UTERINE. 



noiiridied. In this cafe, it frequently happens that after 

 the ovum has attained the fize of a hen's or a goofe's egg, 

 the fides of the tube (not being able to bear further diften- 

 fion ) burft, and hemorrhage from the ruptured veffels en- 

 fuing, the woman dies. De Graaf and Santonnus have 

 each of them related a cafe of thi-; kind that fell under thtir 

 notice (fee Obf. Anatom. J. D. Santorini, 4to. p. 22j.), 

 and have given engravings, reprefenting the appcrirance of 

 the parts on diffeaion. In which it is remarkable, that 

 though the fcetus, in neither cafe, had reached the uterus, 

 yet that vifcus had increafed, and its cavity was diftended, 

 nearly to tlie fame fize it would have been if the foetus had 

 been there. But when the ovum is not reftrifted in its 

 growth by the ilraightnefs of the place where it happens to 

 be depofited, or is not blighted and deftroyed by any other 

 caufe, it continues increafing, and the inclofed fcEtus grows, 

 and attains nearly the fame fize it would have done if it had 

 been lodged in the uterus, and at tlie end of nine months, 

 the ufual term of geftation, the woman has pains fimilar to 

 thofe of labour ; but as there is no opening by which the 

 foetus can be excluded after fhe has been tormented with 

 pains for feme days, they ceafe, and the child dies. If the 

 cyft or bag in which the ovum is contained happens to be 

 placed in a part not very fufceptible of pain, it may remain 

 in a quiefcent ftate many weeks, months, or even years, 

 without occafionimg much difturbance to the woman, and 

 the foetus, with its involucra, attain a carlilaginous con- 

 fiftence. It more frequently happens, however, that the 

 fcetus becoming putrid foon after death, and the fleflt dif- 

 folving, the now denuded bones, preffnig againft the cyft, 

 excite inflammation and pain in the parts of the woman to 

 which it is contiguous, which at length fuppurating, or 

 floughing away, an opening is made either externally, 

 through the mufcles and teguments of the abdomen, or in- 

 ternally, through the coats of the bowels, and the bones of 

 the fcetus are either voided with the ftools, or through the 

 abfcefs in the abdomen. Women after thefe diftreffing cir- 

 cumH.ances, during which their fufferings have been extreme, 

 not unfrequently recover a good ftate of health, and live 

 many years. 



In thefe cafes, though art can do but little, yet fome 

 afiiftance may be occafionally given. When the cyft has 

 opened internally into the bowels, after the difcharge of the 

 putrid ciilUivies, into which the foft parts of the child has 

 been diffoKed, the bones begin to come away ; and if one 

 of them ftiould lie acrofs the reftum, occafioning violent 

 ftrainings and pain, by paiTmg a finger into the gut, the 

 pofition of the bone may be altered, and its exit promoted. 

 The paffage of the bones may alfo be facilitated, and the 

 pain occafioned by them alleviated, by injefting emollient 

 o-lyfters, to vvhich it may be fometimes ufeful to add thirty 

 or forty drops of the tinfture of opium. When the abfcefs 

 is external, its fuppuration may be promoted by poultices, 

 or the apertun-, after it has burft, may be enlarged with a 

 lancet or knife, and the bones taken out with a pair of for- 

 ceps. Wlien the fcEtus makes its exit through the bowels 

 or vagina, it may fometimes be many weeks, months, or even 

 years, before the bones are completely evacuated ; but when 

 the opening is external, through the parietes of the ab- 

 domen, the whole procefs is ufually over, and the abfcefs 

 healed in the fpace of a few weeks. 



Ordinarily there are no fymptoms, in the early months of 

 pregnancy particularly, by which we may fufpeA the fetus 

 not to be in the uterus. The menfes ceafe, and there is the 

 fame naufea, ficknefs, and fullnefs of the breafts, as in na- 

 tural conception or pregnancy. The uterus increafes in 

 bulk, and its cavity enlarges, though not to the fame extent 



as when the foetus is included. At the end of the period of 

 geftation, pains are excited fo like to thofe in a natural la- 

 bour, as to deceive for a time even experienced praftitioners. 



Many cafes of this kind have been recorded by medical 

 writers, befides thofe mentioned by De Graaf and Santo- 

 rinus. The following account of a fcstus of fix months, 

 which was voided entire by the anus, is taken from Mr. 

 William Giffard's Colleftion of Cafes in Midwifery, N° 157, 

 publiftied by Dr. Edward Hody, in 4to. 1734. The 

 woman died a few days after the exclufion of the foetus, and 

 was opened by Mr. Giffard, affifted by Mr. Nourfe, one of 

 the furgeons to Bartholomew's hofpital, in the prefence of 

 Dr. Dodd, phyfician to the fame hofpital. The parts were 

 exhibited to the Royal Society, and drawings of them taken, 

 under the direttion of fir Hans Sloane, the prefident. From 

 them two engravings were executed, which are publifhed 

 with the volume. 



The ovum appears not to have completely left the ova- 

 rium, which, with the fimbiiated end of the Fallopian tube, 

 and the ligamentum latum of the right fide, appear to be 

 confufedly joined together, and each of them contributing 

 towards forming the facculus, or bag, containing the ovum. 

 The foetus had been perfeft, but was beginning to be putrid. 

 It was of the fize foetufes ulually arc at fix months. It is 

 not dehneated. The woman had the ufual figns of breeding, 

 and at the proper time felt the motion of the child, which 

 increafing, and by its weight finking down behind the uterus, 

 and dragging the fundus of that vifcus with it, at length, 

 by its prefigure on the reftum, occafioned inflammation, and 

 a portion of the reftum, and of the bag floughing off, the 

 foetus fell into the gut, and was voided by the anus. 



The uterus was not examined, but it appears by the 

 drawing to have been of a larger fize than it is ufually feen 

 to be in women who are not pregnant, and if it had been 

 opened, the cavity would doubtleis have been found propor- 

 tionably increafed. 



De Graaf, in his work " De Organis Muherum," p. 252. 

 tab. 21, has given a delineation of an ovum that was detained 

 in one of the Fallopian tubes, from Vefalius, who diffeAed 

 the body of the woman. The embryo was between three 

 and four months old, when the fides of the tube giving way, 

 the woman died. Vefalius thought the cavity in which the 

 ovum had been retained was a fecoud uterus. 



Ciprianus, in a letter to Dr. Millington, prefident of the 

 college of phyficians, London, has given the cafe ot an ex- 

 traordinary foetus that had continued in the abdomen of its 

 mother twenty-one months. He extracted it by enlarging 

 the opening of an impofthume that had broken naturally. 

 The letter is dated Ley den, 1707. 



Straufius gives an account of a woman, aged fixty-three 

 years, who died in confequence of a fall. She had, for 

 twenty years previous to her death, complained of a pain 

 and fwelling in the middle and lower part of the abdomen. 

 On opening the body, a foetus was found perfeftly formed, 

 but of the hardnefs of ftone. " Cutiferat faxi in modum 

 dura," he fays, " Caput erat malleo frangendum, &c." 

 Laur. Straufii Refolutio cafus Muffipantani foetus extra 

 uterum, &c." p. 39. 



Uterine Hemorrhages. See Flooding. 



In this dangerous diforder the ftyptic powder of Helvetius 

 is much recommended : and the ftibium ceratum has alfo 

 been tried with great fuccefs. See Vitrum antimonii 

 ceratum. 



In the Stockholm A£ls, 1770, there are feveral cafes 

 of uterine hemorrhages cured by a third or half a grain of 

 ipecacuanha, rubbed with fugar, given every four hours or 



oftener. 



