The Project Gutenberg EBook of Graphic illustrations of abortion and the
diseases of menstruation, by A. B. Granville
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Title: Graphic illustrations of abortion and the diseases of menstruation
Consisting of Twelve Plates from Drawings Engraved on
Stone, and Coloured by Mr. J. Perry, and Two Copper-plates
from the Philosophical Transactions, Coloured by the Same
Artist. the Whole Representing Forty-five Specimens of
Aborted Ova and Adventitious Productions of the Uterus,
With Preliminary Observations, Explanations of the Figures
and Remarks, Anatomical and Physiological.
Author: A. B. Granville
Release Date: July 8, 2019 [EBook #59875]
Language: English
Character set encoding: UTF-8
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GRAPHIC ILLUSTRATIONS
OF
ABORTION
AND
THE DISEASES OF MENSTRUATION.
CONSISTING OF
TWELVE PLATES FROM DRAWINGS ENGRAVED ON STONE,
AND COLOURED BY MR. J. PERRY,
AND
TWO COPPER-PLATES
FROM THE PHILOSOPHICAL TRANSACTIONS,
COLOURED BY THE SAME ARTIST.
THE WHOLE
REPRESENTING FORTY-FIVE SPECIMENS OF ABORTED OVA AND ADVENTITIOUS
PRODUCTIONS OF THE UTERUS,
WITH
PRELIMINARY OBSERVATIONS, EXPLANATIONS OF THE FIGURES
AND
REMARKS,
ANATOMICAL AND PHYSIOLOGICAL.
BY
A. B. GRANVILLE, M.D., F.R.S., F.L.S., F.G.S., F.R.A.S.,
ETC. ETC. ETC.
FOR FIFTEEN YEARS PHYSICIAN-ACCOUCHEUR TO THE WESTMINSTER GENERAL
DISPENSARY, AND DURING TEN YEARS PHYSICIAN TO THE BENEVOLENT LYING-IN
INSTITUTION.
LONDON:
PRINTED FOR JOHN CHURCHILL,
Medical Bookseller and Publisher,
16, PRINCES STREET, SOHO.
MDCCCXXXIV.
G. WOODFALL, ANGEL COURT, SKINNER STREET, LONDON.
HENRICO HALFORD,
BARONETO,
EX GUELPHORUM EQUITUM PRIMÂ COHORTE; BRITANNIARUM REGIS ARCHIATRO;
COLLEGII REGALIS MEDICINÆ LONDINENSIS PRÆSIDI;
MEDICO DOCTO, PERITO, FELICI,
IN OMNI DOCTRINÆ GENERE ILLUSTRI,
OBSERVANTIÆ ET AMICITIÆ ERGO
GRAPHICA HÆC LINEAMENTA
D.D.D.
AUCTOR.
------------------------------------------------------------------------
CONTENTS.
DEDICATION.
Advertisement, XI.
PROLEGOMENA, p. i.–xxi.
Perfect (Normal) Animal Reproduction, prop. 1–3.
Imperfect (Anormal) Animal Reproduction (Abortion) prop. 4–7.
Study of Abortion, prop. 8–12.
CONCEPTION, prop. 13.
Ovulum (Description of before Fecundation), prop. 14–17.
FECUNDATION, prop. 18.
Ovulum (Description of after Fecundation), prop. 19–22.
CORTICAL MEMBRANE of the Ovulum, prop. 23–26.
Deciduous Membrane of the Uterus, prop. 27–31.
Corpora Lutea, prop. 34–37.
Transit, Volume, and First Development of the Ovulum, prop.
38–42.
THE CHORION, prop. 43–44.
Structure, Function and Vascularity of the Chorion, prop. 45–51.
Fluid of the Chorion, prop. 55.
THE AMNION, prop. 54.
Structure, Function and Vascularity of the Amnion, prop. 52–54.
Fluid of the Amnion, prop. 53.
Progressive Increase of the Ovulum, prop. 56.
Independent Life of the Ovulum, prop. 57–59.
Earliest or Mechanical Connection of the Ovulum with the Uterus,
prop. 60.
Metamorphoses of the newly engendered Being, prop. 61.
Growth and Progress of the Embryo and Fœtus, prop. 62–66.
Priority of the Vascular over the Nervous System in the Fœtus,
prop. 67.
Formation of the Blood in the Fœtus, prop. 68.
Formation of the Nerves in the Fœtus, prop. 69.
Apparatus for Digestion, prop. 70.
VESICULA UMBILICALIS, prop. 71.
THE ALLANTOID, prop. 72.
THE UMBILICAL CORD, prop. 73–75.
Omphalo-mesenteric Vessels, prop. 76.
More advanced, or Vascular Connection of the Ovum with the
Uterus, prop. 77,
FIRST FORMATION OF THE PLACENTA, prop. 77.
Cotyledons of the Placenta, prop. 78–80,
Deciduous Vessels of the Placenta, prop. 81–83,
Membrana Propria of the Placenta, prop. 84.
Proofs of the Existence of Deciduous Vessels in the Placenta,
prop. 85.
Deciduous Vessels, form the connecting Vascular Link between the
Uterus and Placenta, prop. 86.
Proofs of it from Anormal Anatomy, prop. 87.
CIRCULATION, Utero-fœtal, prop. 88 and 90.
Recent Fallacies respecting the Structure of the Placenta, prop.
89.
FUNCTIONS OF THE PLACENTA, prop. 91.
Physiological Proofs of the Deciduous and Fœtal Structure of the
Placenta, prop. 92.
NUTRITION of the Fœtus through the Placenta, prop. 93.
Lymphatics and Lymphatic Absorption in the Placenta, prop. 94.
Pretended Nutrition by the Amnionic Fluid, prop. 95–96.
RESPIRATION of the Fœtus in Utero, prop. 97.
Nature of the Changes in the Fœtal Blood, prop. 98.
Bile secreted by the Placenta, prop. 99.
Distinction between Life and Nutrition in the Fœtus, prop.
100–102.
EXPLANATIONS OF PLATES, AND REMARKS.
PLATE I. page 1–6.
SPECIMENS OF VERY EARLY MISCARRIAGES.
Remarks on Fig. 1 and 2. page 2.
Remarks on Fig. 5, 6, 7, 8, 9. p. 5.
PLATE II. p. 7–8.
MISCARRIAGE BETWEEN TWO AND THREE MONTHS.
Remarks on Fig. 10, 11, 12. p. 8.
PLATE III. p. 9–12.
MISCARRIAGE BETWEEN TWO AND THREE MONTHS.
Remarks on Fig. 13, 14, 15. p. 11.
PLATE IV. p. 13–16.
MISCARRIAGE DURING THE THIRD AND BEFORE THE COMPLETION OF THE FOURTH
MONTH.
Remarks on Fig. 16. p. 14.
Remarks on Fig. 17. p. 15.
PLATE V. p. 17, 18.
MISCARRIAGE BETWEEN THE THIRD AND FOURTH MONTH.
Remarks on Fig. 18. p. 17.
Remarks on Fig. 19. p. 18.
PLATE VI. p. 19–24.
MISCARRIAGE BETWEEN FOUR AND FIVE MONTHS.
Remarks on Fig. 20. p. 20.
Remarks on Fig. 21. p. 22.
Remarks on Fig. 22. p. 23.
PLATE VII. p. 25–26.
MISCARRIAGE AT FIVE MONTHS.
Remarks on Fig 1. p. 26.
PLATE VIII. p. 27.
FIRST SPECIMEN OF ABERRANT GESTATION.
Remarks on Fig. 1. p. 28.
PLATE IX. p. 29.
SECOND SPECIMEN OF ABERRANT GESTATION.
Remarks on Fig. 1. p. 30.
PLATE X. p. 33–36.
THIRD SPECIMEN OF ABERRANT GESTATION.
Remarks on Fig. 1. p. 33.
Remarks on Fig. 2. p. 35.
Classification of Erratic (Extra-uterine) Gestation. p. 35.
PLATE X. (A.) p. 37–38.
FOURTH SPECIMEN OF ABERRANT GESTATION.
References to Do. p. 37.
PLATE X. (B.) p. 39–40.
CONTINUATION OF ABERRANT GESTATION.
Remarks on Do. p. 39.
PLATE XI. p. 41–44.
DYSMENORRHOIC ORGANIZATIONS.
PLATE XII. p. 45–51.
POLYMENORRHOIC STRATIFICATIONS.
Remarks on Figs. 1, 2, 3, 4, 5. p. 48.
Classification of the Adventitious Productions of the Uterus. p. 48.
Classification of the Diseases incidental to Menstruation. p. 48–49.
Synopsis of a Work on Abortion. p. 51–52.
LIST OF THE FORTY-FIVE COLOURED FIGURES OF HUMAN OVA, AND ADVENTITIOUS
PRODUCTIONS OF THE UTERUS REPRESENTED IN THE PLATES.
1. Ovulum bigeminum lanuginosum.
2. Ovulum semi-lanuginosum.
3. Ovulum lanuginosum.
4. Ovulum semi-lanuginosum.
5 and 6. Ovula of the same species.
7. Ovum denudatum, or diaphanous Ovum.
8 and 9. Ova of the same species.
10. Ovum piriforme externè opacum.
11. The same laid open.
12. Ovum opacum plethoricum.
13 and 14. Ova semi-coriacea.
15. Ovum omnino opacum rotundum.
16. Ovum pseudo-membranosum.
17. Ovum uviforme.
18. Ovum coriaceum, cum hydrope funis et placentâ hydaticâ.
19. Ovum cum placentâ, nec vasculare nec plene cotyledonica, sed
filiforme. Amnion morbosum.
20. Ovum tuberculosum.
21. Ovum pane solidum. Placenta sarcomatosa cum tuberculis. Involucra
fœtüs solidificata.
22. Ovum cum involucris internis ab amnio-chorionitide condensatis.
23. Ovum fœtiferum optimè conditum, subitò, ab amnio-chorionitide
interfectum.
24. Ovum fœcundum in receptaculo Ovarico.
25 and 26. Ovum fœcundum in receptaculo Tubico.
27 and 28. Ovum fœcundum in receptaculo Interstitiale.
29. Ovum fœcundum in receptaculo Ovarico.
30. The sac of the preceding Ovum laid open.
31. Membrana pseudo-textilis intro-uterina bi-tubulata.
32. Membrana pseudo-textilis intro-uterina sine tubulis.
33. Coagulum intro-uterinum hæmatosum pseudo-membranaceum incavum.
34. Coagulum intro-uterinum hæmatosum laminare cavum.
35. Coagulum intro-uterinum spongiosum cavum, interne velatum.
36 and 37. Coagulum intro-uterinum, interne solidum, externe
membranaceum.
38. Mola avellana tunicata.
39. The same laid open.
40. Mola avellana nuda.
41. The same laid open.
42. Mola conchula.
43. The same laid open.
44. Mola Mytilus.
45. The same laid open.
N. B. In the last Plate, the figures 2 and 3 should be reversed, in
order to correspond with the text or printed explanations.
ADVERTISEMENT.
I submit to my professional friends and acquaintances, as well as to all
those medical brethren who take an interest in the progressive
advancement of the sciences they cultivate, a series of beautifully
executed Drawings of anatomical preparations, intended to explain and
illustrate the important subjects of “Abortion”, and “The Diseases
incidental to Menstruation”; subjects in which all classes of the
medical profession, whether specifically devoted or not to obstetrical
practice, are equally interested. The drawings speak for themselves. The
Artist, under my immediate and constant superintendence, and with the
anatomical preparations in every case before him, explained and
demonstrated to him, has, in the course of six years, been able to
produce twelve plates, containing upwards of forty anatomical figures,
lithographed and coloured by himself, which reflect no small honour on
the arts of this country, and are highly creditable to his abilities.
These plates, I will venture to say, leave nothing to be desired in such
a mode of representing anatomical subjects, (a mode which appears from
the present endeavours to be the best calculated of any for that
purpose,) whilst they remove every cause of regret, hitherto
entertained, that the most successful efforts of anatomical lithographic
representation, of which foreign countries can boast, had never yet been
equalled in England. It may now be asserted that those efforts have been
triumphantly rivalled by Mr. Joseph Perry on the present occasion; and,
in some of the plates, unquestionably surpassed.
Having said thus much in favour of the Artist, I hope I shall be excused
if I add, for myself, that I have selected such specimens only as I
considered likely to illustrate some of the most interesting points of
the physiology of human generation, and which might assist in
unravelling the various practical difficulties which beset that
mysterious question;—that I have chosen those which, I believe, (with
the exception of one or two preparations,) have never been published
before either in this or any other country, and many of which are to be
found only in some private anatomical collection;—that I have explained
them in such a way as to render their meaning and usefulness evident to
all my brethren;—and that, under such circumstances, I venture to
believe that the plates so explained will prove of no inconsiderable
service to every medical practitioner as a work of reference, where
either a private or a public museum is not at hand to solve cases of
doubt.
I am aware that I might have extended this series of representations to
more than double the present number of analogous preparations; but I
purposely limited it to what it is, from a consciousness that any
unnecessary increase in the number of plates, which the peculiarity of
the subject did not absolutely require, would only tend to increase the
bulk, and with it the expense of the “Graphic Illustrations”, without
any adequate or corresponding advantage.
It may, after all, be asked: were these delineations wanted? Were there
not already in existence works of a similar, or at least analogous
character, executed in an equally masterly style, to which the medical
reader and the physiologist could refer for information and in cases of
doubt? I reply, yes, to the first—and negatively, to the second
question.
And first, of the second question. Not to speak of the many authors on
matters of this description, who preceded Dr. Hunter and Professor
Soemmering, in giving representations of the human embryo in many of its
metamorphoses, such as Ruysch, Noortwyk, Albinus, Krapft, Wrisberg,
Camper, Blumenbach, Denman, and others, I am ready to admit that both
Hunter and Soemmering had given to the world delineations, such as are
here referred to, which ought to satisfy the medical profession. The one
in his splendid work on the “Gravid Uterus”, gigantic folio edition—the
other in his no less valuable folio plates of the human embryo. But,
unfortunately, neither of those works can be considered as accessible to
the generality of professional readers, on account of their high price
and rarity; and even if either were accessible, the subjects therein
treated are viewed differently from those collected in the present work.
Those works, moreover, present no coloured specimen of delineations of
parts, most of which, if not all, from that simple circumstance, lose
their principal value;—and as productions of art they are not equal to
what Mr. Perry has enabled me to offer to the public. Soemmering
himself, in his “_Icones Embryonum Humanorum_”, admits, that although
those who had gone before him in the same channel of inquiry, had
produced valuable works and splendid plates, particularly Dr. Hunter and
Dr. Denman; there was yet room for a more complete, and, above all, for
a more minute representation of the metamorphoses of the human embryo.
“_Elegans profecto et utilis admodum speculatio!_” exclaims the veteran
physiologist; and forthwith he proceeds to compare what he had been able
to give to the public on the subject of embryology with that which his
predecessors had done. This leads him to the conclusion that, from
having paid greater attention to minuteness, from being more strictly
accurate, from the advantage of having a better collection of specimens
than fall to the lot of most anatomists, and from the circumstance of
both his delineator and engraver being much superior to those of former
times—he had been able to complete a work of art on the progressive
development of the human fœtus which left those of his predecessors far
behind.
With one or two exceptions, the representations in Soemmering’s work are
simply those of the fœtus in its progressive advancement from the third
week after fecundation, to the fifth or sixth month of gestation. Those
representations have no reference to the whole ovum at those several
periods of fecundation: and they are not coloured. Still they are, as he
has stated, superior as a work of art to any that had appeared before.
Soemmering tells us that he selected for his plates the best specimens
of the human embryo, the best draughtsman, and the most skilful
engraver; and that when he compared those plates with those of
Trioenius, Albinus, Wrisberg, Hunter, and Denman, in order that he might
better understand, explain, and perhaps correct his own: “_magnopere
delectabatur_”, to find, on such a comparison, that the superiority of
his plates was not inconsiderable. Well, then, let the reader who has
the means of doing so, turn to the two folio plates of Soemmering, and
then direct his attention to the fourteen plates contained in the
present volume, and I will abide by their decision whether or no, in all
such delineations as relate to either parallel or identical subjects in
the two publications, the palm of superiority (in every circumstance of
design, precision, and execution,) which Soemmering claimed for _his_
publication, ought not to be yielded by him to _another_ sent forth
under the advantage of recent improvements in drawing, and a newly
invented art admirably adapted for such imitations of nature.
Independently of which advantages there is to be added the charm of
colour—a circumstance which so greatly embellishes, without disfiguring,
truth.
With such impressions, I can feel no hesitation in giving publicity to
my collection; and if in selecting, denominating, and appropriating to
particular views of my own the several specimens I now publish, there
should be found neither taste nor judgment, novelty nor utility, the
blame must rest on me—but the merit of superiority will still remain to
it as a work of art, which, in the department of morbid embryology, has
at present no equal either in England or on the Continent.
Now to the first question—whether these delineations were wanted? I
support the affirmative by appealing to all those of the profession who
have had occasion to be consulted in cases of abortion and the expulsion
of those singular productions of the uterine cavity, which seem
connected with menstruation or faulty conception. Let them say whether a
work, in which the principal of the infinitely varied aborted human ova,
and of the uterine productions alluded to, are faithfully represented,
be not likely to be useful; whether, in fact, it be not wanted—or
whether it exist already anywhere. If the want of such a work be made
manifest, its importance must be self-evident. But that importance is
not a little enhanced when we find Denman—a plain unsophisticated
practitioner—with quite enough of science to constitute him an authority
in physiological questions concerning human generation,—recommending the
inquiry, in his own work on an analogous subject, entitled “Engravings
representing the Generation of some Animals”, in which he has given
three drawings of aborted ova. “It must be allowed”, observes the
Doctor, “that the generality of these things (the aborted ova) are
preserved for their beauty, or as matter of curiosity, rather than of
use. I suspect, nevertheless, that there are some appearances besides
the _vesicula umbilicalis_ not yet perfectly understood, and therefore
recommend the whole subject as worthy of being reviewed”: and, in a
subsequent part, he says, that “in every collection there must be some
example, which may enable us to distinguish the different parts of which
an ovum is composed, the proportion which they bear to each other at
different periods of pregnancy, and sometimes the process of utero
gestation which failed”. What greater encouragement, therefore, needed I
than this opinion and advice of one of the best obstetricians England
can boast of, to select, prepare, and point out the importance of this
species of anatomical and physiological delineations?
I shall conclude, by remarking, that the plates are intended to
illustrate a work “On Abortion and the Diseases incidental to
Menstruation”, which I have been preparing for several years, and a
prospectus of the contents of which will be found at the end of the
present volume. That work will appear, DEO favente, in the course of the
present year; but for the convenience of such persons as may not feel
inclined to purchase it, the collection of plates has been purposely so
arranged, as to be published, with a corresponding text, in a separate
form, and independently of the forthcoming volume.
_Grafton-street, Berkeley-square, 30th March, 1833._
PROLEGOMENA
OF
THE DEVELOPMENT AND METAMORPHOSES
OF
THE HUMAN OVUM.
PROLEGOMENA.
1. The ultimate purpose of nature, in associating the two sexes in the
human species, is to bring to maturity and produce, in a fit state to
live and procreate, a constant succession of individuals, that shall
perpetuate the species to the end of time.
2. This object is invariably accomplished by one uniform series of laws
and phenomena, which have been studiously inquired into, accounted for,
and, in most instances, explained in a satisfactory manner, amounting
almost to demonstration.
3. The study of the function of reproduction, in all the other classes
of animals, affords no other nor any dissimilar evidence. On the
contrary, both by comparison and analogy, the study in question serves
to confirm us in the notion, that Man differs in nought, in this
respect, from the animated beings placed below him in the scale of
creation. One same primary intention is manifest in their sexual
distinctions; the means to ensure the ultimate purpose—their
perpetuation—are the same; the same laws and the same phenomena mark the
appearance, the development, and the final production of successive
generations of individuals.
4. Any deviation from those laws—any violent change in those
phenomena—and, still more so, any impediment to the accomplishment of
the _ultimate purpose_ of Nature, is a defeat of her intention.
5. Such a deviation, change, or impediment may occur at any time
previously to the period established for the appearance of a new and
perfect being. If it occur at such a time as shall be incompatible with
the maturation, and consequently with the life of the new creature, or
even with its maturation alone, (although tokens of life be observed at
the time in question,) a MISCARRIAGE is said, in common parlance, to
have taken place; for Nature has _miscarried_ in her undertaking: she
has been foiled in her expectations.
6. In the reproduction of the human species, such an event might justly
be considered to have occurred, if, at any time before the completion of
the natural period of gestation, the fœtus be expelled, whether dead or
alive. But as in many instances, notwithstanding its premature
expulsion, the fœtus has grown and has continued to live its
extra-uterine life, in spite of the want of maturity, (a case known to
have occurred even so early as between the sixth and the seventh month,)
the expression, before mentioned, (5) is not applied to any untimely
expulsion of the fœtus that may take place later than that period—at
which, and after which, and till the completion of the ninth month of
gestation, such an expulsion would be called a _premature_ labour. The
distinction, however, is more specious than useful: it is an offering to
social etiquette, rather than to science.
7. The premature expulsion of the produce of conception before the
seventh month, has also received the name of ABORTION. This denomination
has been generally adopted, and is used by the writers of every
civilized nation, ancient or modern, according to their respective
languages. It is that which has been employed in the following
explanations of figures taken from nature, which are intended to exhibit
several examples of abortion in the human species.
8. The study of abortion, in this point of view, (7) is an infinite
source of interest, whether considered in reference to science and the
important question of generation, or simply in reference to medical
practice. On the continent of Europe, and even in the States of America,
but more particularly in Germany, the subject, under its two-fold
aspect, has engaged the serious attention of some of the most learned
philosophers and most skilful practitioners. I know of no other
professed writer on the same subject, besides Burns, in this country.
