great object should be, to avoid making a communication between the cavity of the abdomen, and that in which the fœtus is lodged, (which last is separate and distinct from the first) by extending the incision beyond the adhesion of the sac to the peritoneum; thereby making unnecessarily a penetrating wound into the cavity of the abdomen, and subjecting the patient to all the miseries of a large purulent discharge among the abdominal viscera, instead of the matter passing out as it ought to do, (and as it will do if this caution is rightly observed) through the opening made into the cavity, proper to the child only, and which opening should be no larger than will be sufficient for the easy extraction of the fœtus. It appears to me, that the success of the operation depends entirely on this; for the particular place where the incision is to be made is not so important, and will be pointed out by

the tumour itself, viz. in the most prominent part, beginning from above, and carrying it near to, and in the direction of the linea alba; the dressings and mode of treatment after the operation being very simple.

At Dr. Hunter's Lectures in London, I had seen one instance where the impregnated ovum, missing the fallopian tube, had fallen into the abdomen, and had attached itself, and grown among the viscera. The fœtus however was very small, not larger, if I remember right, than one of between two and three months old. I recollect to have seen also the bones of another small fœtus, which my friend Mr. Robert Kent, of London, had shown me, and which his patient had passed per anum, who afterwards recovered. In these cases the fœtus soon perishes for want of nourishment, (like a seed dropt by accident on a barren soil, which just vegetates and dies); and then, acting as an extraneous body, it is afterwards expelled by the operation of nature, peacemeal, through the natural, or some artificial outlets; otherwise the patient dies. In those cases where the fœtus arrives to full maturity, I am apt to suppose that the embryo is stopt in its passage from the ovarium in the fallopian tube, or some other part favourable to its growth, to which it attaches itself; a placenta is formed, and the fœtus is nourished (as in the natural uterus) by an artificial one formed by the ovum, which is gradually enlarged by the growth of the fœtus; and as it enlarges, it probably increases in thickness, adhesions take place with the parieties of the abdomen and the neighbouring parts; thus enclosing the fœtus in a place of perfect security, where it is supplied with nourishment from an entirely new set of vessels. The woman, with more or less inconveniency, goes on to her full time, and then is taken with labour pains, unaccompanied with other usual symptoms of parturition; as in the cases already related. Such gradual enlargements, and similar attachments are found to take place in dropsies of the ovaria.

Note. We have been informed by Mr. Smith, that he has lately examined the VOL. 1.

23

woman on whom he operated, whose case is mentioned at p. 54 of this volume; that he found a tumour about the size of a goose's egg, which communicated externally by a small fistulous orifice, from which an inconsiderable quantity of matter occasionally oozed. The woman is fat and hearty, and experiences no inconvenience from it. Editors.

To the Editors of the Medical and Philosophical Journal and

GENTLEMEN,

Review.

I send you the enclosed for publication, without any comments of my own. I confess I am wholly unable to account for se extraordinary a production of nature. Should you not have previously received it, I trust it will not be unacceptable; and hope some able physiologist will attempt to elucidate the subject.

Tours, &c.

J. PERCIVAL.

Extract of a Letter from Dr. GAITHER, of Washington County, Kentucky, to the Editor of the Western World, dated Springfield, April 26, 1809.

Intra-Muscular abdominal Monsters.

BELIEVING it the duty of professional men to lay be fore the public such occurrences in their practice, as, from their singularity, may either awaken useful inquiry, or substantially promote the happiness of man, by increasing the catalogue of facts whence a knowledge of the animal economy is derived; I, who am a young and diffident practitioner in the science of medicine, beg leave to submit to the public a fact of that description. It is so contrary to the common course of nature, and to the prevailing and generally received opinions of the learned in the science of physiology, as to justify the conjecture that nature has yet many myste ries in reserve of great importance to the human family.