1885 v. 28 - Lane Medical Library Digital Document Repository

Correspondence. 25
dorsum towards the mother's' stomach, and the head in the right
lumbar region. I did not subsequently make any examination.
I then informed the friends of the serious nature of the case, and
also told them that if they called in a doctor, (a man) I would
come next day and render any assistance I could. In the meantime
I directed that the patient be kept quiet, that she be well
supplied with nourishment, and kept under the influence of opium.
On the following day, 11th, Dr. Laird of Soledad arrived. In
consultation we decided to deliver by extracting the child through
the abdominal wall, as being the best method, if the foetus were
by any chance encysted.
The patient having been encased in flannels, was anestheticised,
and placed on a table which answered every purpose very well.
I then made an incision from the spine of the left pubes parallel
with Poupart's ligament, and above it, to a little beyond the spine
of the illium; and carefully divided the parts on a director till
the peritoneum was exposed. This membrane looked quite gangrenous.
On pushing the fetus towards the wound, I saw that it
was in the peritoneal cavity. I next divided the peritoneum the
whole length of the wound; and whilst extractiug the child I
found that I had to enlarge the opening, which was done by carrying
the incision upwards from the spine of the illium. The
child was full grown, and in such a state of decomposition that
the cuticle peeled off wherever I laid hold of it. The placenta
was free, and also in a state of decomposition. The abdominal
bandage, which had been placed in position before the operation,
was then tightened up, and a large quantity of foul-smelling fluid
came away. This was all drained off, and the wound was being
dressed when symptoms of collapse set in, though the anesthetic
had been discontinued after the delivery of the child. The patient
never rallied, notwithstanding that every effort was made at
restoration.
I was much disappointed that I could not get permission to
make a post mortem examination. It would be very interesting
to know positively whether the case were one of extra-uterine fetation
or rupture of the uterus. I opine strongly towards the
rupture. Yours, etc.,
J. T. SHIPSEY, L.M., K.Q.C.P.I.
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