His work on abortion is brief, and more valuable for the practical
suggestions it contains, than for any luminous or accurate view of the
various scientific points connected with that subject. But like every
thing which proceeds from the hands of that able practitioner, the
performance is respectable.
9. It is impossible, thoroughly and accurately, to comprehend the mode
in which abortion takes place, without being previously acquainted with
the origin, formation, progress, and metamorphoses of the fœtus, and its
connection with the mother. On all these points, we have, until lately,
been in the habit of professing the same articles of belief as our
predecessors: we have repeated what we heard them say, or what we read
in their writings; and many, both here and elsewhere, repeat still the
antiquated theories respecting conception and the structure of the human
ovum, which they have learned on the obstetrical benches.
10. The great advancement—the great and forward strides which physiology
has made in France, as well as in Germany, have contributed to explode
those antiquated theories. Acute and indefatigable anatomists have been
busy watching Nature in all her movements, from the first moment of her
calling the rudiments of a human embryo into existence, until her
magnificent work has been completed by the production of a new,
life-gifted, individual of the species. They have called to their aid
the much improved art of microscopical observation, and have thereby
succeeded in almost tracing the very earliest instant of embryonic
existence. The register of their observations constitutes the biography
of the human fœtus.
11. It is with the view of contributing to the common stock of new and
interesting information on this all-important question, that I bring
forth the result of my inquiries into the morbid state of the human
Ovum, and its structure under circumstances of premature expulsion. If
such inquiries have led me to adopt the improved notions of the more
modern physiologists and anatomists in these matters (which I have
professedly studied, and have had the most ample opportunities of
studying for many years); they have, likewise, enabled me to detect some
of the oversights of those observers, and to add a little to what has
already been brought forward; while, at the same time, they have induced
me to join that class of writers who dismiss, as inconsistent with
facts, the theories and assumptions of olden times, whose strongest
authority has been their mere repetition.
12. The ideas which are now entertained respecting fecundation,
after the successful congress of the two sexes, in the human
species—respecting its seat—respecting the first origin, station,
and rudimental creation of the embryo—respecting the journey of the
latter into the womb, its sojourn in that cavity, and the various
metamorphoses it undergoes therein, up to the period fixed for its
projection into the WORLD, may be comprised within a small number of
propositions. I shall support those propositions by references to
facts, or the quotations of competent authorities, and the
allegation of anatomical discoveries. But as the object of the
present work is to illustrate abortion, and not the complete
life-circle of the fœtus, I shall stop the number of my propositions
at the _fifth_ month of its intro-uterine existence. After that
period, the various phenomena of fœtal gestation are so uniform,
that they afford less matter of interest to the philosopher.
13. CONCEPTION, or that result which follows sexual congress, in virtue
of which one, or more individuals, of the same species is called into
being, takes place in the ovarium of women. This is doubted by Meckel
and others, who look upon all cases of ovaric gestation (see Plates IX.
and X, A. and B.) as mere accidents, and as only proving that if
conception has not before taken place in the womb, it _may_ take place
in some other part connected with it; but the point has been set at rest
by the more recent experiments and microscopical observations of
Professor BOER, of Kœnigsberg. I adopt his conclusions. Their
correctness is corroborated by the interesting experiments of Prevost
and Dumas, although these experimenters admit not that fecundation takes
place in the ovarium.
14. The intended receptacle of the embryo is the OVULUM. An ovulum
exists in all the vesicles of Graaf, which the ovarium of a woman, who
has reached maturity, contains.
15. Viewed by means of a powerful microscope, the ovulum is found to
consist of a small yellow spherical body, placed within the vesicula
Graafiana, with the upper portion of which it is, internally, in
contact; so that it does not float freely in the liquid of that vesicle.
This contact becomes more and more intimate as the ovulum enlarges, when
that part of the capsule of the vesicle which lies over it becomes, in a
correspondent degree, thinner.
16. At first, the little yellow body, being rather opaque, is distinctly
seen even without a magnifying glass; but as it advances, it becomes
more transparent and, consequently, less distinguishable.
17. This little yellow body is a minute spherical mass, with a roughish
or slightly granular surface, and is hollow. Its parietes are thick;
around them is an envelope of a much thinner texture, which is
distinctly seen, owing to a small space lying between it and the surface
of the little yellow body, which space is filled with a fluid substance
of a peculiar nature.
18. When FECUNDATION takes place, that part of the vesicle of Graaf to
which adheres, internally, the ovulum, bursts, and the ovulum escapes
with its external envelope, together with a small portion of the liquid
peculiar to the Graafian vesicle, and thus it passes into the fallopian
tube.
19. Independently of the external envelope, and within it, the
microscope has detected, after fecundation, the existence of another
covering, completely investing the little spherical yellow body.
20. The ovulum has been traced, after fecundation, into the cavity of
the womb, where the external covering (17) becomes what Boer has called
“the cortical membrane”, (_cortex ovi_ of the present work,) improperly
considered as a uterine production by preceding writers, and denominated
the _reflected_ caducous or deciduous membrane.
21. The more intimate covering of the yellow body of the ovulum, that
which closely invests its surface, and appears only after fecundation,
(19) is afterwards changed into what has been denominated the shaggy
chorion: my observations and my plates shew this. Boer, however,
professes not to know what becomes of it during the progressive
intro-uterine development of the ovulum.
22. The hollow and spherical yellow body of the ovulum corresponds with
the yelk or _vitellus_ of the ovum of oviparous animals, and from it all
the other several parts of the fœtiferous ovum are derived or formed, as
gestation advances, and a progressive development of the parts takes
place, from within, without[1].
23. The existence of the cortical membrane is proved in many parts of
the present work, but particularly by Fig. 15, Plate III., and Fig. 17,
Plate IV. in both of which specimens of abortion, the said _cortex_ had
persisted to a longer period than usual during gestation, and had
become, consequently, thickened, opaque, fleshy indeed, and the cause of
abortion. Figure 15, too, shews strongly the probability of my notion
that the thin membrane investing the surface of the yellow body of the
ovulum is, in good truth, what has been usually denominated the shaggy
chorion.
24. Another proof, amounting to demonstration, of the existence of a
cortical covering to the human ovulum, and that of the filiform envelope
called the shaggy chorion within it, I find in a striking and beautiful
preparation belonging to Sir Charles Clarke, marked 87. We there see a
complete cast of the lining (caducous membrane) of the uterine cavity
after fecundation, thrown off at a very early period, and with it the
ovulum, (of the size of a Portugal grape,) exhibiting the _cortex ovi_,
shelly and membranaceous, of a dense texture, yet flexible, which has
burst like the pericardium of some seeds, and allows the shaggy chorion
beneath it to be seen. It is a curious fact, that even Ruysch has, in
his fanciful manner, represented a human ovulum of about three weeks
with the cortex burst, yet still _in situ_, and the shaggy chorion
beneath it, in every way resembling the specimen of Sir Charles Clarke’s
in the Museum of St. George’s Hospital.
25. Even the errors of some of the very able anatomists of the present
day come in beautifully to corroborate Professor Boer’s observations of
the cortical membrane. Breschet and Velpeau, for instance, state, that
within what they (with their predecessors) have looked upon as the
decidua in the human ovum, there is a cavity containing a peculiar
liquid which, in their opinion, is essential to the nutrition of the
fœtus. Now what is this but the very description of the ovulum by Boer
(17), proving that there is a cortical membrane in the human ovum?
26. The cortical membrane is destined to be absorbed during the first
months of utero-gestation, thus exposing the next membrane to the
contact of the uterine lining (decidua), with which a connection takes
place in that part where the placenta is to be formed. In that part,
however, the cortex ovi is never altogether obliterated, but only made
thinner; and, in process of time, it is converted into a mere pellicular
envelope, which not only serves to divide the filiform vessels of the
chorion into groups or cotyledons in order to form the placenta, but
also covers all over those cotyledons or groups of vessels. (Plate I.
Expl. of Fig. 1.) I have called this the _membrana propria_[2].
27. While the process or metamorphosis of the ovulum noticed by Boer
takes place in the ovarium, in consequence of fecundation, the cavity of
the womb does not remain idle, but forthwith sets about weaving for
itself a general lining—a sort of pseudo-textile membrane—which extends
all over the cavity, descends partly into the cervix, and is _often_,
(not necessarily always,) projected even into a great portion of the
fallopian tubes.
28. This adventitious lining of the cavity of the womb is formed quite
independently of the presence of the ovum, for it has been found in most
cases of devious gestation, where the fœtus was _extra muros uteri_
(Plate VIII. IX. X. Fig. 1 and 2, and page 35), and has been found
advanced in its progress of formation, while the ovulum was, as yet, on
its way through the fallopian tube after fecundation. (Haller, Lobstein,
Velpeau, Meckel, Pockels.)
29. To this adventitious lining described by many ancient authors, but
by none better than by Harvey, the name of decidua already mentioned
(24, 26) has been given by Hunter, because, viewed as a production of
the uterus it is caducous and not permanent like its own natural lining;
as, however, it is no more caducous than any other of the involucra of
the ovum, the denomination is not strictly correct. It is, nevertheless,
more generally adopted than that of epi-chorion, given to the same
pseudo-membrane by Chaussier.
30. Its mode of formation and its structure have been differently
explained by different authors. The explanation offered by Burns runs
counter to facts and realities. That author speaks of all the minute
steps of generation, with the same confidence as if all had been
demonstrated. His imaginings respecting primary and secondary vessels
shooting out from the inner surface of the womb to form the decidua must
be gratuitous, as no other anatomist or physiologist, either before or
after him, has been able to ascertain the reality of such a process.
31. It is probable that the decidua consists of two laminæ, inasmuch as
we always find it with one surface perfectly smooth and the other rough.
If so, they are most intimately connected. It is at least one-twentieth
of an inch in thickness during the first five or six weeks of
uterofœtation, when its tissue is found to be more knotty, coarse, and
full of short threads, (not unlike a very ordinary mat,) than a purely
membranaceous or cloth-like lining would be. It is not until a more
advanced period of gestation that the decidua becomes distinctly
membranaceous, in which state it lines the entire cavity of the uterus.
(Plate IX. and prep. 73, 75, 76, of Sir Charles Clarke’s Collection:
also Dr. Agar’s beautiful specimen of impregnated uterus, Mus. Coll.
Reg. Lond. Med., and several specimens in the College of Surgeons,
particularly Sir W. Blizard’s case.)[3]
32. Into this chamber, then, so lined and so prepared the fecundated
ovulum, in the condition described by Professor Boer, is received after
its journey from the ovarium through the fallopian tube.
33. The pre-existence of an ovulum in the Vesiculæ Graafianæ, or Ovarian
Vesicles—and its metamorphosis, after fecundation (14, 15, 16, 17, 18,)
have been amply confirmed by Plagge of Bentheim, who published an
account of his experiments and observations, illustrated by figures, in
Meckel’s Journal of Physiology. (See also Prevost and Dumas, 3rd
memoir.)
34. As soon as the Ovulum has departed from its vesicular nest in the
Ovarium, the cavity which remains begins to fill up with a yellow
substance, different in texture from the surrounding tissue of the
Ovarium, and having, generally, a radiated centre of a whiter colour.
This is the _corpus luteum_. (Plate IX., page 30 and 31; also, Spec.
3468 B and C, Gallery College of Surgeons, and Dr. Agar’s case Royal
College of Physicians[4].)
35. The presence of _corpora lutea_ in the Ovarium of women, is always
an indication that as many ovula have escaped from that organ; but it is
not necessarily an evidence that the individual has been impregnated, as
ovula have escaped without the congress of the two sexes.
36. It is inaccurate, therefore, to state that a woman has been pregnant
because a _corpus luteum_ has been found in one of the Ovaria after
death, or to calculate the number of children she has borne from the
number of _corpora lutea_ so detected. _Corpora lutea_ have been found
in the Ovaria of very young girls, of unmarried women of the strictest
virtue, in newly-born female infants, and lastly, in sterile animals,
such as mules. (Brugnone, Joer. Roose.)
37. Sir Everard Home’s notion that the _corpus luteum_ was formed first,
and that, too, independently of sexual congress, and that the Ovulum was
formed afterwards, is disproved by more accurate and recent observers.
(Boer, Plagge.) There is reason to believe that Sir E. Home had been too
precipitate in his inquiry[5].
38. The Ovulum, on entering the womb, is about the size of a small pea.
The cavity, on the contrary, into which it enters, from the very first,
is of considerable dimensions. One cannot help being struck at this
great disparity in the relative dimensions of the Ovulum and the cavity
of the womb. When they first come in apposition, that of the latter is
from ten to twenty times greater than that of the former. (See Sir W.
Blizard’s case, Royal College of Surgeons, and Spec. 73, 75, 76, in Sir
C. Clarke’s Collection[6].)
39. The time at which the Ovulum enters the womb after fecundation is
not precisely known. (Meckel.) The fimbriated end of the fallopian tube
has been found actually applied to a Graafian vesicle after copulation.
(Magendie.) An ovulum, containing the rudiments of an embryo has been
observed in the human subject half engaged within the tube, and half
still resting on the Ovarium. (Bussieres.) The Ovulum has been detected
on its way through the fallopian tube.—(Burns, Haighton, Cruikshank,
Prevost, Dumas.) It is said to have been detected in the uterine cavity
on the eighth day. (Home.) Although it has lately been the fashion to
doubt the accuracy of such a fact, there is reason to believe it to be
correct, from the circumstance of M. Bauer’s microscopian examination of
that Ovulum and description of its structure corresponding with more
recent discoveries. (Boer.) The embryo contained in an Ovulum of a
week’s growth has been seen and measured. (Autenrieth _Supplementa ad
Historiam Embryonis Humani_.) The Ovulum, until the eighth day, has been
observed in the uterus under a gelatinous form by another anatomist.
(Walker.) Ovula in the fallopian tubes have also been seen on the eighth
day by Prevost and Dumas.
40. I have had occasion, within the last two months, to see a perfect
Ovulum ejected from the womb fourteen days after a single sexual
congress, which had taken place the day after the cessation of the
menses. Dr. Pockels (Isis, December 1825,) examined more than fifty
human Ova, among whom four had been expelled from the womb between the
eighth and sixteenth day after conception. On the fourteenth day the
Ovulum is about the size of a Spanish nut. The chorion is surrounded by
a thick membrane[7].
41. An Ovulum at three weeks is mentioned by Hunter (Gravid Uterus). At
twenty-two days a perfect Ovulum, with the embryo clearly defined, was
shewn by Dr. Combe to Dr. Baillie. Blumenbach asserts seeing an Ovulum
of the size of a small cherry, which could not have had more than
twenty-three days’ existence. M. Ogle’s case, published in the
“Transactions of the Society for the Improvement of Medical and Surgical
Knowledge”, was one of an Ovulum in Utero at five weeks. These facts
contradict Burns’ assertion, that at “three weeks or a month after
impregnation no fœtus is in the uterus.”
42. After being safely lodged within the cavity of the womb, the Ovulum
continues to grow on its own life-principle, for a while, until its
connection with the mother is effected, through the medium of the
deciduous membrane, which becomes, at a more advanced period, as it
were, a new and additional covering to the Ovulum. The growth of the
Ovulum causes the _cortex_ to burst, as happens with the receptacle or
cortex of certain seeds, and with the outer shell of the ova of some
oviparous animals. (See Plate I., fig. 1, 2, 3, 4.)
43. On the cortex bursting, the lanuginous or fibrillous membrane within
it (21) is exposed, when the fibrils will forthwith entwine themselves
with the flocculi of the decidua, and thus the Ovulum fastens itself to
the uterus by one or more contiguous points. (Carus.)
44. The membrane having these fibrils on its surface, has been called
the Chorion—and from the circumstance that these fibrils, both before
the cortex which lies over them has burst, as well as afterwards, serve
to promote the nourishment of the fœtus, I have styled it, the nutritive
membrane or involucrum of the fœtus. It has been so considered by
Ruysch, who calls the villous side of the Chorion, “_succosa nutritioni
fœtus inserviens_.”
45. The fibrils of the Chorion have generally been considered as
filiform vessels. When examined with the microscope, they appear
diaphanous and ramiform; some of them terminate into little bulbs like
the ampullæ of the villosities of the intestines. These bulbs adhere so
firmly to the cortex ovi, that when an attempt is made to detach them,
many are lacerated. (Carus.) It is only when the cortex bursts of its
own accord that they are set at liberty. (43.)
46. These fibrils, however, are not all vessels. Some are only suckers,
others are real vessels. (Carus.) The existence of any vessels among the
fibrils of the Chorion has been denied very recently upon the same
ground, namely, microscopical observations. (Breschet and Raspail.) But
there must be an evident mistake in such observations; for the actual
progress of those filiform vessels, and their gradual swelling into
large veins and arteries, at an advanced period of fœtation, have been
noticed in examining various human ova of different ages. (Lobstein,
Velpeau, Dutrochet, and myself.)
47. The nutritive envelope or involucrum, or membrane (Chorion) of the
Ovum is bifoliated. I have a beautiful preparation of the transparent
membranes of the Ovum, even after regular parturition, which proves this
fact. It is probably even trifoliated. (Dutrochet.) A fluid has been
found between the two laminæ of the Chorion. (Meckel.)
48. The internal surface of the Chorion is likewise supplied with
fibrils, which connect it with the next and innermost involucrum of the
fœtus, called the Amnion. Between the fibrils or filiform vessels of the
two surfaces, a communication is kept up by small vascular trunks which
meander between the two laminæ of the Chorion. (Meckel and myself.)
49. The vascularity of the Chorion is further proved by its diseases,
chiefly of an inflammatory character, ending in the thickening of its
texture. (Plate III., page 12—Plate IV., page 13—Plate V., page 17—and
many other examples in this Work.) There is a preparation in Sir Charles
Clarke’s collection which shews the vessels of the Chorion as evidently
as if they were injected.
50. But the vascularity of the transparent membranes is proved further
by fine injections thrown into the vessels of the ovaria of women; on
which occasion a beautiful net-work of minute vessels is rendered
manifest, forming a species of vascular ring around the _Vesiculæ
Graafianæ_. The same observation has been made by comparative
anatomists. (Cuvier, Home, Lobstein.)
51. These facts, demonstrative and corroborative of the vascularity of
the Chorion, (45, 46, 48, 49,) explain and account for the reality of
that self-existing life-principle inherent in the fecundated Ovum (42),
which detaches it from its nest (vesicula Graafiana), enables it to
travel through the tube, to grow or expand while thus travelling, and to
maintain that same power of growth and development for a short time
after its reception into the womb, until its final and effectual
implantation on the maternal stock (uterus).
52. The same holds good with regard to the amnion, or inner transparent
membrane of the Ovum, which, although normal anatomy has failed, morbid
anatomy has succeeded in proving to be vascular. (Plate VI. fig. 20, and
Description, p. 19, and Remarks, pp. 20–24.) (Haller, Monro, Chaussier,
Meckel.)
53. If it be true that the amnion is a vascular membrane, there is no
difficulty in viewing it also as a secreting membrane. Hence the source
of that particular fluid, to which the name of Liquor Amnii has been
given, and in which the embryo is suspended to the end of gestation.
(Plate I. fig. 4, but particularly fig. 7, 8, and 9, and Remarks.)
54. The amnion is a sac formed by the reflected epidermis of the embryo.
(Velpeau, Boer, Pockels.) It does not exist before the twelfth day.
(Velpeau.) At the eighteenth day it is found as a bladder placed on the
back of the embryo, and continuous to it along its edges or sides and at
its extremities. (Velpeau.) It has been distinctly seen on the twelfth
day. (Pockels.) It is then not a concentric membrane within the chorion,
but a vesicle, on the outside of which the embryo rests as on a bed.
Until the day in question the embryo is connected to the vesicular
amnion at the back, by a cellular transparent membrane. From that time
till the sixteenth day the embryo progressively gets into the cavity of
the amnion, which before was connected with the chorion by one of its
piriform extremities, while the other conical extremity penetrates
slowly into the albuminous fluid of the chorion. (Pockels.)
55. While the embryo is within the chorion (nutritive involucrum) and
rests on the vesicular amnion, the former membrane, or sac, contains a
reddish transparent fluid having the consistency of the albumen of an
egg, (54.) with a colourless and very slender membrane crossing it in
various directions. (Pockels.)
56. The progressive increase of the Ovulum, from the time of its
quitting the Ovarium until it has stationed itself firmly within the
womb, has been demonstrated (Magendie, Prevost). In examining, between
eight and twelve days after fecundation, the female organs of such of
the mammalia as are multiparous at a single gestation, one Ovulum has
been found near the fimbriated end of the fallopian tube of one size; a
little farther into the tube another of a larger size; and lastly, near
to the uterine orifice of the tube, a third of a still larger size;
shewing the relative progressive increase that had taken place in such
Ovula subsequently to a single act of fecundation, and proportionate to
the time employed by such Ovula in travelling to the spot in which they
were found. (Prevost, and Dumas’s 3rd Memoir on Generation.)
57. While thus circumstanced, the Ovulum is never connected with the
part through which it passes. On plunging that part into water, the
Ovulum is found not only to rise to the surface, but to float. (Home,
Prevost, Dumas.)
58. What stronger proofs need be required of the existence of an
inherent life-principle in the Ovulum, which is, at one time at least,
(indeed I suspect throughout the period of gestation,) independent of
any connection with the parent mother? (Plate I., and several of the
explanations of figures throughout the work.) Yet none of the earlier
writers who adopted the Ovarian theory of generation have ever asked
themselves this question: What supports the vitality of a fecundated
Ovulum after it has left the Ovarium, and previously to its becoming
connected with the womb? In fact, the subject had never been mooted,
before the more modern physiologists took it up and satisfactorily
explained it[8].
