An Account of an Extra-Uterine Conception; By Starkey Myddelton, M. D.

XXII. An Account of an extra-uterine Conception; by Starkey Myddelton, M.D. London, March 28. 1745. ALTHO' extra-uterine Conceptions have frequently appear'd from Cases of undoubted Authority, many of which stand now upon the Records of the Royal Society; nevertheless I have thought a Doctrine of so extraordinary a Nature cannot be too strongly supported, as it is of the highest Consequence, as well in establishing the received Opinions of Conception in general; as in regulating the Judgment and Practice of those who are more particularly employed in the Business of Midwifry. I shall therefore make no Apology for laying before this Learned Society a Case which affords such convincing Proofs of this Doctrine, and comes at the same time too well attested to admit of any Doubt, either as to the Fact, or the Circumstances. On the 28th of October last, I was sent for to a Woman of about 42 Years of Age. When I came, I was told by the Patient, that she had been taken with a Flooding the Day before; which a little surprised her, as having been very irregular in her menstrual Discharges for near a Year before. At the same time she complained of a great Pain in her Belly and Loins, with a continual Forcing both forward and backward; which still continued, tho' her Flooding was then in a manner stopp'd. I order'd her a gentle Paregoric for that Night, and the next Day I found her in great Pain; at which time time she told me, she had some Reason to believe she had conceived with Child. I then examined her, and found the Os Tincæ intirely close. I was not very curious in my Examination at this time; taking it for granted, from what she had told me, that Nature would, in a little time, dispose the Uterus to discharge its Contents, tho' at present there was not the least Appearance of it. I order'd her an anodyne Clyster, and a Paregoric to be taken after it; and the next Day I found her Pains continued, which now appeared like a Ténesmus; tho' so violent, as to prevent her Rest all that Night. I then ordered her a Repetition of the Clyster and Paregoric; and the next Day (finding her in great Pain, and still without any Rest, and beginning to be a little feverish) I ordered 8 Ounces of Blood to be taken away, and continued the Paregoric, which I likewise order'd her to repeat as she found Occasion; from the Use of which she sometimes rested tolerably well; but as the Power of the Opiate went off, her Pains always returned. Several Days having now passed without any Alteration, I again examined her, and found the Os Tincæ still as close as ever; but, on a stricter Inquiry, I felt something, which seem'd to me to be the Head of a Child fluctuating in its Membranes. I told her my Thoughts of her Case, and that it was not in my Power to help her; but that Nature must take its Course, or at least point out a Method how to act. She seemed very much surprised at my Opinion, and asked me, If ever I had met with such a Case before? I told her, I had been engaged in the Practice of Midwifry upwards of 20 Years; in all which time I had never met with a Case of the like Nature: Being positive I felt the Head of a Child, but could not absolutely determine whether it was in the *Uterus* or *extra Uterum*. I then told her, I would desire the Favour of Dr. Bamber to give her a Visit; which I did; and the next Day we went together; when, on Examination, he confirm'd what I had before asserted; but seem'd more inclinable to believe the Child (the Head of which he felt) was *extra Uterum*. Indeed he proceeded in his Inquiry at that time further than I had done before, having pass'd his Finger into the *Anus*, where, he said, he could distinguish the Head more plainly. We then both left her, after having order'd her to repeat the Paregoric, when in more Pain than ordinary, and once in two or three Days to take a gentle lenitive Purge to keep her Body soluble; because the continual Use of Opiates would naturally tie her up. In this manner she went on for about three Weeks longer; when I waited on Dr. Nichols, and desired the same Favour of him as I had before ask'd of Dr. Bamber, that I might have his Opinion also of a Case which appeared so very singular. The next Day we went together; and when we came, I desired he would examine her, which he did; and after having heard all her Complaints, said, He was of Opinion, that there was some Abscess forming in (or in Contact with) the *Uterus*, which, very likely, in a little time, would break and discharge itself; but as, at that time, nothing of a Child could be perceived by the Touch, so he was obliged to submit that to the Credit of my Opinion, who had before frequently felt it. Thus she continued for about a Fortnight after this Visit; when, calling on her one Day, she told me, she was much easier than she had been; and that something came constantly draining away by the Anus, of a very offensive Smell, which, upon Examination, appeared to be true Pus. I now began to think Dr. Nichols's Opinion of her Case the most eligible, and the rather, as it was not inconsistent with my own Sentiments, that there had been a Child; which, being now dead, might have given Occasion for the forming such an Abscess. In this State of violent Pain she continued to the Time of her Death, which happen'd on the 28th of January, being thirteen Weeks from the first of her Illness; when, by her particular Desire, I open'd her, in the Presence of Dr. Bamber, Dr. Nicholls, Dr. Eaton, and Mr. Jones Surgeon, &c. After having divided the Integuments of the Abdomen, every thing, at first View, appeared in a healthy State. On turning aside the Intestines, I found the Uterus sound and perfect, and of a Size common to Women who have had Children; but, in the Place of the Right Fallopian Tube, there appeared a large Tumour, formed by the Expansion of the Tube extending itself from the Os Ilium towards the Extremity of the Sacrum. Upon opening it, we discover'd a Mass of fetid Pus, in which the Bones of a Fetus, of about 5 or 6 Months old, were buried. These Bones were, for the most part, wholly divested of their Flesh; so that the Edges of the thin Bones must, of Necessity, cut and irritate from every Motion of of the Body. The Pus had made its Way thro' the Rectum, in which there was a small Passage a little above the Sphincter. Upon examining the Bones, after having wash'd them in Water, a new Matter of Surprize appeared; viz. the inferior Jaw was consolidated with the Os Temporis and superior Maxilla; and six of the Ribs, with their correspondent Vertebrae, were united into one Bone. May we not attribute these Anchyloses to the Want of Motion in the Fœtus, which was here prevented, by its being closely pent up in so unnatural a Situation? If this be the Case, we see great Advantages arising from the frequent Motions of the Fœtus in the Uterus; and that Providence has not subjected the tender Part of our Species to such constant Disturbances without great Necessity. See Tab. I. Fig. 8. A, The Uterus. B, The Os Tincæ. C, The Vagina. D, The left Fallopian Tube. E, The Beginning of the right Fallopian Tube in its natural State. F, The Sacculus, formed by the Expansion of the right Fallopian Tube, in which the Fœtus was contained. G, The Ligamentum rotundum on the left Side. Printed for C. Davis, over-against Gray's-Inn Gate in Holbourn, Printer to the Royal Society, M.DCC.XLV.