The first positive diagnosis of unruptured tubal pregnancy was made by Veit in 1883, and the first one made in America was by Janvrin in 1886, eight years before Father Holaind's article was written. Before 1883, only eleven years in advance of the same article, when Lawson Tait performed the first coeliotomy for the purpose of checking hemorrhage from a ruptured tubal gestation, extrauterine pregnancy was as mysterious as the old "inflammation of the bowels," which turned out afterward to be appendicitis. Hence common skill in the difficult diagnosis of ectopic gestation can not be looked for.
The doctrine given in all the leading medical works at present concerning the treatment of extrauterine pregnancy is this:
1. As soon as an extrauterine pregnancy is discovered remove the foetus through an opening made in the mother's abdominal wall. Do not use electricity or the injection of poisons into the foetal sac, or the incandescent knife. Emmet and a few others approved of the use of electricity at times, but this is against the teaching of the great majority of writers at present. The reason for removing the foetus at once is that it is apt at any moment to cause rupture and fatal hemorrhage before surgical aid can be effective.
2. In a case of rupture with free hemorrhage and collapse the only operation advised is an immediate coeliotomy to stop the bleeding by ligatures. The rupture should not be approached through the vaginal wall according to the common doctrine, but through the abdominal wall.
3. If there is a rupture in which the bleeding is confined and there is no collapse, do not operate at once unless the haematocele increases steadily or shows signs of suppuration. Sometimes evacuation of the haematocele through the vaginal wall is possible.
4. In the later months of an extrauterine pregnancy, whether the case is intraligamentous or abdominal, perform coeliotomy as soon as the diagnosis has been made, and remove the foetus, because there is always danger of sudden and fatal hemorrhage before the surgeon can reach the source of the bleeding. What is to be done in a case where the surgeon is certain before operating that the foetus is [{11}] dead, has interest only for the physician, and it involves no moral question.
Operating for extrauterine pregnancy maybe a simple coeliotomy, if any coeliotomy is really simple, but it commonly is the most dangerous operation for the mother that the gynaecologist is called upon to perform.
The discussion of the moral questions that arise in cases of ectopic gestation which began in volume ix. of the American Ecclesiastical Review was very valuable, but as the moralists had not full data to work on their decision as a whole is not satisfactory. The original cases presented are in part obsolete in the medical practice of to-day, and important physical conditions were not disclosed in some of the other parts of the cases. Father Holaind tentatively agreed with Father Lehmkuhl in one decision, Fathers Eschbach and Sabetti directly attacked Father Lehmkuhl's reasons, and Father Aertnys indirectly opposed Father Sabetti's chief argument. These men are all eminent authorities, but as each, except Father Holaind, was dissatisfied with the arguments advanced by the others, and as their data were incomplete, we can not rest the case on their decision.
In Father Holaind's fifth question, if I understand it correctly, he seemed to think it possible to baptize a foetus through the opening in the mother's abdominal wall while it lies in the abdominal cavity before surgical removal. He mentions antiseptic precautions in the baptism, which would have no meaning if the foetus were out of the abdomen.
Baptism would not be possible in that case: the priest could not get at the foetus, he ordinarily could not even see it, and certainly no surgeon would permit the attempt. There would be no time for the attempt in a rupture case, even if the foetus could be seen; and there would be no advantage gained by baptizing the foetus in the abdominal cavity where the conditions gave time to do so. If it is alive it will live long enough for baptism after removal from the abdomen, provided, of course, it is baptized immediately in the operating room. That it does not breathe is no proof of immediate death. It is not unusual for a full-term child not to breathe for even an hour or longer after birth.
If Father Holaind had not in view baptism within the abdominal cavity, the question has this meaning: What is the most effective method after the foetus has been removed from the abdomen to open its enveloping membranes so as to give it a chance for a life lasting long enough to allow baptism?
The best method is to slit the membranes with a scalpel or scissors as quickly as possible. The envelopes, cord, and placenta are essential parts of the foetus itself, and they grow from itself, not from the mother. They take the place of the lungs and the alimentary tract, which do not come into action until after normal birth. It would be worth discussing whether a baptism on the intact foetal envelopes is valid, were it not that we may not apply probabilism in such a case. The remaining matter brought out in Father Holaind's questions will be considered in the course of this article.