59. That the embryo probably lives in utero in virtue of its own
life-principle, even through the entire period of gestation, (51, 56,
and 58,) is rendered probable by many facts related by unimpeached
authorities, which go to prove that when the whole intact Ovum has been
expelled at an advanced period of gestation, or at the natural
termination of that period, the fœtus has continued to live, and the
circulation of the blood has not ceased for an instant during a space of
time of from nine minutes to a quarter of an hour. (Roederer, Wrisberg,
Osiander, and Meckel, who repeated the experiments of the latter.) It
has been asserted by a venerated authority that in an intact Ovum,
expelled at seven months, the fœtus lived upwards of an hour. (Harvey.)
The truth of this assertion is confirmed by very recent observers
(Green, Velpeau, Gardien, Dr. Campbell)[9]. I once destroyed a female
cat by prussic acid near the time of parturition; and having removed
from the horns of the uterus the entire Ova, with their beautiful
annular placentæ, while the fœtus in each of them was still perfectly
lively, and could distinctly be seen, through the membranes, to move, I
found that at the end of thirty-five, forty, and even forty-two minutes,
some of them were still alive, the Ova remaining entire all the time,
and upon the table[10].
60. When the Ovulum has made good its fastening to the adventitious
lining of the womb (decidua), the circulation of the blood in it is as
yet imperfect. The Ovulum does not—cannot—receive the blood of the
mother. How could such a gossamer-like being, organized as the Ovulum
has been proved to be, during the first days after fecundation, be made
a part of so impetuous a torrent as the circulation of the blood of the
mother, without instant destruction to the produce of conception? No.
The blood of the embryo is first formed within itself. (Prevost, Home,
Magendie, Adelon, Serres, Rolando.)
61. The newly-engendered being passes through two striking metamorphoses
previously to the enjoyment of its extra-uterine life. These are the
Embryonic and the Fœtal states. The latter succeeds immediately to the
former; beginning at the moment when the new being is grafted on the
maternal womb, and continuing until its expulsion from thence at the
full period of gestation. It follows, therefore, that the Embryonic or
former state is that in which the new being is as yet, without any
direct or indirect communication with the mother, and still less so with
external objects. This state persists for about two weeks after
fecundation, during which the Embryo continues to derive its nourishment
from the cortical membrane of the Ovum. (Boer, Soemmering, Plagge,
myself.)
62. The growth and progress of the Embryo or Fœtus follow a very
irregular march. Up to the second month the increase is somewhat slow—it
is accelerated during the third—it slackens again at the fourth and
fifth months—between which and the last month the increase is more
rapid, until it has acquired its proper maturity. (Autenrieth,
Soemmering.)[11]
63. The Embryo may be perceived, with the naked eye, at the fourteenth
day after conception. It measures then 1–12th of an inch in length. (Dr.
Pockels.) On the third week, it is 1–10th of an inch long. It is as
large as a house-fly at four weeks, and as a horse-fly at six weeks. At
two months it weighs twenty grains, and is one inch long. It weighs an
ounce and a half at three months, and measures three inches; between
which time and the sixth month it increases in dimensions from three to
nine inches, and in weight from one ounce and a half to one pound. The
relative weights of augmentation of length for the seventh, eighth, and
ninth months stand thus:—from two to four pounds, and twelve inches;
from four to five pounds, and seventeen inches: from five to eight
pounds and twenty-two inches. (Averages of minute and accurate
observations made by Autenrieth, Soemmering, Bichat, Pockels, Carus,
&c.—confirmed by my own observations made on several early ova, and many
fœtuses examined in the course of seventeen years obstetrical practice.)
64. Towards the end of the first month it is easy to distinguish the
head of the fœtus, which has the appearance of a vesicle composed of
thin membranes, and is as large as the rest of the body. The latter is
straight—and there is in one part of the head a black dot, marking the
spot for the eyes. (Plate I. fig. 5.)[12] But it is during the second
month that the various parts of the face, as well as the superior and
inferior extremities, become visibly delineated in the fœtus. The eyes
are indicated by two black spots of considerable size, compared to the
volume of the fœtus. The eyelids are not spread over them until the
tenth week, at which time the external concha of the ear, as well as the
profile form of the nose, become properly defined. At this same period
we find the mouth, which was at first a simple opening of no mean size,
becoming more distinctly delineated, owing to the formation of the lips.
These soon approach each other, leaving a simple transversal slit or
depression between them. (Plate II. fig. 11 and 12.)
65. The extremities appear in the form of globular tubercles at first;
the superior preceding the inferior by a short period of time. Until
between the third and fourth month, the lower are smaller than the
superior extremities. Even at the latter month they are shorter than the
projection of the os coccygis. The parts of reproduction may then be
distinctly seen. In the male as well as in the female, these parts are
exceedingly prominent. (Plate V. fig. 18 and 19.) But the difference of
the sexes may be deduced from other circumstances besides the sexual
organs. Such as the particular structure of the thorax and abdomen, the
form of the head, the extremities, and the dorsal spine. (Autenrieth,
Soemmering, Meckel, Velpeau.)
66. The external organs of the fœtus are all well defined at the end of
the fourth month. The abdomen is fully covered in; the intestines are no
longer visible. By the sixth month the fœtus is perfect in its shape and
formation. In the seventh, eighth, and ninth months, its successive
development is limited to mere size, volume, or amplitude, and a
proportionate increase in weight. It is well to keep in mind, that
although the growth of the various parts of the fœtus bears a proportion
to the general development of its body, that part of the body which is
above the navel, measures in length more than the part below it, until
the full and complete period of gestation, when the navel marks the
precise middle of the length of the fœtus. This circumstance assists us
materially in forming our opinion respecting the age of any fœtus,
either as a matter of curiosity, or as a guide in questions of forensic
medicine. (Foderé, Chaussier.)
67. It was supposed, until within the last fifteen years, that the
nervous system was the first to be formed in the human embryo; but
recent discoveries have proved that the vascular system has precedence
of the former. The nerves invariably appear after the arteries which
they are intended to accompany. The spinal marrow appears before the
brain, and the latter before the cerebellum, and accordingly it is found
that the arteries of the spinal marrow shew themselves before those of
the brain, and the arteries of the brain become manifest before those of
the cerebellum. In this respect the organogenesy of the human fœtus is
analogous to that of birds. (Serres, Desmoulins, Adelon.)[13]
68. The blood is formed independently of the heart, and appears at two
distinct points from it, and acquires a motion independently of it.
(Prevost, Dumas, Baer.) The veins are formed first—next, the
heart—lastly, the arteries, &c. (French Physiologists.) The arteries
are, by an Italian physiologist, said to be the first to appear.
(Rolando.)[14]
69. The nervous system is not developed, beginning at the centre and
proceeding towards the circumference of the embryo, but the reverse.
Thus the lateral nerves of the head, trunk, and pelvis, are already
formed, when the cerebro-spinal system is yet in a liquid state. It
follows hence that those nerves cannot be considered (as it has all
along been supposed) in the light of emanations from, but as distinct
bodies proceeding to, that particular portion of the nervous system.
(Serres.)
70. Of the apparatus for digestion, the intestinal canal is the first to
appear. It consists, during the first days of its formation, of an open
gutter, extending the whole length of the embryo, placed before the
vertebral column, and gently curved like a canoe. It is in communication
with the _vesicula umbilicalis_, or intestinal vesicle. (Wolf, Meckel,
Oken, Baer.) The gutter, without losing altogether its communication
with that vesicle or chamber during the first ten or twelve weeks,
becomes closed at last, and extends, lengthens, and expands in a variety
of ways. One of its extremities, the mouth, appears between the fourth
and fifth week. It is open on the sixth. The other extremity, the anus,
opens on the seventh week. About the ninth week, the outlines of a
stomach are visible. (Meckel., Adelon, Velpeau.)[15]
71. The VESICULA UMBILICALIS (intestinal vesicle) corresponds to the
vitelline sac of birds. The discovery is due to Bojanus. In the human
embryo it measures about half an inch in diameter. It is situated
immediately against the anterior surface of the embryo (Lobstein); but
it gets further from it at the end of the first month, when it is found
on the outside of the sheath of the cord. (Meckel.) It is composed of a
granular membrane of considerable tenacity. It contains a whitish
liquid, which gradually diminishes—becomes thicker, and ultimately,
hardened; while the vesicle itself withers, and becomes opaque. It
receives the blood vessels called omphalo-mesenteric. (Pockels.) It
disappears generally about the third month. (Meckel.) It has been
observed, though extremely rarely, at the full period of
gestation—placed at a short distance from the insertion of the cord into
the placenta, but not larger than when seen at between two and three
months. (Hunter, Meckel.) It is connected, as stated before, by a short
neck, and by vessels, with the smaller intestines at the termination of
the ileum (Meckel)—or at the cæcum, which is, in reality, the
representative of the vesicula vitellaria drawn into the abdomen as in
birds. (Oken.)
72. At the lower end of the anal intestines, there projects another
vesicle or sac, to which the name of Allantoid has been given. It exists
in birds—in all the mammalia—and in the human embryo. In the latter it
appears about the fourth week, and by the sixth week it has almost
disappeared. Its existence is therefore but short, while the size it
attains is always trifling. Not so with the mammalia, in which it
acquires great amplitude. The communication of this sac with the
bladder, by a canal called the urachus, and which canal is found
impervious after the first three or four months of gestation, is
admitted by all observers. (Meckel, Baer, Dutrochet.)
73. The umbilical cord or navel string, in man, has been found to spring
from a vesicle to which the discoverer has given the name of Erythroid.
(Dr. Pockels.) This vesicle had been before observed in the mammalia.
(Oken.) The cord appears at the end of the third week. (Pockels.) It
then consists of a vein and two arteries, the urachus, a species of
gelatine of a ropy nature, called the _gelatine of Wharton_, a portion
of the intestinal canal, (larger in proportion as the embryo is
younger,) the vesicula umbilicalis, in part, and the omphalo-mesenteric
vessels, the whole enveloped by a sheath proceeding from the involucra
of the ovum already described. The last three constituent elements of
the cord, however, become obliterated or disappear after the third or
fourth month of gestation—the others remain permanent throughout that
period.
74. The umbilical vein and the arteries are spirally twisted together
and in the majority of cases they are so from left to right. (Hunter.)
The former contrivance is evidently intended for the purpose of giving
the greatest possible extension of tubular passage for the blood
compatible with the smallest increase in the length of the cord. The
cord which is very short at five or six weeks, becomes at the conclusion
of gestation from one foot six to two feet long. (Chaussier.)
75. The umbilical arteries, two in number, are a continuation of the
primitive iliac arteries; they pass over the lateral regions of the
bladder, ascend along the internal surface of the anterior abdominal
covering of the fœtus, approaching each other as they get nearer to the
navel, through which they emerge in order to enter the sheath of the
cord, winding round the vein in their way to the placenta. (77) The vein
on the contrary which proceeds from the placenta is of a larger calibre
than that of the two arteries taken together. It is soft and
extensible—and after having slightly meandered within the umbilical
sheath penetrates through the navel into the abdomen of the fœtus,
directs its course towards the inferior surface of the liver, enters the
antero-posterior fissure of that viscus, unites with the left branch of
the hepatic and vena portarum, and reaches under the name of the venous
duct, the inferior cava. It has no valves, except one at its
intro-abdominal bifurcation. This vessel, throughout its course, becomes
obliterated after birth.
76. The omphalo-mesenteric vessels consist of a vein and an artery, the
ramifications of which, externally to the fœtus, are seen distinctly on
the umbilical vesicle (vesicula intestinalis). They accompany the cord
as far as the navel through which they pass into the abdomen. They then
separate, the former proceeding on the right to join the trunk or one of
the branches of the mesenteric vein, and the latter on the left to join
the superior mesenteric artery. These vessels are obliterated, as the
vesicula umbilicalis to which they belong disappear, and lastly
disappear in their turn. They have, however, been observed sometimes in
the cord of the full grown fœtus, like whitish solid filaments.
(Chaussier, Beclard.) In the recent case of an individual twenty years
of age, who died of consumption, these vessels were found as pervious as
when existing in the embryonic state, and contained blood.
(Spakenberg.)[16]
77. When the Ovum is advanced to the second or third month of its
fecundated existence (for the period varies in different examples I have
had under my observation); its attachment to the Uterus, is firm and
complete. Many of the vessels of the external surface of the chorion,
which by this time have increased in size, while their free ends have
luxuriantly branched out in innumerable minute vessels, have clustered
together and formed what are in reality cotyledons—by means of which the
said attachment is principally effected. (Personal observations and
experiments.) The congeries of these clusters of vessels constitute the
principal part of what has been called the Placenta, which grows in size
and expands as the gravid uterus expands progressively during gestation.
78. The Cotyledons sometimes consist of only one short and very thick
principal trunk—dividing itself, at a short distance from the surface
whence it springs, into two, three, sometimes more, lesser trunks, and
then again subdividing into thousands of smaller tubes;—at other times
the cotyledons consist of two or three distinct straight trunks of
different calibre springing from the chorion close to each other (as
insulated clusters of lofty and straight trees are often seen here and
there on a plain); in which case, the corresponding subdivisions being
more numerous, the cotyledon is necessarily larger. (Personal
observations, 1825, 1826.)
79. The main trunks of these cotyledons are ramifications of the
umbilical vein and arteries, seen to spring from the subdivision of
those vessels which are observed to run horizontally on the fœtal
surface of the placenta, and which are the termination of the umbilical
cord. Between these cotyledons there are spaces of various sizes in
which the surface of the Chorion is clear of all filaments, vessels, or
any other attachment or projection whatever,—such surfaces are smooth
and shining. (Personal experiments, 1825, 1826.)[17]
80. The trunks of the cotyledons and their subdivisions whether
springing from the vein or from the arteries of the cord have their
coats made of the Chorion and amnion which accompany each cluster so as
to form the thinnest pellicular receptacle for their ramifications. It
follows hence, that when a coloured liquid, or even air is injected
through the arteries of the cord, no escape of the injection takes
place, nor can take place, from the terminal vessels of the clusters or
cotyledons—and as it is found also that the same injection, if projected
long enough (without lacerating any part of the gossamer-like structure
we act upon) is brought back by the vein of the cord (which has no
valves to prevent such a return) another conclusion is inevitable,
namely that the terminal arterial vessels become, by a continuous
arrangement, incipient radicles of the venous tubes. (Personal
experiments, 1825, 1826.)
81. Now in as much as in the human placenta, expelled at the full period
of gestation, before any experiment be undertaken to disturb its
integrity, the lobes which it presents have each the appearance of a
continuous mass, without any intervening spaces (79); and as these
appear only clear, smooth, and shining, after maceration and much
patient dissection that leaves nothing rough, or lacerated or divided by
violence, behind; it follows that a something must have been removed,
during the process of maceration and dissection, which before the
employment of those processes occupied the spaces in question. (79.)
82. That something consists in a congeries of blood-vessels, arterial as
well as venous, proceeding from the longitudinal vessels of the decidua
covering the placenta (Dr. Hunter, Chaussier, Meckel, Lesauvages,
myself). These vessels ramify in a manner analogous to that in which
those of the fœtus have been described to ramify, (78, 79.) They
penetrate between the interstices left by the minutest branches of the
umbilical cotyledons. Their direction is lateral, perpendicular,
oblique, and variously tortuous, in reference to the plane of the
decidua whence they originate. Wherever they form a thick cluster, they
are found to occupy one of the spaces already described (79). To
facilitate this arrangement, and to render the distribution of the
decidual vessels throughout the masses of the umbilical cotyledons more
effectual—the membrane itself (decidua) is found to dip among the
latter, dividing the general mass into lobes of various sizes, by which
contrivance the decidua acquires an additional extension. (Personal
Observations and Experiments.)
83. The decidual vessels are formed by continuous arterio-venous tubes.
They reach, but do not connect themselves with the chorion. In the same
manner as the terminal vessels of the umbilical cotyledons reach, but do
not connect themselves with the superimposed decidua. When an attempt is
made to remove (peel off) the latter from the surface of the placental
mass, we notice certain attachments between them which are torn in the
removal. These are the decidual vessels (82) and not as stated
incorrectly by some, the terminal vessels of the umbilical system.
(Recent German, and French, and Personal Experiments.) In the same
manner as the umbilical vessels are accompanied by the chorion, the
decidual vessels are accompanied by a membrane peculiar to the placenta,
which I have called the _membrana propria_.
84. If we take a placenta which has been expelled from the womb, in all
its integrity, between the fifth and seventh month, when the vascularity
of the decidua is considerable, and after carefully washing its surface
in tepid water, we plunge it in a weak solution of alcohol, so as to
harden the decidua in some degree, we shall be able to slice off the
latter from the surface of the placenta, at the depth of about the tenth
of an inch, without injuring the delicate texture of the membrane. This
should then be carefully macerated by turning the under surface upwards,
under water, when, after a time, much of the tomentous attachment seen
floating, will gradually be detached, and leave part of a smooth surface
behind. If the membrane be then viewed with a strong magnifying glass,
on its upper surface several orifices, with regular edges, but of
various aperture, will be observed, through which, if we introduce a
slender pipe and blow air into them, not only the longitudinal vessels
in the decidua will be seen to fill with that fluid; but the short
fragments of their ramifications pendent from the under surface of the
membrane, will be distended, and the air will pass through them bubbling
up through the water, thus denouncing their own vascular nature and
arrangement. This is _an experimentum crucis_. (Original, 1826–27).
85. The orifices in the decidua have been denied by one or two recent
writers, particularly by Professor Lauth; but they are admitted by all
the rest of the modern physiologists and anatomists, from Dr. Hunter
down to the latest experimentalist on the subject. It is through these
that the injection, thrown into the uterine vessels, while the placenta
is still adhering to the uterus, passes into that part of the placental
mass which is formed by the decidual ramifications. In a very beautiful
and most accurately conducted experiment made at the Middlesex hospital,
by Dr. H. Ley, (March, 1833,) the particulars of which, I hope, to see
published by that able physician; a red injection was pushed, without
any difficulty,—laceration,—or extravasation, towards the adherent
placenta, from the uterine vessels of a pregnant woman, who died of a
disease of the heart, undelivered; when it was found to have penetrated,
in the most regular and uniform manner, to the very remotest terminal
ramifications of the decidual vessels. The placenta was then carefully
detached, the decidual surface was carefully examined with magnifying
glasses, no laceration could be detected, except what had been made by
accident or violence in a small part of its circumference while the
placenta was being detached from the womb. Orifices, as distinct and as
properly organized as orifices can be in membranous textures, were seen
in many parts of it by more than one competent and unbiassed person; and
air was blown through some of them, or a small silver pipe introduced,
without effort or laceration. Not the slightest vestige of
extravasation, or lump of injection, was observed in any part of the
intact placenta when cut into. This same result has been obtained, it is
understood, in a recent injection by Sir A. Cooper, but the nature of
the experiment is not yet known. The same result was obtained by Dr.
Hunter, whose positive affirmation has been so recently questioned. The
same result has been obtained by Lobstein. The same result has been
obtained by Chaussier. Such a result is believed to be correct by
Magendie. Professor Mende, in a report to the Obstetrical Society of
Gottingen, states having made the experiment of injecting the uterine
vessels with air—and with milk, in the case of a woman who died (1830)
after the Cæsarean operation, the placenta remaining firmly adherent to
the uterus, and he obtained the like result—as Hunter and others. Can
we, therefore, refuse credence to such a host of eminent men and
experimenters?
86. The decidual vessels derive their fluid from the uterine vessels.
The arteries which convey uterine blood to the decidual vessels, are
tortuous and very small; they are the adventitious produce of the
_membrana propria_ of the womb acting under the influence of a peculiar
stimulation which produces the decidual membrane, as inflamed surfaces
produce organized exudations. Though the latter be formed in the uterus,
even when the embryo is lodged, by aberration, in some other part of the
abdomen, its presence must not be deemed, on that account, unessential
to the embryo; for a vascular membrane, as nearly alike to it in texture
as can be, has invariably been found to connect, by blood-vessels, the
embryo to some vital part nearest to where that embryo has been casually
deposited, that part having, at the same time, its circulation and
vascularity greatly increased, and becoming, in fact, the parent of the
connecting vascular membrane in question.
87. Nothing proves more distinctly, (it might be said, almost to
demonstration,) the accuracy of the views (82, 83, 84, 85) which tend to
establish the fact of a vascular communication between the
arterio-venous system of the mother and the placenta (by intermediate
decidual circulation) and to shew the fallacy of those who deny such a
communication, than the very phenomenon just noticed (86). Here, morbid
anatomy again comes to the assistance of normal anatomy and physiology,
and affords evidence which is not liable to the errors that have been
unjustly affixed to experimenters with injected fluids. Of the many
examples that might be quoted in support of this proposition, the one
which is stamped with the authority of Lallemand may be selected as the
most striking[18]. In a case of ventral aberrant fœtation, which had
proceeded to the end of the sixth month, before it destroyed the
patient, a vascular and tomentous membrane had been formed on the
surface of the peritoneum, to which adhered the regular placenta and
chorion of the fœtiferous ovum. This membrane resembled in every respect
the decidua, at six months—it was thicker, and more red and vascular
where the placenta was adherent than any where else. “Vessels as visible
as those of the inflamed conjunctiva,” observes the author, “passed from
the highly injected peritoneum, opposite the placenta, into the membrane
which lay between them; while other vessels from the placenta reached as
far as the same membrane, and were lost in it where they probably
anastomosed by their very minute terminal ramifications.” (Lallemand).
The conclusion which this really eminent physiologist and good man has
come to, upon this subject, is striking, and truly to my purpose. “The
decidua,” says he, “has no other function to perform than that of
serving as a capillary system, intended to be the medium of
communication between the blood-vessels of the mother and those of the
fœtus” (page 21).
88. It is possible that the venous blood of the decidual vessels may be
returned through the great uterine sinuses, the large open orifices of
which, covered with an almost valvular flap, have been described by the
best anatomists, as being applied to the surface of the decidual
placenta. Magendie[19] thus states his opinion on this subject. “In
women large openings, which communicate with the uterine veins, are
observed on that part of the uterus to which the placenta adheres; but
it is not clear whether these venous orifices are destined to absorb the
blood of the fœtus, or to suffer that of the mother to escape on the
surface of the placenta. I am inclined to admit the latter idea—but no
proof whatever exists of its correctness.” (page 554).
