Chapter III: Part 3

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.

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.

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.

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.

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.

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.

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.

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.

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.

Plate 10 (B)