OVARIAN TUMOR COMPLICATING PREGNANCY. 
Read before the State Medical Society by title 
BY 
E. E. MONTGOMERY, M.D., 
Professor of Didactic and Clinical Gynaecology in the Medico-Chirurgical College, 
Obstetrican to the Philadelphia Hospital, etc. 
\Reprinted from the Philadelphia Medical Times for July 23, c88y.~} OVARIAN TUMOR COMPLICATING PREGNANCY. 
THE field of ovarian disease has been 
so often gleaned that the hasty ob- 
server may deem it impossible to cull any- 
thing new therefrom. While I do not, in 
this paper, make any pretence to special 
originality, I hope to be able to present 
what experience teaches to be the most 
successful method of treating " Pregnancy 
complicated by Ovarian Tumor." 
It may be questioned whether this com- 
plication is frequent enough to render the 
subject of sufficient importance to occupy 
the time of this scientific body. Its fre- 
quency may be appreciated when I am able, 
from a very cursory investigation of the 
literature, to present tables of over one 
hundred and fifty cases. 
Ovarian disease does not preclude the 
possibility of conception so long as the 
ovaries contain healthy ovarian stroma. 
In Spencer Wells's first one thousand 
cases of ovariotomy over two hundred 
children have since been born. A woman 
upon whom I did ovariotomy in the Phila- 
delphia Hospital in 1879, whose second 
ovary contained so many cysts that its 
removal was debated, has been treated in 
the same institution for abortion. Schroe- 
der, with the knife, and Pippingskoeld, 
with the galvanic cautery, have destroyed 
the cystic tissue of the second ovary, and 
the woman subsequently became pregnant. 
Indeed, rare instances, have shown that 
the removal of the ovaries is not an abso- 
lute safeguard against conception. In such 
cases there are undoubtedly rudimentary 
masses of ovarian stroma or supplemen- 
tary ovaries. 
This probability of subsequent concep- 
tion is a strong argument for the preserva- 
tion of the second ovary during the period 
of sexual activity. Instead of complete 
extirpation, we should follow the course of 
Schroeder and Pippingskoeld. 
The investigations of Jetter have shown 
that any form of ovarian cyst may compli- 
cate pregnancy. Of his collection of one 
hundred and sixty-six cases, ninety-seven 
were cystomata, thirty-seven dermoid, 
eleven carcinomata, and twenty-one un- 
certain. In a majority of the cases the 
tumor had existed for a length of time 
before pregnancy. 
It is frequently asserted that owing to the 
pelvic hypersemia consequent upon preg- 
nancy the growth of these tumors is greatly 
accelerated. This growth, however, is 
probably more apparent than real. The 
great distention and distress are due to the 
natural growth of the tumor, plus the 
accompanying development of the uterus. 
Wernich not only accepts the accelerated 
growth as an established fact, but asserts 
that benign cysts, during pregnancy, are 
more likely to take on malignant action. 
Ruge explains the latter by claiming that 
the malignant element was originally pres- 
ent. 
The dermoid cysts, from their smaller 
size, are most frequently found in the true 
pelvis. 
The situation and size of the tumor are 
of marked significance in determining the 
prognosis. Of seventy-five cases, includ- 
ing those of Playfair, the tumor was found 
in the recto-vaginal septum in forty-one, 
on the right and left sides each five times. 
When small, the growths may frequently 
be overlooked, and the hinderance to de- 
livery remain undiscovered or be ascribed 
to pelvic narrowing. Grigg's post-mortem 
researches in puerperal septicaemia render 
it probable that many cases of this disease 
are due to injury of unrecognized ovarian 
tumors during parturition. 
The diagnosis of the coexistence of 
pregnancy and ovarian tumor is of the 
greatest importance, and oftentimes a dif- 
ficult problem, but the limits of this paper 
will not permit of its discussion. 
