The injection of narcotics into the fcetal sac has been once successfully done by Friedreich and Prof. Lange. A girl twenty-seven years' old had a hen's-egg-sized, smooth, rather immovable tumor lying to the right of the uterus and parallel with Poupart's ligament. It could be reached from the vagina; and since the menses remained absent and colostrum appeared in the left breast, it was decided that there very probably existed extra-uterine pregnancy. A Pravaz syringe was filled and with a long nee dle curved like a uterine sound Friedreich injected grain of morphine into the sac four times. The tumor got smaller, and in four weeks only an irregular lump as large as a walnut was left. Joulin and Koberle have also successfully done this operation (Hennig).
Recently Reiinert has destroyed the fetus at the fifth month of preg nancy in the same way. The vagina was disinfected with a 1 to 1000 sublimate solution, and fifteen drops of a 3 per. cent morphine solution, together with a little carbolic acid, was injected into the sac. Vesical paralysis and occasional pains and febrile attacks occurred for six weeks subsequently; but the foetus was killed, and the mass atrophied.
Thus the destruction of the fcetus with morphine seems to be less dangerous than the complete and sudden evacuation of the liquor amnii; but whether it can compete with laparotomy only the future can tell us.
Destruction of the Reins by Electricity.—There have recently been many very favorable reports published regarding this method, especially by American specialists. The method has hardly been tried in Europe, and we are not yet in a position to say much about it.
Burci and bacchetti introduced two acupuncture needles into the tumor in question and then passed a current through the mass. Two cases are said to have been cured. According to Carl v. Braun, Cazeaux and Duchesne suggested in 1862 the killing of the foetus by a strong discharge from a Leyden jar.
Favorable reports have appeared in the American literature of the last ten years from Lovering, Landis, Garrigues, Rockwell, P. Munc16, Bozeman, Thomas and others.' b. When the Pregnancy is far Advanced and the Child alive.
If the child has attained viability, the dangers for the mother are in creased. Labor pains set in, with peritonitis, detachment of the placenta and hemorrhage into the membranes. or rupture of the sac; and death follows in a longer or shorter time. In only a small minority of cases does the foetus die and the pregnancy end in a cure. And the life of the child itself must now be a factor in our consideration.
Therefore many of the older physicians held that it was incumbent on us to deliver the living or even recently dead child by abdominal incision (laparotomy, gastrotomy), or by vaginal incision (kolpotomy, elytrotomy).
It is true that recorded cases were not very favorable to this mode of procedure. Thus Campbell states that out of nine women in whom gas trotomy was done while the foetus was alive, or shortly after its death, not a single one survived. And since an occasional case that was not operated upon recovered, physicians recoiled from interference save only in those cases in which nature herself seemed to be endeavoring to eliminate the foetus.
Kiwisch was the first to raise his voice against such indecision; he recommends extraction by the most appropriate method when the infant is at term, or near it. He claimed that we were only justified in tem porizing so long as the pregnancy took its normal course; but insisted that as soon as disturbances occurred, and especially as soon as pains set in, an operation was indicated. Since the time that Kiwisch made these statements the results of abdominal incision have been so good that most obstetricians now incline to agree with him. Only recently Keller has collected ten cases, in which an operation was done while the child was alive, and Schroder adds to the list a recent case of Meadows. The results are not so unsatisfactory as those of Campbell. Four out of eleven mothers, and eight.out of twelve children (one case of twins), were saved.
We may say to-day that operative procedure is more than justifiable so long as the child is alive.
C. Litzmann has recently collected twelve selected cases, in which laparotomy was done towards the end of the pregnancy, and while the child was living. Of ten mothers only one survived; and of the ten children four lived for some time, five died in the first twenty-four hours, and one after • two days. Let us note that the births were premature in several of the latter cases.
In spite of these discouraging results, Litzmann approves, with certain reservations, of the operation while the child is alive. While Gusserow holds that the eight month of pregnancy is the appropriate time for oper ation, Litzmann would only do it at the tenth month, when the child appears to be well developed and strong, and if lie feels moderately cer tain that the placenta is not inserted under the line of incision in the anterior wall of the sac.