89. Such is the real structure of the human placenta (77 to 88,
inclusive). Its description is founded on positive and direct
experiments, first-rate authorities, and anatomical inquiries, which may
be repeated, referred to, or ascertained any day, and to which many can
bear witness: any other description differing from it and not so
grounded, must be erroneous. This view of the real structure of the
placenta differs from that of Dr. Hunter only in the non-adoption of
that great man’s notion that continuous vessels go from the uterus,
_through_ the decidua, direct into appropriate cells or laminæ, where he
supposed that the arteries deposited their blood, which the veins pumped
back into the uterine system of the mother, after it had served the
purpose of bathing the terminal or cotyledonic vessels of the fœtus. The
existence of cells, however, has been frequently denied, and by none
more stoutly than by Professor Lauth, of Strasburgh, and others; but as
these individuals deny, at the same time, that which a hundred
anatomists of great skill and veracity have seen, namely, the
transmission of fluids, by means of decidual vessels, from the uterine
system into the placenta, their opinion is liable to suspicion. However,
it is unquestionably true, that on looking at the appearance exhibited
by the fluid injected from the uterine vessels, in those portions of the
placenta which it reaches, (Experiment at the Middlesex Hospital, 85,)
we feel more inclined to consider it as dendritic and ramose, than
extravasated or diffused. I entertain the former opinion. I submitted a
thin section of the injected placenta (March, 1833) (85) to a powerful
magnifying lens before a very strong flame of an argand burner, and
could not perceive any sensible difference between the appearance of the
red and that of the yellow injection. Now, that the latter, which was
thrown in through the umbilical vessels, had been deposited within
minute vessels, and not within cells, no one doubts. It is, therefore,
likely that the other fluid is also so deposited. If Hunter and his
followers were wrong in their conclusions, (though accurate in their
experiments,) Professor Lauth, and the author of a paper on the
placenta, inserted in the Philosophical Transactions for 1832, (who, by
a most singular coincidence repeats all that Lauth had said long before
him respecting the non-existence of cells and of continuous vessels from
the uterus in the placenta) are not less chargeable with even greater
errors; inasmuch as they have denied anatomical facts which have been
observed and ascertained by many. They have overlooked the function of
the decidual vessels, and they have said not a word of that beautiful
arrangement of the fœtal vessels of the placenta which Dr. Hunter
compared to the “vascular portion of the chorion forming part of the
placentulæ in a calf,”[20] and which I have succeeded in demonstrating
in a human placenta prepared for that purpose, and still in my
possession (79, note). It is evident that under such negative
circumstances their view of the structure of the human placenta, and its
connection with the uterus, will be repudiated.
90. The circulation of the blood in the Ovum is independent of that of
the mother (personal experiment (59), and all the more recent
physiologists). The embryo creates its own blood, and through it,
sustains its own existence. But its blood, like that of all other
animals, whether during its intro or extra-uterine life, requires to
undergo certain changes at every minute period of that life—and those
changes it experiences through the influence of the blood of the mother.
(Magendie, Mende, Pockels, Baer, Chaussier).
91. The function of the Placenta, therefore, seems to be to facilitate,
and in good truth to effect, the necessary changes in question (90). The
decidual vessels receive the arterial blood of the mother. This is
spread over a very considerable surface of tubular structure, which
being, in its distribution, made to come in apposition with the infinite
ramifications of the umbilical placental vessels, at innumerable points,
(like the inspired air distributed through the bronchial passages is
made to come in apposition with the myriads of vascular rami of the
lungs); the required changes in the blood of the fœtus are produced,
just as the changes called for in the pulmonic blood, are produced by
the peculiar arrangement of that part of the animal economy. When the
arterial blood of the mother has produced the desired effect on that of
the fœtus—it is returned by the decidual veins to the uterine sinuses
applied, like absorbing mouths, to the surface of the decidua, when it
enters into the general venous system of the mother (Magendie; Personal
Observations).
92. Of the two vascular systems, forming the machinery of the
utero-decidual and fœto-placental circulation, (82 and 77,) that of the
former is the smallest and least extensive (See injections in all the
Museums). In point of origin, also, the latter has precedence. The
Umbilical vessels unite the fœtus to the chorion before any regular
placenta is formed outside of the membrane. Up to the tenth week the
decidual vessels are as yet slender, straight, and insulated; while the
umbilical vessels begin already to arrange themselves into minute
cotyledons[21]. The reason of these arrangements is obvious. The embryo
needs growth. This it gets through the maternal blood. But as its
gossamer frame, for the space of two and three months, requires but
little assistance from such a source for the promotion of growth; and as
a large supply of maternal blood, at that early period, would overwhelm,
instead of enlarging, the embryonic fabric, such an arrangement of means
only obtains, in the reciprocal circulation, as is calculated to ensure
the desired effect (Personal Observations).
93. This effect is nutrition. “Considering the power which the Ovulum
displays when it first reaches the uterine cavity, of imbibing matter
for its growth, together with the facility with which, according to
Dutrochet, fluids may be drawn through animal membranes, it is not
difficult to believe that nourishment is directly imbibed from the
vessels of the mother by the circulating fluid of the embryo, through
the fine intervening membranes.” (Mayo’s Outlines of Physiology, p. 437.
3d. Edit.)
94. It is possible, also, that other means may be at play in the
promotion of such an effect (93) in the fœtus, besides the one before
mentioned (91). We may instance as a probable one, lymphatic absorption.
The probable existence of lymphatics in the placenta was admitted by Dr.
Hunter. “It is most probable that it (the fœtus) is nourished by
thousands of small lymphatic vessels which absorb nourishment from the
blood of the mother and carry it along the navel-strings. It is true we
cannot see any lymphatics running upon the navel-string, _yet it is
reasonable to conclude they do_.”[22] Hunter’s conjecture has since been
realized (Chaussier, Fohman, Uttini, Lauth). The second of these
anatomists has delineated them in rich profusion, extending from the
placenta along the funis, leaving the funis at the navel, and directing
their course to the groin (Mayo).
95. Some have ascribed the nutrition of the fœtus to a regular
deglutition and digestion of the amnionic fluid. Many facts render this
opinion probable (Meckel). But there are also facts which would make
nutrition by such a means impossible (Dr. Hunter). 1st. An embryo, at an
early period, cannot be nourished by the mouth. 2dly. The amnionic fluid
is mere water with a vestige only of albumen, the only nutritive quality
in it. 3dly. A fœtus was seen whose intestine, a little below the
duodenum, was impervious and divided through, and the lower end began at
some distance from the higher portion. (Dr. Hunter’s MS. Lect.) 4thly. A
full grown child was brought into the world without head, heart, lungs
or intestines (Dr. Cooper, in Dr. Hunter’s MS. Lect.) 5thly. A kitten
was sent to the Royal Society, full grown, born without either nose or
mouth. (Dr. Hunter, ibid.) 6thly. I have the drawing of a pig (the
preparation of which I exhibited at the Med. Ch. Soc. in 1814,) which
was born, at the proper period, and full grown, without any vestige of
the under jaw, and consequently without either mouth or any passage into
the stomach.
96. Some have thought that the amnionic fluid was absorbed through the
pores of the skin (Osiander), others through the mammæ of the fœtus
(Oken). That the vesicula intestinalis (umbilicalis) contributes to the
growth of the embryo is a great deal more probable (Blumenbach,
Sœmmering, Lobstein, Joerg.) It is also not improbable that the gelatine
of Wharton, contributes to that object (Lobstein). But these are all
conjectures, for the probability or improbability of which as many
arguments and real facts have been alleged on equally unquestionable
authority. “Ce sujet,” observes Magendie, “a souvent exercé
l’imagination des physiologistes, sans aucun profit réel pour la
science.”
97. I am more inclined to believe in the existence of respiration in the
fœtus as an additional means of facilitating growth and entertaining
inherent life (Geoffroy St. Hilaire, Müller). The presence of air,
analogous to atmospheric air, in the amnionic fluid, has been detected
(Lassaigne). I once had in my possession an intact ovum at five months
(30th June, 1826,) which served me for the purpose of studying more
particularly the real structure of the placenta, and which contained,
besides the amnionic fluid, a bubble of air about the size of a small
plumb. Only a portion of this was, through the awkwardness of my
assistant, received in a glass tube containing distilled water, while I
punctured, under water, the membranes in the centre of the bubble. This
portion was afterwards made to pass through a saturated solution of lime
in water, and produced a visible cloudiness denoting the presence of
carbonic acid. The respiration of the fœtus is supposed to be effected
by the cutaneous pores, as in aquatic insects (Geoffroy St. Hilaire). In
addition to which the placenta is looked upon as performing the office
of lungs (Müller). Dr. Edwards’s experiments on the asphyxia of the
_Batraciens_, may serve to throw light upon this question (Breschet).
98. The nature of the changes which the blood in the fœtus may be
supposed to undergo from arterial to venous, and the converse, has not
been satisfactorily ascertained. The colour of the blood in the
umbilical vein is something lighter than that in the umbilical arteries
(Mayo). This alleged change is not admitted by others (Meckel). I have
never been able to detect the least difference between the
arterio-umbilical and venous-umbilical blood, in the many cases I have
examined. But the absence of any change of colour does not necessarily
imply the absence of any inherent change in the blood of the two
systems. The globules of the fœtal blood do not resemble those of the
blood of the mother (Experiments alluded to by Dr. Breschet).
99. Connected with the subject of the nutrition of the fœtus and the
changes which take place in the blood of it, may be mentioned certain
recent discoveries[23], which would lead to the belief, that the
function of the placenta is probably analogous to that of the liver
during the intro-uterine life of the fœtus, and that the presence of
bile in the blood of the placenta, discovered by modern chemists, is
necessary to the maintenance of fœtal life (Breschet).
100. It is of the utmost importance to bear in mind the great
distinction which exists between the independence of the fœtus, _quoad_
life, and its dependence, _quoad_ nutrition, in respect to the mother.
The former state is secured by a total separation of the two
circulations (maternal and fœtal). The latter by the close reciprocal
contact of the organs of those circulations. Thence is it that we find
the fœtus to live on, notwithstanding that its connection with the
mother has been partially and sometimes even wholly, severed;—while on
the other hand we cannot help admitting that, albeit this independence,
the influence of the mother over the fabric of her offspring is
unquestionable.
101. Here are two important positions. I have mentioned my experiments
on the intact ova of the genus cat, (59,) to illustrate the first of
them, and Dr. Prevost has since come to my assistance with as strong a
case in further support of it[24]. This gentleman having observed an
ovum still alive in the uterus of a ewe, which was a short time advanced
in gestation, removed it and placed it upon a warm glass plate exposed
to the rays of the sun, and attentively examined it with the microscope.
The beatings of the heart became more lively. He noticed the blood arise
to the surface of the chorion from the fœtus, there ramify plentifully,
and by anastomosing vessels, return to two of the larger trunks which
were the veins of the embryo. He concluded, therefore, that the ovum was
an isolated substance.
102. In proof of the accuracy of the second position, we have equally
strong evidence founded on experiments. Magendie introduced camphor into
the veins of a pregnant bitch, and he found that the blood of the fœtus
had, at the expiration of a quarter of an hour, acquired distinctly the
smell of that drug (Physiology, 2d Edit. 1825). Quadrupeds carrying
young were made to take with their food four ounces of madder-root. The
colouring matter of that substance was found to have passed from the
mother to the fœtus; as all the serum of the blood of the latter, the
urine, the liquor amnii, the teeth and the bones were tinged with it
(Dr. Mussy, 1829)[25]. In 1827, I undertook, at the request of Sir E.
Home, a set of experiments on the human subject, with a view to
ascertain the truth of my second position. Six gravid patients of one of
the lying-in institutions under my direction, who required the constant
use of aperient medicines, were instructed, towards the close of their
time of gestation, to take at night, for a period which averaged about a
week, from ten to fifteen grains of rhubarb in powder. After two or
three days the effect was visible in the colour and smell of the urine
of the patients previous to their confinement, and in one of them, in
the colour and smell of the transpiration also. During the labour care
was taken to preserve part of the amnionic fluid in a cup, the umbilical
vessels were suffered to bleed on the side of the child after their
recision, and the blood set apart so as to separate the serum, which was
obtained in small quantity only.—Lastly, the first urine of the child
was collected in sufficient portions. Each of these secretions appeared
distinctly tinged by the yellow root, and bore the smell of it. When
carbonate of magnesia was mixed with the fluids their colour became
lateritious, and a reddish sediment was thrown down, evincing the
presence of the drug which the mother had ingested. (MS. notes.)
ERRATA.
PROLEGOMENA.— Page iii, Prop. 20, _for reference_ (16), _read_ (17).
Page vii, Prop. 39, _for_ Haygton, _read_ Haighton.
———— idem, _for_ Embryoni, _read_ Embryonis.
Page viii, Prop. 46, 1st line, _dele_ (5).
PLATE III.— Page 9, Exp. of Fig. 13, _for_ membrane proper, _read_
membrana propria, and the same mistake occurs at pages
11, 14, and 26.
The following letter from the artist to whose skill and patience I am
indebted for the principal part of the engravings, and the entire
colouring of the present collection, is inserted in this place, with
the hope of increasing that confidence in the reader, with which it
is desirable that graphic representations of extraordinary or
anomalous objects should be received.
9, Warren Street, Fitzroy Square,
January 27, 1832.
DEAR SIR,
In sending you the last of the series of engravings on stone which I
have executed under your directions for your work on Abortion, &c.,
I cannot omit stating, that I have endeavoured, to the best of my
abilities, to copy in every instance and every minute particular the
anatomical preparations which you placed before me and explained to
me as I proceeded in my designs. The figures, in every case, have
been drawn of the natural size, and are perfect facsimiles of the
originals.
It gives me great pleasure to learn that they have given you
satisfaction, and I am not a little flattered at having been assured
by several medical gentlemen of eminence, who have seen my drawings,
that the manner in which they are executed, and the work altogether,
meet with their unqualified approbation.
I have the honour to be,
Dear Sir,
Your obedient servant,
JOSEPH PERRY.
To DR. GRANVILLE,
&c., &c., &c.
GRAPHIC ILLUSTRATIONS
OF
ABORTION
AND
THE DISEASES OF MENSTRUATION.
[Illustration:
Plate 1
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
EXPLANATIONS,
ETC.
PLATE I.
SPECIMENS OF VERY EARLY MISCARRIAGES.
Fig. 1. Ovulum bigeminum lanuginosum.
(Four weeks after menstruation.)
This twin Ovulum has lost its outer shell or _cortex_, within
which it originally made its way from the Ovarium into the womb.
The mossy or filiform vessels which, like an efflorescence,
surround the present surface of the Ovulum, are, as yet, deprived
of that extremely delicate membrane, which at a more advanced
period of utero-gestation will cover them, and dipping amongst
them, (after the fashion of the inner membranous envelope of the
brain,) will separate them into vascular groups or cotyledons,
having a single principal trunk in each, and many short and
tortuous branches besides, constituting the placenta.
The slit visible in one part of the Ovulum leads to a small cavity
from which the embryo escaped. In the second cavity to the left,
which is still intact, the embryo is visible when the Ovulum is
placed before a strong light.
Fig. 2. Ovulum semi-lanuginosum.
(Three weeks and a half after menstruation.)
In this specimen of an early miscarriage, the Ovulum exhibits the
filiform vessels as in No. 1; but one half of its circumference is
denuded of them, and the diaphanous involucra are distinctly
visible in that part. They are represented flaccid owing to the
escape of a part of the liquor amnii. In size the embryo (which
required to be viewed in a very strong light) resembled that of
No. 6.
Fig. 3. Ovulum lanuginosum.
(Three weeks after menstruation.)
A mossy Ovulum, shewing the inner or secreting membrane, within
which I could not discover any embryo at the time of the
miscarriage occurring. On searching among the coagula consequent
on a very extensive hemorrhage, the Ovulum was found flat, and
appeared like a confused mass. The liquor amnii had escaped, and
probably the embryo along with it. The artist has most skilfully
delineated the peculiar turns of the involucra where they have
been divided so as to display those marked inflexions which are
still more distinctly seen in No. 4.
Fig. 4. Ovulum semi-lanuginosum.
(Four weeks after menstruation.)
I look upon this as one of the most perfect specimens of
mono-embryoferous Ovula at four weeks, I have seen; exhibiting as
it does, not only the mossy or _nutritive_, but also the inner,
amnionic, or _secreting_ involucrum, with its peculiar inflected
turn, forming a _sacculum_ within which is lodged the embryo. The
nutritive involucrum is separated from the middle membrane by the
_allantoid_ cavity, and the middle membrane itself stands aloof
from the amnion, owing to the _vesicula umbilicalis_. The
existence of these various elementary parts of the human Ovum in
the present specimen, shews its early development, and serves to
fix its age, which I consider to be of about three weeks and a
half.
As gestation advances, some of those elements are obliterated, and
others confounded together.
REMARKS.
I imagine that these Ovula pass away from the womb almost
immediately after they have entered it, owing to a tardy or
deficient formation of that peculiar lining which the uterine cavity
begins to weave for itself from the first moment of a successful
copulation, and to some part of which the Ovula are destined to
adhere.
The preceding objects are represented of their natural size, and as
they lost their colour during the first maceration in water, owing
to the great readiness with which the mossy vessels discharge their
blood, the colour adopted in the Plate is that which they attain
afterwards, and such as it appeared when the artist sketched them.
They have in every instance been examined and dissected under water.
Such early Ovula are not rare. In the Museum of the Royal College of
Surgeons of London there are four such specimens, marked 3432—3—4—5
in red ink on the black varnished cover of the bottles[26]. In Sir
Charles Clarke’s collection there are also several. I have likewise
examined many of them in Meckel’s magnificent museum; but it is in
that of the late Professor Sœmmering that I have been gratified by
the sight of not a few beautifully prepared and arranged specimens
of this early stage of the human Ovum. Among them were the identical
preparations which he selected and arranged in a graduated series of
human embryos, and afterwards caused to be delineated and engraved,
for his valuable work entitled “_Icones Embryonum humanorum_.”
Fig. 5.
The rudiments of the embryo in this specimen are more than usually
diminutive, compared to the mass which constituted the entire Ovum
before it was flattened and pinned to a piece of blue pasteboard
placed in spirits within a glass jar. This preparation, now in the
museum of St. George’s Hospital, exhibits the transparent
involucra and the placental envelope with the intermediate
membranes, imperfectly developed, of an Ovum which I should judge
to have been fecundated about three weeks. At this period of
conception the embryo is generally straight, consisting of that
part which is to be the trunk, terminated, as in this case, by a
round swelling, which is the head. Here the embryo is in reality
straight, and has the appearance of a worm. It is attached to the
inside of the secreting membrane by its abdominal surface without
any visible cord. As illustrative, and that in a very distinct
manner, of this early stage of pregnancy, Fig. 5 is a valuable
specimen.
Fig. 6.
The same remarks apply to this as to No. 5. The embryo is somewhat
more clearly delineated. Its trunk is gently curved forward, and
the tubercular-like rudiments of the extremities appear visibly
marked. This circumstance denotes its age to be of five weeks.
The volume of the transparent involucra is disproportionate to the
embryo itself: yet the placental covering, with its filiform
vessels, bears a still larger proportion to them; so that the want
of equilibrium between the external and internal apparatus of the
Ovum has destroyed, first the growth, and next the life of the
embryo. The preparation is in the museum of St. George’s Hospital,
and like the preceding preparation (5), has been flattened and
pinned to a pasteboard—a mode which, for the _steady_ display of
the peculiarities of the Ovum in both cases, was, perhaps, the
most judicious.
Fig. 7. Ovum denudatum, or diaphanous Ovum.
(About eight weeks after menstruation.)
Its structure is imperfect. It wants the nutritive membranes or
involucra. It is defective also in the arrangement of the inner or
secreting membranes. Hence the great accumulation of fluid within,
and the scanty appearance of the filiform vessels without. The
embryo has consequently been retarded in its development, which is
scarcely greater than that of Ovulum No. 4, although the period at
which the former had been ejected, was nearly twice as long as
that of the latter.
Fig. 8, and 9.
Are also examples of denuded or diaphanous Ova, to which the same
remarks apply as to the preceding specimen. The enlargement of
Ovum 8 is even greater than that of Ovum 9: yet the embryo of the
latter is more advanced and more clearly delineated by nature than
is the case with Embryo 8. We know that these two Ova and No. 7,
are more than two months old from the length of the umbilical cord
as compared to that of the fœtus: for from the second to the sixth
month of pregnancy, the length of the cord is proportionately
greater than that of the fœtus.—(_See_ Meckel and others.)
In examining these denuded or diaphanous Ova, I have been struck
with that small circular spot on their surface, generally of an
opaque colour, which has been called the _cicatricula_, and is not
unlike that which is found in some of the Ova of birds. This spot
is well marked by the artist in the last three specimens, and in
two of the figures of _Plate 3_. I take the _cicatricula_ to be
that part of the _Ovulum_ which adhered to its ovarian nest
(called the _vesicula graafiana_), before it burst from the
Ovarium to pass into the womb consequently on fecondation. It is
to be seen on all the ovula so situated in the Ovaria of women,
and is considered to contain the rudiments of the embryo, which
certainly begin from a little straight line that may be distinctly
seen in the _cicatricula_.—(_See_ Meckel, Adelon, Geoffroy St.
Hilaire, Prevost, &c.)
REMARKS.
This class of human Ova throw no inconsiderable light on the
progress of fœtal intro-uterine life. They prove that the embryo,
called into existence by the mysterious act of fecondation (the only
point that _is_ mysterious about the process of generation according
to Cuvier) may, and will, and does live independently of the
mother,—with a life wholly its own, and that it derives from its
parent growth only, or accretion of substance, as I stated in my
preliminary observations. The museum of the Royal College of
Surgeons supplies a most striking illustration, and I may add,
corroboration of this opinion.
