anomalies and curiosities of medicine-第13部分

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　operation　was　performed。　In　one　case　the　mother　died；　but　both　the　uterine　and　the　extrauterine　conceptions　lived。　In　another　the　mother　and　intrauterine　fetus　died；　and　the　extrauterine　fetus　lived。　Wilson　a　gives　an　instance　of　a　woman　delivered　of　a　healthy　female　child　at　eight　months　which　lived。　The　after…birth　came　away　without　assistance；　but　the　woman　still　presented　every　appearance　of　having　another　child　within　her；　although　examination　by　the　vagina　revealed　none。　Wilson　called　Chatard　in　consultation；　and　from　the　fetal　heart…sounds　and　other　symptoms　they　decided　that　there　was　another　pregnancy　wholly　extrauterine。　They　allowed　the　case　to　go　twenty…three　days；　until　pains　similar　to　those　of　labor　occurred；　and　then　decided　on　celiotomy。　The　operation　was　almost　bloodless；　and　a　living　child　weighing　eight　pounds　was　extracted。　Unfortunately；　the　mother　succumbed　after　ninety　hours；　and　in　a　month　the　intrauterine　child　died　from　inanition；　but　the　child　of　extrauterine　gestation　thrived。　Sales　gives　the　case　of　a　negress　of　twenty…two；　who　said　that　she　had　been　〃tricked　by　a　negro；〃　and　had　a　large　snake　in　the　abdomen；　and　could　distinctly　feel　its　movements。　She　stoutly　denied　any　intercourse。　It　was　decided　to　open　the　abdominal　cyst；　the　incision　was　followed　by　a　gush　of　blood　and　a　placenta　came　into　view；　which　was　extracted　with　a　living　child。　To　the　astonishment　of　the　operators　the　uterus　was　distended；　and　it　was　decided　to　open　it；　when　another　living　child　was　seen　and　extracted。　The　cyst　and　the　uterus　were　cleansed　of　all　clots　and　the　wound　closed。　The　mother　died　of　septicemia；　but　the　children　both　lived　and　were　doing　well　six　weeks　after　the　operation。　A　curious　case　was　seen　in　1814　of　a　woman　who　at　her　fifth　gestation　suffered　abdominal　uneasiness　at　the　third　month；　and　this　became　intolerable　at　the　ninth　month。　The　head　of　the　fetus　could　be　felt　through　the　abdomen；　an　incision　was　made　through　the　parietes；　a　fully　developed　female　child　was　delivered；　but；　unfortunately；　the　mother　died　of　septic　infection。

