A CASE OF 
Intra-Ovarian Pregnancy, 
VVLTII POST-MORTEM EXAMINATION 
BY 
TALBOT JONES, M. D„ 
OF ST. PAUL, MINN. 
(Reprinted from the American Journal of the Medical Sciences.) 
PHILADELPHIA : 
1880. A CASH OF INTRA-OVA RIAN PREGNANCY, WITH 
POST-MORTEM EXAMINATION. 
TALBOT JONES, M. D., 
OF ST. PAUL, MINNESOTA. 
Few events connected with the parturient state are more disastrous 
to the patient than the arrest of the vitalized germ in its passage from 
the ovary to the cavity of the uterus. This is true whether the fe- 
cundated ovule be retained in the ovary constituting what is known 
as ovarian pregnancy ; is arrested in the Fallopian tube—tubal J or 
becomes imbedded in the uterine walls—interstitial. Ventral preg- 
nancy—that variety in which the ovum, after impregnation, escapes 
into the abdominal cavity, there to remain indefinitely, is fortunately 
not nearly so fatal as the other varieties, although it too is attended 
with a very high rate of mortality. 
This deviation from the normal course appears to have been known, 
tnough very imperfectly, to the ancients, for several of the early wri- 
ters have alluded to such a condition. Albucasis saw a case where 
foetal bones and debris were taken from what he termed an abcess, 
which had formed near the umbilicus. Horstius and Riolan, Jr., 
have mentioned somewhat similar cases. 
Causes.—The etiology of this arrest is very obscure, and must re- 
main so, for the obstacles are insuperable in the way of ascertaining 
with a reasonable degree of certainty the causes of extra-uterine foeta- 
tion, from our ignorance of the mechanism by which the fimbriated 
extremity of the Fallopian tube grasps the ovary. Again, the means 
at our command for diagnosticating this condition are not very relia- 
ble, and cannot be depended upon. Various theories have from time 
to time been advanced by different observers, yet to candid persons it 
must appear that with all that has been written our knowledge is still 
merely speculative. It has been supposed that there exist some mor- 
bid condition of the Fallopian tubes, such, for example, as paralysis 
or spasm, some deviation of its length, but especially some engorge- 2 
dent of its mucous membrane, either congestive or inflammatory, 
producing mechanical obstruction to the passage of the fecundated 
ovule. This explanation appears plausible enough, when we remem- 
ber that the Fallopian tube normally will scarcely admit of a bristle: 
Some have supposed that the tubal variety is often dependent on com- 
plete closure and obliteration of the tube. Indeed several cases of 
this variety have been observed. M. Gaide (Journal Hebdomadaire, 
t. i.) ascertained that in an interstitial pregnancy the right tube had no 
uterine orifice. M. Meniere (Archives Gen., June, 1826,) encountered 
a similar case, only that in this instance the left instead of the right 
tube was impermeable. Cazeaux also had the opportunity of observ- 
ing two cases of complete stricture of the tube, recorded in the Bull, 
de la Societe Anat. Virchow has noticed that this variety of preg- 
nancy is frequently accompanied by adhesions of the internal genital 
organs, caused by false membranes, or cicatricial tissue, and is noticed 
much more frequently on the left side. Why ovarian pregnancy 
should ever occur must remain problematical. 
Among the accidental causes numerous facts seem to show that 
fright or terror, occurring at the moment fecundation is being effected, 
may produce such a profound impression through the nervous system 
as to arrest the further progress of the ovule towards the uterus. 
