Chapter IV: Part 4

(BEING PLATE VII. OF THE PHIL. TRANS. FOR 1820.)
]

PLATE X. (B).
(BEING PLATE VII. OF THE PHIL. TRANS. FOR 1820.)

Fig. Unica. Ovum ovaricum fœtiferum patefactum.

The cavity formed in the substance of the ovarium by the
progressive advancement of the fecundated ovum, is here laid open,
in order to exhibit how distinctly and perfectly the fœtus had, up
to the time of the death of the mother, found station, nourishment
and growth without the assistance of the cavity of the uterus, or
of those membranes which physiologists are wont to look upon as
essential to the development of the child in utero.

A placental mass with distinct cotyledonous vessels, connects the
child with the inner covering of the ovarian cyst. The secreting
or transparent involucra are quite distinct. The _cortex ovi_ is
almost wholly absorbed, as it ought to be at such an advanced
period. The fœtus is perfect.

REFERENCES TO THE PLATE.

A, the amnion. B, the chorion. C C C, the placental cotyledons. D
D D, fragments of the corpus luteum, which surrounded the ovum,
and was broken to pieces by the enlargement of the fœtus. Some of
these fragments adhere to the inside of the ovarian coat, others
are among the placental cotyledons. E E E E the covering or coat
of the ovarium; F the Fallopian tube, which passes behind the flap
of the ovarian coat thrown back. G the omentum, &c.

REMARKS.

The paper, accompanied by the drawings from which the Plates, (so
kindly lent me for my present purpose by the Council of the Royal
Society) were engraved, was transmitted by me to that scientific
body in June 1819; and was honoured with a place among the
Philosophical Transactions for 1820.

The drawings were made for the Royal Society, soon after the death
of the patient, by Mr. Bauer, under my inspection, and coloured by
him from the preparation, which has remained ever since in my
possession, and may be considered as perfectly unique. It is
sufficient to mention that gentleman’s name to vouch for the
accuracy of every part of this interesting representation. A case so
perfect, so indubitable, and so far advanced, of a fecundated
Ovarian Ovum had never been recorded before, and completely gainsays
the hasty, and I must admit, unwarrantable _dictum_ of a venerable
naturalist and philosopher whom I highly esteem, Geoffroy St.
Hilaire, who, in a report made to the Institute of France on the
subject of Breschet’s memoir, respecting the interstitial
extra-uterine gestation already mentioned, ventured to make the
following assertions, _six years after the publication_ of my
undisputed case of purely ovarian fœtiferous Ovum in the
Philosophical Transactions.

“Il n’y a _jamais_ de grossesse Ovarique, dans ce sens que le fœtus
_puisse se developer dans l’interieur de l’Ovaire_; on connaît des
cas de fœtus arrivé _sur_ l’Ovaire; mais très certainement l’ovule
en était sorti pour n’y rentrer, ni comme œuf, ni comme embryon.”

Plate 11

_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._

D^r. Granville on Abortion
and the Diseases of Menstruation
]

PLATE XI.

A. DYSMENORRHOIC ORGANIZATIONS.

Fig. 1. Membrana pseudo-textilis intro-uterina bi-tubulata.

A pulpy tissue of a very loose texture, scarcely deserving of the
name of membrane,—of a bright red colour when thrown off by the
womb, but, soon after maceration in water, assuming a yellowish
tint, and appearing like a gelatinous, thickish, and translucid
web, the component molecules of which possess but slightly the
power of cohesion, being easily lacerated. Examined with a
powerful lens, it looks like a congeries of globules of gelatine,
arranged together into a flat, but not even surface. It possesses
flexibility, but scarcely any elasticity.

This tissue lines the womb; and the two superior tubes drawn up
vertically in the preparation are the prolongations of that lining
into the fallopian tubes.

It was thrown off in the case of a patient suffering habitually
from dysmenorrhœa, after acute pain; and on the third day of a
very scanty menstruation. The patient was not a married lady, and
under twenty-five years of age. The same production had been
observed on more than one occasion before by the attendant, but
not especially noticed until after I began to visit the patient.

Fig. 2. Membrana pseudo-textilis intro-uterina sine tubulis.

A pulpy tissue like the preceding,—rather firmer in its texture,
but presenting in every other particular the same characters.

This also must have lined the uterus; for it was pulled away from
the orifice of it, through which it was found to hang partially
during an examination made in consequence of sharp _forcing_ pains
being experienced the day after the complete cessation of the
menses. The patient, a married lady from Scotland, suffered
considerably at every return of the monthly period, and had done
so on the present occasion. She had had no children; and was
thirty years of age.

