The 43-year pregnancy

In years gone by, it was quite common for a doctor to pass on his practice to one of his children: successive generations of medics might serve their local community for decades. The Watkins family, originally from the Northamptonshire town of Towcester, is an extreme example of such a dynasty: Timothy Watkins (1755-1834) was the first of seven generations of Watkinses to become doctors, 13 of them at last count, spanning more than 250 years.*

Three of Timothy’s grandsons became medics: the youngest, John Webb Watkins, has a permanent place in medical history as the first person to undergo chloroform anaesthesia, in an experiment performed by Sir James Simpson.

His older brother Robert Webb Watkins took over the family practice in Towcester, and in 1867 published the following unusual case in the Transactions of the Obstetrical Society of London – and the patient was an old lady familiar to both his father and grandfather:

Case of retention of foetus in the abdomen for forty-three yearsOn the 10th of January, 1866, I visited by request Elizabeth J—, aged 74, widow of William J—, a small village shopkeeper at Stoke Bruerne, Northamptonshire. She gave me the following history, which I will narrate as nearly as possible in her own words. About forty years ago she was in labour with her second child; her first, born two years previously, having had water in the head, had survived its birth only a few hours.

‘Water in the head’ almost certainly refers to hydrocephalus, a build-up of fluid (not water, but cerebrospinal fluid) inside the skull. This is often a congenital condition, and in this period was frequently fatal.

The labour being very lingering, they had sent for my late father, who attended her and remained with her during the night. On the following day, being very busy, and the labour having made no progress, he left her in charge of the midwife who was in attendance upon her. The pains were lingering, but not very severe. On the third day she “suddenly felt something drop down inside her, and the child, the movements of which she had constantly felt up to that time, at once became cold as a stone.”

The woman was in great pain, and the elder Dr Watkins had to stay with her for a considerable period of time. She refused to undergo an operation or to see any other physician, even though her pregnancy had terminated without the appearance of a child.

She gradually improved in health, although she was very weak for a long time, but did not decrease in size for several years.

All this had taken place in the 1820s. Forty years later, it was the son of that original doctor who was now examining the patient. To his astonishment, he realised that he could feel the remains of her unborn child:

I found her much emaciated, with a hard, bony tumour in the lower part of the abdomen, exactly resembling the foetal head; it could be easily moved from side to side, and on careful manipulation I believed I felt the back part of the thorax in close approximation to it. She was evidently sinking from chronic renal disease, and, knowing that her end was approaching, had sent for me to request that I would make a post-mortem examination.

When Dr Watkins was told the story of the pregnancy that ended without the appearance of a baby he was at first sceptical, but others confirmed it:

The story was corroborated by some of her neighbours, and by the rector of the parish, who had heard from my father (who died in 1844) a full report of the case. It was also stated that at different times three little bones, “like finger-bones,” had come away from her, but they had not been preserved.

An alarming occurrence, which was apparently not thought worth bothering the doctor with.

On referring to old ledgers, I found the entry of the attendance on the 8th October, 1822, in the handwriting of my grandfather, with the subsequent payment of the fee marked in my father’s handwriting, and with his initials.

The story was evidently true; but not long afterwards Dr Watkins was able to put the matter beyond any doubt.

The woman died on the 13th January, 1866, and the examination was made on the 15th, by Mr. William Knott, in the presence of Mr. Knott, senr., Mr. Garlike, and myself. On making an incision through the abdominal parietes, and opening the peritoneum, we immediately observed a hard white substance, which proved to be the vertex of a foetal skull; and on enlarging the opening a perfect foetus was extracted without difficulty…It was attached by the umbilical cord to a vascular tumour, about the size of half an orange, which appeared to be the atrophied placenta, and which was connected by ligamentous attachment to the peritoneal covering of the broad ligament near the left ovary.

It became clear that this had been an ectopic pregnancy: the foetus had become attached inside one of the Fallopian tubes instead of the uterus. Such an event is often fatal, but in this case the woman had been lucky to survive.

The above extraordinary case is, so far as I am aware, quite unique, and will be interesting, not only as an instance of recovery from tubular gestation, and probably rupture, but also from the comparatively slight local and constitutional effects of a foreign body retained in the cavity of the peritoneum for more than forty-three years.

A remarkable case indeed. It is not unheard of for doctors to find the calcified remains of a foetus years or even decades after conception (usually, these days, after an X-ray) – but usually such foetuses have died at a much earlier stage of gestation. What is highly unusual about this case is that the woman had lived for almost half a century with the remains of a fully-developed infant inside her abdomen.

* A fascinating article about the seven generations of Watkins medics was written a few years ago by Peter Watkins, great-great-great-grandson of Timothy, a distinguished physician and expert on diabetes. It’s behind a paywall, but those with access can read it here.

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