The　British　Medical　Journal　quotes：　〃Pinard　（Bull。　de　l'Acad。　de　Med。；　August　6；　1895）　records　the　following；　which　he　describes　as　an　ideal　case。　The　patient　was　aged　thirty…six；　had　had　no　illness；　and　had　been　regular　from　the　age　of　fourteen　till　July；　1894。　During　August　of　that　year　she　had　nausea　and　vomiting；　on　the　22d　and　23d　she　lost　a　fluid；　which　was　just　pink。　The　symptoms　continued　during　September；　on　the　22d　and　23d　of　which　month　there　was　a　similar　loss。　In　October　she　was　kept　in　bed　for　two　days　by　abdominal　pain；　which　reappeared　in　November；　and　was　then　associated　with　pain　in　micturition　and　defecation。　From　that　time　till　February　26；　1895；　when　she　came　under　Pinard's　care；　she　was　attended　by　several　doctors；　each　of　whom　adopted　a　different　diagnosis　and　treatment。　One　of　them；　thinking　she　had　a　fibroid；　made　her　take　in　all　about　an　ounce　of　savin　powder；　which　did　not；　however；　produce　any　ill　effect。　When　admitted　she　looked　ill　and　pinched。　The　left　thigh　and　leg　were　painful　and　edematous。　The　abdomen　looked　like　that　of　the　sixth　month　of　pregnancy。　The　abdominal　wall　was　tense；　smooth；　and　without　lineae　albicantes。　Palpation　revealed　a　cystic　immobile　tumor；　extending　2　inches　above　the　umbilicus　and　apparently　fixed　by　deep　adhesions。　The　fetal　parts　could　only　be　made　out　with　difficulty　by　deep　palpation；　but　the　heart…sounds　were　easily　heard　to　the　right　of　and　below　the　umbilicus。　By　the　right　side　of　this　tumor　one　could　feel　a　small　one；　the　size　of　a　Tangerine　orange；　which　hardened　and　softened　under　examination。　When　contracted　the　groove　between　it　and　the　large　tumor　became　evident。　Vaginal　examination　showed　that　the　cervix；　which　was　slightly　deflected　forward　and　to　the　right　and　softened；　as　in　uterine　gestation；　was　continuous　with　the　smaller　tumor。　Cephalic　ballottement　was　obtained　in　the　large　tumor。　No　sound　was　passed　into　the　uterus　for　fear　of　setting　up　reflex　action；　the　diagnosis　of　extrauterine　gestation　at　about　six　and　a　half　months　with　a　living　child　was　established　without　requiring　to　be　clinched　by　proving　the　uterus　empty。　The　patient　was　kept　absolutely　at　rest　in　bed　and　the　edema　of　the　left　leg　cured　by　position。　On　April　30th　the　fundus　of　the　tumor　was　35　cm。　above　the　symphysis　and　the　uterus　11　1/2　cm。；　the　cervix　was　soft　as　that　of　a　primipara　at　term。　Operation；　May　2d：　Uterus　found　empty；　cavity　14　1/2　cm。　long。　Median　incision　in　abdominal　wall；　cyst　walls　exposed；　seen　to　be　very　slight　and　filled　with　enormous　vessels；　some　greater　than　the　little　finger。　On　seizing　the　wall　one　of　these　vessels　burst；　and　the　hemorrhage　was　only　rendered　greater　on　attempting　to　secure　it；　so　great　was　the　friability　of　the　walls。　The　cyst　was　therefore　rapidly　opened　and　the　child　extracted　by　the　foot。　Hemorrhage　was　restrained　first　by　pressure　of　the　hands；　then　by　pressure…forceps　and　ligatures。　The　walls　of　the　cyst　were　sewn　to　the　margins　of　the　abdominal　wound；　the　edge　of　the　placenta　being　included　in　the　suture。　A　wound　was　thus　formed　10　cm。　in　diameter；　with　the　placenta　for　its　base；　it　was　filled　with　iodoform　and　salicylic　gauze。　The　operation　lasted　an　hour；　and　the　child；　a　boy　weighing　5　1/2　pounds；　after　a　brief　period　of　respiratory　difficulties；　was　perfectly　vigorous。　There　was　at　first　a　slight　facial　asymmetry　and　a　depression　on　the　left　upper　jaw　caused　by　the　point　of　the　left　shoulder；　against　which　it　had　been　pressed　in　the　cyst；　these　soon　disappeared；　and　on　the　nineteenth　day　the　boy　weighed　12　pounds。　The　maternal　wound　was　not　dressed　till　May　13th；　when　it　was　washed　with　biniodid；　1：4000。　The　placenta　came　away　piecemeal　between　May　25th　and　June　2d。　The　wound　healed　up；　and　the　patient　got　up　on　the　forty…third　day；　having　suckled　her　infant　from　the　first　day　after　its　birth。〃

Quite　recently　Werder　has　investigated　the　question　of　the　ultimate　fate　of　ectopic　children　delivered　alive。　He　has　been　able　to　obtain　the　record　of　40　cases。　Of　these；　18　died　within　a　week　after　birth；　5　within　a　month；　1　died　at　six　months　of　bronchopneumonia；　1　at　seven　months　of　diarrhea；　2　at　eleven　months；　1　from　croup；　1　at　eighteen　months　from　cholera　infantummaking　a　total　of　26　deaths　and　leaving　14　children　to　be　accounted　for。　Of　these；　5　were　reported　as　living　and　well　after　operation；　with　no　subsequent　report；　1　was　strong　and　healthy　after　three　weeks；　but　there　has　been　no　report　since；　1　was　well　at　six　months；　then　was　lost　sight　of；　1　was　well　at　the　Last　report；　2　live　and　are　well　at　one　year；　2　are　living　and　well　at　two　years；　1　（Beisone's　case）　is　well　at　seven　years；　and　1　（Tait's　case）　is　well　at　fourteen　and　one…half　years。　The　list　given　on　pages　60　and　61　has　been　quoted　by　Hirst　and　Dorland。　It　contains　data　relative　to　17　cases　in　which　abdominal　section　has　been　successfully　performed　for　advanced　ectopic　gestation　with　living　children。