No. 3448 is a single spherical denudated diaphanous Ovum about six
inches in diameter, without the slightest appearance of any
placenta, filiform or cotyledonous vessels, or other of the
nutritive involucra or membranes. The secreting or amnionic
membrane, is capable of containing more than six ounces of fluid;
yet the embryo is not larger than an embryo at one month. When this
specimen was sent by Mr. Lugar, of Richmond, to the College, Mr.
Clift found it attached to a PLACENTAL OVUM, containing a perfect
fœtus of the proper size at four months and a half, with an
umbilical cord nine inches long. The attachment of the two or _twin_
Ova, was by a spot not larger than a shilling, which is still
visible on the smaller or diaphanous Ovum, and was of a bright red
colour at the time of separating the two Ova for the purpose of
making a distinct preparation of the more complete Ovum, marked in
the museum 3448 A.
It appears that the twin Ova were ejected together five months after
menstruation.
That the embryo in the smaller Ovum _lived_ is proved by its size as
well as by the secreting involucrum having enlarged with fluid to
the capacity afore stated. But it did not grow, because
_unconnected_ with the mother; while the twin fœtus properly
encircled by the placental envelopes, which placed it in immediate
communication with its parent, lived as well as acquired growth.
[Illustration:
Plate 2
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
PLATE II.
SPECIMENS OF MISCARRIAGES BETWEEN TWO AND THREE MONTHS.
Fig. 10. Ovum pyriforme externe opacum.
(Eleven weeks after menstruation.)
None of the transparent involucra were visible in this Ovum, when,
after excruciating and prolonged sufferings, it was expelled in
the intact state here represented. The external or placental
envelope invests the entire Ovum, and explains the cause of the
abortion. The artist has seized with much felicity the uneven and
almost cribriform surface of the fleshy envelope, exhibiting
numerous orifices, through which its adherence to the uterine
vascular lining, resulting from the act of fecondation, was
effected.
Fig. 11.
We here see the immediate and direct effects of the peculiarity of
an _entire placental covering_, as represented in the preceding
Ovum (10.). The secreting or inner involucrum (amnion) of that
Ovum, when laid open, was found tinged with blood and the cord
distended by the same fluid which pervaded also the _liquor
amnii_, as well as the fœtus itself. The morbid adhesions,
contracted by the middle membrane with the chorion in consequence
of plethora, are well marked in one part of the drawing by the
artist to whom I carefully dissected the preparation. The chorion
itself is in a morbid state.
Fig. 12. Ovum opacum plethoricum.
(Eleven weeks after menstruation.)
Placental or cortical covering, lying over three-fourths of the
Ovum. A pellucid membrane entirely surrounds the placental
covering to which it adheres. The chorion is thickened, and has
contracted morbid adhesions with the middle membrane. The
transparent or inner involucra are easily separated into four
laminæ, three of which belong to the middle membrane.—(Dutrochet.)
The liquor amnii was of a brilliant red colour—the cord large,
flattened, and the vein ruptured.
Here we see the same direct consequences from the same defects in
the structure of the Ovum which we noticed in Fig. 11. This
abortion was brought to me by a midwife immediately after its
expulsion. I carefully examined and dissected it, and before the
least change could take place in its parts or colour, it was drawn
by Mr. Perry (1827). No hemorrhage followed the expulsion of this
Ovum. The woman had had several children, and miscarried three
times between every two successful pregnancies; whereupon her
general health was greatly impaired.
REMARKS.
These two morbid Ova are represented of their natural size, and were
carefully drawn and coloured as soon after their expulsion as could
be accomplished. I believe they are unique of their kind. At least I
have not seen any such in the various collections I have visited:
neither do I think that they have been mentioned, still less
delineated, by any writer.
It is manifest, that under the various unpropitious circumstances in
which these Ova were placed, growth must have been materially
retarded and ultimately impeded; while life must have ceased
sometime before the Ova were expelled.
Judging from their size and the length of time during which they
lodged in the uterine cavity, these Ova must have acted the part of
parasitic animals upon that organ.
[Illustration:
Plate 3
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
PLATE III.
SPECIMENS OF MISCARRIAGE BETWEEN THE SECOND AND THIRD MONTH.
Fig. 13. Ovum semi-coriaceum.
(Nine weeks after menstruation?)
The external covering has been laid open. It is thick and fleshy.
A second or inner covering is observed equally dense in texture
and opaque; and a third involucrum, lying over the secreting
membranes, (which are seen through a wide slit, bearing at their
upper portion the filiform vessels,) is not only thick, like the
second involucrum, but is actually seen passing from the
transparent into the dense and opaque texture. The artist has
portrayed this circumstance most accurately in his engraving. The
placental cotyledons are at the posterior part of the figure,
mossy, in groups, and some of them covered with their _membrana
propria_. The embryo of this, and of Ovum 15, are not visible.
There can be little doubt but that intro-uterine inflammation,
extended to the involucra of the Ovum, has produced, first, its
morbid change of structure, and lastly, its early expulsion from
the womb.
Fig. 14. Ovum semi-coriaceum.
(Ten weeks after menstruation?)
This is somewhat larger than the preceding Ovum, although of the
same tissue and structure. The withered fœtus is visible through
the opening made in the secreting membranes, and the _cicatricula_
may also be perceived on one part of the inner layer of the middle
membrane, or involucrum, which lies immediately over the amnion.
I attribute both the structural condition, and the untimely
expulsion of the Ovum, to the same causes.
Fig. 15. Ovum omnino opacum, rotundum.
(After the lapse of three menstrual periods?)
The external covering, or _cortex_, is one twelfth of an inch
thick, with an uneven surface, having vascular orifices upon it to
the extent of about three fourths of that surface. The rest is
smooth, shewing that in that part, the Ovum had not contracted any
adhesion, by vascular connexion, to the inner cavity of the womb.
That connexion was accomplished by means of the placenta, which is
seen at the posterior part of the preparation, and appears quite
compact, and one twentieth of an inch thick, judging by the
portion which has been purposely laid open. It is through this
aperture that the _cortex Ovi_ is seen, as described above. On
removing a good portion of this thick cortex, a large cotyledon,
or group of vessels belonging to the middle membrane, is exposed
to view. The middle membrane itself is seen perfectly transparent,
and upon it the _cicatricula_.
I have been the more particular in designating this Ovum as
globular, because the fact of its having such a configuration
assists (with other circumstances) in proving that these solid and
thick general envelopes, found over human Ova expelled from the
sixth to the twelfth, and even fourteenth week, _cannot_ (as
pretended by some) be the so called caducous membrane of the womb.
We have here a thick and solid shell, perfectly round, closely
embracing in every part the lanuginous surface of the Ovum;
whereas the cavity of the womb is never otherwise than triangular
in its shape, or like unto a congeries of triangular vertical
planes, however much the organ itself may be developed. Nor could
any membrane (lining such a cavity) in detaching itself from its
walls, or falling off during abortion, surround in a globular
form, and in so compact a manner, the Ovum, as we see in the
present instance. Here again, slow, insidious, persisting
inflammatory action, must have done the mischief.
REMARKS.
The three preparations here represented of morbid human Ova, or
abortions, are in the museum of St. George’s Hospital, and belong to
Sir Charles Clarke’s collection. They admirably illustrate the
_morbid_ development of the external involucra. Although the
specimens retain scarcely any colour, (as is the case with most of
the morbid preparations not injected,) the artist was directed in
the choice of the colours applied to his drawings, by recent
specimens of analogous abortions, which offered themselves to my
attention in the exercise of my profession, during the six years
that he was engaged in the present work. I regret that I can procure
no data respecting the three abortions delineated in this Plate, nor
have I any positive knowledge of their age—but judging of the latter
by their appearance and from analogy, I affixed that age to them
which seemed to me the most probable.
There are many similar specimens in the museum of the Royal College
of Surgeons, and I have seen some in that of Professor Meckel at
Halle, and of the late venerable Professor Sœmmering, both of whom
honoured me with their friendship. In the first of these three
establishments there is a preparation which in many respects
resembles Ovum 14. It is marked 3447 and was presented by Mr.
Lawrence. Viewed externally, the Ovum in the latter case looks
almost sarcomatous. It has a triangular outline with two short
prolongations at each of the two upper angles corresponding with the
situation of the uterine orifices of the fallopian tubes. The inner
or transparent involucra of the Ovum (which is _bigeminum_) are
covered by the cotyledonous prolongations weaved into a general
placenta with its _membrana propria_, and a coriaceous envelope over
all. The internal cavity is laid open so as to exhibit an embryo in
each half of the Ovum, the one being double the size of the other.
The smaller embryo is about as large as a good-sized house-fly. The
cord of the largest embryo is nearly an inch and a half long,
sacculent, and expanding towards the abdomen so as to form the only
covering of that cavity. The cord of the smaller embryo is half an
inch in length and filiform.
I have before me two other specimens of the semi-coriaceous Ovum
obtained in cases of abortion which occurred in the course of my
practice last year: the one in June, the other in December. In the
first case the lady had had several live children, and had also
miscarried often before. In the second case the lady was
primiparous. Both suffered dreadfully—and it is to be remarked, that
the pains experienced by the patient during the process of this
species of miscarriage is always excessive, and the escape of the
Ovum generally followed by violent hemorrhage. Many years ago I
succeeded in saving the life of a patient of high rank, then in the
country, who was sinking under an almost total loss of blood,
consequent on a miscarriage of this kind, in which a large portion
of the semi-coriaceous envelopes had remained behind adhering partly
to the inner orifice of the womb, thereby producing and keeping up
the hemorrhage. In all these cases, the Ovum could not have been in
existence more than three months, reckoning from the cessation of
the menses. They were all nearly of the same volume, but the size of
the fœtus varied in proportion to the greater or less thickness of
the envelopes.
On examining that part of the anatomical collection of the Royal
College of Physicians, in London, which relates to these subjects, I
found a very interesting specimen of the globular and wholly opaque
Ovum, marked 7. G. No. 19. All the involucra, without any
distinction, adhere together most compactly, so as to form a species
of egg-shell of an equal thickness throughout; that thickness being
no less than one third of an inch. The Ovum resembles in size a
large duck’s egg, though more spherical than the latter.
The inscription on the label is, “A Miscarriage at Six Weeks”, but
the embryo appears of no more than four weeks’ growth.
[Illustration:
Plate 4
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
PLATE IV.
SPECIMENS OF MISCARRIAGE DURING THE THIRD AND BEFORE THE COMPLETION OF
THE FOURTH MONTH.
Fig. 16. Ovum pseudo-membranosum.
(Three months and a half after the cessation of the menses.)
There are not fewer than seven membranes, or involucra of some
sort or another, in this example of aborted Ovum. Its age is
unknown to me, as well as its medical history. I can only judge
from appearances, as the preparation speaks for itself. In one
point of view, more especially, is the present diseased Ovum
particularly interesting to me; for it exhibits the most distinct
proof that what I call the _cortex_ of the Ovum, and which others
have, without direct evidence, considered as a membrane of the
uterus, is, in good truth, a natural covering of the Ovum. It is
this very natural covering of the Ovum which is liable, from
disease, to become fleshy, opaque, vascular, and lastly
coriaceous, thereby cutting short the supply, or accretion of
substance to the fœtus, and thus destroying its life and producing
abortion. Were it not so, we should not observe, as in the design
before us, another membrane external to the one I allude to, as
seen at the bottom and on the right of the figure, which is the
true caducous or uterine membrane of authors. Its structure is far
different from the former; it is of a loose texture,—I was about
to say, almost gelatinous, or like a reticulated gauze.
The chorion, in this instance, is thickened nearly as much as the
_cortex Ovi_. A considerable space intervenes between those two
involucra; and within this thickened chorion a false membrane is
distinctly seen to surround the Ovum. The embryo is advanced to
about the third month, but retarded in its growth.
A specimen, analogous to the present, was deposited in 1817, by
Mr. Lawrence, in the Museum of the Royal College of Surgeons of
London, where it is to be seen marked 3437 C. The involucra are
coriaceous, but we have besides, over the nutritive membrane
(chorion), not fewer than three false membranes, the result of
_uteritis post conceptionem_. The fœtus has evidently been stinted
in its growth, and in size resembles a small insect.
REMARKS.
Instances of additional or pseudo membranes in aborted Ova are by no
means of unfrequent occurrence. On one of the shelves in the Museum
in Lincoln’s Inn Fields, I observed one marked 3443, in which a
pseudo membrane has formed externally to the placenta, pressing on
the cotyledons of the latter. The embryo is stinted. Upon another
shelf I find No. 3442, with the nutritive as well as the secreting
(amnion) involucrum thickened and pergamenous—the coat which they
form being one twentieth part of an inch in thickness. The amnion,
internally, is lined with a delicate pseudo-membrane. Here, also,
although the entire Ovum is of such capacity as to admit about half
a pint of fluid, the embryo has not acquired more than the size of
an ordinary house-fly. The placenta is compressed and covered by an
adventitious membrane, besides its _membrana propria_.
In Ruysch’s Thes. Anat. VI. Tab. II. Fig. 5, there is represented a
specimen of human Ovum, with a pseudo inter-membrane, not unlike my
present preparation; like it, too, it exhibits the cord hydropical.
Fig. 17. Ovum uviforme.
(In the third month after the suspension of the menses.)
A _uviform_ abortion is so rare an occurrence that when Mr. Clift
first saw the figure of it in the present work, he remarked that
it appeared more pictorial than true. The preparation, however, of
the size of the design, and as it was sketched by Mr. Perry in
1827, is still in my possession, and I hold it to be most valuable
on many accounts.
Under a _shower_ of minute grape-like or granular bunches, is seen
suspended that portion of a transparent Ovum, (exhibiting through
its diaphanous involucra an embryo bearing no proportion to the
magnitude of the Ovum,) which has been denuded of its nutritive
involucra. The latter are superimposed to the granular bunches,
and are curiously fringed at their margins. They are two in
number, and externally to them may be seen the loosely weaved
caducous membrane. During three months of utero-gestation, from
the moment of conception, has this mass lived—but the embryo has
not advanced from what it was at four or five weeks, nor could it.
The time was spent by Nature in playfully modelling, forming, and
cutting out what would almost appear an artificial plaything; so
fantastical it looks.
REMARKS.
There can be no difficulty in understanding how this curious
formation came about. The Ovum with its _cortex_ adhered to the
ceiling (fundus) of the womb, and contracted an intimate connexion
with that organ through its caducous lining. During the first weeks,
that external covering, _cortex_, or membrane, became fleshy and
vascular. Plethora took place in consequence, as we have seen in
some of the preceding cases of abortion; but, instead of an
increased secretion of amnionic fluid, as was the case in the Ova
denudata, or diaphanous, of Plate I., the effect has been a
dropsical bead-like enlargement of the mossy or filiform vessels of
the Ovum. In proportion as these advanced and enlarged, they
detached and forced outwardly the coriaceous envelopes, which began
to absorb at their inferior edges in that irregular progression
which left them as they are now seen, irregularly _echancrés_. This
process of absorption in the outer envelopes of the Ovum, from the
first to the fifth month, is what takes place generally, even when
they are not morbidly affected in their texture in the way in which
they are in the present instance, and is the process by which the
placenta is formed. But in order to effect this properly, the mossy
or filiform vessels, of nearly three fourths of the circumference of
the young Ovum should also become progressively obliterated; while
those which remain, mingling with the superimposed envelopes, swell
into large blood vessels to assist in the formation of the placenta.
Here, however, such a process was impossible, inasmuch as the mossy
or filiform vessels, having taken up a morbid action and become
distended with the serosity, which kept constantly pouring into
them, could not become absorbed to the extent required to form the
placental cake, but on the contrary continued to increase in size
and number. This operation took place at the expense of the growth
and life of the embryo, which is consequently seen to be stinted and
undeveloped. Abortion, therefore, was inevitable sooner or later.
The specimen is also valuable, as it affords positive evidence of
the mode in which the placenta is formed, for here we actually see
the process of absorption of part of the involucra, on which that
process depends.
Some who have seen this specimen, confound it with a case of
hydatous placenta; and a few similar preparations exist under that
name in more than one collection. It is evidently by mistake that
they are so styled, as we shall see in a succeeding Plate.
Professor CARUS of Dresden, (a name revered by anatomists and
physiologists,) here comes to my assistance. That accurate and
indefatigable observer, on submitting an entire Ovum, expelled
towards the sixth week of gestation, to a powerful microscope,
remarked that the greater number of the filiform vessels were
diaphanous as well as their ramifications, and that their free
extremities terminated into little roundish knobs, not unlike the
terminal bulbs of the villosities of the intestines. These bulbous
expansions of the filiform vessels of the Ovum adhered so firmly to
a superincumbent dense membrane (which Carus calls decidua, but must
be the _cortex_) that they could not be separated from it without
tearing some of them[27]. These very expansions, or roundish knobs
then, of the filiform vessels of the Ovum, are precisely those
which, from plethora of the involucra lying over them, acquired
what, in my specimen, I have called “a dropsical bead-like
enlargement,” as represented in figure 17 of an “Uviform Ovum.”
SOEMMERING has also noticed these terminal bulbs of the filiform
vessels, which he calls _noduli vel vesiculæ_, somewhat _like_
hydatids.
In questions of natural history, it is impossible to desire and meet
with a more satisfactory corroboration of the explanation of any
given fact, than the above observation of Carus affords to my view
of the conformation of the “Uviform Ovum.” Nor can a more convincing
refutation be required after it, of the doctrine of hydatids in the
placenta being the cause of that singular conformation.
There was but a trifling hemorrhage after the coming away of the
present Ovum, and scarcely any suffering. During the three preceding
weeks the patient had had some slight, colourless, and thin
discharge from the vagina.
[Illustration:
Plate 5
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
PLATE V.
SPECIMENS OF MISCARRIAGE BETWEEN THE THIRD AND FOURTH MONTH.
Fig. 18. Ovum coriaceum, cum hydrope funis et placentâ hydatica.
(Aborted at twelve or thirteen weeks?)
It is impossible to describe in words, better than Mr. Perry’s
pencil has done, the two lovely specimens consigned to this Plate.
The drawings speak for themselves. They convey, with a precision
which is one of the great merits of that artist, every minute
feature of two preparations calculated to afford a fund of
knowledge, on the subject of the formative process of the human
Ovum, for which we should look elsewhere in vain.
The nutritive involucra are fleshy or coriaceous. Bunches of real
hydatids hang pendulous from a part of their external
surface—while internally they are lined with the secreting
membrane in a morbid state, and that portion of the cord which is
farthest from the fœtus appears to be dropsical. The hydatids are
connected with the placenta. The fœtus is well formed, and in its
growth no impediment seems to have intervened.
REMARKS.
The contrast between this and the preceding Ovum, fig. 17, cannot
fail to strike my readers. In the present specimen we have the
regular involucra of the Ovum thickened around its whole
circumference; but the mossy or filiform vessels have disappeared
inside and out, being converted, in the latter situation, into the
placenta, and having become obliterated in the former. The placenta
(the intervening means of affording accretion of substance to the
fœtus by the mother) being once formed, the fœtus grew; but the
placenta at last was stricken with disease, (the hydatids,) and this
produced the dropsical swelling of the cord, which began to
interrupt the growth, and lastly destroyed the life of the fœtus. In
Ovum 17, circumstances are reversed. We have no regular placenta;
the coriaceous envelopes cover the dropsical bulbs of the filiform
vessels, and the growth of the fœtus is consequently checked at the
first onset.
Fig. 19. Ovum cum placentâ, nee vasculare, nec plenè cotyledonicâ, sed
filiforme. Amnion morbosum.
(Aborted at twelve or thirteen weeks after menstruation?)
Another of the manifold species of deviation from the natural
process of growth and development in the human Ovum. By its size I
should judge the fœtus to be about fourteen weeks old. About that
period the amnion became probably affected, and the life of the
child fell a sacrifice to that circumstance. That membrane is
translucid and of a brownish colour, thicker than usual, and in
parts nearly opaque. Next, (reckoning outwardly,) and separated
from the amnion, is another membrane, resembling closely that
which lines the outer-shell of a hen’s egg. No filiform vessels
appear on either of its surfaces. Between these two membranes a
third is distinguishable on the left of the opening made into the
Ovum, and the three are very well separated from each other. The
filiform vessels which connect the outer or third membrane with
the thick envelopes lying over it, are well marked in the drawing.
The placenta is amorphous—not local and defined, but general and
mossy. The umbilical cord is covered over by its membranes, lies
by the side of the fœtus, and is about twice its length, but
withered down to a bare filament. Yet the proper fœtus itself is
of fair growth and plump.
REMARKS.
One cannot help comparing together the two Ova, thus placed side by
side in this Plate. In the figure which represents a larger fœtus,
we have a smaller ovum altogether, and a smaller inner cavity; than
in the other figure representing a larger Ovum with a larger inner
cavity, from which has escaped a smaller fœtus. Yet I hold their
respective ages to be the same. This apparent paradox is to be
explained by a consideration of the difference of circumstances in
which the two Ova were placed. In Ovum 18, the disease was of slow
progress; the increase of the fœtus was retarded from the beginning;
and its life became extinct after the disorganization of the Ovum
had lasted some time: the appearances of the various parts of the
Ovum, as pointed out in my explanation of the figure, shew these
facts. In Ovum 19 there was nothing in the least analogous. Though
the placenta is imperfectly formed; even in its filiform or mossy or
primitive texture, it might serve and has served the purpose, of
forwarding the nutrition and growth of the fœtus. The disease which
destroyed the latter, being of an inflammatory nature, must have
been more rapid in its effect. It put an end to _life_ before there
could have been time for _growth_ to be much affected.
