A case of ovarian pregnancy.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
[1896]
Catalogue details

Licence: Public Domain Mark

Credit: A case of ovarian pregnancy. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    *'***%£*crI» XY^/^// \ ' ^ SJ/r/'tyy A CASE OE OVARIAN PREGNANCY. To the Editors of The Lancet. Sirs,—I have read with great interest Dr. Oliver’s case of ovarian pregnancy published in The Lancet of July 25th. The writer states that ‘ ‘ the tumour, which was the right ovary, was found to be a closed sac containing a full- grown foetus with its cord and placenta No breach i: the right Fallopian tube could be detected either at the til of operation or afterwards.” I trust that so valuably1 q specimen will be skilfully mounted and carefully prese; It appears to be an instance of ovarian pregnancy; evidence is wanting that the ovary was the primary si the abnormal gestation. Allow me to refer Dr. Olb some notes which I published in the Transactions o! Obstetrical Society, vol. xxxv., 1893, p. 222; entl 11 Foetus in Peritoneal Cavity : Question of Abdominal Gel tion, with a Summary of Reported Cases of Primary Abdomii and Ovarian Pregnancy.” Dr. A. Beale’s case, on which thi notes were founded, is very instructive. The foetus lay on the broad ligament close to the tube, whence it had pro- bably been shed. I noted (p. 232) that Dr. Lusk attached little credit to cases where the tubes are reported as intact and not in communication with the sac. I iurther observed that the theory that the fimbrim might retract from an ovum developed in the ostium was supported by the high authority of Braun of Vienna, who observed that when the ovum developed in the outer part of the tube the membranes might project freely from the ostium and contract adhesions to the surrounding structures, the ovary, for example. Further development would lead to the evident source of fallacy indicated by Lusk. Thus in an advanced case like Dr. Oliver’s it is impossible to prove that the ovary was the primary seat of the pregnancy. In four out of the five cases of alleged primary ovarian preg- nancy which I analysed gestation was more or less advanced. I concluded by showing that we cannot hold primary ovarian pregnancy as proved until some ob- server can demonstrate a minute foetus lodged in a sac entirely inside the ovary, just as we so often detect a very early ovum entirely inside the tube. Such a specimen has not been satisfactorily demonstrated, whilst early tubal pregnancy is familiar to us all. Hence it is more probable that the foetus in Dr. Oliver’s case developed originally in the tube^ind escaped after the fashion indicated by Braun, than that it was from the first an inhabitant of the adjacent ovary. If primary ovarian pregnancy be possible, how is it that we do not meet with hsematoceles destroying the ovary at an early stage of gestation ? This accident is very frequent in tubal sacs. I published in The Lancet1 four cases which came under my own care within four months. Yet an early ovum in the ovary would be poorly protected and very liable to burst. The grafting of an older ovum with strong membranes on the surface of the ovary is not difficult to understand. I am, Sirs, yours faithfully, Granville-place, W., July 25th, 1896. ALBAN DORAN.