The mortality of ovarian tumor compli- 
cating pregnancy treated by the expectant 
plan is frightful. In the seventy-five cases 
culled from literature, thirty-one, or forty- 
one per cent., were fatal, while but twenty- 
two children, or twenty-nine per cent., are 
quoted as having been saved. The mater- 
nal mortality differs but little from that 
given by Litzman,-maternal, forty-three 
per cent. ; foetal, eighty-three per cent. 
Such a death-rate urgently demands the 
investigation of other plans of treatment. 
When we come to the consideration of 
ovariotomy during pregnancy, we find far 
better results. 
In the accompanying table of sixty-one 2 
OVARIAN TUMOR COMPLICATING PREGNANCY. 
cases, but seven, or less than eleven per 
cent., were fatal; thirty-nine went to full 
term, or reached the period when the child 
became viable. The comparison of the 
results of ovariotomy (maternal mortality 
twelve per cent., foetal mortality thirty- 
five per cent.) with those of the expectant 
treatment (maternal mortality forty-three 
per cent., foetal mortality eighty-three per 
cent.) unquestionably demonstrates the 
value of the former. It is seen that the 
presence of pregnancy does not materially 
enhance the danger of ovariotomy. Fur- 
ther, it is rendered prominent that after 
performing ovariotomy the prognosis is 
extremely favorable for mother and child. 
Finding that ovariotomy can give such 
good results, it remains then to be taken 
in consideration in each individual case. 
The following points naturally present 
themselves for discussion : 
1. Is ovariotomy the most secure and 
best proceeding for the removal of the 
complication ? 
2. Shall one in all cases do ovariotomy? 
3. When is the most favorable time for 
its performance? 
Those having large experience, as Spen- 
cer Wells, Tait, Cauchois, Olshausen, and 
the late Carl Schroeder, unite in commend- 
ing ovariotomy as the most desirable pro- 
ceeding. Most agree that it should be 
done at once in recognized ovarian tumor 
during pregnancy, on account of the dan- 
ger of rupture of the cyst, twisting of the 
pedicle, exhaustion of the patient from 
the great abdominal distention, the possi- 
ble complication of labor from the pres- 
ence of the tumor, and the greatly in- 
creased mortality where ovariotomy is 
required during the period of puerperal 
convalescence. Its early performance is 
especially important when we take in con- 
sideration that Cohn has proved every 
sixth tumor to be probably malignant. 
With the experience before us of the 
late Carl Schroeder, of fourteen cases and 
no deaths, Spencer Wells and Tait each 
eleven cases with one death each, the 
presence of pregnancy should hasten rather 
than retard the performance of ovariotomy. 
The sixty-one cases of the accompanying 
table, with a mortality of eleven per cent., 
show that, while pregnancy does not im- 
prove the prognosis, it certainly does not 
make it worse. 
Next to ovariotomy, tapping has always 
been more or less employed. Our first 
table will show that it is just about as dan- 
gerous and as free from danger as ovariot- 
omy, with the disadvantage that it is not 
a radical operation. It is still further un- 
satisfactory in that it increases the dan- 
ger of subsequent ovariotomy, and that 
there is greater danger of wounding neigh- 
boring organs. Artificial labor is now 
but little performed, for the reasons that 
it does not preclude the necessity of ovari- 
otomy and that it diminishes the chances of 
the foetus. Abortion and tapping do not 
preclude ovariotomy, but rather augment 
the necessity of its performance under un- 
favorable circumstances. If, then, in the 
complication of ovarian tumor with preg- 
nancy, ovariotomy gives clearly better re- 
sults than either the purely expectant 
treatment upon the one hand or tapping 
and abortion on the other, it is the most 
secure and best proceeding. But shall 
we do ovariotomy in all or only in isolated 
cases ? 
The answer to this question is the fol- 
lowing : one must, in all cases in which 
ovarian tumor has been diagnosticated, 
do ovariotomy, because- 
1. Ovariotomy is unavoidable, and the 
prognosis is not made worse by the exist- 
ence of pregnancy. 
2. The labor and convalescence with the 
tumor offers a far more unfavorable prog- 
nosis than without it. 