Here, there were no tubular prolongations of the lining, but two
apertures near to the upper margin of this _cloth_, with smooth,
rounded edges, as if they had corresponded with the uterine
orifices of the fallopian tubes. A similar aperture, considerably
larger, existed at the inferior margin; or rather, I should say,
that the inferior margin of the cloth, perfectly smooth, was drawn
round, so as to leave an opening in the centre, which must have
been placed over the internal orifice of the womb.

Both this, and the preceding tissue had one of their surfaces more
_lisse_ than the other.

B. POLYMENORRHOIC STRATIFICATIONS.

Fig. 3. Coagulum intro-uterinum hæmatosum pseudo-membranaceum incavum.

This sanguineous mass consists of a series of layers of the same
species of pseudo-textile membrane described at No. 1 and 2;
rather striated, neatly wrapt over one another, and easily
separable without laceration, until we come near to the nucleus,
where the layers are thinner and adhere more firmly together.

Some of these quasi-membranaceous wrappings are generally entire
at one of the extremities of the mass, and open at the other,
while two of the innermost are open at both ends, as if their
organization had been checked by the supervening of another and
external coating. This is properly marked by the artist on the
second membrane, reckoning from the outside covering.

The colour of the latter is most brilliant, and has been well and
correctly represented by Mr. Perry, from nature. The former, or
inner layer, is darker in places, not so gelatinous in appearance,
more distinctly striated, and puckered up superficially into
slender longitudinal ridges, giving it the semblance (in form
though not in colour) to a dry Egyptian date, or a very ripe
banana.

Fig. 4. Coagulum intro-uterinum hæmatosum laminare cavum.

There is no nucleus in this species of coagulum. In its centre, we
remark an oblong cavity, which extends nearly the whole length of
the mass, and remains partially open longitudinally. The walls of
this cavern are not thick.

Over the latter another coat is thrown, likewise open, the margins
of whose aperture do not reach those of the inner coat. Over these
again arrange themselves one, two, three, and sometimes more
stratifications of grumous blood, bearing a nearer resemblance to
fleshy laminæ than to membranes. Their colour is of a bright
vermilion, whereas that of the two innermost coats is of a dark
violet, while the central cavity itself has a perfectly dark tint.

Like the _coagulum incavum_, the present measures three inches in
length, is oblong, and rounded at both ends, one of which has an
open orifice not unlike that of the unimpregnated womb in its
configuration.

Fig. 5. Coagulum intro-uterinum spongiosum cavum interne velatum.

A spongeous substance, irregularly globular, flattened into a sort
of depression at one part, and terminated by a round teat-like
extremity at the opposite parts of its circumference.

Externally this coagulum might be taken for a cast of the interior
of the uterus about three weeks after conception. This resemblance
is even greater when the coagulum is cut into and laid open. A
cavity is then found of shape almost triangular, with an open,
smooth, and rounded orifice, the whole inside being lined by a
pellucid silvery-looking membrane, not unlike a serous membrane.
This membrane prolongs itself through the orifice, which it lines
also, and passing outwardly, goes to join and merges into the
coarser external covering of the coagulum.

A section of the walls of this intro-uterine mass, exhibits a
thickness of two fifths of an inch, studded with a vast number of
small apertures, not unlike a honey-comb. The colour of the
divided coagulum is of a bright vermilion, but the inside of the
several apertures is of a much deeper tint. The lining of the
cavity consists of a very fine pellucid whitish membrane, (as I
before stated,) which resting on a dark red, assumes in aspect a
lilac hue: while externally the mass presented a dirty brown
colour at the time of its coming into my possession, _immediately_
after its expulsion.

Plate 12

_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._

D^r. Granville on Abortion
and the Diseases of Menstruation
]

PLATE XII.

(POLYMENORRHOIC STRATIFICATIONS CONTINUED.)

Fig. 1. Coagulum hæmatosum intro-uterinum internè solidum, externè membranaceum.

An oblong mass, rounded at each extremity, one of which is more
tapering than the other, and is perforated by an external orifice.
Its whole length is 2½ inches, the difference in the circumference
at the two opposite ends is as 1:2. The orifice is puckered at its
edge: the colour of the mass of a marbled red.

This mass may be carefully unravelled in a weak mixture of alcohol
and water, when it is found to consist of several membranaceous
oblong pouches, placed one within the other, until we arrive at
the centre, which is found occupied by a solid black coagulum of
blood, perfectly homogeneous, friable when dried, shining in its
fracture, and leaving streaks of a brown red colour on paper, when
rubbed over its surface.

