Margaret Parry of Berkshire in 1668 voided the bones of a fetus through the flesh above the os pubis, and in 1684 she was alive and well, having had healthy children afterward. Brodie reports the history of a case in a negress who voided a fetus from an abscess at the navel about the seventeenth month of conception. Modern instances of the discharge of the extrauterine fetus from the walls of the abdomen are frequently reported. Algora speaks of an abdominal pregnancy in which there was spontaneous perforation of the anterior abdominal parietes, followed by death. Bouzal cites an extraordinary case of ectopic gestation in which there was natural expulsion of the fetus through abdominal walls, with subsequent intestinal strangulation. An artificial anus was established and the mother recovered. Brodie, Dunglison, Erich, Rodbard, Fox, and Wilson are among others reporting the expulsion of remnants of ectopic pregnancies through the abdominal parietes. Campbell quotes the case of a Polish woman, aged thirty-five, the mother of nine children, most of whom were stillborn, who conceived for the tenth time, the gestation being normal up to the lying-in period. She had pains followed by extraordinary effusion and some blood into the vagina. After various protracted complaints the abdominal tumor became painful and inflamed in the umbilical region. A breach in the walls soon formed, giving exit to purulent matter and all the bones of a fetus. During this process the patient received no medical treatment, and frequently no assistance in dressing the opening. She recovered, but had an artificial anus all her life.

Sarah McKinna was married at sixteen and menstruated for the first time a month thereafter. Ten months after marriage she showed signs of pregnancy and was delivered at full term of a living child; the second child was born ten months after the first, and the second month after the second birth she again showed signs of pregnancy. At the close of nine months these symptoms, with the exception of the suppression of menses, subsided, and in this state she continued for six years. During the first four years she felt discomfort in the region of the umbilicus. About the seventh year she suffered tumefaction of the abdomen and thought she had conceived again. The abscess burst and an elbow of the fetus protruded from the wound. A butcher enlarged the wound and, fixing his finger under the jaw of the fetus, extracted the head. On looking into the abdomen he perceived a black object, whereupon he introduced his hand and extracted piecemeal an entire fetal skeleton and some decomposed animal-matter. The abdomen was bound up, and in six weeks the woman was enabled to superintend her domestic affairs; excepting a ventral hernia she had no bad after-results. Kimura, quoted by Whitney, speaks of a case of extrauterine pregnancy in a Japanese woman of forty-one similar to the foregoing, in which an arm protruded through the abdominal wall above the umbilicus and the remains of a fetus were removed through the aperture. The accompanying illustration shows the appearance of the arm in situ before extraction of the fetus and the location of the wound.

Bodinier and Lusk report instances of the delivery of an extrauterine fetus by the vagina; and Mathieson relates the history of the delivery of a living ectopic child by the vagina, with recovery of the mother. Gordon speaks of a curious case in a negress, six months pregnant, in which an extrauterine fetus passed down from the posterior culdesac and occluded the uterus. It was removed through the vagina, and two days later labor-pains set in, and in two hours she was delivered of a uterine child. The placenta was left behind and drainage established through the vagina, and the woman made complete recovery.

Combined Intrauterine and Extrauterine Gestation. Many well-authenticated cases of combined pregnancy, in which one of the products of conception was intrauterine and the other of extrauterine gestation, have been recorded. Clark and Ramsbotham report instances of double conception, one fetus being born alive in the ordinary manner and the other located extrauterine. Chasser speaks of a case in which there was concurrent pregnancy in both the uterus and the Fallopian tube. Smith cites an instance of a woman of twenty-three who became pregnant in August, 1870. In the following December she passed fetal bones from the rectum, and a month later gave birth to an intrauterine fetus of six months' growth. McGee mentions the case of a woman of twenty-eight who became pregnant in July, 1872, and on October 20th and 21st passed several fetal bones by the rectum, and about four months later expelled some from the uterus. From this time she rapidly recovered her strength and health. Devergie quotes an instance of a woman of thirty who had several children, but who died suddenly, and being pregnant was opened. In the right iliac fossa was found a male child weighing 5 pounds and 5 ounces, 8 1/2 inches long, and of about five months' growth. The uterus also contained a male fetus of about three months' gestation. Figure 4 shows combined intrauterine and extrauterine gestation. Hodgen speaks of a woman of twenty-seven, who was regular until November, 1872; early in January, 1873, she had an attack of pain with peritonitis, shortly after which what was apparently an extrauterine pregnancy gradually diminished. On August 17, 1873, after a labor of eight hours, she gave birth to a healthy fetus. The hand in the uterus detected a tumor to the left, which wag reduced to about one-fourth the former size.

In April, 1874, the woman still suffered pain and tenderness in the tumor. Hodgen believed this to have been originally a tubal pregnancy, which burst, causing much hemorrhage and the death of the fetus, together with a limited peritonitis. Beach has seen a twin compound pregnancy in which after connection there was a miscarriage in six weeks, and four years after delivery of an extrauterine fetus through the abdominal walls. Cooke cites an example of intrauterine and extrauterine pregnancy progressing simultaneously to full period of gestation, with resultant death. Rosset reports the case of a woman of twenty-seven, who menstruated last in November, 1878, and on August 5, 1879, was delivered of a well-developed dead female child weighing seven pounds. The uterine contractions were feeble, and the attached placenta was removed only with difficulty; there was considerable hemorrhage. The hemorrhage continued to occur at intervals of two weeks, and an extrauterine tumor remained. Two weeks later septicemia supervened and life was despaired of. On the 15th of October a portion of a fetus of five months' growth in an advanced stage of decomposition protruded from the vulva. After the escape of this putrid mass her health returned, and in four months she was again robust and healthy. Whinery speaks of a young woman who at the time of her second child-birth observed a tumor in the abdomen on her right side and felt motion in it. In about a month she was with severe pain which continued a week and then ceased. Health soon improved, and the woman afterward gave birth to a third child; subsequently she noticed that the tumor had enlarged since the first birth, and she had a recurrence of pain and a slight hemorrhage every three weeks, and distinctly felt motion in the tumor. This continued for eighteen months, when, after a most violent attack of pain, all movement ceased, and, as she expressed it, she knew the moment the child died. The tumor lost its natural consistence and felt flabby and dead. An incision was made through the linea alba, and the knife came in contact with a hard, gritty substance, three or four lines thick. The escape of several quarts of dark brown fluid followed the incision, and the operation had to be discontinued on account of the ensuing syncope. About six weeks afterward a bone presented at the orifice, which the woman extracted, and this was soon followed by a mass of bones, hair, and putrid matter. The discharge was small, and gradually grew less in quantity and offensiveness, soon ceasing altogether, and the wound closed. By December health was good and the menses had returned.

Tags: Pregnancy & Childbirth