Lectures on ectopic pregnancy and pelvic haematocele / by Lawson Tait, F.R.C.S., Edin., & Eng., LL.D.
- Lawson Tait
- Date:
- 1888
Licence: Public Domain Mark
Credit: Lectures on ectopic pregnancy and pelvic haematocele / by Lawson Tait, F.R.C.S., Edin., & Eng., LL.D. Source: Wellcome Collection.
Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.
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![which survive primary rupture, and are developed extra- pcvitoneally), arrive at that term, and die at or shortly after it, (if not destroyed hy surgical interference), the minority dying at various periods in the progress. I have not tested the evidence on which he bases his conclusions, for I do not think they are of much moment. I am inclined to think that most of the women will not present themselves till they begin to believe that, liaving gone past their time and the child liaving ceased to move, some- thing has gone wrong. Then it will sim])ly be a matter of relieving the mother of a risky burden. If the child is living, an effort ought, in my opinion, to be made to save it. But whether the child be living or dead the steps of the operation will be practically the same, and the early part of the proceedings will not vary very much from the ordinary processes of any abdominal section, save in one particular—that the opening should not be made in the middle line, so as to avoid opening the peritoneum. In fact, the operation should not be an abdominal section at all, in the strict sense of the definition I have adopted. This fact has been the cause of much confusion on the part of one perverse critic, whose diatribes require no further notice or explanation. To understand the motive of this avoidance of the ordinary incision in dealing with a case of ectopic pregnancy we must revert to the explanations already given of the process at the time of rupture, and to the views I have advanced, that all the full term ectopic pregnancies are those which have grown in the broad ligament—extra-peritoneally. As they grow they separate the folds of the broad ligament, and finally lift the peritoneum slowly out of Douglas' pouch, off the rectum, sides and brim of the pelvis, off the posterior surface of the uterus, and off the back and sides of the lower abdominal walls as far round as a point corresponding to the cornu of the uterus on each side. The result of this is that the posterior and lateral levels of the reflections of the peritoneum are raised very materially, whilst the utero-vesical pouch is uninterfered with, and it remains as a long process, like the finger of a huge glove running down in front of the gestation sac, to its normal ending on the base of the bladder. This curious re-arrangement of the peritoneum is similar to what we constantly find in cysts of the broad ligament, only the arrangement in them is less systematic, and the explanation of both is simple. The peritoneum is very easily lifted off any of the organs round which it is wrapped, if the process is slowly carried on. The growth of the ovum, therefore, easily lifts the peritoneum everywhere if the pull is direct; but when the pull comes to be indirect, as it nnist be the moment the top of the fundus is reached, the lifting of the peritoneum ceases, and the long tulndar process is formed. As the growth of the ovum is not quite symmetrical, this tube is some- times on one or other side, and sometimes iii the middle, and](https://iiif.wellcomecollection.org/image/b21448048_0089.jp2/full/800%2C/0/default.jpg)