The appearance of the mass is here represented as it came away, of
its natural size and colour, and by its side is placed the same
mass after undergoing the process of careful separation of some of
its different investitures or coatings. It should be observed that
the orifice which exists at the pointed end of the external
membrane corresponds with a similar orifice in each of the
different subincumbent coverings. These, in their texture and
appearances, differ scarcely from the Dysmenorrhoic pseudo-textile
membranes described in a former plate.

C. pseudo-ova: molæ. (vulgo, false conceptions.)

Fig. 2. Mola Avellana tunicata.

A small, round, and oblong body, shaped not unlike a good-sized
Spanish nut, which it resembles in colour even, and smoothness of
surface. This led me to adopt the distinguishing appellative of
Avellana. It measures about one inch in length, and is wide at one
end and nearly pointed at the other.

When expelled it was covered by a tunic, which is easily detached,
and is tolerably flexible. The external surface of this tunic is
tomentose or lanuginous—the internal surface smooth, almost
shining, and in its centre pellicular.

The nut itself, or mole, being cut open longitudinally, exhibits a
cavity lined with a thin stratum of coagulated blood, interspersed
by pellicles in all directions. On examining the cut edges of the
mole, they appear to consist of at least three superimposed
layers.

There is no communication whatever between the internal cavity of
the mole and its surrounding tunic, and consequently none with
external objects.

Fig. 3. Mola Avellana nuda.

This is a smaller uterine production than the last, and it differs
also in one essential character, that of the surrounding tunic
being wanted.

In other respects the resemblance is perfect externally as well as
internally, and also with regard to the total absence of any
outlet from its interior. The coats are similarly constructed, but
the deposition of a bloody stratum on the inner surface is thinner
and smoother.

Fig. 4. Mola conchula.

It is the external tunic of this mole that resembles a little
shell, and which circumstance induced me to distinguish this
species of _Mola_ by the surname _Conchula_.

The mole itself is more like a small date, the well-known Egyptian
fruit. When just discharged it felt pulpy, yet firm, and I should
imagine, from the feeling it imparted to the fingers, that it
contained some fluid. That it has a central cavity there can be no
doubt, for when compressed, it immediately returned to its former
state as soon as the pressure was withdrawn. Having laid open so
many of these curious productions, I was unwilling to do so in the
present instance.

The tunic in this case was not cut open, but separated by a needle
in the direction of what appeared to be a _raphe_ or joint running
the whole length of the mass in a waved line. When the edges were
sufficiently parted, the _naked_ mole was withdrawn without much
effort.

Internally the tunic had a loose lining, dense, opaque, and
membranaceous, between which lining and the external coat of the
tunic a thin deposition of blood was observed.

Fig. 5. Mola Mytilus.

This is a highly interesting case of _Mola_, to which I have given
the designating appellative of _Mytilus_ from its suggesting, when
laid open longitudinally, the idea of that shell (muscle).

It is an oblong mass, broader at one end than at the other, as all
these productions of the uterine cavity are found to be. In its
external appearance it is fleshy, pulpy, of variegated tints even
at the very moment of its expulsion, irregularly smooth, and free
from any pellicle or membranaceous covering.

Internally it exhibits an oblong cavity, corresponding in figure,
relative breadths, and length to the containing mass, which looks
like a thick coagulum at the sectional edges. This cavity,
however, is not a mere hollow in the general mass, but looks like
an oblong membranous pouch imbedded in that mass. Its interior is
lined by an exquisitely delicate and almost fumiform
pellicle—lactescent or opalescent. The pointed extremity of this
cavity loses itself in the brilliantly red mass of the tapering
end of the mole, at neither of whose extremities is there the
least semblance of any aperture.

When I laid open this curious mole, its cavity contained a small
quantity of clear fluid.

REMARKS.

I have for a great many years past been in the habit of arranging
into three distinct groups all those adventitious productions, or
excretions of the uterine cavity, connected either with irregular
menstruation or faulty conception, which authors have described
under so many different names. I consider that all such productions
are either the result of an organizing effort on the part of the
uterus during painful menstruation, or a successive arrangement of
coagula of blood pending a profuse or critical menstruation; or
lastly a blighted ovum, passed as an originally-imperfect seed into
the womb from the ovarium, or which has become imperfect
subsequently to its reception within that organ.

To the first of these groups I have given the name of Dysmenorrhoic
organizations.

To the second the name of Polymenorrhoic stratifications.

To the third the name of Pseudo-Ova, or Molæ, including what are
vulgarly called _False Conceptions_.