3. Many tumors are malignant, al- 
though we cannot certainly so diagnose 
them; and it is difficult to say how far 
the spreading of the malignant element 
is favored by pregnancy and the resorption 
in convalescence. 
The most favorable period for operation, 
as recognized by all operators, is during 
the first half of the pregnancy. In the 
last months, the increased hyperaemia and 
engorgement of the broad ligaments ren- 
der it less favorable. Then, too, there is 
more probability of the convalescence be- 
ing complicated by premature labor. The 
experience of a number of operators, as 
quoted in the table, shows that the opera- 
tion can be performed in advanced stages 
of pregnancy with good results. The case 
of Pippingskoeld, in which it was per- 
formed during labor, is eminently encour- 
aging. 
My own experience (limited to one case) 
has led me to question whether, in the last 
stages of pregnancy, it would not be better 
to follow the excision of the ovarian tumor OVARIAN TUMOR COMPLICATING PREGNANCY. 
3 
by removal of the contents of the uterus 
through Caesarean section. 
The history of the case to which I 
allude is as follows. April 4, 1886, I 
was called in consultation with Dr. George 
Mays, to see Mrs. N., aged 24 years. 
She had been married less than a year, and 
had ceased to menstruate August 15, 1885. 
The menstrual function had become estab- 
lished during her thirteenth year, and,while 
regular, had always been scanty. For the 
past year she had had considerable distress 
and sense of weight in the pelvis, with 
occasional attacks of difficult micturition 
amounting, at times, to retention. The 
sensation of weight was greatly increased 
after marriage, but very naturally was. at- 
tributed to pregnancy. At the date men- 
tioned she believed herself in labor. She 
was complaining of severe pain, and the 
doctor informed me that upon digital exam- 
ination he could not find the os. He had 
also unsuccessfully attempted to catheterize 
her. Inspecting the abdomen, the uterus 
was seen distending it as high as the ensi- 
form cartilage; below, reaching nearly to 
the umbilicus, was a second spherical tu- 
mor which fluctuated and was evidently 
the distended bladder. By the vagina was 
felt a moderately elastic mass, filling up 
the curvature of the sacrum and reaching 
to the symphysis in front. I first supposed 
it a case of pregnancy in marked ante- 
flexion of the uterus, in which we would 
find the os uteri situated high up ; pushing 
the finger well up forward, I could reach 
the cervix just above and behind the sym- 
physis. The os was undilated. The press- 
ure of the cervix upon the neck of the 
bladder was the cause obstructing urina- 
tion. By means of a male catheter nearly 
two quarts of urine were drawn off. The 
pelvis was filled up with a smooth round 
tumor which had pushed the bladder and 
uterus completely out of the pelvis. A 
rectal examination disclosed some projec- 
tions from the cyst, showing that it was not 
a single cyst, although unmistakably of 
ovarian origin. Failing in the effort to 
push the tumor up while the patient was 
in the genu-pectoral posture, we were con- 
fronted by the necessity of relieving her 
of its presence to permit the expected de- 
livery. She had now about reached the 
eighth month of pregnancy. Should we 
induce premature labor ? This would not 
be possible unless the tumor was simulta- 
neously reduced. Tapping was thought 
unwise, for the reason that the majority of 
these intra-pelvic ovarian growths are 
either dermoid or multilocular cysts, with 
very viscid contents. Our examination 
had shown the growth to be multilocular. 
The escape of its contents into the pelvic 
cavity would insure the development of 
peritonitis, and this would be still further 
aggravated by the bruising of the sac in 
the passage of the foetus over it. Accord- 
ingly, it was thought better to do ovariot- 
omy. 
After thorough disinfection of the room, 
assisted by Drs. Mays, Warder, Eshleman, 
and West, the operation was performed, 
April io, 1886. Beginning one inch 
below the umbilicus, an incision five inches 
long was made towards the symphysis. 
The left hand was passed between the left 
abdominal wall and uterus, behind and 
below the latter, until the cyst was reached. 
