Case of Extra Uterine Pregnancy, of over twenty years standing.
By Wm. D. Christian, M. D., of Appomattox Co., Virginia.
Mrs. T. aged about 40. In the early part of the summer of
1848, Dr. D. and myself were called to visit Mrs. T. We found
her suffering with violent pain in the abdomen, attended with
obstinate constipation. On making a minute examination of the
case, we found a considerable tumour, occupying the right iliac
and right lumbar regions. Inquiry being made in relation to said
tumour, duration, &c., we received from her the following state-
ment. About twenty years ago, and not long after her marriage,
she conceived, or felt all the symptoms of a conception, passed
through the regular stages of pregnancy, quickening at regular time,
&c., and at the end of her full term, 9 months, she was taken with
ordinary labour pains. In anticipation of a speedy delivery, a mid-
wife was summoned. After remaining in labour for a day or two,
(during which time she felt distinctly the motions of the foetus,) the
motions of the foetus suddenly ceased, and very soon after the
labor pains subsided. A distinguished physician of Campbell
county, Dr. S., was then called in to see her. The following is an
extract from a letter received from him, in answer to inquiries
made by us of him in relation to this case. “ 1 visited Mrs. T. on
the 8th day of December, 1827, the old lady in attendance, then
supposed her to have been in labor a day or two, and from the
history of the case I presumed she was correct; upon examination
I found the parts moderately dilated, and in some short time after
the examination there were expelled from the uterus some two or
three bunches of hydatids, varying in size from large shot to par-
tridge eggs. After this she became much relieved, and in an
hour or two I left her again in the hands of the midwife, who
informed me afterwards that she continued to improve. Early in
the year 1828, she removed from the neighborhood, and I saw her
no more until the 9th January, 1833, Iwhen, on examination, I
found the tumour described by you. I did not renew my visit nor
did I have any conversation with her on this subject, until the 5th
of August, 1843, when I was again called to see her, renewed my
examination, and then became fully convinced it was a case of
extra uterine pregnancy, (having had in the meantime, a case
similar to your description of Mrs. T.’s, excepting that the woman
had no children after this conception, nor was there any ossification
of the placenta ; this case was one of twenty-five years standing.)
I made known to Mrs. T. ai this time, my opinion of her case, and
she requested me to make a post-mortem examination at her death,
and/ ascertain all about the matter.’ I need not add that I am truly
gratified you have done so.’7
During our attendance on Mrs. T. she exhibited signs of having
again conceived. This was her eighth conception after the appear-
ance of the tumour. She was then the mother of seven living
children. On the 9th December, 1848, we were summoned to
attend her in labor with this eighth foetus; the labor was an
ordinary one, the tumour not at all interfering; she did remarkably
well—getting up unusually soon. Early in January she left the neigh-
borhood, and was taken ill soon after her arrival at her new home;
of which'sickness she soon after died. We were requested by the
physician who had charge of the case in her last illness, to aid him
in making a post-mortem examination. On opening the abdomen,
we found a compact tumour, (resembling in shape and appearance
an ostrich egg, though much larger,) adhering closely to the walls
of the abdomen anteriorly, and completely enveloped in a bony
structure, except the upper part, which was the cranium of the
foetus. On cutting through this bony envelope or sack, we found
a perfect child, very much compressed, occupying the smallest
possible space, and about the size of a six or seven months foetus,
but as perfect in all respects as a nine months one, and not in the least
degree decomposed. The cord was entire, and adhering to the
inner part of the sac, which was of a soft bony structure as before
remarked, and evidently the placenta. The edges of this
bony placenta were firmly united to the frontal, parietal and
occipital bones, thus, with the cranium of the foetus, forming a com-
plete osseous sac ; there were also attachments at the elbows and
knees. In this case nature had protected the mother from danger,
by making a covering for the foetus of the placenta and converting
this into an osseous structure. I am not aware of any case being
reported in which the child was enveloped in a bony sac. Death
in Mrs. T.’s case was purely mechanical; by getting up too soon
after delivery, and while the muscles of the abdomen were relaxed,
the tumour by its gravity fell into the pelvis, (drawing the abdomi-
nal parietes after it) and thereby pressing on the large intestine,
and stopping the alvine discharges, &c., thus causing death.
As a matter of course, the left ovary was in a healthy condition, for
she could not have conceived after this case of extra uterine con-
ception had it not been so, unless we suppose the right ovary was
healthy, with this unusual condition of things in its region, which
was not true in this case, and is not likely to be in any other case
like it