In order to understand the first two appellations, it is necessary
that I should state in tills place that they are denominations
adopted by me, (in my work on Abortion and Menstruation,) to signify
certain modifications of the latter function, which have been
considered and treated as diseases, and as such variously
denominated by nosologists and others. In the work alluded to,
wishing to simplify as well as to rectify the uncertain and
incorrect nomenclature generally employed in such cases, I formed,
and have ever after used the following scheme of classification.

Menorrhœa, (the radical) Menstruation, from μὴν mensis,
ῥέω, to flow.

_A_-Menorrhœa, Suspended Menstruation, from α, privative.

_Dys_-Menorrhœa, Painful or Difficult Menstruation, from δὺς
difficult.

_Poly_-Menorrhœa, Profuse Menstruation, from πολὺ a great deal.

_Lego_-Menorrhœa, Ceasing, Decreasing Menstruation, from λήγω, to
cease.

_Allo_-Menorrhœa, Vicarious (erratic) Menstruation, from ἄλλο,
one for another.

Of these five modifications of the menses, the first four may
produce either organized substances, or stratifications in the
cavity of the womb; but those modifications, which more commonly
give rise to such productions are Dysmenorrhœa and Polymenorrhœa,
and from them, therefore, I have borrowed my denominations of the
groups.

Having said thus much as to generalizations, I come to speak more
particularly of the specimens which I have selected, with a view to
illustrate my groups. These, although not numerous, are the most
complete of their kind. They have in themselves all the generic as
well as the specific characters which distinguish them from every
other preparation. Few of those characters, perhaps one or two, are
to be met with in other specimens, but in that case the latter are
mere varieties of the species I have represented. Membranous
organizations,—coagula,—stratifications,—moles,—false conceptions,
may vary from one another in some slight point, so as to appear
different to different observers; but in the end, and in reality,
they can only be referred to the groups I have adopted, and to these
therefore I must take leave to adhere.

With respect to the pseudo-ova, or molæ, it would have been an
endless task had I attempted to transcribe the smallest part of the
long list which ancient as well as modern authors have drawn up of
such substances; or had I registered their singular names: most of
which imply some anatomical or physiological error. My scheme of
classification contains only four species, and I have limited myself
to that number because they are the most distinct forms of
pseudo-ova or moles I have seen in the course of twenty years’
practice. I have preferred giving them an unmeaning name,—one of
supposed resemblance to some well-known object,—rather than to run
the risk of misleading people by the use of denominations which must
give rise to false notions.

One word more by way of general remarks on these important points
before I conclude.

Almost every author who has written on the subject of moles, has
differed from his predecessor in the use of that term, applying it
to very different productions of the uterus. Some have
indiscriminately called by this name the polypi of the uterus;
hardened, soft or spungy coagula of blood; carneous masses expelled
by the uterus; diseased or deformed ova; and in fact almost any
thing in the shape of a mass that has come away from the genital
passages of a female after supposed conception, or subsequently to
parturition. To embrace so many different substances under one
general denomination, is surely wrong, (as Denman said,) and
accordingly we find such a practice condemned by many. But as the
difficulty of distinguishing a real mole from an organized coagulum
was supposed to be very considerable, no successful attempt was ever
made to prevent the confusion which ensues from that practice.
Denman himself, for instance, has not been very felicitous in
pointing out a distinction between a morbid ovum and a coagulum of
blood. That writer assumes that every mole, consisting of a decayed
ovum, will be found to present, “notwithstanding the external
appearance of a shapelessness of flesh, various parts of a child,
&c.,” and also that, “although a coagulum of blood long retained in
the womb, may, at the first view of its external surface, appear
like organized flesh, the internal part, if cut into, will be found
to consist merely of coagulated blood.” Now neither of these
positions is exclusively true, for, as may be seen by a reference to
plates 11 and 12 of this series, we have _organized_ coagula without
any nucleus of hardened blood, but on the contrary with a centre or
cavity lined by a membrane, on the one hand; and we have on the
other hand pseudo-ova, or real moles, entirely free from the
slightest trace of embryonic rudiment.

What then is the distinction between a real mole and a coagulum, no
matter of what species or variety the latter be? It is this: that
the former has invariably a central cavity wholly enclosed _without
any opening or aperture_; whereas the latter—let it be formed in any
way you please, stratified, laminated, concentric, membranaceous,
solid, hollow, or with a regular cavity lined by a membrane, no
matter,—will be found invariably to have at one of its extremities
_an aperture_, either leading straight into the inner cavity, where
such an one exists, or simply passing from one membrane or stratum
of coagulated blood to the next, until it reaches the innermost,
which is also perforated like the rest. This is a striking and
important distinction, and I am not aware that it has been noticed
or made public by any author before me.

