Much emaciated, abdomen concave, but on pressing it the tumour can be felt
at the brim of the pelvis. On opening the abdominal cavity, the mass was
found adhering firmly to the neighbouring intestines, and on the right
side to the soft linings of the pelvis: it was of an irregular form, with
spots of livid vascularity in different parts: on the upper and left side
of it, fetid purulent matter was seen exuding from a small orifice. The
uterus was below, its fundus pushed over to the left side. On separating
its adhesions, and attempting to raise the sac from the pelvis, the
half-softened parietes gave way, and the decomposed putty-like mass of the
foetus became visible; the cranial bones were at the left side; the feet
were still distinct on the right side; the whole was immersed in a
quantity of thick fetid pus, and there were no traces either of umbilical
cord or placenta.
Cases of ventral pregnancy have been recorded where the child has remained
in the mother's abdomen without producing any dangerous symptoms, and
where she has again become pregnant in the natural way. The earliest
instance of this sort was recorded so long ago as by Albucasis. A very
interesting case of this nature is described by Dr. Bard of New York.
(_Med. Obs. and Inquiries_, vol. ii. p. 369.) It was the patient's second
pregnancy; at the end of nine months she had pains, which after a time
went off; the tumour gradually diminished somewhat, and in about five
months after she conceived again, and in due time was delivered, after an
easy labour, of a healthy child. "Five days after delivery she was seized
with a violent fever, a purging, suppression, pain in the tumour, and
_profuse fetid sweats_:" an abscess formed in the abdomen, which was
opened, and a vast quantity of extremely fetid matter was discharged; the
opening was enlarged, and a foetus of the full size was extracted. Dr.
Bard "imagined the placenta and funis umbilicalis were dissolved in the
pus, of which there was a great quantity."
It becomes a question of deep interest whether it be really possible to
save the patient and the child in cases of ventral pregnancy, by
performing gastrotomy. The separation of the placenta from the walls of
the cyst can only be effected with much difficulty and hazard; indeed, we
are at a loss to conceive how it can be removed with any degree of safety,
where the child has been found alive. The attachment in these cases was
more than usually firm, and it has been left to undergo that process of
solution which has been described in Dr. Bard's case. In all the cases
where gastrotomy has been performed some time after the child's death,
little or no trace of the placenta has been found, but in its place a
quantity of ill-conditioned purulent matter, which was excessively fetid.
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