A small cyst projected above the pelvis 
and ruptured under the pressure of the 
hand. Dr. Mays introduced his hand into 
the vagina to facilitate the delivery of the 
larger cyst. It also ruptured under the 
pressure. The sac was raised up, and, 
having its origin on the right side, it was 
passed behind the uterus to the opposite 
side. Its pedicle was ligated with the 
Staffordshire knot, the tumor removed, the 
abdomen carefully cleansed, the wound 
closed with silk sutures. The wound was 
dressed with sublimated gauze and absorb- 
ent cotton. The operation was completed 
in forty minutes. The left ovary presented 
a cyst the size of an orange, but it was 
thought best not to remove it. 
The night following the temperature was 
102.20, but soon subsided, not again reach- 
ing 1020, becoming normal on the fourth 
day. On the seventh day the sutures were 
removed and the dressing renewed. The 
central portion of the integument was un- 
united, the sutures having cut out. This 
was supported by adhesive plaster. A few 
hours later labor set in. This occurred 
during my absence. Dr. Mays, seeing 
serum oozing from the abdominal open- 
ing, applied the forceps and delivered a 
strong, healthy child. As the forceps 
were applied with the patient lying upon 
her back in the centre of the bed, the 
vulvar orifice was necessarily considerably 
lacerated. When I saw her about an hour 
after the labor, she was very much ex- 
hausted and had lost considerable blood. 
The second day following the temperature OVAR 1AN TUMOR COMPLICATING PREGNANCY. 
4 
began to rise, the lochia became offensive, 
the abdominal wound opened, and offen- 
sive serum was discharged. Intra-uterine 
injections were given, and the abdomen 
washed out with chlorinated soda and lis- 
terine, but despite all our measures the 
septic symptoms continued, and death 
occurred April 24, two weeks after the 
operation. It has since been a regret that 
while the abdomen was open I did not 
remove the contents of the uterus and 
close the uterine wound with sutures, after 
Sanger's method. I am encouraged to 
believe such a course would have been suc- 
cessful from those cases of Wells and By- 
ford in which the uterus was injured 
during ovariotomy and emptied of its con- 
tents. In Byford's case the pregnancy had 
reached the eighth month. My patient 
showed no septic symptoms until after the 
delivery, and by the course suggested this 
source of origin would have been avoided. 
Cases of Ovarian Tumor complicating Pregnancy Treated. Expectantly. 
Reference. 
Position of Tu- 
mor in Pelvis. 
Left to Natural Powers. 
Punctured. 
Embryotomy. 
Pushed above Brim. 
Turning. 
Forceps. 
Rupture of Uterus. 
Results. 
Remarks. 
Mother. 
§ 
I 
Hewlett, Med.-Chir. Tr., vol. vi. 
Recto-vag.pouch. 
I 
... 
D. 
D. 
Tumor flattened by pressure; ex- 
tensively adherent. 
2 
Merriman, Ibid., vol. iii 
• • 
D. 
D. 
3 
Ibid., vol. x 
I 
I 
R. 
R. 
R. 
D. 
D. 
Preceded by puncture. 
4 
I 
5 
6 
Parks, Ibid., vol. ii 
•• 
I 
I 
D. 
Preceded by puncture. 
7 
I 
R. 
A. 
8 
ft tt it 
•• 
I 
R. 
A. 
Same patient as JNo. 7. 
9 
I 
A. 
10 
11 
« « « 
« 
I 
I 
... 
D. 
Ovarian origin somewhat doubt- 
12 
T3 
Lever, Guy's Hosp. Rep., 1842.... 
Left side of pelv. 
I 
D. 
R. 
D. 
A. 
ful. 
I 
R. 
A. 
15 
tt tt ft tt 
Recto-vag.pouch. 
D. 
D. 
Cyst ruptured spontaneously. 
16 
tt tt tt it 
Left side of pelv. 
I 
R. 
A. 
J7 
tt tt it it 
Recto-vag 
I 
R. 
A. 