Having been accustomed, for many years, to examine and compare
together every uterine production that came away during abortion, or
morbid menstruation, whenever an opportunity offered itself to me to
do so, either in public or private practice; I was led to make those
observations which enabled me to establish the above distinction,
and which have afforded me the advantage of selecting clear and
well-defined specimens of the two kinds of productions alluded to,
and of afterwards submitting them to the strictly correct copying
powers of Mr. Perry, the artist. The result of his accurate copies
from nature is registered in the present collection of plates.

I may add that such representations are not to be found in the
medical literature of either this or of any other country; and that
I hope they will be the means, (even if they should fail to do any
other good,) of preventing the recurrence of erroneous opinions,
which lead to injurious aspersions, and often fatal conclusions.

I need scarcely repeat, at the conclusion of these Explanations, that as the plates are illustrations of the views I entertain respecting abortion, and the diseases incidental to menstruation, formed in the course of, and corroborated by, twenty years’ experience,—the result of which experience I have embodied into a large volume preparing for the press; all the cases which relate to the individual delineations given in this collection of plates, will be found detailed in that work, particularly those connected with the specimens of dysmenorrhoic organizations, polymenorrhoic stratifications, and pseudo-ova.

END.

☞ The Work, in connection with the present Graphic Illustrations,
which the Author has been preparing for the press since the year
1826, and to which allusion has been made in the course of the
Explanations to the Plates, will be published without delay,
entitled as follows:

ON

=ABORTION=

AND

THE DISEASES INCIDENTAL TO

=MENSTRUATION;=

PRACTICAL COMMENTARIES

BY A. B. GRANVILLE, M.D. F.R.S.

ETC. ETC. ETC.

An Octavo Volume of about Five Hundred Pages.

CONTENTS.

PRELIMINARY REMARKS.

FIRST COMMENTARY,
ON ABORTION.
EIGHT SECTIONS.

Sect. 1. Literary and Medical History of Abortion.

—— 2. Definition of Abortion, and mode in which it takes place.

—— 3. Classification of Abortions.

—— 4. Frequency of Abortion.

—— 5. Abortions in Biparous Gestation.

—— 6. Diagnosis and Prognosis in Cases of Abortion.

—— 7. Treatment of Abortion.

—— 8. Moles and False Conception.

APPENDIX. —VARIOUS JURIDICAL QUESTIONS RESPECTING ABORTION.

SECOND COMMENTARY,
ON MENSTRUATION (MENORRHŒA) AND ITS DISEASES.
FIVE SECTIONS.

Sect. 1. Literary and Medical History of Menstruation.

—— 2. Physiology of Menstruation.

—— 3. Experiments on the Menstrual Fluid.

—— 4. Enumeration of the principal Diseases attendant or consequent
on Menstruation.

—— 5. Precautions to be adopted in regard to Menstruation.

THIRD COMMENTARY,
FEVERS OF MENSTRUATION.

FOURTH COMMENTARY,
A-MENORRHŒA,
(TARDY, CHECKED, OR TOTALLY INTERRUPTED MENSTRUATION.)

Sect. 1. Its definition.

—— 2. Treatment.

—— 3. Cases.

FIFTH COMMENTARY,
DYSMENORRHŒA,
(DIFFICULT, OR PAINFUL MENSTRUATION.)

Sect. 1. Its definition.

—— 2. Treatment.

—— 3. Cases.

SIXTH COMMENTARY,
POLY-MENORRHŒA,
(INORDINATE—PROFUSE—HEMORRHAGIC MENSTRUATION.)

Sect. 1. Its definition.

—— 2. Treatment.

—— 3. Cases.

SEVENTH COMMENTARY,
LEGO-MENORRHŒA,
(CEASING OR RETREATING MENSTRUATION; AT THE CRITICAL AGE.)

Sect. 1. Its definition.

—— 2. Treatment.

EIGHTH COMMENTARY,
ALLO-MENORRHŒA,
(TRANSFERRED, ERRATIC, OR VICARIOUS MENSTRUATION.)

Sect. 1. Its definition.

—— 2. Treatment.

CONCLUSION.