Long　Retention　of　Extrauterine　Pregnancy。The　time　of　the　retention　of　an　extrauterine　gestation　is　sometimes　remarkable；　and　it　is　no　uncommon　occurrence　for　several　pregnancies　to　successfully　ensue　during　such　retention。　The　Ephemerides　contains　examples　of　extrauterine　pregnancy　remaining　in　the　abdomen　forty…six　years；　Hannaeus　mentioned　an　instance　remaining　ten　years；　the　mother　being　pregnant　in　the　meantime；　Primperosius　speaks　of　a　similar　instance；　de　Blegny；　one　of　twenty…five　years　in　the　abdomen；　Birch；　a　case　of　eighteen　years　in　the　abdomen；　the　woman　bearing　in　the　meantime；　Bayle；　one　of　twenty…six　years；　and　the　Ephemerides；　another。　In　a　woman　of　forty…six；　the　labor　pains　intervened　without　expulsion　of　the　fetus。　Impregnation　ensued　twice　afterward；　each　followed　by　the　birth　of　a　living　child。　The　woman　lived　to　be　ninety…four；　and　was　persuaded　that　the　fetus　was　still　in　the　abdomen；　and　directed　a　postmortem　examination　to　be　made　after　her　decease；　which　was　done；　and　a　large　cyst　containing　an　ossified　fetus　was　discovered　in　the　left　side　of　the　cavity。　In　1716　a　woman　of　Joigny　when　thirty　years　old；　having　been　married　four　years；　became　pregnant；　and　three　months　later　felt　movements　and　found　milk　in　her　breasts。　At　the　ninth　month　she　had　labor…pains；　but　the　fetus　failed　to　present；　the　pains　ceased；　but　recurred　in　a　month；　still　with　a　negative　result。　She　fell　into　a　most　sickly　condition　and　remained　so　for　eighteen　months；　when　the　pains　returned　again；　but　soon　ceased。　Menstruation　ceased　and　the　milk　in　her　breasts　remained　for　thirty　years。　She　died　at　sixty…one　of　peripneumonia；　and　on　postmortem　examination　a　tumor　was　found　occupying　part　of　the　hypogastric　and　umbilical　regions。　It　weighed　eight　pounds　and　consisted　of　a　male　fetus　of　full　term　with　six　teeth；　it　had　no　odor　and　its　sac　contained　no　liquid。　The　bones　seemed　better　developed　than　ordinarily；　the　skin　was　thick；　callous；　and　yellowish　The　chorion；　amnion；　and　placenta　were　ossified　and　the　cord　dried　up。　Walther　mentions　the　case　of　an　infant　which　remained　almost　petrified　in　the　belly　of　its　mother　for　twenty…three　years。　No　trace　of　the　placenta；　cord；　or　enveloping　membrane　could　be　found。

Cordier　publishes　a　paper　on　ectopic　gestation；　with　particular　reference　to　tubal　pregnancy；　and　mentions　that　when　there　is　rupture　between　the　broad　ligaments　hemorrhage　is　greatly　limited　by　the　resistance　of　the　surrounding　structures；　death　rarely　resulting　from　the　primary　rupture　in　this　location。　Cordier　gives　an　instance　in　which　he　successfully　removed　a　full…grown　child；　the　result　of　an　ectopic　gestation　which　had　ruptured　intraligamentally　and　had　been　retained　nearly　two　years。

Lospichlerus　gives　an　account　of　a　mother　carrying　twins；　extrauterine；　for　six　years。　Mounsey　of　Riga；　physician　to　the　army　of　the　Czarina；　sent　to　the　Royal　Society　in　1748　the　bones　of　a　fetus　that　had　been　extracted　from　one　of　the　fallopian　tubes　after　a　lodgment　of　thirteen　years。　Starkey　Middleton　read　the　report　of　a　case　of　a　child　which　had　been　taken　out　of　the　abdomen；　having　lain　there　nearly　sixteen　years；　during　which　time　the　mother　had　borne　four　children。　It　was　argued　at　this　time　that　boys　were　conceived　on　the　r