Curious examples are on record where shock and great agitation re- 
ceived in coitu have been supposed to produce this. Thus Baude- 
locque {Diet, des Sciences Med., vol. xix.) relates a case of extra-uter- 
ine pregnancy, which is supposed to have been due to the shock re- 
ceived during the conjugal embrace, from hearing some one trying to 
enter the apartment. Lallemand [Noun. Journal de Med., vol. ii. 
page 320] cites a similar case, “an l a third woman experienced much 
alarm by a stone being thrown through'the window of her chamber 
during the time of sexual connection. ’ Though these and other 
cases which might be cited seem to establish some connection be- 
tween fright and the abnormal condition under consideration, yet, 
notwithstanding the high authority of the advocates of this doctrine, 
I cannot accept the explanation as satisfactory, or as having as a basis 
any foundation in fact. The truth is that the o/ule does not part 
from the ovary either at the moment of fructification or during the 
time of sexual connection, but may do so several days prior or subse- 
quent to this time, and this I think is fatal to the theory of fright. 
M. Dezeimeris relates a case where, shortly after fruitful connection, 
a blow received upon the hypogastrium was supposed to have caused 
this anomaly : and Montgomery, in one reported by Jackson in the 3 
Dub. Med. Journ., vol. ii., “thinks a blow received on the abdomen 
shortly after conception produced such a degree of inflammation and 
engorgement as to arrest the ovule in its transit from the ovarium.” 
It is a surprising fact that this accident is much more apt to occur in 
widows and unmarried women—a statement which rather lends sup- 
port to this theory of fright or agitation. Campbell, in his learned 
and valuable memoir, says that out of fifteen caees, five were single, 
certainly a very large proportion when we remember the comparative- 
ly small number of unmarried females who become pregnant. 
Malformation of the uterus is supposed in some instances to stand 
in causative relation. Meadows had the opportunity of examining, 
post-mortem, two cases of this kind, and found that the Fallopian 
tube, on the side corresponding with the arrested ovule, joined the 
uterus one inch below the fundus, thus causing “a deviation of the 
Fallopian canal and consequent arrest of the ovum in its passage to 
the uterus.” Years ago Coste [Embryogenie Comparee, vol i. page 
3H3] made the assertion, which, for a long time, remained uncontro- 
verted, that of all animals woman alone was subject to extra-uterine 
pregnancy. This, however, is now known to be untrue : it has been 
known to occur repeatedly amongst brutes, and in Campbell’s memoir, 
there are cited instances in which it has been observed in the hare, 
bitch, sheep, cow, and other animals- but it is the consideration of 
the ovarian variety, pure and simple, which chiefly concerns us in 
this article—that in which the ovum after being fructified lies imbed- 
ded in the avary. 
Occurrence. —Ovarian pregnancy is so rare that many eminent 
anatomists and pathologists deny its ever occurring except where the 
fimbriated extremity of the Fallopian tube, having grasped the ovary, 
formed part of the cyst, and which, therefore, strictly speaking, 
would constitute a tubo-ovarian pregnancy. Those who hold to this 
belief maintain that fecundation can never occur in the vesicle of the 
ovary before the rupture of the ovisac. In other words that it is im- 
possible for the spermatozoon to penetrate the ovisac without disturb- 
ing its integrity. So accurate an observer as Velpeau [Trait. EUmen. 
de la V Art des Accouch.. vol. 1.] was led into the error of this belief. 
His opinion was founded upon the hypothesis, which subsequent in- 
vestigation has shown to have been badly taken, that the ovum 
could never be impregnated without being jdetached from its bed. 
Allen Thomson | Cyclop, of Anat. and Physiol., part xiii.] likewise 
maintained that intra-ovarian pregnancy for the same reasons never 
existed. 
Farre and Thomas also hold to this view, and the latter has main- 
tained his opinion with his accustomed ability and vigour. But the 
fact has been established beyond all doubt that the foetus has been 
found within the ovary, and has in some instances progressively de- 
veloped there up to the 4th or 5th month, when rupture of the cyst 
occurs. “No doubt there is great difficulty in determining the exact 
locality of the misplaced gestation in these cases of supposed ovarian 4 
pregnancy, but there seems to be no reason why, when the fimbria is 
applied to the ovary which is on the point of rupturing, the sperma- 
toza should not trail along the tube, and actually penetrate the outer 
coat of the ovisac just as the ovum is escaping. In this way ovarian 
gestation would be commenced”—[Meadows.] Indeed there are just 
such cases on record. In the work of M Vl. Bernutz and Goupil, 
translated by Meadows, for the New Sydenham Society, vol. page 
249, there is such a case recorded. 