18 
Ingleby, Facts and Cases in Obst. 
•• 
R. 
19 
I 
I 
I 
D. 
R. 
D. 
Embryotomy on account of child's 
death. 
21 
tt tt it tt 
I 
R. 
A. 
22 
Denman, vol. ii. p. 102 
tt tt tt 
I 
D. 
D. 
23 
R. 
A. 
24 
Jackson, Lond. Med. Rep., vol. ii. 
I 
R. 
D. 
25 
26 
Behrend 
Beclard, Bulletin Lond., No. 
•> 
I 
I 
R. 
D. 
A. 
D. 
Puncture followed by version. 
27 
Meissner, Diet, de Med. et Chir.... 
? 
R. 
? 
Cyst ruptured spontanously. 
28 
" ** 
9 
I 
... 
D. 
b. 
Arm - presentation; spontaneous 
evolution. 
29 
Herbineaux, Sur les Accouch.Lab. 
Recto-vag.pouch. 
I 
... 
R. 
9 
3° 
Baudelocque, Traits del'Accouch. 
I 
D. 
31 
Moreau, Nouveau J. de Med., 1820 
Right side 
I 
R. 
A. 
32 
Steir (Puchelt) 
I 
I 
R. 
D. 
Perforation only on account ot 
child's death. 
33 
Davis, Op. Midwif... 
tt tt tt 
Recto-vag 
I 
... 
R. 
A. 
34 
I 
D. 
D. 
35 
Huper, Grafe, and Jour. 
de Chir 
Right side 
I 
D. 
D. 
36 
Shuzer( Puchelt) 
Leftside 
I 
R. 
D. 
37 
J. G. Baker, Rev. Med., vol. vii... 
? 
I 
D. 
A. 
Cases 35 to 40, inclusive, were 
3« 
39 
La Chapelle 
Greenhalgh, Guy's H. Rep., vol. i. 
? 
Posteriorly and 
I 
D. 
D. 
of malignant disease. 
laterally 
I 
... 
D. 
D. 
Spontaneous premature labor. 
40 
11 tt tt 
Recto-vag. at- 
tached to bones. 
D. 
D. 
Csesarean section. 
41 
tt tt tt tt 
Recto-vag 
R. 
A. 
Premature labor induced. 
42 
tt tt tt tt 
I 
I 
R. 
A. 
" ' spontaneous. 
43 
La Chapelle 
D. 
D. 
44 
Perfect, vol. ii. p. 341 
I 
R. 
I). 
45 
Lees, Clinical Midwif., Case 46.... 
" " « " 49.... 
I 
D. 
D. 
46 
I 
D. 
D. OVARIAN TUMOR COMPLICATING PREGNANCY. 
5 
Cases of Ovarian Tumor complicating Pregnancy Treated Expectantly.-Continued. 
1 No. 
Reference. 
Position of Tu- 
mor in Pelvis. 
Left to Natural Powers. 
| Punctured. 
Embryotomy. 
| Pushed above Brim. 
| Turning. 
j Forceps. 
Rupture of Uterus. 
Results. 
Remarks. 
Mother. 
| Child. 
47 
48 
Lees, Clinical Midwif., Case 48.... 
<< cc <c << << 
Recto-vag 
1 
1 
R. 
D. 
D. 
D. 
j- Nature of case doubtful. 
49 
Ward, Path Trans., vol. vi 
9 . 
... 
1 
D. 
D. 
5° 
Mr. Wroman, Lane., vol. ii., 1849. 
Recto-vag 
1 
R. 
A. 
5i 
Headland, Lancet, 1846 
•• 
1 
D. 
A 
52 
Ramsbotham, Obst. Med., p. 216. 
9 
1 
1 
R. 
D. 
Perforation; after child's death 
tumor had disappeared. 
53 
Ashwell, Guy's Hosp. Rep., No. 2. 
9 
? 
9 
Spontaneous rupture. 
54 
Langley, Lond. M. and S. Jour.... 
Right side 
R. 
