It is to our venerable friend, the late Dr. Heim, of Berlin, that we are
indebted for much curious and interesting knowledge respecting
extra-uterine pregnancy. Although the symptoms in the very early stages
are so obscure as to render it nearly impossible to detect its presence,
he has nevertheless observed some facts connected with it, which are
peculiar, and deserve to be noticed. No morning sickness has been observed
in cases of extra-uterine pregnancy, a circumstance which can easily be
accounted for, if we bear in mind the causes of morning sickness in
natural pregnancy: the patient could only lie on the affected side, and
the abdomen was observed to swell irregularly, not in the same manner as
in regular pregnancy.
In tubarian and ovarian pregnancy, the pain was in the pelvis, but in
ventral pregnancy it occupied more or less the whole abdomen, the parietes
of which were very tender upon pressure. In cases where the foetus died at
an early period, the symptoms gradually disappeared after a time,
especially when followed by the bursting of an abscess through the rectum
or any other part. One of the most remarkable facts which Dr. Heim
observed, was a peculiar whining tone of voice, with which the patient
expressed her sufferings during a paroxysm of pain; so peculiar, that when
once heard, the sound can never be mistaken. On several occasions Dr. Heim
was enabled by means of this symptom alone to decide confidently as to the
nature of the case the moment he entered the room, a fact which would
appear scarcely credible had not the results of the cases proved the
correctness of his assertion. A most interesting case of this sort
occurred, which he pronounced to be ventral pregnancy, and when it had
gone the full term gastrotomy was performed, a living child was extracted
but the unfortunate mother perished: she could not be induced to submit to
the operation until inflammation had come on, and she died in two days
after.
It must always remain a matter of great obscurity as to the immediate
_causes_ of extra-uterine pregnancy, more especially of the ovarian and
ventral species; and the more so as we are still ignorant of the mechanism
by which the fimbriated extremity of the Fallopian tube grasps the ovary
immediately over the impregnated vesicle of de Graaf at the moment of
conception. In many cases we are inclined to think that this function of
the Fallopian tube is destroyed by adhesions between it and the ovary, a
circumstance of not uncommon occurrence; but from the alteration in the
shape and size of these parts, as also from the extensive adhesions which
are usually found after death, in such cases it will ever be difficult,
and perhaps impossible, to prove it.
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