These facts and inductions may perchance be looked upon by some as
merely curious, or at most singular, without being useful. But I
think it will be found hereafter, unless I am much mistaken, that by
studying such facts and such inductions, as the consideration of the
human ovum in its many varieties of diseased development can afford,
we may expect no inconsiderable facility in the unravelling of that
mystery which yet hangs over the process of utero-gestation.
[Illustration:
Plate 6
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
PLATE VI.
SPECIMENS OF MISCARRIAGE BETWEEN FOUR AND FIVE MONTHS.
Fig. 20. Ovum tuberculosum.
(Aborted at four months and a half after menstruation.)
I do not apply to the term _tuberculosum_ the more usual meaning,
but by it I wish to imply that there are in the structure of this
Ovum a great many small swellings like tubercles, some of which
are larger than the rest, and not a few of them granular, while
others present a great variety in their configuration. All of them
have very prominent blood vessels running across their surface,
which, while the preparation was still very recent, exhibited a
very florid tint. In this state, the specimen was submitted to Mr.
Pearsall, late of the Royal Institution, who is very well skilled
in the art of sketching and colouring, and still more so in
science, and who undertook very kindly to draw it for me. The
drawing corrected by Mr. Perry, was afterwards transferred by that
gentleman on stone for the present work.
The tubercles are _sub-amnionic_, and the presence of these morbid
accretions will settle the question of the vascularity of the
inner, or as I call it, the secreting membrane (amnion) in the
human Ovum. That the transparent membranes of the human Ovum are
vascular, has been supposed from mere analogy to what we observe
in other viviparous animals, particularly of the larger class of
quadrupeds; but no proof has ever been adduced of the reality of
such a fact, for no anatomist ever succeeded in injecting the
supposed vessels of those involucra. What art has failed in
demonstrating however, nature has shewn quite manifest in its
career of disease. And thus it is that morbid anatomy, besides its
more direct effect of teaching us the nature of diseases, produces
the no less beneficial consequence to those who carefully
investigate it, of unravelling structures which from their
minuteness in the normal condition would have escaped detection.
Look at the figure of the fœtus in this Ovum, see how its growth
has been checked!—In size it represents an embryo scarcely five
weeks old—yet the Ovum came away at four months and a half from a
patient whom I was engaged to attend in her confinement. Examine
the cord; it is like the amnionic vessels, distended with florid
blood.
REMARKS.
In the knowledge of the doctrine of abortion and the treatment of
it, a preparation like the present is of infinite value. But this is
not the place to enter into practical views and details which are
reserved for my professed work on that subject.
I saw, on the 29th of May, 1828, in Sir Charles Clarke’s collection,
which was then in Mr. Stone’s possession, a specimen of tuberculated
placenta, larger than, yet in other respects similar to, my own. The
fœtus, however, was not of greater dimensions than the one in the
present figure. In the same collection there were two smaller
specimens of this identical disease of the human Ovum, very neatly
put up, one of which, like my own case, exhibits most distinctly the
injected state of the amnionic vessels. It was stated on the label
of the largest specimen, that the growth of the child had been
impeded by the pressure of the tubercles on the cord. This is not
apparent on examination of the preparation. The cause of that
impediment is manifestly the defective structure of the placenta.
The College of Surgeons possesses two specimens of tuberculated
placenta. One is small, marked 3443, (old series,) and placed in the
Gallery; the other, a very large specimen, is among the morbid
preparations in the body of the Museum, No. 983. (old series). The
latter was presented by Sir E. Home, who has entitled it a case of
_Cysts_ of the Amnion. On close examination it will be found that
these pretended cysts (or, as he has called them afterwards in a
printed paper, hydatids) are nothing more than elevations of the
amnion, beautifully exhibiting the vessels of that membrane,
elevations which are produced by no other process than the one
described below.
No. 3447 in the same Museum, demonstrates by another fact and
process the vascularity of the amnion. The case is one of twins,
aborted at about two months and a half. The fœtus in the one cavity
is as fully and properly developed as that in the other, and they
are separated by a translucid septum, formed by two layers of the
amnion. Into this septum, and not into the placental cake,
terminates the cord of one of the fœtuses, expanding itself on its
surface; while the cord of the other proceeds regularly to the
placenta. It is manifest, therefore, that the vessels of the amnion
must have carried blood to the umbilical vessels in the one fœtus,
as he was not in direct communication with the placenta.
The preparation before alluded to, as being in the collection of the
Royal College of Physicians, marked 7 G. 19, is another excellent
specimen of tubercular amnion. Denman has given us a very striking
example of this same diseased structure of the Ovum, which I
strongly suspect, must be a delineation of the largest specimen in
Sir Charles Clarke’s collection mentioned before. The fœtus, like
the one in the present plate, is small, and the cord inflated, but
the entire Ovum remained in the womb until the completion of the
ninth month.
All the tubercles of placentas which I have seen, were on the fœtal
and not on the uterine side of the membranes. They seem to be formed
by the enlargement of those filiform vessels which exist on the
inside of the same involucrum, (Chorion,) the outer surface of which
bears the mossy or filiform vessels, destined to group themselves
into cotyledons for the purpose of forming the placenta. When the
Ovum, after having lived and grown on its own life-principle,
through its journey from the Ovarian nest into the cavity of the
womb, has accomplished that connexion with the mother which before
did not exist, the filiform vessels on the inner surface of the
membrane in question, ought forthwith to begin to wither and be
absorbed. When this is not the case, and they on the contrary
enlarge, tubercles are formed, which are nothing else than
cotyledons, or groups or tufts of vessels, like those on the
external surface, and which push the innermost membranes, the amnion
in particular, forward, and give rise to congestion and diffusion of
blood.
Ruysch, who has published some engravings of this structural
deviation in the human Ovum, has accompanied them with an
explanation of its causes.
Fig. 21. Ovum pene-solidum; placenta sarcomatosa cum tuberculis
hœmatosis; involucra fœtûs solidificata.
(Gestation four months and a half?)
What havoc has disease effected in this Ovum! Scarcely can we
recognize a single element of its structure. The placental
covering is composed of many substances, has lost its spongy
vascularity—it has acquired several solid tumours, and is
altogether unfit for its intended function. The cortex of the Ovum
is fleshy; but within it a supernumerary fine membrane is seen,
which might, but must not, be mistaken for the chorion. The latter
involucrum, and the rest of the membranes within it, have become
compact, they adhere together, and form a solid whole, which has
scarcely the appearance of what it is—a human Ovum.
It is said to have been aborted in the fifth month of pregnancy;
yet the embryo that can lodge within so narrow a chamber can
scarcely have more than a few weeks’ growth. It is in Sir Charles
Clarke’s collection, and I am indebted to Mr. Stone for permission
to have it drawn by Mr. Perry, with three or four more specimens
contained in the present publication.
On the right of the drawing, the real extent of the thickening of
the external covering is not sufficiently denoted. There are in
the substance of
REMARKS.
Calculous, steatomatous, and solid placentas are not of unfrequent
occurrence in practice. I have seen several such cases. Sir Wm.
Blizard presented to the Royal College of Surgeons a very
instructive specimen of a human Ovum having a sarcomatous and
calculous placenta, which had been expelled at three months and a
half, by a patient who had miscarried three times within the three
previous months.
There is also in the same college a magnificent specimen of a solid
Ovum, of the size of a hen’s egg and shape. A small portion of the
_shell_ of this Ovum having been cut off, the embryo is seen, of the
size of a common fly, within the cavity, which may be just large
enough to admit the top of a man’s thumb. The ordinary involucra are
so compact, and so firmly adhesive to one another, that they cannot
be separately distinguished. The parietes thus formed are at least
one fourth of an inch in thickness. On the right of the inside of
the cavity there is seen a large swelling, which projects within the
said cavity, and is probably the receptacle of another embryo, or a
deposition of blood between what ought to be the translucid
membranes or involucra.
Sometimes the fœtus alone has been found to have become an
in-formed, hardened, or steatomatous mass. This is the case with a
preparation, a striking one, in the Museum of St. George’s Hospital,
midwifery division, marked F. 94. The fœtus, two inches long and
perhaps one inch in diameter, is converted into a solid mass,
retaining barely the outline of some parts of its form, with the
exception of the vertex of the head, which is clearly defined. The
mass appears to be steatomatous, and is suspended at a point
considerably below the centre, by a regular umbilical cord pending
from a large placenta, having the transparent and other involucra,
which are laid open for inspection. A minute dissection of these
various parts could not fail to throw considerable light on many
important points connected with the diseases of the human Ovum, the
fœtus, and its structure. At present the preparation is only
imperfectly instructive.
Fig. 22. Ovum cum involucris internis, ab amnionitide et chorionitide,
condensatis.
(Gestation, near upon five months?)
Here we have a specimen which will embarrass not a little those
writers in obstetrics who, either through respect for olden
authorities, or from habit, keep repeating what has been said
before them, respecting the structure of the human ovum. I will
describe the ovum as it stands before me this day, the 21st of
January, 1833, on which occasion I again compared it with the
drawing made some years before, and found the latter most
strikingly correct in all its parts.
Beginning externally, we find a thin pellicle, many fragments of
which are seen floating, covering the whole of the placenta, which
seems consolidated and to have been compressed. These parts are
not visible in the figure here represented, as they are placed at
the posterior portion of the specimen. From each side of, and at
the edge of the placental cake, comes a loosely-webbed,
semi-transparent, coarse membrane, in some parts porous, in other
parts opaque, which proceeds from _under the placenta_, and must
have embraced the entire ovum before it was laid open. This
membrane resembles that called _the caducous_,—and is in fact the
membrane marked as such in all the preparations of human Ova in
most obstetrical collections. Within this membrane we find
another, considerably thickened, which, judging from the several
portions that remain yet transparent, is actually passing from the
latter into the opaque state: it is bifoliated. Immediately within
the last-described envelope, and at the inferior part of the Ovum,
we observe a thick cake, which was probably extravasated blood: it
extends upwards on the right of the observer, getting less thick
as it proceeds. The cake itself, on the side next to the fœtus, is
lined, but loosely, by another bifoliated transparent involucrum,
held fast to the involucrum just described by filiform vessels,
which in some parts are distinctly visible even to the length of
half an inch, with a space of the same dimension between the
membrane and the cake before mentioned. The inside lining of the
whole is the amnion, from the upper and lateral portion of which
hangs an umbilical cord of three quarters of an inch in length,
with an imperfect fœtus the size of half a wasp, in which however
the rudiments of the abdominal extremities are quite distinct. The
whole Ovum measures four inches vertically, and three inches
transversally.
REMARKS.
That some of the involucra here enumerated are the produce of
inflammation and of diffused blood in consequence of it, I entertain
no doubt. The cake of blood between two of the involucra, the
variously shaped points of solid matter deposited in that
involucrum, which is actually passing from a transparent into a
thickened or opaque state, demonstrate in my mind the above
position, and prove, moreover, the vascularity of the secreting or
inner involucrum of the human Ovum. Again, look at the great
expansion of the Ovum and amnionic cavity compared to the size of
the fœtus. Could the great quantity of fluid contained in such a
cavity be otherwise than the result of inflammation of secreting
vascular membranes?
Another beautiful illustration of the amnio-chorionitis producing
thickening of those membranes, in an Ovum which contained a
well-formed fœtus at four months’ growth, and in which the placenta
is also condensed as if it had been artificially compressed, was in
my possession some years ago, and was accurately sketched and
coloured by Mr. Perry before it was pilfered from my collection. The
Ovum came away entire, having simply the two inner membranes and the
placenta,—from the edges of the latter hung fragments of a thicker
envelope—and from the external of the two pellucid membranes hung
some of those peculiar filiform vessels which are seen on the
chorion on Ova of very recent formation. In this specimen the amnion
was in some parts quite fleshy. I attended the patient, who
considered herself five months and a half gone with child.
I have likewise seen another striking case of amnio-chorionitis, in
a specimen marked F 84, in the museum of St. George’s Hospital,
midwifery division, which has produced thickening of the transparent
membranes and diffusion of blood throughout the Ovum, to the degree
that even after long maceration the red tint prevails throughout the
entire structure.
[Illustration:
Plate 7
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
PLATE VII.
SPECIMEN OF A MISCARRIAGE AT FIVE MONTHS.
Figura unica. Ovum fœtiferum optimè conditum, subitò ab
amnio-chorionitide interfectum.
I had an opportunity of satisfying myself most completely as to
the state and condition of this Ovum, it having been aborted at
more than four months and three weeks, according to the lady’s
reckoning, while I was in attendance upon her in consequence of
considerable flooding, which had been going on for some days, and
had preceded its expulsion. The Ovum came away entire; and through
that part of its envelopes which were transparent, the fœtus and
the liquor amnii appeared of a deep bluish red. The hemorrhage
ceased almost immediately after the ejection of the Ovum. The case
occurred in the spring of 1828. The lady had been ill from
inflammation in the chest, with cough and other symptoms of
pleurisy.
I carefully dissected and examined the Ovum, taking down the
various appearances as they presented themselves to view; and
having requested the immediate attendance of Mr. Perry, it was
sketched and coloured without loss of time, in order to avoid any
misrepresentation of parts or colouring.
The Ovum is perfect in all its parts, and has evidently progressed
through its successive changes and developments during the first
four months of gestation in the most satisfactory manner. The
fœtus is of the proper size for its age, and, judging from the
state of the cutaneous covering, appeared to have lived up to the
very latest hours antecedent to its expulsion.
The remarkable facts in this Ovum, in a physiological point of
view, are the number and arrangement of its envelopes; the morbid
state of some of them; and the effusion of bloody serum within the
cavity of the amnion.
Externally we find the placenta covering three-fourths of the
Ovum, pulpy, vascular, almost cotyledonous, and covered with the
_membrana proper_. It was gorged with blood. That portion of the
outer envelope of the Ovum which is not covered by the placenta,
seems to originate from the thinning edges of the latter, and to
be denser than usual. On being carefully divided and laid open, it
appeared bifoliated,—the laminæ are connected by cross filaments.
Within this, another membrane is seen, separated however by a
slight space which was occupied by effusion of bloody serum, and
is itself tinged with red. Next came two less dense and
transparent membranes, within which the fœtus lay coiled up,
immersed in a bloody fluid.
REMARKS.
In all probability we have had here first, an extension of the
complaint under which the mother laboured, (membranous
inflammation,) to the Ovum; next, an inundation of blood into its
internal cavities, through an engorgement of the placental
cotyledons. How to explain the actual facts presented to us by this
interesting preparation, in any other manner than what is here
suggested, I know not.
[Illustration:
Plate 8
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
PLATE VIII.
FIRST SPECIMEN OF ABERRANT FŒTAL GESTATION.
(EARLY PERIOD).
Figura unica. Ovum fœcundum in receptaculo ovarico.
Through a transversal aperture in the left Ovarium we see the
remains of some membranes, three in number at the least, lining a
cavity which measures transversely one inch and a quarter, and
about an inch vertically.
The membrane in contact with the parietes of the cavity is
pulpy—the other membranes are better weaved and clothy. The cavity
itself seems to occupy nearly the entire volume of the ovarium,
which is enlarged to nearly four times the size of the right
ovarium. The fallopian tube corresponding to the enlarged ovarium,
is not in the least involved in that enlargement, although it is
adhering to the periphery of its ovarium by a portion of the
fimbriated end,—the fimbriæ, however, being left free. We have
neither disease nor enlargement in the ovarium and fallopian tube
of the right side.
The uterus is larger than in the unimpregnated state.
Nevertheless, its triangular cavity does not appear to have
enlarged, in proportion to the general increase of volume, which
is rather due to a thickening of its walls. Amorphous and
flocculent depositions, in very moderate quantity, occupy a
portion of that cavity. They are not membraniform.
No filiform vessels are to be seen or detected on any of the three
linings of the Ovaric cavity.
REMARKS.
Sir Charles Clarke, who was kind enough to accompany me to the
museum of St. George’s Hospital very lately, and who greatly admires
the present drawing of his preparation[28], assured me, that a small
embryo hung pendulous from the yet visible rudiment of an umbilical
cord. That embryo, however, is not now to be seen. Sir Charles also
stated that the case which furnished this specimen was that of an
unmarried female, who acknowledged herself to be pregnant, and who
died from a natural disorder. On examining the uterine system after
death, with a view to ascertain the state of the parts under the
presumed condition of impregnation, the appearances portrayed in
this plate presented themselves to view,—certainly of sufficient
interest to be preserved.
Sir Charles does not recollect any account being published of the
Case; nor any other particulars.
[Illustration:
Plate 9
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
PLATE IX.
SECOND SPECIMEN OF ABERRANT FŒTAL GESTATION.
(MORE ADVANCED PERIOD).
Figura Præcipua. Ovum fœcundum in receptaculo tubico.
The uterus is about double the size of its unimpregnated form; but
neither the enlargement of its cavity, nor the shortening of its
cervix, corresponds to this general increase of outline, which is
due rather to the thickening of its walls. Nay, the cervix is
unusually long even for an unimpregnated uterus. In it, as well as
within the upper cavity, we observe some adventitious production,
differing so far from each other in appearance, that the one,
(that of the cervix,) is flocculent and of small texture; while
the other is composed of broken flakes, or thickish laminæ, of a
smooth, compact, suetty substance. This corresponds in its visible
character with the adventitious coating cast off by the uterus two
or three weeks after successful copulation, whenever the Ovum has
been blighted in its development during that period. In my
collection, in that of St. George’s Hospital, and of the two Royal
Colleges, there are specimens of this species of production, which
by most writers is looked upon as the decidua.
Proceeding with our description of the parts as they appear in the
preparation, we find that the middle third of the whole length of
the right fallopian tube is lacerated, being also in that part,
pouchy and larger than usual; that a fecundated Ovum is lodged
within the portion of the tube in question, which has acquired
sufficient development to shew all its component parts; and that a
fœtus with its navel string is contained within the transparent
membranes or involucra of that ovum. The membranes are two in
number, and as the drawing beautifully represents them, accurately
separated in the preparation. Now, according to the common
doctrine, the outer of these involucra, being the chorion, ought
to have the shaggy or filiform vessels which are said to
characterize that membrane. Nothing of the kind, however, is here
seen, nor any vestige of them. But externally to this outer
transparent membrane we have the cortex Ovi, which has contracted
adhesion by means of branches of vessels, indistinctly made out in
the preparation, owing to the dried clots of blood with which they
are interspersed. These clots of blood are the remains of the
accumulation of that fluid around the Ovum, which led to the
laceration of the tube, and with it to the fatal hemorrhage that
inundated the abdomen and produced death. I have not hesitated a
moment in colouring these clots as blood in the drawing, although
in the preparation, as is generally the case, they look brown
instead of being of a bright red.
Both ends of the fœtiferous tube are made to appear pervious, by
the insertion of bristles.
The rudiments of the inferior extremities in the fœtus are well
marked; the cord is of the length of the fœtus, which is itself
about half an inch long, and coiled up anteriorly.
Turning now the preparation to examine the ovarium of the same
side, as it lies open before us, we find the vesicula Graafiana
(the nest) from which the ovulum escaped into the tube, quite
evident. The centre of that nest, itself yellow in colour,
presents a white radiated _scar_ or cicatrix, which must have
formed subsequently to the escape of the ovulum, and during the
period between that escape and the death of the patient. This
yellow substance with its scar is the _corpus luteum_ of the
authors.
The left appendages of the uterus were sound.
The side figure represents a front view of the tubic seat of the
fœtus.
REMARKS.
I have ventured to rescue this interesting case, which my readers
will find most ably detailed by the late Dr. Clarke (a truly
philosophical obstetrician) in the first volume of the transactions
of the Society for improving Medical and Surgical Knowledge, from
the very imperfect and indistinct representation given of all its
most important details by the artist employed on the occasion. Three
plates accompany the original paper, professing to be delineations
of the preparation, as seen anteriorly, posteriorly, and laterally;
and I have no hesitation to assert, that the fine arts must have
been at a very low ebb indeed (as far as anatomical subjects are
concerned) in those days, if such were the productions of the pencil
and the graver at that time. When I say that it is next to
impossible to distinguish in the plates any of the parts referred to
in the narrative, and that the important details exhibited by the
preparation itself, are not only indistinct, but faulty and
deficient in design, I may be deemed to have advanced sufficient
grounds for offering to the public a far more accurate and perfect
picture of this highly instructive and almost proverbial case. Such
is my first reason for introducing it in this place. My second
reason is, that it is marvellously adapted to advance my object in
publishing the present graphic illustrations of abortion—for it
affords me not only some curious facts respecting the formation of
the impregnated Ovum, but also a contrast to the preceding and two
following species of fecundation _extra muros uteri_. Thus the
present work will contain a striking and well authenticated specimen
of each of the four kinds of impregnation that occasionally takes
place in some part or other of the uterine system of woman beside
its cavity.
Dr. Clarke’s preparation being still in existence, and in the
collection of his worthy successor and brother, I requested
permission to have a front and lateral view of it made by Mr. Perry;
and I fearlessly challenge a comparison, first between the old and
the present engraving, and next between these and the preparations
themselves, which may be viewed in the Museum of St. George’s
Hospital. I have described the parts as I found them in the
preparation in question, which I have again, for the fortieth time,
examined this day, January 23d, 1833.
Dr. Clarke, in his account of this case, says, that the substance in
the cervix was gelatinous in the recent state, and that within the
uterine cavity it is the decidua which we observe. The Doctor
afterwards remarks that such decidua is _always_ formed in the
cavity in question, whether the fœtus gets into it or not; but his
own description of another and even more important case of _tubic_
gestation, which occurred at St. Bartholomew’s Hospital and was
carefully examined by Mr. Abernethy, gainsays the assertion; for it
is there stated, “that in the cavity of the uterus nothing
remarkable was found”; and in my own case of Ovarian gestation, “no
production whatever” was found within the cavity of the enlarged
uterus.