A. 
<< it 
55 
Playfair 
Recto-vag 
1 
D. 
D. 
5<> 
Benny, Obst. Trans 
9 
1 
R. 
A. 
Laceration of vagina; tumor 
57 
1 
R. 
D. 
passed through and removed by 
Right side 
D. 
ligature. 
58 
Abdom. Tumors, Sp. Wells 
1 
D. 
Died four days after peritonitis 
from cyst-rupture; one child 
born during life of tumor. 
59 
• • 
D. 
D. 
Premature labor spontaneous at 
sixth month; week later, after 
great pain, cyst ruptured; death 
immediate. 
60 
<< 
Two tumors 
D. 
D. 
Death from rupture of cyst; unde- 
livered. 
61 
62 
1 " " 
? 
2 
... 
2 R. 
2D. 
Ovariotomy a few weeks after la- 
bor; one died, other recovered 
63 
Above 
1 
... 
R. 
A. 
Subsequent successful ovariotomy. 
65 
66 
J " " 
? 
4 
... 
4r. 
4 A. 
One tapped three times, one twice, 
two once. 
68 
Obs. Tr. Lond., vol. xi. p. 266 
? 
I 
R. 
A. 
Successful ovariotomy later. 
69 
Fischel 
Recto-vag 
1 
R. 
9 
70 
Crawford, Med. Rec., 80, xviii. 
R. 
P- 473 
9 
I 
? 
At a subsequent tapping pus was 
71 
Wiart, Arch, de Tocol., 82, ix. 428. 
Recto-vag 
I 
1 
R. 
? 
found ; ovariotomy ; recovery. 
Dermoid right ovary ; subsequent 
enlargement, peritonitis, dis- 
charge of tumor and contents 
Warn, Obs. Tr., vol. xi., p. 198.... 
D. 
per rectum; recovery. 
72 
? 
I 
? 
Rupture of cyst. 
73 
Grigg, Br. Gy. J., 86-7, p. 264 
<< << it Ci 
Recto-vag 
1 
D. 
9 
Died following dav. 
74 
Left side 
... 
1 
D. 
Multilocular, suppurating, ovarian 
cyst. 
75 
Recto-vag 
D. 
Braxton Hicks.-Six cases left to nature; all did well. 
Barnes saw death in one case from cyst-rupture at seventh month; in another peritonitis caused death. 
Rogers saw five cases : one tapped before delivery, mother and child lived; a second went to full term, mother and child 
did well; three premature labors, all mothers lived. 
Chadwick.-Three cases, non-interference ; all recovered. 
Battey.-Four cases, non-interference ; three died from cyst-rupture; one died from abortion. 
Sutton.-Two cases in which death followed abortion from twisted pedicles. 
Table of Cases in which Ovariotomy was Performed during Pregnancy. 
No. 
Reference. 
Operator. 
Months 
Preg- 
nant. 
Re- 
sult. 
Remarks. 
I 
Zeits. f. Geb. u. Gynak., 
1880, p. 383. 
Schroeder. 
7 
R. 
Delivered at full term. 
2 
• • 
4 
•» 
Previously tapped ; aborted thirteenth day. 
3 
< t 
it 
3 
* ' 
Delivered at full term. 
4 
<< 
7 
• • 
Premature delivery on fifth day. 
5 
• « 
3 
• • 
Delivery at full term. 
6 
•» 
• * 
3 
' * 
Normal delivery at full term. 
7 
4 
Aborted in seventh week, followed by septic infection. 6 
OCA RIAN TUMOR COMPLICATING PREGNANCY. 
Table of Cases in which Ovariotomy was Performed during Pregnancy.-Continued. 
No. 
Reference. 
Operator. 
Months 
Preg- 
nant. 
Re- 
sult. 
Remarks. 
*8 
Abdominal tumor. 
Spencer Wells. 
4 
R. 
Delivered of a living child at full term. 
9 
IO 
tt 
3 
3 
t. 
tt tt it tt tt 
4 
** 
" at sixth month. 
