34 The Philippine Journal of Science i9i7 



pregnancy, except that she was becoming fleshy and her breasts 

 were slightly enlarged, though painless and not containing milk. 

 Her appetite has been usually good. The bowel movements are 

 regular. 



PHYSICAL EXAMINATION 



The patient is well developed and nourished and is able to be 

 about without discomfort. The sensorium is clear. Examina- 

 tion of the body reveals nothing important except the following : 



Chest. The breasts appear slightly enlarged, but no secretion 

 could be obtained from them, even on strong pressure. No other 

 signs of importance. 



Abdomen. There is a bulging occupying almost the whole lower 

 part, reaching to midway between the umbilicus and symphysis 

 pubis. It appears globular and free from the anterior abdominal 

 wall. It is movable and can be pushed in all directions. There 

 is slight fluctuation; the sensation is much like that of a fluid 

 under high tension. The mass measures about 20 by 20 centi- 

 meters and is not tender on pressure. The greatest circumfer- 

 ence of the abdomen passing over this tumor is 93 centimeters. 



Vaginal examination. The perineum is lacerated in the second 

 degree. The vaginal mucosa is of normal color. The cervix 

 is soft, slightly oedematous, and follows with the mass described 

 above, when moved. The body of the uterus cannot be felt 

 due to the pressure of the tumor. 



As the history given by the patient is somewhat misleading, 

 the diagnosis of ovarian cyst or some kind of tumor was sus- 

 pected by the resident surgeon in charge of the case before 

 operation. 



OPERATION 



The patient was operated upon by me. A low median incision 

 was made. On opening the peritoneum, a tumor mass was en- 

 countered filling the lower abdomen, rather toward the left iliac 

 region. Its surface is covered with numerous dilated vessels. 

 It was of uneven consistence, soft in some parts and firm in 

 other places. A cannula was introduced, but pure dark blood 

 only was obtained. On manipulation, a piece of cauliflowerlike 

 tissue came out and a suspicion of papilloma was then enter- 

 tained; but while shelling off the tumor from the folds of the 

 left broad ligament, a hairy surface appeared. Then the mass 

 was opened, and a foetus of about five months was found. 



The foetus was between the folds of the broad ligament dis- 

 placing the uterus, which was enlarged and soft, toward the 

 right side. The placenta was shelled out entirely by the fingers. 



