Chapter II: Part 2

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.

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.

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.

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.