At a meeting of the N. Y. Obstetrical Society, Feb. 1865, Dr. 
Kammerer presented a specimen of extra-ucerine gravidity from a 
woman 30 years of age, who died a year previous. She ha 1 been un- 
der treatment for chronic metritis, and had passe 1 from under his 
care, with the exception of the introduction of a large sound, once a 
month, to keep the cervix open. Seven or eight years previously she 
had a child. She became again pregnant, and a little time subse- 
quently was taken suddenly ill with symptoms of internal hemorrh ige 
and peritonitis, and in the course of a few hours died. Upon post- 
mortem examination, several quarts of blood were foun l within the 
peritoneal cavity, and on the left ovary a rent revealing the source of 
the hemorrhage On opening the ovary an embryo was disc >vered 
about four weeks old. In reply to a question by Dr. E. R. Peas lee. 
Dr. K. said that he could see no decidua within the uterine cavity 
[Ar. Y. Medical Journal, May, l«65]. The case which I report in 
this article was one of pure uncomplicated intra-ovarian pregnancy. 
The earliest example on record of this variety of foetation is found in 
the Philos. Trans., vol. ii., reported by the Adbe de la Roque in 1682. 
An interesting case of ovarian gestation has been reported by J. Hall 
Davis in the Transactions of the Obstetrical Society of London, 1860, 
where the left ovary had degenerated into a mere cyst, and contained 
a dead foetus. 
In addition to these cases I will mention one recorded by Granville 
and Boehmer, together with the ten well-known cases collected by 
Spiegelberg. [Arch.f. Gyiue.,, xii. p. 74], which include cases of Wil- 
ligk. Hein, Martyn, Giesserow, Hess, Kiwisch, Wright, Hecker, and 
others. 
Since Spiegelberg collected these cases there have been two addi- 
tional ones reported, viz., one in the Giz. Obstetricale, Bernutz, Jan. 
1879, and one by Patenko [Arch. f. Gynce., xiv., lately issued]. 
Cohnstein [Arch. f. Gyncefcologie, xii. p. 367] has formulated certain 
rules for the proof that*ovarian pregnancy exists, and without which, 
lie maintains, no case of this variety is entitled to recognition. His 
rules are in the highest degree arbitrary,-and. although I am quite 
willing to accept them and abide by the result, so far as they apply 
to the case I report, still, if adopted without reservation, it is almost 
certain to deny recognition to others which are clearly cases of intra- 
ovarian pregnancy, but which for various reasons cannot be estab- 
lished as such with the absolute clearness which a strict compliance 
ivith all his rules demands. 
Among his rules may be mentioned the following : [a] Cylindrical 
epithelium must be seen under the microscope, taken from the interior 5 
of the cavity inclosing the ovum ; \b] passage of the fibres of the 
tunica albuginea into the wall of the ovisac ; [c] particles of ovarian 
tissue in close continuity to the cavity containing the ovum; [t/J 
absence of the ovary of that side ; [ej connection of the ovisac with 
the uterus through the ovarian ligament. 