12 
• • 
»» 
7 
" next morning after operation. 
T3 
<« 
Ci 
5 
D. 
Previous rupture of cyst; peritonitis and moribund when 
operation done; delivery nine hours later; death fifth 
day. 
14 
• • 
tt 
4 
R. 
Delivered at full term. 
IS 
• • 
7 
• • 
Child born twenty-five days later. 
" at full term. 
16 
tt 
(( 
4 
T7 
tt 
3 
*• 
Abortion six days later. 
fi8 
tt 
cc 
4% 
*• 
Uterus opened by mistake ; contents removed. 
>9 
Austral. Med. Gazette, 
Fortescue. 
4 
• • 
Accidental puncture of uterus ; Porro's operation. 
1883-4, iii. p. 169. 
20 
Berl. K. Wochenschrift, 
W. Baum. 
4% 
Aborted two days later. 
1876, p. 172. 
21 
Am. Journ. Obstetrics, 
Munde. 
5 
*• 
Uninterrupted pregnancy. 
1886, xix. p. 1272. 
22 
Ib., p. 525. 
Thornton. 
3 
Both ovaries removed ; delivered eighth month ; healthy 
child. 
23 
Canada Lancet, 1886-7, 
Gardner. 
3 
»• 
Delivered at full term ; living child. 
xix. p. 161. 
24 
Centralbl. f. Gynak., 
Barony. 
6 
" twenty-one days later. 
1887, xi. p. 139. 
25 
Medical Record, 1882, 
Bennett. 
3 
•• 
Abortion ten days later. 
xxi. p. 22. 
26 
London Lancet, 1885, 
Stony. 
3 
Delivery at full term. 
11. p. 985. 
27 
Am. Journ. Obstetrics, 
Pippi ngskoeld. 
( ( 
" seven hours after. 
1880, xiii. p. 304. 
28 
Trans. Am. Gyn. Soc., 
Wilson. 
4 
tt 
Continuation of pregnancy. 
1880, v. Ixxxi. p. 100. 
29 
tt 
J. M. Sims. 
4 
tt 
Delivery at full term. 
30 
W. L. Atlee. 
2 
tt 
Died a month later from exhaustion. 
31 
• * 
? 
• • 
Went to full term. 
32 
F. Bird. 
? 
Abortion two days later. 
33 
• • 
Gabahin. 
6 
• • 
Delivered at full term. 
34 
L. Tait. 
7 
D. 
Labor sixth day after, and death in a few hours. 
35 
36 
tt 
W. Baum. 
T. G. Thomas. 
6 
9 
Miscarriage day following; peritonitis resulted. 
37 
(( 
J. G. Kimball. 
3 
tt 
Peritonitis. 
3« 
Am. Journ. Obstetrics, 
• ' 
3 
»• 
»t 
39 
W. H. Byford. 
7 
R. 
Pregnancy unsuspected ; uterus punctured; contents re- 
1879, xiii. p. 31. 
moved. 
4° 
Austral. Med. Gazette, 
Thomas Hillas. 
8 
Uterus accidentally wounded; opened; contents re- 
February, 1875. 
moved ; living child. 
4i 
Unpublished. 
Montgomery. 
7% 
D. 
Premature labor seventh day, followed by septicaemia; 
Stratz Zeitschr. f. Geb. 
death thirteenth day. 
42 
Schroeder. 
4 
R. 
At full term ; convalescence normal; child living. 
u. Gynak., 1887. 
43 
3 
twins; child living. 
44 
8 
forceps delivery ; child living. 
« 
tt 
3 
3 
tt 
child living. 
(I 
tt 
6 
(( 
49 
Unpublished private 
letter. 
E. Y. Beall 
(Texas). 
3 
Operation May 12,1887 ; course of gestation undisturbed. 
* Winckel (Parvin's edition) operated twice; both recovered ; no miscarriage. 
t Tait (Disease of the Ovaries, fourth edition, p. 293) reports ten additional cases ; all recovered.