From the state of the right Ovarium and the appearances and
situation of the corpus luteum, we gather two probable facts. First,
that the actual seat of the Ovulum is the place occupied afterwards
by the corpus luteum, which fills the vesicula Graafiana
considerably enlarged subsequently to fecundation. The fecundated
Ovulum escapes from the Ovarium by bursting through the coats of the
said vesicula Graafiana, which is generally found close to the
periphery of the Ovarium. Secondly, that the process by which the
breach made in the structure of the vesicle (or egg-nest) by the
escape of the Ovulum is restored, is cicatrization, and that much
time is not required for such a restoration.
Does not the first of these probable facts explain the acute pain
which many women feel in the course of the first week subsequent to
successful coition,—which some experience even for some time
after,—and which is by all assigned to that part, of one or the
other of the iliac regions, which corresponds to the situation of
the Ovarium? Indeed, I have known Ovaritis of a very serious nature
to follow shortly after impregnation.
[Illustration:
Plate 10
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
PLATE X.
THIRD SPECIMEN OF ABERRANT FŒTAL GESTATION.
(EARLY PERIOD).
Fig. 1. Ovum embryoferum in receptaculo interstitiale.
The uterus is enlarged in its general volume and appendages to the
size which it more commonly acquires at the second month of
pregnancy. The section of its coats shews their increased
thickness, and the many hundred orifices of its enlarged
blood-vessels. Within the cavity of the womb there was no vestige
of any ovum, but in its stead a spongious and woolly membrane was
found.
On the upper and outer surface or basis of the uterus, a swelling
of a red colour was observed, nearer to the left than to the right
side. It was richly streaked with blood-vessels, which gave it the
appearance of inflammation. Two lacerations had taken place in the
thinnest part of the coats of this eminence or tumour. These
lacerations led to a cavity or sac, or cyst, which contained an
embryo of from eleven to twelve weeks’ growth: it was regularly
enveloped within the two transparent membranes, on the external of
which the rudiments of a placenta were found. This embryoferous
cyst was separated from the real cavity of the womb; there being
no communication whatever between them.
The left Fallopian tube was impervious throughout its whole
length.
On opening the body of the patient, who had before borne three
children, and had also miscarried twice, and died when she
supposed herself two months gone with child, the cavity of the
abdomen was found filled with blood.
This case is related by Hendrick in the “archives”, by Horn,
Sept. and Oct. 1817; transmitted and vouched to Dr. Breschet
of Paris by Professor Carus of Dresden, who sent the drawing,
from a lithographic copy of which the present plate is taken.
Fig. 2. Ovum embryoferum in receptaculo interstitiale.
Uterus enlarged; more so on the right than on the left side. A
three-lobulated tumour or swelling of the substance of the womb
immediately above the insertion of the right Fallopian tube, and
on the external surface. Ulceration of the coats of this swelling,
which had taken place during life, exhibits to view an excavation
or cyst in the interstitial substance of the uterus, containing an
embryo which appeared to have acquired a growth of six weeks.
The cavity of the womb had no communication whatever with the
fœtiferous cyst. It was found lined with a woolly pseudo-like
membrane.
The internal or uterine orifice of the right Fallopian tube was
absolutely impervious: that of the left open; but the fimbriated
end of the latter was closed, and some serum was found within the
tube.
The patient had had several children before: the last time she was
pregnant she miscarried at four months. On the present occasion
she was not conscious of being with child, as she continued to be
regular every month; whereas during every preceding pregnancy her
menstruation had ceased. She felt better than usual on the day of
her death, soon after which, on opening the abdomen, the above
appearances offered themselves to view. There was a large quantity
of blood in the cavity of that region.
This case is quoted by Dr. Breschet from a memoir in the
Transactions of the Medico-Chirurgical Society of Vienna for
1801, drawn up by Professor Schmidt, and farther vouched by
Professor Carus.
REMARKS.
Cases of aberration in the first development and ultimate station of
the human embryo like these, were not known to science (according to
Dr. Breschet’s statement) before the two preceding instances were
laid before the profession. I selected them, therefore, on account
of their priority, from among the six cases collected by that
indefatigable and highly gifted anatomist, whom I am proud to call a
very old friend, in his memoirs on “A New Species of Extra-uterine
Pregnancy,” published in the first volume of a very valuable work,
edited by himself, Dupuytren, and others, in 1826, entitled,
“Repertoire General d’Anatomie et de Physiologie.” The facts are
singular, yet authentic in all their particulars. It is, therefore,
impossible to deny the existence of another distinct species of
pregnancy, _extra muros uteri_, in which the fœtus is lodged among
the interstitial elements of that viscus, and has no communication
whatever either with the cavity of it on the one side, or the cavity
of the abdomen on the other; unless ulceration or laceration take
place.
We may, therefore, reckon four species of erratic gestation,
namely:—
1. Gestatio Ovarica.
2. Gestatio Tubica.
3. Gestatio Interstitialis.
4. Gestatio Abdominalis.
The design of the parts, the statement of facts, and all the
particulars connected with such cases of gestatio interstitialis, I
give on the authority of the respective authors whose names I have
mentioned. It has never fallen to my lot to witness a single
instance of such anomaly in the mode of propagation of our species.
Of the six cases reported by Breschet, the last only fell
immediately under his care, at the Hôtel Dieu, in July 1825.
It is to be remarked, that in all these cases the uterus was found
enlarged, its cavity filled with some adventitious production of
variable texture and not always membranaceous, and the Fallopian
tube on the side next to the seat of the embryoferous tumour
invariably impervious. The mother dies from internal hemorrhage, in
consequence of the laceration of the coats of the cyst containing
the embryo. During life menstruation has ceased in some and not in
other cases of this description.
The reader will not fail farther to notice the very great difference
which appears manifest in the drawing of the present plate, and that
of the rest of the plates, from the hand of our artist. Mr. Perry
had, in this instance, a very inferior lithographic delineation of
the facts only to copy,—instead of having to imitate nature, as he
has done in every other instance. The consequence has been, that we
see but a feeble, and not always an intelligible, representation of
the several interesting points connected with these two cases, the
nature of which has been attempted to be explained by Breschet
himself, and Geoffroy St. Hilaire, in his report to the Institute of
France—but with indifferent success.
[Illustration:
Plate 10 (A)
(BEING PLATE VI. OF THE PHIL. TRANS. FOR 1820.)
]
PLATE X. (A).
(BEING PLATE VI. OF THE PHIL. TRANS. FOR 1820.)
FOURTH SPECIMEN OF ABERRANT FŒTAL GESTATION.
(ADVANCED PERIOD).
Fig. Duplex. Ovum fœtiferum in receptaculo ovarico.
Uterus considerably enlarged, so as nearly to have reached the
size which it is known to attain when bearing the produce of
conception between three and four months. Its parietes thickened
in proportion. The cavity free from either fluid or membrane, or
indeed from any adventitious production.
The left ovarium presented a large swelling, which contained
within its own outward covering an Ovum bearing a fœtus with all
its appendages, of about four months’ growth. The ovarian covering
burst in three places, and allowed the partial protrusion of the
ovum, whereby the adhesion of the placenta to the inner surface of
the ovarian envelope was torn asunder, and a sudden and fatal
hemorrhage took place, which destroyed the life of both mother and
child, and filled the cavity of the abdomen with blood.
The corresponding Fallopian tube was perfectly sound, and loose,
particularly at its fimbriated extremity, which had no connection
whatever with the embryoferous tumour in its neighbourhood. Like
its fellow tube, it was pervious only from its loose extremity
inwards to about half its length and no farther; nor were their
uterine orifices discovered.
REFERENCES TO THIS PLATE.
A. The uterus enlarged. B, its cavity, with a section of its
coats, a a, to exhibit their thickness; and b b, marking a cluster
of enlarged vesicles in and about the inner cervix of the womb.
C, is the right ovarium, having a singular long thread-like
appendix, c c, of a tendinous nature, which connected it with the
neighbouring viscera.
D. The Fallopian tube of the same side turned and fastened to the
womb by an adventitious band, the result no doubt of some previous
inflammation. Had conception taken place in the right ovarium, the
transmission of the ovulum through that tube could not have taken
place.
E E. The ligamenta rotunda dissected and truncated. The broad
ligaments were carefully removed, to free all the other parts from
every species of obstruction that might impede a proper
investigation of the nature of the case.
F. The Fallopian tube of the left side.
O O O. The left ovarium containing the fœtus.
P. Portion of the placenta visible.
1 2 3. The lacerations in the ovarian envelope, through which the
Ovum protruded. The omentum had contracted adhesions with the
tumour.
[Illustration:
Plate 10 (B)
(BEING PLATE VII. OF THE PHIL. TRANS. FOR 1820.)
]
PLATE X. (B).
(BEING PLATE VII. OF THE PHIL. TRANS. FOR 1820.)
Fig. Unica. Ovum ovaricum fœtiferum patefactum.
The cavity formed in the substance of the ovarium by the
progressive advancement of the fecundated ovum, is here laid open,
in order to exhibit how distinctly and perfectly the fœtus had, up
to the time of the death of the mother, found station, nourishment
and growth without the assistance of the cavity of the uterus, or
of those membranes which physiologists are wont to look upon as
essential to the development of the child in utero.
A placental mass with distinct cotyledonous vessels, connects the
child with the inner covering of the ovarian cyst. The secreting
or transparent involucra are quite distinct. The _cortex ovi_ is
almost wholly absorbed, as it ought to be at such an advanced
period. The fœtus is perfect.
REFERENCES TO THE PLATE.
A, the amnion. B, the chorion. C C C, the placental cotyledons. D
D D, fragments of the corpus luteum, which surrounded the ovum,
and was broken to pieces by the enlargement of the fœtus. Some of
these fragments adhere to the inside of the ovarian coat, others
are among the placental cotyledons. E E E E the covering or coat
of the ovarium; F the Fallopian tube, which passes behind the flap
of the ovarian coat thrown back. G the omentum, &c.
REMARKS.
The paper, accompanied by the drawings from which the Plates, (so
kindly lent me for my present purpose by the Council of the Royal
Society) were engraved, was transmitted by me to that scientific
body in June 1819; and was honoured with a place among the
Philosophical Transactions for 1820.
The drawings were made for the Royal Society, soon after the death
of the patient, by Mr. Bauer, under my inspection, and coloured by
him from the preparation, which has remained ever since in my
possession, and may be considered as perfectly unique. It is
sufficient to mention that gentleman’s name to vouch for the
accuracy of every part of this interesting representation. A case so
perfect, so indubitable, and so far advanced, of a fecundated
Ovarian Ovum had never been recorded before, and completely gainsays
the hasty, and I must admit, unwarrantable _dictum_ of a venerable
naturalist and philosopher whom I highly esteem, Geoffroy St.
Hilaire, who, in a report made to the Institute of France on the
subject of Breschet’s memoir, respecting the interstitial
extra-uterine gestation already mentioned, ventured to make the
following assertions, _six years after the publication_ of my
undisputed case of purely ovarian fœtiferous Ovum in the
Philosophical Transactions.
“Il n’y a _jamais_ de grossesse Ovarique, dans ce sens que le fœtus
_puisse se developer dans l’interieur de l’Ovaire_; on connaît des
cas de fœtus arrivé _sur_ l’Ovaire; mais très certainement l’ovule
en était sorti pour n’y rentrer, ni comme œuf, ni comme embryon.”
[Illustration:
Plate 11
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
PLATE XI.
A. DYSMENORRHOIC ORGANIZATIONS.
Fig. 1. Membrana pseudo-textilis intro-uterina bi-tubulata.
A pulpy tissue of a very loose texture, scarcely deserving of the
name of membrane,—of a bright red colour when thrown off by the
womb, but, soon after maceration in water, assuming a yellowish
tint, and appearing like a gelatinous, thickish, and translucid
web, the component molecules of which possess but slightly the
power of cohesion, being easily lacerated. Examined with a
powerful lens, it looks like a congeries of globules of gelatine,
arranged together into a flat, but not even surface. It possesses
flexibility, but scarcely any elasticity.
This tissue lines the womb; and the two superior tubes drawn up
vertically in the preparation are the prolongations of that lining
into the fallopian tubes.
It was thrown off in the case of a patient suffering habitually
from dysmenorrhœa, after acute pain; and on the third day of a
very scanty menstruation. The patient was not a married lady, and
under twenty-five years of age. The same production had been
observed on more than one occasion before by the attendant, but
not especially noticed until after I began to visit the patient.
Fig. 2. Membrana pseudo-textilis intro-uterina sine tubulis.
A pulpy tissue like the preceding,—rather firmer in its texture,
but presenting in every other particular the same characters.
This also must have lined the uterus; for it was pulled away from
the orifice of it, through which it was found to hang partially
during an examination made in consequence of sharp _forcing_ pains
being experienced the day after the complete cessation of the
menses. The patient, a married lady from Scotland, suffered
considerably at every return of the monthly period, and had done
so on the present occasion. She had had no children; and was
thirty years of age.
Here, there were no tubular prolongations of the lining, but two
apertures near to the upper margin of this _cloth_, with smooth,
rounded edges, as if they had corresponded with the uterine
orifices of the fallopian tubes. A similar aperture, considerably
larger, existed at the inferior margin; or rather, I should say,
that the inferior margin of the cloth, perfectly smooth, was drawn
round, so as to leave an opening in the centre, which must have
been placed over the internal orifice of the womb.
Both this, and the preceding tissue had one of their surfaces more
_lisse_ than the other.
B. POLYMENORRHOIC STRATIFICATIONS.
Fig. 3. Coagulum intro-uterinum hæmatosum pseudo-membranaceum incavum.
This sanguineous mass consists of a series of layers of the same
species of pseudo-textile membrane described at No. 1 and 2;
rather striated, neatly wrapt over one another, and easily
separable without laceration, until we come near to the nucleus,
where the layers are thinner and adhere more firmly together.
Some of these quasi-membranaceous wrappings are generally entire
at one of the extremities of the mass, and open at the other,
while two of the innermost are open at both ends, as if their
organization had been checked by the supervening of another and
external coating. This is properly marked by the artist on the
second membrane, reckoning from the outside covering.
The colour of the latter is most brilliant, and has been well and
correctly represented by Mr. Perry, from nature. The former, or
inner layer, is darker in places, not so gelatinous in appearance,
more distinctly striated, and puckered up superficially into
slender longitudinal ridges, giving it the semblance (in form
though not in colour) to a dry Egyptian date, or a very ripe
banana.
Fig. 4. Coagulum intro-uterinum hæmatosum laminare cavum.
There is no nucleus in this species of coagulum. In its centre, we
remark an oblong cavity, which extends nearly the whole length of
the mass, and remains partially open longitudinally. The walls of
this cavern are not thick.
Over the latter another coat is thrown, likewise open, the margins
of whose aperture do not reach those of the inner coat. Over these
again arrange themselves one, two, three, and sometimes more
stratifications of grumous blood, bearing a nearer resemblance to
fleshy laminæ than to membranes. Their colour is of a bright
vermilion, whereas that of the two innermost coats is of a dark
violet, while the central cavity itself has a perfectly dark tint.
Like the _coagulum incavum_, the present measures three inches in
length, is oblong, and rounded at both ends, one of which has an
open orifice not unlike that of the unimpregnated womb in its
configuration.
Fig. 5. Coagulum intro-uterinum spongiosum cavum interne velatum.
A spongeous substance, irregularly globular, flattened into a sort
of depression at one part, and terminated by a round teat-like
extremity at the opposite parts of its circumference.
Externally this coagulum might be taken for a cast of the interior
of the uterus about three weeks after conception. This resemblance
is even greater when the coagulum is cut into and laid open. A
cavity is then found of shape almost triangular, with an open,
smooth, and rounded orifice, the whole inside being lined by a
pellucid silvery-looking membrane, not unlike a serous membrane.
This membrane prolongs itself through the orifice, which it lines
also, and passing outwardly, goes to join and merges into the
coarser external covering of the coagulum.
A section of the walls of this intro-uterine mass, exhibits a
thickness of two fifths of an inch, studded with a vast number of
small apertures, not unlike a honey-comb. The colour of the
divided coagulum is of a bright vermilion, but the inside of the
several apertures is of a much deeper tint. The lining of the
cavity consists of a very fine pellucid whitish membrane, (as I
before stated,) which resting on a dark red, assumes in aspect a
lilac hue: while externally the mass presented a dirty brown
colour at the time of its coming into my possession, _immediately_
after its expulsion.
[Illustration:
Plate 12
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
PLATE XII.
(POLYMENORRHOIC STRATIFICATIONS CONTINUED.)
Fig. 1. Coagulum hæmatosum intro-uterinum internè solidum, externè
membranaceum.
An oblong mass, rounded at each extremity, one of which is more
tapering than the other, and is perforated by an external orifice.
Its whole length is 2½ inches, the difference in the circumference
at the two opposite ends is as 1:2. The orifice is puckered at its
edge: the colour of the mass of a marbled red.
This mass may be carefully unravelled in a weak mixture of alcohol
and water, when it is found to consist of several membranaceous
oblong pouches, placed one within the other, until we arrive at
the centre, which is found occupied by a solid black coagulum of
blood, perfectly homogeneous, friable when dried, shining in its
fracture, and leaving streaks of a brown red colour on paper, when
rubbed over its surface.
The appearance of the mass is here represented as it came away, of
its natural size and colour, and by its side is placed the same
mass after undergoing the process of careful separation of some of
its different investitures or coatings. It should be observed that
the orifice which exists at the pointed end of the external
membrane corresponds with a similar orifice in each of the
different subincumbent coverings. These, in their texture and
appearances, differ scarcely from the Dysmenorrhoic pseudo-textile
membranes described in a former plate.
C. pseudo-ova: molæ. (vulgo, false conceptions.)
Fig. 2. Mola Avellana tunicata.
A small, round, and oblong body, shaped not unlike a good-sized
Spanish nut, which it resembles in colour even, and smoothness of
surface. This led me to adopt the distinguishing appellative of
Avellana. It measures about one inch in length, and is wide at one
end and nearly pointed at the other.
When expelled it was covered by a tunic, which is easily detached,
and is tolerably flexible. The external surface of this tunic is
tomentose or lanuginous—the internal surface smooth, almost
shining, and in its centre pellicular.
The nut itself, or mole, being cut open longitudinally, exhibits a
cavity lined with a thin stratum of coagulated blood, interspersed
by pellicles in all directions. On examining the cut edges of the
mole, they appear to consist of at least three superimposed
layers.
There is no communication whatever between the internal cavity of
the mole and its surrounding tunic, and consequently none with
external objects.
Fig. 3. Mola Avellana nuda.
This is a smaller uterine production than the last, and it differs
also in one essential character, that of the surrounding tunic
being wanted.
In other respects the resemblance is perfect externally as well as
internally, and also with regard to the total absence of any
outlet from its interior. The coats are similarly constructed, but
the deposition of a bloody stratum on the inner surface is thinner
and smoother.
Fig. 4. Mola conchula.
It is the external tunic of this mole that resembles a little
shell, and which circumstance induced me to distinguish this
species of _Mola_ by the surname _Conchula_.
The mole itself is more like a small date, the well-known Egyptian
fruit. When just discharged it felt pulpy, yet firm, and I should
imagine, from the feeling it imparted to the fingers, that it
contained some fluid. That it has a central cavity there can be no
doubt, for when compressed, it immediately returned to its former
state as soon as the pressure was withdrawn. Having laid open so
many of these curious productions, I was unwilling to do so in the
present instance.
The tunic in this case was not cut open, but separated by a needle
in the direction of what appeared to be a _raphe_ or joint running
the whole length of the mass in a waved line. When the edges were
sufficiently parted, the _naked_ mole was withdrawn without much
effort.
Internally the tunic had a loose lining, dense, opaque, and
membranaceous, between which lining and the external coat of the
tunic a thin deposition of blood was observed.
Fig. 5. Mola Mytilus.
This is a highly interesting case of _Mola_, to which I have given
the designating appellative of _Mytilus_ from its suggesting, when
laid open longitudinally, the idea of that shell (muscle).
It is an oblong mass, broader at one end than at the other, as all
these productions of the uterine cavity are found to be. In its
external appearance it is fleshy, pulpy, of variegated tints even
at the very moment of its expulsion, irregularly smooth, and free
from any pellicle or membranaceous covering.
Internally it exhibits an oblong cavity, corresponding in figure,
relative breadths, and length to the containing mass, which looks
like a thick coagulum at the sectional edges. This cavity,
however, is not a mere hollow in the general mass, but looks like
an oblong membranous pouch imbedded in that mass. Its interior is
lined by an exquisitely delicate and almost fumiform
pellicle—lactescent or opalescent. The pointed extremity of this
cavity loses itself in the brilliantly red mass of the tapering
end of the mole, at neither of whose extremities is there the
least semblance of any aperture.
When I laid open this curious mole, its cavity contained a small
quantity of clear fluid.
REMARKS.
I have for a great many years past been in the habit of arranging
into three distinct groups all those adventitious productions, or
excretions of the uterine cavity, connected either with irregular
menstruation or faulty conception, which authors have described
under so many different names. I consider that all such productions
are either the result of an organizing effort on the part of the
uterus during painful menstruation, or a successive arrangement of
coagula of blood pending a profuse or critical menstruation; or
lastly a blighted ovum, passed as an originally-imperfect seed into
the womb from the ovarium, or which has become imperfect
subsequently to its reception within that organ.
To the first of these groups I have given the name of Dysmenorrhoic
organizations.
To the second the name of Polymenorrhoic stratifications.
To the third the name of Pseudo-Ova, or Molæ, including what are
vulgarly called _False Conceptions_.
In order to understand the first two appellations, it is necessary
that I should state in tills place that they are denominations
adopted by me, (in my work on Abortion and Menstruation,) to signify
certain modifications of the latter function, which have been
considered and treated as diseases, and as such variously
denominated by nosologists and others. In the work alluded to,
wishing to simplify as well as to rectify the uncertain and
incorrect nomenclature generally employed in such cases, I formed,
and have ever after used the following scheme of classification.