I h tve no doubt hat cases of ovarian foetation are sometimes met 
which show themselves as such with great distinctness, but which 
are difficult if not impossible of demonstration For example, in one 
case the Fallopian tube might be seen ; also the round and ovarian 
ligaments ; that it was inclosed within the broad ligaments ; absence 
of the ovary of that side; you might even secure the ovary, post- 
mortem. and, with a care which would admit of no mistake, open it 
and find therein a foetus, as has been done, and yet, because no cylin- 
drical epithelium could be shown, or perhaps no fibres of the tunica 
albuginea discovered penetrating the wall of the ovisac, therefore the 
case was not entitled to recognition, although it would be perfectly 
apparent alike to reason, analogy, and to sight, that it was one of 
intra-ovarian gestation. Cohnstein’s formulated rules, if adopted, 
would deny recognition to Dr. Kammerer’s interesting case, already 
alluded to, because the latter failed to examine for ovarian fibres and 
cylindrical epithelium under the microscope, or perhaps neglected to 
search sufficiently for the ligament of the ovary, although he exhibit- 
ed his specimen to the New York Obstetrical Society, was closely 
questioned in regard to it by Dr. Peaslee and other eminent members, 
and even opened the ovary and found therein the four weeks' embryo, 
llaselberg has lately reported a case, and described it minutely, still, 
because he neglected to make mention of the Fallopian tube, the case 
was for that reason omitted in the number recently collected and re- 
ported by Spiegelberg. For the same reason the case of J. Hall Davis 
and those of Granville and Boehmer would fail of recognition if 
judged by the rule insisted upon by our Herman confreres. 
Symptoms-—As soon as the impregnated ovum takes up its abode 
in the ovary the uterus at once undergoes decided changes. There is 
a determination of blood to the organ, as in ordinary impregnation. 
A tough, gelatinous mucus, thick and ropy, secreted by the glands of 
the cervix, plugs the neck of the womb. The organ increases in size 
to a remarkable degree, sometimes enlarging even to two or three 
times its ordinary bulk ; the mucous membrane becomes hypertro- 
phied and considerably congested. There is a true decidua formed 
within its cavity, although Dr. Robert Lee does not believe this, and 
in the Med. Gazette, vol xxvi., cites two cases which came under his 
observation to disprove such an idea. Velpeau concurred with Dr. 
Lee in the belief that a true intra-uterine decidual membrane never 
formed in extra-uterine impregnation. There are now, however, few 
if any who hold to this opinion. The late Dr. John S. Parry, from a 
careful analysis of over five hundred cases {Extra-uterine Prey nancy, 
Phila., 1876], came to the conclusion that a true decidual membrane 
forms in the uterus alone and never in the cyst. His work is the 
most comprehensive in any language, and the deductions of Dr. Parry 
are entitled to great weight. Indeed, the weight of testimony is well 6 
nigh unanimous that such a membrane does form,*but that it is of 
short duration, “for, as ihe ovum does not enter the uterus, it has no 
office to perform, and therefore, like every other useless organ, be- 
comes atrophied, loses its vascularity, and in a few months has re- 
turned to its normal condition.” It undergoes a process of disinte- 
gration, and is eventually thrown off. Fortunately this matter is 
taken from the domain of speculation, and placed within that of 
clinical observation by Breschet. Campbell, and others, borne of 
these observers have seen the decidual membrane in the uterus in situ 
or after its expulsion by uterine action, which is usually accompanied 
by some sanguineous discharge. 
In addition to the symptoms already enumerated may be mentioned 
the fact that in the intra-ovarian variety, the enlargement of the ab- 
domen. if the patient does not die from rupture of the cyst before 
this is well marl ed, is not in the mesial line, but upon the side. 
Sometimes menstruation continues regularly, in other cases it disap- 
pears entirely. Severe hemorrhage may occur, which will probably 
lead to the supposition that abortion has taken place. In almost all 
cases there is from the start more or less abdominal pain ; this may 
be so severe as to excite suspicion of peritonitis. Generally, however, 
the pain is analogous to uterine pain. A sense of weight and op- 
pression is oftentimes felt by patients. There may be present much 
irritability of the bladder, painful diarrhoea, and perhaps tenesmus. 