G. Woodfall, Printer, Angel Court, Skinner Street, London.

-----

Footnote 1:

Professor Boer, who fills the Chair of Zoology at Kœnigsberg, is a man
of undoubted veracity, a keen and accurate observer, and has been
engaged for many years in the investigation of that most interesting
function—reproduction—in mammiferous animals. He made a great number
of minute and extremely delicate experiments and microscopical
observations on animals and the ovaria of women, which led him to the
conclusions I have embodied in my propositions, and which he forwarded
in a Latin epistle, entitled “De Ovi mammalium et hominis genesi”, to
the Imperial Academy of St. Petersburgh, with a plate, carefully
engraved, representing all the details above alluded to. These he
afterwards, and within the last four years, enlarged upon very
considerably in a subsequent publication.

Footnote 2:

If the reader can procure a placenta which has been thrown off
immediately after the birth of the child, without any effort, and
cleaning it of all coagula from off the surface which lay next to the
uterus, by careful maceration and washing, he will afterwards
introduce a small quill or pointed tube into one of the arteries of
the navel-string, and blow strongly into it, he will find that the air
raises upon that surface, to various degrees of puffiness, a very
delicate pellicular covering, through which none of the air can
escape, unless through an accidental laceration. I have often made the
experiment, which I used to relate to my class in my lectures on
midwifery many years ago. Lauth, of Strasburgh, has stated the same
thing; so had Ruysch long since, and others, proving at once that
there is not a direct communication with the mother from the fœtus.

Footnote 3:

It has hitherto been supposed, and Dr. Hunter first gave rise to the
opinion, that on reaching the uterine orifice of the tube, the ovulum
found an obstacle in the presence of the inner lamina of the
_decidua_, which latter is said to be projected across that orifice.
This obstacle the ovulum overcomes, Dr. Hunter _supposes_, by pushing
the said lamina forward, and following it close, so at last to make
good an entrance into the womb, surrounded by this inner lamina of the
decidua, which the ovulum compels to enlarge with its own gradual
enlargement, until both fill the entire cavity of the uterus, and the
inner lamina of the decidua comes in contact with itself. It is
impossible to conceive a more improbable operation, or one more
contrary to facts. Yet such is the notion formed by Hunter of an
imaginary membrane, to which he has given the name of reflected
decidua; and so enamoured was he of this notion, that he has not
hesitated to portray in his large work on the gravid uterus a section
of the womb at several weeks after conception, (again purely
imaginary,) representing things as he supposes them to be in regard to
that membrane! Hunter’s notion was gradually converted into an
opinion, which most of his successors have repeated over and over
again, out of respect for him, and without ever inquiring
experimentally into the correctness of it. No one has advanced a
single fact to prove it. There is no such a thing as a _decidua
reflexa_. The improbability of such a process as has been imagined to
account for its supposed existence, has been demonstrated very
adroitly by Dr. Dewees, as skilful and clear-sighted an obstetrical
writer, of the United States of America, as any that have appeared in
Europe. (Comp. of Midwifery, 1824, page 66.) He there shews, that if
we adopt Burn’s description of the _decidua reflexa_, given by that
author in a tone of positiveness, as if Hunter’s notion was a
mathematical proposition, either that membrane must have three,
instead of two, laminæ, as admitted by them, or it must have even a
fourth lamina, namely, one more than has ever been imagined by any
body. But the truth of the non-existence of a membrane formed in the
manner in which the _reflexa_ is said to be formed, is proved by
actual facts. A few will suffice. A specimen of an impregnated uterus
marked 3468 C. Gallery, Coll. Surg. of London, exhibits distinctly a
round ovum naturally suspended within the decidua, as a globe may be
supposed to hang from some point of the inside of an oblong sack. Here
the ovum has pushed no part of the uterine decidua forward. The ovum
has only its natural involucra, and there is a large space between
them and the deciduous lining of the womb. In Dr. Agar’s case, alluded
to before, in the Museum of the R. C. of Physicians, (impregnated
uterus 2½ months,) no decidua reflexa is seen. Specimen 73, in Sir
Charles Clarke’s collection, exhibits an ovulum which has already
penetrated about an inch into the cavity of the uterine decidua,
without pushing any part of it forward. Specimen 75 in the same
collection is another illustration of the same fact. In good truth,
the existence of the decidua reflexa is disproved by facts, and is
moreover rendered inconceivable and inexplicable by the very account
and explanation given by those who contend for that existence. It is
now scarcely admitted by one out of ten Continental anatomists.