Menorrhœa, (the radical) Menstruation, from μὴν mensis,
ῥέω, to flow.
_A_-Menorrhœa, Suspended Menstruation, from α, privative.
_Dys_-Menorrhœa, Painful or Difficult Menstruation, from δὺς
difficult.
_Poly_-Menorrhœa, Profuse Menstruation, from πολὺ a great deal.
_Lego_-Menorrhœa, Ceasing, Decreasing Menstruation, from λήγω, to
cease.
_Allo_-Menorrhœa, Vicarious (erratic) Menstruation, from ἄλλο,
one for another.
Of these five modifications of the menses, the first four may
produce either organized substances, or stratifications in the
cavity of the womb; but those modifications, which more commonly
give rise to such productions are Dysmenorrhœa and Polymenorrhœa,
and from them, therefore, I have borrowed my denominations of the
groups.
Having said thus much as to generalizations, I come to speak more
particularly of the specimens which I have selected, with a view to
illustrate my groups. These, although not numerous, are the most
complete of their kind. They have in themselves all the generic as
well as the specific characters which distinguish them from every
other preparation. Few of those characters, perhaps one or two, are
to be met with in other specimens, but in that case the latter are
mere varieties of the species I have represented. Membranous
organizations,—coagula,—stratifications,—moles,—false conceptions,
may vary from one another in some slight point, so as to appear
different to different observers; but in the end, and in reality,
they can only be referred to the groups I have adopted, and to these
therefore I must take leave to adhere.
With respect to the pseudo-ova, or molæ, it would have been an
endless task had I attempted to transcribe the smallest part of the
long list which ancient as well as modern authors have drawn up of
such substances; or had I registered their singular names: most of
which imply some anatomical or physiological error. My scheme of
classification contains only four species, and I have limited myself
to that number because they are the most distinct forms of
pseudo-ova or moles I have seen in the course of twenty years’
practice. I have preferred giving them an unmeaning name,—one of
supposed resemblance to some well-known object,—rather than to run
the risk of misleading people by the use of denominations which must
give rise to false notions.
One word more by way of general remarks on these important points
before I conclude.
Almost every author who has written on the subject of moles, has
differed from his predecessor in the use of that term, applying it
to very different productions of the uterus. Some have
indiscriminately called by this name the polypi of the uterus;
hardened, soft or spungy coagula of blood; carneous masses expelled
by the uterus; diseased or deformed ova; and in fact almost any
thing in the shape of a mass that has come away from the genital
passages of a female after supposed conception, or subsequently to
parturition. To embrace so many different substances under one
general denomination, is surely wrong, (as Denman said,) and
accordingly we find such a practice condemned by many. But as the
difficulty of distinguishing a real mole from an organized coagulum
was supposed to be very considerable, no successful attempt was ever
made to prevent the confusion which ensues from that practice.
Denman himself, for instance, has not been very felicitous in
pointing out a distinction between a morbid ovum and a coagulum of
blood. That writer assumes that every mole, consisting of a decayed
ovum, will be found to present, “notwithstanding the external
appearance of a shapelessness of flesh, various parts of a child,
&c.,” and also that, “although a coagulum of blood long retained in
the womb, may, at the first view of its external surface, appear
like organized flesh, the internal part, if cut into, will be found
to consist merely of coagulated blood.” Now neither of these
positions is exclusively true, for, as may be seen by a reference to
plates 11 and 12 of this series, we have _organized_ coagula without
any nucleus of hardened blood, but on the contrary with a centre or
cavity lined by a membrane, on the one hand; and we have on the
other hand pseudo-ova, or real moles, entirely free from the
slightest trace of embryonic rudiment.
What then is the distinction between a real mole and a coagulum, no
matter of what species or variety the latter be? It is this: that
the former has invariably a central cavity wholly enclosed _without
any opening or aperture_; whereas the latter—let it be formed in any
way you please, stratified, laminated, concentric, membranaceous,
solid, hollow, or with a regular cavity lined by a membrane, no
matter,—will be found invariably to have at one of its extremities
_an aperture_, either leading straight into the inner cavity, where
such an one exists, or simply passing from one membrane or stratum
of coagulated blood to the next, until it reaches the innermost,
which is also perforated like the rest. This is a striking and
important distinction, and I am not aware that it has been noticed
or made public by any author before me.
Having been accustomed, for many years, to examine and compare
together every uterine production that came away during abortion, or
morbid menstruation, whenever an opportunity offered itself to me to
do so, either in public or private practice; I was led to make those
observations which enabled me to establish the above distinction,
and which have afforded me the advantage of selecting clear and
well-defined specimens of the two kinds of productions alluded to,
and of afterwards submitting them to the strictly correct copying
powers of Mr. Perry, the artist. The result of his accurate copies
from nature is registered in the present collection of plates.
I may add that such representations are not to be found in the
medical literature of either this or of any other country; and that
I hope they will be the means, (even if they should fail to do any
other good,) of preventing the recurrence of erroneous opinions,
which lead to injurious aspersions, and often fatal conclusions.
I need scarcely repeat, at the conclusion of these Explanations, that as
the plates are illustrations of the views I entertain respecting
abortion, and the diseases incidental to menstruation, formed in the
course of, and corroborated by, twenty years’ experience,—the result of
which experience I have embodied into a large volume preparing for the
press; all the cases which relate to the individual delineations given
in this collection of plates, will be found detailed in that work,
particularly those connected with the specimens of dysmenorrhoic
organizations, polymenorrhoic stratifications, and pseudo-ova.
END.
☞ The Work, in connection with the present Graphic Illustrations,
which the Author has been preparing for the press since the year
1826, and to which allusion has been made in the course of the
Explanations to the Plates, will be published without delay,
entitled as follows:
ON
=ABORTION=
AND
THE DISEASES INCIDENTAL TO
=MENSTRUATION;=
PRACTICAL COMMENTARIES
BY A. B. GRANVILLE, M.D. F.R.S.
ETC. ETC. ETC.
An Octavo Volume of about Five Hundred Pages.
CONTENTS.
PRELIMINARY REMARKS.
FIRST COMMENTARY,
ON ABORTION.
EIGHT SECTIONS.
Sect. 1. Literary and Medical History of Abortion.
—— 2. Definition of Abortion, and mode in which it takes place.
—— 3. Classification of Abortions.
—— 4. Frequency of Abortion.
—— 5. Abortions in Biparous Gestation.
—— 6. Diagnosis and Prognosis in Cases of Abortion.
—— 7. Treatment of Abortion.
—— 8. Moles and False Conception.
APPENDIX. —VARIOUS JURIDICAL QUESTIONS RESPECTING ABORTION.
SECOND COMMENTARY,
ON MENSTRUATION (MENORRHŒA) AND ITS DISEASES.
FIVE SECTIONS.
Sect. 1. Literary and Medical History of Menstruation.
—— 2. Physiology of Menstruation.
—— 3. Experiments on the Menstrual Fluid.
—— 4. Enumeration of the principal Diseases attendant or consequent
on Menstruation.
—— 5. Precautions to be adopted in regard to Menstruation.
THIRD COMMENTARY,
FEVERS OF MENSTRUATION.
FOURTH COMMENTARY,
A-MENORRHŒA,
(TARDY, CHECKED, OR TOTALLY INTERRUPTED MENSTRUATION.)
Sect. 1. Its definition.
—— 2. Treatment.
—— 3. Cases.
FIFTH COMMENTARY,
DYSMENORRHŒA,
(DIFFICULT, OR PAINFUL MENSTRUATION.)
Sect. 1. Its definition.
—— 2. Treatment.
—— 3. Cases.
SIXTH COMMENTARY,
POLY-MENORRHŒA,
(INORDINATE—PROFUSE—HEMORRHAGIC MENSTRUATION.)
Sect. 1. Its definition.
—— 2. Treatment.
—— 3. Cases.
SEVENTH COMMENTARY,
LEGO-MENORRHŒA,
(CEASING OR RETREATING MENSTRUATION; AT THE CRITICAL AGE.)
Sect. 1. Its definition.
—— 2. Treatment.
EIGHTH COMMENTARY,
ALLO-MENORRHŒA,
(TRANSFERRED, ERRATIC, OR VICARIOUS MENSTRUATION.)
Sect. 1. Its definition.
—— 2. Treatment.
CONCLUSION.
G. Woodfall, Printer, Angel Court, Skinner Street, London.
-----
Footnote 1:
Professor Boer, who fills the Chair of Zoology at Kœnigsberg, is a man
of undoubted veracity, a keen and accurate observer, and has been
engaged for many years in the investigation of that most interesting
function—reproduction—in mammiferous animals. He made a great number
of minute and extremely delicate experiments and microscopical
observations on animals and the ovaria of women, which led him to the
conclusions I have embodied in my propositions, and which he forwarded
in a Latin epistle, entitled “De Ovi mammalium et hominis genesi”, to
the Imperial Academy of St. Petersburgh, with a plate, carefully
engraved, representing all the details above alluded to. These he
afterwards, and within the last four years, enlarged upon very
considerably in a subsequent publication.
Footnote 2:
If the reader can procure a placenta which has been thrown off
immediately after the birth of the child, without any effort, and
cleaning it of all coagula from off the surface which lay next to the
uterus, by careful maceration and washing, he will afterwards
introduce a small quill or pointed tube into one of the arteries of
the navel-string, and blow strongly into it, he will find that the air
raises upon that surface, to various degrees of puffiness, a very
delicate pellicular covering, through which none of the air can
escape, unless through an accidental laceration. I have often made the
experiment, which I used to relate to my class in my lectures on
midwifery many years ago. Lauth, of Strasburgh, has stated the same
thing; so had Ruysch long since, and others, proving at once that
there is not a direct communication with the mother from the fœtus.
Footnote 3:
It has hitherto been supposed, and Dr. Hunter first gave rise to the
opinion, that on reaching the uterine orifice of the tube, the ovulum
found an obstacle in the presence of the inner lamina of the
_decidua_, which latter is said to be projected across that orifice.
This obstacle the ovulum overcomes, Dr. Hunter _supposes_, by pushing
the said lamina forward, and following it close, so at last to make
good an entrance into the womb, surrounded by this inner lamina of the
decidua, which the ovulum compels to enlarge with its own gradual
enlargement, until both fill the entire cavity of the uterus, and the
inner lamina of the decidua comes in contact with itself. It is
impossible to conceive a more improbable operation, or one more
contrary to facts. Yet such is the notion formed by Hunter of an
imaginary membrane, to which he has given the name of reflected
decidua; and so enamoured was he of this notion, that he has not
hesitated to portray in his large work on the gravid uterus a section
of the womb at several weeks after conception, (again purely
imaginary,) representing things as he supposes them to be in regard to
that membrane! Hunter’s notion was gradually converted into an
opinion, which most of his successors have repeated over and over
again, out of respect for him, and without ever inquiring
experimentally into the correctness of it. No one has advanced a
single fact to prove it. There is no such a thing as a _decidua
reflexa_. The improbability of such a process as has been imagined to
account for its supposed existence, has been demonstrated very
adroitly by Dr. Dewees, as skilful and clear-sighted an obstetrical
writer, of the United States of America, as any that have appeared in
Europe. (Comp. of Midwifery, 1824, page 66.) He there shews, that if
we adopt Burn’s description of the _decidua reflexa_, given by that
author in a tone of positiveness, as if Hunter’s notion was a
mathematical proposition, either that membrane must have three,
instead of two, laminæ, as admitted by them, or it must have even a
fourth lamina, namely, one more than has ever been imagined by any
body. But the truth of the non-existence of a membrane formed in the
manner in which the _reflexa_ is said to be formed, is proved by
actual facts. A few will suffice. A specimen of an impregnated uterus
marked 3468 C. Gallery, Coll. Surg. of London, exhibits distinctly a
round ovum naturally suspended within the decidua, as a globe may be
supposed to hang from some point of the inside of an oblong sack. Here
the ovum has pushed no part of the uterine decidua forward. The ovum
has only its natural involucra, and there is a large space between
them and the deciduous lining of the womb. In Dr. Agar’s case, alluded
to before, in the Museum of the R. C. of Physicians, (impregnated
uterus 2½ months,) no decidua reflexa is seen. Specimen 73, in Sir
Charles Clarke’s collection, exhibits an ovulum which has already
penetrated about an inch into the cavity of the uterine decidua,
without pushing any part of it forward. Specimen 75 in the same
collection is another illustration of the same fact. In good truth,
the existence of the decidua reflexa is disproved by facts, and is
moreover rendered inconceivable and inexplicable by the very account
and explanation given by those who contend for that existence. It is
now scarcely admitted by one out of ten Continental anatomists.
There is another physiological fact which we have overlooked—it is
this: That the uterine decidua is always pervious at the uterine
orifices of the fallopian tubes, as well as over the internal orifice
of the cervix uteri. The error thus signalized has arisen from not
knowing that the ovulum comes from the ovarium with a _cortical
membrane_ over the shaggy chorion. It is curious to see how, even
among some of the most skilful of the modern physiologists, their
ignorance of the existence of a _cortex ovi_ has misled them in their
respective descriptions of the decidua or uterine lining. Carus, for
example, has asserted, that the decidua uteri had an opening over the
internal orifice of its cervix. Velpeau and Breschet have denied this
to be the fact, and consider the decidua to be a complete sac, to
which they have ascribed the functions of a serous membrane. Professor
Heusinger confirms the opinion of the two French authors, but denies
that the decidua is a serous membrane. The truth lies between: Carus
described the real decidua, which has three apertures; while Breschet,
Velpeau, and Heusinger evidently refer to the cortex ovi which has no
aperture whatever, when the ovulum enters the cavity of the womb. Well
might Meckel exclaim, “il n’est pas très facile d’expliquer le mode de
formation de la caduque reflechie.” (See specimen 73, 75, 76, 87,
Museum of Sir Charles Clarke.)
Footnote 4:
It is impossible to desire a stronger or a more beautiful illustration
of the modern theory of fecundation, than we find in the preparation
here alluded to. It is the impregnated uterus (between two and three
months) of a female who died of hydrophobia. Both the ovaria are laid
open. In the left there are no appearances, beyond the Vesiculæ
Graafianæ hardened by the alcohol: but in the right, namely, the
ovarium of that side on which it is supposed that the fecundated
Ovulum entered the womb, (from the circumstance of the placenta being
implanted in that quarter,) we find not only a scar still red on the
surface of the ovarium, but corresponding with it, and beneath it, in
the thickness of the ovarium, a large shallow depression or hollow
from which the Ovulum had escaped, and which is beginning to fill with
the substance that is to constitute the corpus luteum destined to stop
up the gap in the ovarium.
Footnote 5:
Meckel, with many others, entertain still the opinion that the corpus
luteum precedes fecundation—but instead of supposing with Sir E. Home
that it generates an Ovulum, the physiologist of Halle imagines that,
like a _testis_, it serves to secrete a generating liquor—the semen
feminæ. This theory is demolished by Boer’s, Plagge’s, and Messrs.
Prevost and Dumas’s positive observations.
Footnote 6:
This disparity has not been noticed before by writers. Like many other
circumstances, it militates, not a little, against the theory of the
decidua reflexa.
Footnote 7:
Dr. Pockels calls this the Decidua—but in good truth it is the _Cortex
Ovi_—for this good reason, that at so early a period, and even as late
as the end of the first six weeks, the Decidua is many times larger in
capacity than the ovulum, and is never globular like the latter.
Besides, when Ovula of such early periods are thrown out, the decidua
remains behind, and is ejected in its triangular shape, a little
while, and sometimes even a day, after. In other respects, Dr. Pockels
confirms _Boer’s_ more precise description of the “_Structure of the
Ovum_.”
Footnote 8:
The whole of the English physiologists, writers on midwifery, and
lecturers, whether ancient or modern, are entirely silent on this
important stage of embryonic life. They have talked rather loosely on
the subject without the species of life which he must suppose the
embryo to enjoy. He tells us, that even at the end of three weeks the
Ovum is not found in the uterus, but how it exists during that period,
wherever it may be, he has not even alluded to a single reference to
facts or anatomical remarks of their own. Burns, in his work on
abortion, never once alludes to
Footnote 9:
See a very interesting paper on the Structure of the Human Placenta,
by T. Radford, Surgeon, &c. Manchester, 1832.
Footnote 10:
I shall submit to the Profession these curious and interesting
experiments very shortly.
Footnote 11:
Autenrieth, in his “Supplementa ad Historiam Embryonis Humani”, has
given the dimensions of the embryo and fœtus from a week to the 126th
day of growth, with a description of the several parts as they appear
at each period. From these he has drawn several conclusions respecting
the growth of the human fœtus which have been generally adopted.
Soemmering, in his “Icones Embryonum Humanorum,” has also given the
dimensions of the human fœtus, from the earliest period he has seen it
to its full maturity, with plates.
Footnote 12:
“Caput nutans per omne tempus quo in Ovo continetur.” And again,—“Quò
junior embryo, eo major est volumen capitis.” (Soemmering.)
Footnote 13:
This doctrine has been controverted by two more recent
experimentalists, Prevost and Dumas, as far as the chick is concerned.
They assert that the rudiments of the spinal marrow appear before any
other important organ.
Footnote 14:
In describing the figures in Plate I. under the head of “remarks” it
is to be understood that by the expression of “the mossy vessels
discharge their blood” is meant that they present themselves,
immediately after the expulsion of the Ovulum, with very feeble tokens
of the presence of blood at that early period of gestation.
Footnote 15:
The consideration of the development of the human embryo in its
minutest parts, progressively watched and carefully examined and
described, as those parts appear in succession, appertains to
transcendant physiology, and would be out of place in these
Prolegomena to a work which is intended to supply my brethren with
practical information, obstetrical as well as medico-forensic. It is
sufficient for my purpose to mention (as I have endeavoured to do) the
forms which the fœtus presents, its different sizes, and the weights
which correspond with those forms. To those of my readers who take an
interest in embryogenesy, I recommend the careful perusal of the
various continental modern authors repeatedly named in these
Prolegomena. Unfortunately, since Hunter and Home, there has not been
a single British practical and experimental physiologist who has
investigated this subject either originally or otherwise. This fact,
not at all flattering to us, is no where placed in so strong a light
as in Breschet’s very erudite and classical memoirs, entitled “Etudes
anatomiques, physiologiques et pathologiques de l’Oeuf duns l’Espèce
humaine” which that indefatigable inquirer has enumerated and analyzed
every statement and experiment made on that subject by upwards of
thirty physiologists, down to the present day; among whom there is
not, since Hunter and Home, a single English name besides that of Dr.
Burns, recorded.
Footnote 16:
See Journal Complementaire, Vol. 6. p. 375.
Footnote 17:
I possess a placenta exhibiting these appearances (78, 79) in so
distinct and beautiful a manner, that it would be a violation of truth
and sincerity, or a sure sign of ignorance, to state that they do not
properly resemble those which are observed in the Chorion of some of
the mammalia. Those are cotyledons. So are these. I shewed the
preparation to Dr. Hugh Ley. He was delighted with it, and instantly
admitted the similarity in question.
Footnote 18:
Observations relatives à la Géneration. Par F. Lallemand. Paris, 1818.
Footnote 19:
Precis Elementaire de Physiologie, 2d edit. Paris, 1825.
Footnote 20:
Dr. Hunter on the Placenta. In Gravid Uterus, page 43, 9th edit. 1794.
Footnote 21:
A complete ovum, with the investing cortical membrane, and the entire
decidua expelled nine weeks and three days after the last regular
menstruation, in the case of a lady recently married, whom I attended
(March, 1833), has afforded me ample opportunity of verifying the
above and most of the previous propositions, through a careful
dissection of the parts under water, and the use of the microscope.
Footnote 22:
MS. Lectures of Dr. Hunter, taken by John Sheldon, 2 Vol., formerly in
the possession of Joshua Brooks, Esq. and now before me (Vol. II. page
485).
Footnote 23:
Communicated to the Philomatic Society of Paris, 1830.
Footnote 24:
Memoires de la Societé de Physique de Genève, T. IV. part 1.
Footnote 25:
American Journal of the Medical Sciences, Nov. 1829.
Footnote 26:
I am thus particular, because there is a second and even a third
series of numbers in this collection, which are differently marked on
the preparations and in the MS. lists, although belonging to the same
specimens. This confusion which has crept in, in spite of Mr. Clift’s
vigilance and endeavours to prevent it, will disappear as soon as that
skilful naturalist shall have been able to complete the laborious task
of making a catalogue _raisonné_, of the museum.
Footnote 27:
See SIEBOLD Journ. für Geburt Shülfe 1827. T. VIII. p. 1–11.
Footnote 28:
The Cases to which this plate refers occurred in the practice of
Sir Charles Mansfield Clarke, Bart., many years ago.
------------------------------------------------------------------------
TRANSCRIBER’S NOTES
1. P. 40, changed “Il n’y a _jamais_ de grossesse Ovarique, dans ce
sens que le fœtus _puisse se developper dans l’interieur de
l’Ovaire_; on connaît des cas de fœtus arrivé _sur_ l’Ovaire; maîs
très certainement l’ovule en était sorti pour n’y rentrer, ni
comme œuf, ni comme embryon.” to “Il n’y a _jamais_ de grossesse
Ovarique, dans ce sens que le fœtus _puisse se developer dans
l’interieur de l’Ovaire_; on connaît des cas de fœtus arrivé _sur_
l’Ovaire; mais très certainement l’ovule en était sorti pour n’y
rentrer, ni comme œuf, ni comme embryon.”.
2. Made the corrections indicated in the ERRATA.
3. Silently corrected typographical errors and variations in spelling.
4. Retained anachronistic, non-standard, and uncertain spellings as
printed.
5. Footnotes have been re-indexed using numbers and collected together
at the end of the last chapter.
6. Enclosed italics font in _underscores_.
7. Superscripts are denoted by a caret before a single superscript
character, e.g. M^r..
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