The most reliable of all evidence is that obtained by a vaginal exam- 
ination If carefully conducted an enlargement can be readily de- 
tected on the side of the uterus, especially if the conjoined manipula- 
tion be practised. In the majority of cases the uterus is displaced 
Ihe anatcmo-pathokgical phenomenon which has. perhaps, excited 
the greatest interest of embryologists, is that w'hich relates to the 
amnion and chorion, the placenta, and cord. To these iorm in cases 
of intra-ovarian fcetation ? It does not come wnthin the scope of this 
article to enter upon a discussion of the different theories and con- 
flicting opinions which have in the past engaged the attention of in- 
dividual writers or learned societies upon this question. At the ex- 
pense of being considered dogmatic. I will say at once, and without 
fear of its being successfully controverted, that wherever the vitalized 
germ takes up its abode there the ovule w ill have its' proper mem- 
branes—the amnion, chorion, placenta, and cord. This viewo it need 
scarcely be said, is by no means accepted by all. There are men 
whose names carry great weight and whose opinions in such matters 
are entitled to our most respectful consideration, who far from believ- 
ing this are rather disposed to believe that these being uterine organs 
either do not form at all, or. if so are very imperfectly developed. 
There are others wrho maintain that the amnion and placenta are 
formed in extra-ovarian pregnancy, but the chorion and cord are ab- 
sent. Cazeaux mentions, somew here in his works, of a discussion to 
which he listened before the Academy of Medicine, Paris, during 
W’hich learned members contended there was present in the cases of 
extra-uterine pregnancy an amnion but no chorion The fallacy of 
this is apparent at once, when we remember the way in which the 7 
ovum is developed ; the allantois is necessarily absent if the chorion 
is not developed, and without the former no circulation can take 
place between the mother and embryo. Ihe placenta is very much 
like that seen in an ordinary case of pregnancy, though greater in 
circumference, thinner and flatter. Ihe cord closely resembles in 
size, length, and structure that observed in cases of uterine pregnancy. 
Luratuv.—If observers could agree with reasonable unanimity up- 
on ;ny subject admitting of controversy, it would seem they could 
upcn the question of the duration of the different varieties of extra- 
uterine fa tation. But it must be admitted that even here there is the 
greatest difierenceof opinion. “The duration of extra-uterine preg- 
nancy will depend upon the situation ; thus, if it be in the Fallopian 
tube it rarely lasts beyond two months, whereas ovarian pregnancy 
will continue for five or six months ; on the other hand, in ventral 
pregnancy the foetus will not only be carried to full term, but far be- 
yond that period, amounting to several years.” (Rigby.) 
( ampbell, in his monograph, says : “In ninety cases in which we 
can decide, or nearly so, on the stage of pregnancy, the foetus in sev- 
enty-nine patients died at the close ot the ninth month or soon there- 
after—one in the eighth, seven about the seventh, one in the sixth, 
two in the fifth, two in the fourth, fivf in the third, and one at the 
end of the first month.” But I cannot help agreeing with Meadows in 
the doubt he has thrown on the accuracy of these statistics. He 
says : “I cannot help thinking that there is some mistake in these 
figures, for w hereas I r. ( ampbell set ns to imply that the chances are 
largely in favor of the foetus going to the last month of utero-gesta- 
tion, the experience of most men is certainly oppose to this, and taking 
the whole number and varieties of extra-uterine pregnancy, it appears 
that the chance of a rupture of the cyst increases with each succeed- 
ing month, and that very few’ pass beyond the fourth or fifth month.” 
It thus appears that of Campl ell’s ninety cases in seventy-nine, or 
about 85 per cent., the patients remained in good health up to the close 
of the ninth month of gestation whereas the experience of the vast 
majority of ol servers indicates that death from rupture of the cyst 
occurs bef< re the fifth month in fully two-thirds, or 67 per cent, of 
all cases- The cases in which rupture takes place earliest are the tubal. 
In the few cases which have been reported of the internal ovarian 
variety, the rupture occurred on an average some weeks or months 
later than in the tubal variety In the one I shall report death from 
rupture of the cyst occurred during the fourth month. In Dr. Kam- 
merer’s case the rupture took place at the end of four weeks ; in a case 
reported by Ramsbotham between the third and fourth month. All 
these were strictly intra-ovarian. 