There is another physiological fact which we have overlooked—it is
this: That the uterine decidua is always pervious at the uterine
orifices of the fallopian tubes, as well as over the internal orifice
of the cervix uteri. The error thus signalized has arisen from not
knowing that the ovulum comes from the ovarium with a _cortical
membrane_ over the shaggy chorion. It is curious to see how, even
among some of the most skilful of the modern physiologists, their
ignorance of the existence of a _cortex ovi_ has misled them in their
respective descriptions of the decidua or uterine lining. Carus, for
example, has asserted, that the decidua uteri had an opening over the
internal orifice of its cervix. Velpeau and Breschet have denied this
to be the fact, and consider the decidua to be a complete sac, to
which they have ascribed the functions of a serous membrane. Professor
Heusinger confirms the opinion of the two French authors, but denies
that the decidua is a serous membrane. The truth lies between: Carus
described the real decidua, which has three apertures; while Breschet,
Velpeau, and Heusinger evidently refer to the cortex ovi which has no
aperture whatever, when the ovulum enters the cavity of the womb. Well
might Meckel exclaim, “il n’est pas très facile d’expliquer le mode de
formation de la caduque reflechie.” (See specimen 73, 75, 76, 87,
Museum of Sir Charles Clarke.)

Footnote 4:

It is impossible to desire a stronger or a more beautiful illustration
of the modern theory of fecundation, than we find in the preparation
here alluded to. It is the impregnated uterus (between two and three
months) of a female who died of hydrophobia. Both the ovaria are laid
open. In the left there are no appearances, beyond the Vesiculæ
Graafianæ hardened by the alcohol: but in the right, namely, the
ovarium of that side on which it is supposed that the fecundated
Ovulum entered the womb, (from the circumstance of the placenta being
implanted in that quarter,) we find not only a scar still red on the
surface of the ovarium, but corresponding with it, and beneath it, in
the thickness of the ovarium, a large shallow depression or hollow
from which the Ovulum had escaped, and which is beginning to fill with
the substance that is to constitute the corpus luteum destined to stop
up the gap in the ovarium.

Footnote 5:

Meckel, with many others, entertain still the opinion that the corpus
luteum precedes fecundation—but instead of supposing with Sir E. Home
that it generates an Ovulum, the physiologist of Halle imagines that,
like a _testis_, it serves to secrete a generating liquor—the semen
feminæ. This theory is demolished by Boer’s, Plagge’s, and Messrs.
Prevost and Dumas’s positive observations.

Footnote 6:

This disparity has not been noticed before by writers. Like many other
circumstances, it militates, not a little, against the theory of the
decidua reflexa.

Footnote 7:

Dr. Pockels calls this the Decidua—but in good truth it is the _Cortex
Ovi_—for this good reason, that at so early a period, and even as late
as the end of the first six weeks, the Decidua is many times larger in
capacity than the ovulum, and is never globular like the latter.
Besides, when Ovula of such early periods are thrown out, the decidua
remains behind, and is ejected in its triangular shape, a little
while, and sometimes even a day, after. In other respects, Dr. Pockels
confirms _Boer’s_ more precise description of the “_Structure of the
Ovum_.”

Footnote 8:

The whole of the English physiologists, writers on midwifery, and
lecturers, whether ancient or modern, are entirely silent on this
important stage of embryonic life. They have talked rather loosely on
the subject without the species of life which he must suppose the
embryo to enjoy. He tells us, that even at the end of three weeks the
Ovum is not found in the uterus, but how it exists during that period,
wherever it may be, he has not even alluded to a single reference to
facts or anatomical remarks of their own. Burns, in his work on
abortion, never once alludes to

Footnote 9:

See a very interesting paper on the Structure of the Human Placenta,
by T. Radford, Surgeon, &c. Manchester, 1832.

Footnote 10:

I shall submit to the Profession these curious and interesting
experiments very shortly.

Footnote 11:

Autenrieth, in his “Supplementa ad Historiam Embryonis Humani”, has
given the dimensions of the embryo and fœtus from a week to the 126th
day of growth, with a description of the several parts as they appear
at each period. From these he has drawn several conclusions respecting
the growth of the human fœtus which have been generally adopted.
Soemmering, in his “Icones Embryonum Humanorum,” has also given the
dimensions of the human fœtus, from the earliest period he has seen it
to its full maturity, with plates.

Footnote 12:

“Caput nutans per omne tempus quo in Ovo continetur.” And again,—“Quò
junior embryo, eo major est volumen capitis.” (Soemmering.)

Footnote 13:

This doctrine has been controverted by two more recent
experimentalists, Prevost and Dumas, as far as the chick is concerned.
They assert that the rudiments of the spinal marrow appear before any
other important organ.

Footnote 14:

In describing the figures in Plate I. under the head of “remarks” it
is to be understood that by the expression of “the mossy vessels
discharge their blood” is meant that they present themselves,
immediately after the expulsion of the Ovulum, with very feeble tokens
of the presence of blood at that early period of gestation.

