Volume 1

Atlas of clinical medicine, surgery, and pathology / edited under the direction of the Council by Jonathan Hutchinson.

  • New Sydenham Society.
Date:
1901-1907
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Atlas of clinical medicine, surgery, and pathology / edited under the direction of the Council by Jonathan Hutchinson. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    HEMATOSALPINX. Tubal Abortion. The upper figure is a drawing of a firm blood-clot, laid open, and displaying in its interior an embryo in its amniotic sac. The specimen was removed by operation on December ist, 1894, from the pelvis of a woman suffering from extensive intra-peritoneal haemorrhage. The clot measures 6 cm. (2^ inches) x 4^5 cm. (if- inches), and is firm and homogeneous. The embryo is seen near one end of it. The procurved trunk measures, in a straight line, 8 mm., and presents undivided, simple lower limbs and a sharply-curved caudal extremity. The umbilical vesicle has been detached ; above its remains there protrudes a well-developed heart. The embryo corresponds in its development to one between the third and fourth week. The specimen was exhibited at the Obstetrical Society of London on April 6th, 1895, and is now in the Museum of St. Thomas’s Hospital. The history of the case is as follows :— The patient was 36 years of age. She had been married fifteen years and ten months, but was without children. Menstruation had always been irregular. Her last menstrual period occurred on October ist and 2nd, 1894. She had been subject to indigestion for two years, but had not suffered from vomiting. For the last three weeks she had vomited in the early morning. On the evening of Wednesday, November 28th, 1894, she was seized with sudden but not very severe pain in the upper part of the abdomen. She ascribed it to flatulence. After it had continued for two hours she fainted. She became alarmingly ill during the night, and remembers nothing of what occurred. She was told that she fainted a second time between 1 and 2 a.m. She was in pain all the next day, complained much of thirst, and vomited repeatedly. On the 30th she was sent up to the hospital by Dr. Collier, of Wimbledon, as a probable case of ruptured tubal gestation. There had been a slight discharge of blood per vaginam since the previous day. On admission she was very pale, and looked extremely ill. Her pulse was rapid and feeble, and she had frequent vomiting of small quantities of mucus. She complained of no pain, and the abdomen was not distended. Vaginal examination showed the uterus to be freely movable, of normal size, and displaced to the left of the middle line. The vaginal roof on the right side was slightly depressed by an ill-defined softish swelling, such as would be caused by soft blood-clot. No urine had been passed since the morning of the previous day. The bladder was empty. A consultation was held, and it was decided to administer nutritive and stimulating enemata, and to open the abdomen early the following morning if she had rallied sufficiently. During the night the catheter was passed twice ; on one occasion 1^ fl. oz., and on the other 3 fl. oz. of urine being withdrawn. At 10 a.m. on December ist abdominal section was performed. A quantity of dark blood, chiefly fluid, but partly clotted, was found free in the peritoneal cavity. About 28 fl. oz. were collected and measured ; some, of course, escaped. Behind the uterus and at the fimbriated end of the right Fallopian tube, to which it was lightly attached, was found the blood-clot shown in the drawing. On grasping it it came away loose in the hand. There were no adhesions. The right tube and ovary were quickly removed. Though the operation only lasted twenty minutes, the patient ceased to breathe before its termination. She revived somewhat on discontinuing the anaesthetic, and a pint and a half of saline solution was injected into one of the veins of the upper arm. When the patient was put back to bed the pulse was distinctly perceptible and the body warm. About 2 p.m. she became delirious, flushed, and restless. After a time she fell asleep, but about 5.30 p.m. the breathing became noisy and difficult from ineffectual efforts to clear the air passages of mucus. She died at 7.45 p.m., apparently from suffocation. The portion of Fallopian tube removed was found on examination to be quite empty. No trace of a decidual lining was to be seen. The fimbriated end was open, and the lumen of the outer part of the tube was sufficiently dilated to admit the finger. There was a little inflammatory lymph on the outer surface of the tube. The ovary removed presented a corpus luteum half an inch in diameter. At the autopsy the uterus was found to be very little above the normal size. The body was lined by a distinct decidual membrane which was everywhere adherent to the uterine wall. It ceased abruptly at the os internum. The left tube and ovary were normal. This is an indisputable case of complete tubal abortion. It possesses special interest on that account, and because of the extreme rarity of specimens with an embryo in so early a stage of development.