That internal ovarian pregnancy will net, as a rule, be prolonged be- 
yond the fourth or fifth month is clearly indicated, and the indication 
is sustained by concurrent testimony. I am aware that this statement 
is apparently opposed to the view of Campbell on this subject hereto- 
fore quoted, but it may be only apparent since in his statement of the 
probable duration of extra-uterine pregnancy he may have made, and 
probably did make, his estimates without reference to the ovarian 8 
variety. Lesouef, who has given this subject careful study, dwells at 
length on the tendency of the tubal variety to rupture early. 
Abdominal or ventral pregnancy may continue indefinitely. A re- 
markable case is on record where the foetus remained in the abdominal 
cavity of the mother for upwards of forty-three years. Even more 
remarkable still is the case reported by Mr. L. It. Cook in the Trans- 
actions of the Obstetrical Society of London [1864]. A patient died two 
days after delivery of a dead child. Post-mortem examination reveal- 
ed a large tumor in the abdomen. On examination a full sized child 
was found in the abdominal cavity “inclosed in its own membranes 
and having apparently been developed in the fimbriated extremity of 
the Fallopian tube.” 
Termination.—A few words with reference to the probable termin- 
ation of extra-uterine foetatiou. It may be stated as a rule, to which 
there are unfortunately but few exceptions, that the patient dies sud- 
denly from rupture of the cyst, either primarily from shock incident 
to this accident, or secondarily of peritonitis from effusion into the 
peritoneal cavity. The exceptions are those rare cases of ventral 
pregnancy in waich tiie fructified ovule, after having fallen into the 
abdominal cavity, there remains and develops, the foetus advancing it 
may be to full term, then dying, either remains there indefinitely, 
with but little discomfort to the mother, or else—and this is much tne 
moie common rule—undergoes a process of disintegration and ab- 
sorption. Not unfrequently the vitalized ovule after falling into the 
abdominal cavity becomes encysted and may remain there with but 
little constitutional disturbance for years. There are one or two cu- 
rious cases on record where the patient continued in fair health for 
years, although labouring under intra-ovarian pregnancy. Granville 
had such a case in waich the ’ffoetu-s lived for four months, but the 
patient survived ten years and a half, anl then died of internal hem- 
orrhage. ” 
When the foetus dies the circulation in the cyst is diminished, and 
it takes on rapid atrophy ; becomes more indurated, and is now noth- 
ing in ire than a foreign body in the abiomin il cavity. Tne vital 
powers begin to flag. Pain miy be a prominent symptom from the 
start, or, on the contrary, may be but little felt. Generally the cyst 
sooner or later breaks down, ulcerations invade its walls, fistulous com- 
munications form openings either into the bowel, uterus, badder—- 
rarely the stomach/—or else through the abdominal parietes ; the foetal 
debris quickly pass through these fistulous canals by peace-meal, or the 
contents are discharged seriatim. This ulceration and discharge may 
continue for a long time, and undermine the patient’s strength. The 
springs of life are sapped, and, finally, after a variable period, the pa- 
tient succumbs. 
Prognosis.—The prognosis of all varieties of extra-uterine pregnan- 
cy a priori is extremely unfavorable ; in the vast m ijority of cases the 
patient dies, and usually expires suddenly. The mortality has been 
variously estimated from 65 to 99 per cent., the latter having reference 
to the ovarian and tubal the former of the ventral or ab- 
dominal. 9 
To discuss the treatment of extra-uterine gravidity would be incon- 
sistent with the original aim of this article. 
The following interesting case occurreu some time since in the prac- 
tice of Dr. Murphy, of this city, 
Mrs. M., age 38, native, married twelve or fifteen years, of average 
size, and had always enjoyed fair general health. Moved in the higher 
walks of life. Her three former conlinements were perfectly normal. 
Seven years before the last pregnancy she had been delivered of a 
healthy child. In May she again became pregnant, as the subsequent 
history will show, for the fourth time. During the four succeeding 
months she experienced the usual symptoms of this condition—sup- 
pression of the catamenia, morning nausea, enlargement of the 
breasts, d. eply shaded areola an l slight secretion of milk. Even with 
these symptoms present, strange to say, the patient did not consider 
herself pregnant. During the middle of August there was noticed 
some enlargement of the abdomen, not centrally, but rather on the 
leftside. About this time she begin to experience severe spasmodic 
pains in the abdomen, which would usually commence on one side of 
the inguinal region, and suddenly dart to the opposite side. 
