168 
REPORTS OF CASES 
truding per vulva. The os was firmly contracted, but on 
dilating, could easily feel the sides of the uterus, which was 
small and virgin-like. The organ was then replaced (uterus) 
but no signs of a foetus discovered. The left hand was then 
introduced per vagina, and in feeling forwards, downwards 
and towards the right side, could detect the foetal movements, 
which also could be seen on the right flank. After taking into 
consideration the facts here mentioned, extra uterine fcetation 
was diagnosed, but whether tubular or abdominal pregnancy 
was not distinguished until after operating, although Steele 
says that extra uterine foetation in the cow was generally 
abdominal. The question of delivery was considered and 
‘‘laparotomy” “ gastro-hysterotomy,” or “caesarean section,” 
was at once decided upon, although it was deemed best to 
wait until the next day, as better assistance and light 
could be obtained. Then, with the assistance of Dr. 
Zabriskie, (MD.) the operation was performed, to wit: The 
patient was gently cast and laid on the left side, and an ounce 
and a half of chloral administered; feet hobbled, except the 
right hind foot, which was held back by an assistant; the 
hair closely clipped from the flank, thoroughly washed with 
warm water and soap, afterwards sponged with a solution of 
i-iooo of bichloride. An incision was then made in front of 
the anterior spinous process of the ilium, down and slightly 
forward, until the opening, which measured fourteen inches, 
was considered ample. Next the abdominal muscles and 
peritoneum. On incising the latter membrane the large 
dilated portion of the fallopian tube was easily found and 
drawn partly through the incision. 
That part of the sack which seemed the least vascular was 
chosen, incised, and the offspring removed, the cord 
ligatured and severed. The placenta was then removed and 
the uterus pro tern was washed out with a weak solution of 
carbolic acid, and care taken to remove all the fluid, which 
was done with a sponge. The uterine walls were brought to¬ 
gether and sutured with silk and powdered with iodoform. 
The peritoneum and muscles were treated separately, similar 
to the tube, with a good sprinkling of iodoform on each line 