Footnote 15:

The consideration of the development of the human embryo in its
minutest parts, progressively watched and carefully examined and
described, as those parts appear in succession, appertains to
transcendant physiology, and would be out of place in these
Prolegomena to a work which is intended to supply my brethren with
practical information, obstetrical as well as medico-forensic. It is
sufficient for my purpose to mention (as I have endeavoured to do) the
forms which the fœtus presents, its different sizes, and the weights
which correspond with those forms. To those of my readers who take an
interest in embryogenesy, I recommend the careful perusal of the
various continental modern authors repeatedly named in these
Prolegomena. Unfortunately, since Hunter and Home, there has not been
a single British practical and experimental physiologist who has
investigated this subject either originally or otherwise. This fact,
not at all flattering to us, is no where placed in so strong a light
as in Breschet’s very erudite and classical memoirs, entitled “Etudes
anatomiques, physiologiques et pathologiques de l’Oeuf duns l’Espèce
humaine” which that indefatigable inquirer has enumerated and analyzed
every statement and experiment made on that subject by upwards of
thirty physiologists, down to the present day; among whom there is
not, since Hunter and Home, a single English name besides that of Dr.
Burns, recorded.

Footnote 16:

See Journal Complementaire, Vol. 6. p. 375.

Footnote 17:

I possess a placenta exhibiting these appearances (78, 79) in so
distinct and beautiful a manner, that it would be a violation of truth
and sincerity, or a sure sign of ignorance, to state that they do not
properly resemble those which are observed in the Chorion of some of
the mammalia. Those are cotyledons. So are these. I shewed the
preparation to Dr. Hugh Ley. He was delighted with it, and instantly
admitted the similarity in question.

Footnote 18:

Observations relatives à la Géneration. Par F. Lallemand. Paris, 1818.

Footnote 19:

Precis Elementaire de Physiologie, 2d edit. Paris, 1825.

Footnote 20:

Dr. Hunter on the Placenta. In Gravid Uterus, page 43, 9th edit. 1794.

Footnote 21:

A complete ovum, with the investing cortical membrane, and the entire
decidua expelled nine weeks and three days after the last regular
menstruation, in the case of a lady recently married, whom I attended
(March, 1833), has afforded me ample opportunity of verifying the
above and most of the previous propositions, through a careful
dissection of the parts under water, and the use of the microscope.

Footnote 22:

MS. Lectures of Dr. Hunter, taken by John Sheldon, 2 Vol., formerly in
the possession of Joshua Brooks, Esq. and now before me (Vol. II. page
485).

Footnote 23:

Communicated to the Philomatic Society of Paris, 1830.

Footnote 24:

Memoires de la Societé de Physique de Genève, T. IV. part 1.

Footnote 25:

American Journal of the Medical Sciences, Nov. 1829.

Footnote 26:

I am thus particular, because there is a second and even a third
series of numbers in this collection, which are differently marked on
the preparations and in the MS. lists, although belonging to the same
specimens. This confusion which has crept in, in spite of Mr. Clift’s
vigilance and endeavours to prevent it, will disappear as soon as that
skilful naturalist shall have been able to complete the laborious task
of making a catalogue _raisonné_, of the museum.

Footnote 27:

See SIEBOLD Journ. für Geburt Shülfe 1827. T. VIII. p. 1–11.

Footnote 28:

The Cases to which this plate refers occurred in the practice of
Sir Charles Mansfield Clarke, Bart., many years ago.

------------------------------------------------------------------------

TRANSCRIBER’S NOTES

1. P. 40, changed “Il n’y a _jamais_ de grossesse Ovarique, dans ce
sens que le fœtus _puisse se developper dans l’interieur de
l’Ovaire_; on connaît des cas de fœtus arrivé _sur_ l’Ovaire; maîs
très certainement l’ovule en était sorti pour n’y rentrer, ni
comme œuf, ni comme embryon.” to “Il n’y a _jamais_ de grossesse
Ovarique, dans ce sens que le fœtus _puisse se developer dans
l’interieur de l’Ovaire_; on connaît des cas de fœtus arrivé _sur_
l’Ovaire; mais très certainement l’ovule en était sorti pour n’y
rentrer, ni comme œuf, ni comme embryon.”.
2. Made the corrections indicated in the ERRATA.
3. Silently corrected typographical errors and variations in spelling.
4. Retained anachronistic, non-standard, and uncertain spellings as
printed.
5. Footnotes have been re-indexed using numbers and collected together
at the end of the last chapter.
6. Enclosed italics font in _underscores_.
7. Superscripts are denoted by a caret before a single superscript
character, e.g. M^r..