Pain in the back was also a concomitant symptom. It was distinct- 
ly paroxysmal in character, and so intense as often to cause syncope 
outright. It was for the relief of this that she applied to her physi- 
cian for treatment. The latter after hearing her statement told her 
at once that she was pregnant. So satisfied was he of this that no 
vaginal examination was deemed necessary. She was advised to try 
and bear her troubles for a while as patiently as possible. A simple 
opiate to quiet pain was given. 
The patient, it appears, not altogether satisfied with this diagnosis 
and advice, applied to another physician, who, after a vaginal exam- 
ination, came to the conclusion that she was laboring under some ob- 
scure disease of the left ovary, and advised her to un lergo treatment 
appropriate to such cases She was still dissatisfied and now alarmed 
at her condition. After hearing the previous history of the case an 
examination, was made per vaginam with the following result: 
The enlarged uterus was felt distinctly retroflexed with the fundus 
well down in the hollow of the sacrum. The cervix was rather soft 
and spongy, long, and high up. External os slightly open. Internal 
os closed. The uterus was movable and somewhat tender to the 
touch. By conjoined manipulation a tense, resistant tumour was felt, 
occupying the left pelvis, which gave to the finger an impression of 
elasticity. It was only slightly movable, globular in shape, and ap- 
parently about the size of an orange. By percussion through the ab- 
dominal wall over the tumour there was dullness, but not absolute 
flatness. A distinct outline of the tumour could be traced through 
the abdominal walls. Obscure fluctuation was detected over the tu- 
mour. The patient always experienced some pain on the passage of 
her urine, and this was voided more frequently than usual. The 
bladder occupied its normal site A positive diagnosis was not ar- 
rived at, though there was a strong suspicion of either ovarian or 
tubal pregnancy. The attempts to distinguish different portions of 10 
the supposed foetus, as a hand or foot, through the coats of the vagi- 
na, failed. Medical counsel was called, and with the concurrence of 
all present it was decided to care/ully iniroduce a sound into the 
uterus. 
After placing the woman on her back, this was done, though not 
without considerable hesitation, since, with these symptoms of preg- 
nancy present, the probability of a normal pregnancy in a retroflexed 
uterus was not lost sight of. However, the sound readilyentered the uteus 
to the fundus, and no greater obstacle to its entrance was noticed than 
is always experienced in passing this instrument in a uterus bent on 
itself- The womb was considerably enlarged, measuring by the sound 
just five inches in length, is either a tumour nor foetus could be de- 
tected in the uterine cavity. The mother had never experienced any 
movement of the child, and at no time could foetal heart sounds be 
detected. The differential diagnosis now lay between ovarian or tubal 
fcetation and ovarian disease of a mixed character which we oc- 
casionally meet, the gland being converted partly into different cysts 
containing fluid, and partly into a solid tumour. Great obscurity 
still attached to the case. Here was a case where many of the 
symptoms pointed to existing pregnancy, and yet the uterus was 
empty. The propriety of tapping the cyst through the vigina with a 
small aspirator needle was now seriously entertained. The operation 
for gastrotomy was also though of. 
Palliative treatment consisted in giving half-grain morphia supposi- 
tories by the rectum for the relief of the intense pain which came on 
in distinct paroxysms, and which greatly prostrated the patient. Her 
nervous system was now unstrung ; sleep rarely came without artifi- 
cial aid ; the bowels were constipated and the secretions disordered. 
There was a constant pain in the lower back and through the loins. 
A discharge per vaginam occurred from time to time, though this was 
never profuse. Such was the condition of our patient toward the lat- 
ter part of September, and far into the fourth month of her pregnan- 
cy. Being summoned, early one morning, in great haste, on reach- 
ing the patient she was found in a state of collapse, and experiencing 
violent cramps in the side of her abdomen, much like severe colic. 
Hemorrhage was evidently the cause, for all the symptoms plainly 
pointed to this. Cold extremities, pallor of the countenance, excru- 
ciating abdominal suffering, clammy perspiration, extreme depression, 
a flickering pulse, and vomiting wrere a chain of symptoms not to be 
mistaken Death soon closed the scene. 
Post -mortem examination. made the day following her death, revealed 
about two pints of effused blood in the abdominal cavity. The en- 
larged ovary was inclosed between folds of the broad ligament. All 
the ovarian tissues were present. The Fallopian tube wras secured 
with the ovary. No portion of it was enlarged as it would have been 
were it a case of the tubo-ovarian variety. The specimen, as now 
seen in alcohol, shows the fimbriated extremity of the Fallopian tube 
grasping the ovary, at its upper and inner border, and of about norm- 
al size. About two inches in of the tube, including the fimbriated 
cxtreniitjr, was detached wTith the ovary. Unfortunately the ovarian ligament was cut oft' close to the ovary in removing this from the pa- 
tient’s body. The stump can, however, be seen in the specimen 
when closely examined. It is to be regretted that the uterus was not 
secured with the ovary, in order to have shown the relation these or- 
gans bore to each other. However, as a report of the case wras not 
thought of at the time, this was overlooked. I have carefully exam- 
ned under the microscope portions of the mass of tissue near the rent 
in the ovary, and find that it is true ovarian tissue. “Particles of 
ovarian tissue in close continuity to the cavity containing the ovum” 
were plainly seen. I need scarcely say that “no ovary of that side” 
was found, except the one in which impregnation had taken place. 
Ko fibres of the tunica albuginea were seen passing into the wall of 
the ovisac, though for very obvious reasons. In order to have 
demonstrated this, mutilation of the specimen would have been neces- 
sary, and it was not considered desirable to do this. The left ovary 
was about the size of a large orange. There was a rent about three 
inches long in its anterior wall, revealing the source of the hemorr- 
hage. Bulging out through this rent was seen a four months’ foetus 
surrounded by its own membranes—the amnion and chorion—wfith 
the foetus still floating in the liquor amnii. 1 y careful discretion the 
entire ovary was secured without injury to this organ, and without 
rupture of the bag of waters. 
There could he no difference of opinion concerning this case of in- 
tra-ovarian pregnancy. Everything shewed with the utmost dis- 
tinctness. The fontanelles in the child’s head could be seen through 
the delicate membrane inclosing the fotus. The finger could trace 
the different forms af the skull, the fissures, fontanelles, etc., as well 
as detect every portion of the child by pinching it up between the 
fingers. In sh( rt. here was a case of pure internal ovarian feetation, 
in which the foetus was entirely surrounded by ovarian membranes 
and imbedded in the gland, w hich progressively developed there up to 
the fourth month, when rupture of the cyst caused hemorihage into 
the abdominal cavity, ard. as a result of this effusion, death to the 
mother. Examination of the uterus yielded negative results. It. was 
found enlarged, and its mucous membrane much congested ; but 
whether a true decidua was there present, or had been at an}r time, 
could not be determined with any degree of certainty. The ovary, 
is now preserved in alcohol, has teen seen ly many distinguished 
physicians, among whom I may mention Prof bamuel White 'l hayer, 
M. D., of the University of Vermont, and Prof. Ford, of Ann Arbor, 
Mich . none of whem have expressed the slightest doubt as to its be- 
.ng a case of intra-ovarian feetation. The specimen was also exhibit- 
ed before the Minnesota State Medical Society, at its meeting in St. 
Paul two years ago. 
Theoretically, 1 suppose there will be in the future, as in the past, 
doubts thrown on the possibility of this condition ever occurring ; but 
for an unprejudiced man. who has once seen this specimen, to still 
doubt the occurrence of internal ovarian pregnancy, would be for him 
to doubt the accuracy of his own powers of vision. 
11