demonstration,) the accuracy of the views (82, 83, 84, 85) which tend to
establish the fact of a vascular communication between the
arterio-venous system of the mother and the placenta (by intermediate
decidual circulation) and to shew the fallacy of those who deny such a
communication, than the very phenomenon just noticed (86). Here, morbid
anatomy again comes to the assistance of normal anatomy and physiology,
and affords evidence which is not liable to the errors that have been
unjustly affixed to experimenters with injected fluids. Of the many
examples that might be quoted in support of this proposition, the one
which is stamped with the authority of Lallemand may be selected as the
most striking[18]. In a case of ventral aberrant fœtation, which had
proceeded to the end of the sixth month, before it destroyed the
patient, a vascular and tomentous membrane had been formed on the
surface of the peritoneum, to which adhered the regular placenta and
chorion of the fœtiferous ovum. This membrane resembled in every respect
the decidua, at six months—it was thicker, and more red and vascular
where the placenta was adherent than any where else. “Vessels as visible
as those of the inflamed conjunctiva,” observes the author, “passed from
the highly injected peritoneum, opposite the placenta, into the membrane
which lay between them; while other vessels from the placenta reached as
far as the same membrane, and were lost in it where they probably
anastomosed by their very minute terminal ramifications.” (Lallemand).
The conclusion which this really eminent physiologist and good man has
come to, upon this subject, is striking, and truly to my purpose. “The
decidua,” says he, “has no other function to perform than that of
serving as a capillary system, intended to be the medium of
communication between the blood-vessels of the mother and those of the
fœtus” (page 21).
88. It is possible that the venous blood of the decidual vessels may be
returned through the great uterine sinuses, the large open orifices of
which, covered with an almost valvular flap, have been described by the
best anatomists, as being applied to the surface of the decidual
placenta. Magendie[19] thus states his opinion on this subject. “In
women large openings, which communicate with the uterine veins, are
observed on that part of the uterus to which the placenta adheres; but
it is not clear whether these venous orifices are destined to absorb the
blood of the fœtus, or to suffer that of the mother to escape on the
surface of the placenta. I am inclined to admit the latter idea—but no
proof whatever exists of its correctness.” (page 554).
89. Such is the real structure of the human placenta (77 to 88,
inclusive). Its description is founded on positive and direct
experiments, first-rate authorities, and anatomical inquiries, which may
be repeated, referred to, or ascertained any day, and to which many can
bear witness: any other description differing from it and not so
grounded, must be erroneous. This view of the real structure of the
placenta differs from that of Dr. Hunter only in the non-adoption of
that great man’s notion that continuous vessels go from the uterus,
_through_ the decidua, direct into appropriate cells or laminæ, where he
supposed that the arteries deposited their blood, which the veins pumped
back into the uterine system of the mother, after it had served the
purpose of bathing the terminal or cotyledonic vessels of the fœtus. The
existence of cells, however, has been frequently denied, and by none
more stoutly than by Professor Lauth, of Strasburgh, and others; but as
these individuals deny, at the same time, that which a hundred
anatomists of great skill and veracity have seen, namely, the
transmission of fluids, by means of decidual vessels, from the uterine
system into the placenta, their opinion is liable to suspicion. However,
it is unquestionably true, that on looking at the appearance exhibited
by the fluid injected from the uterine vessels, in those portions of the
placenta which it reaches, (Experiment at the Middlesex Hospital, 85,)
we feel more inclined to consider it as dendritic and ramose, than
extravasated or diffused. I entertain the former opinion. I submitted a
thin section of the injected placenta (March, 1833) (85) to a powerful
magnifying lens before a very strong flame of an argand burner, and
could not perceive any sensible difference between the appearance of the
red and that of the yellow injection. Now, that the latter, which was
thrown in through the umbilical vessels, had been deposited within
minute vessels, and not within cells, no one doubts. It is, therefore,
likely that the other fluid is also so deposited. If Hunter and his
followers were wrong in their conclusions, (though accurate in their
experiments,) Professor Lauth, and the author of a paper on the
placenta, inserted in the Philosophical Transactions for 1832, (who, by
a most singular coincidence repeats all that Lauth had said long before
him respecting the non-existence of cells and of continuous vessels from
the uterus in the placenta) are not less chargeable with even greater
errors; inasmuch as they have denied anatomical facts which have been
observed and ascertained by many. They have overlooked the function of
the decidual vessels, and they have said not a word of that beautiful
arrangement of the fœtal vessels of the placenta which Dr. Hunter
compared to the “vascular portion of the chorion forming part of the
placentulæ in a calf,”[20] and which I have succeeded in demonstrating
in a human placenta prepared for that purpose, and still in my
possession (79, note). It is evident that under such negative
circumstances their view of the structure of the human placenta, and its
connection with the uterus, will be repudiated.
90. The circulation of the blood in the Ovum is independent of that of
the mother (personal experiment (59), and all the more recent
physiologists). The embryo creates its own blood, and through it,
sustains its own existence. But its blood, like that of all other
animals, whether during its intro or extra-uterine life, requires to
undergo certain changes at every minute period of that life—and those
changes it experiences through the influence of the blood of the mother.
(Magendie, Mende, Pockels, Baer, Chaussier).
91. The function of the Placenta, therefore, seems to be to facilitate,
and in good truth to effect, the necessary changes in question (90). The
decidual vessels receive the arterial blood of the mother. This is
spread over a very considerable surface of tubular structure, which
being, in its distribution, made to come in apposition with the infinite
ramifications of the umbilical placental vessels, at innumerable points,
(like the inspired air distributed through the bronchial passages is
made to come in apposition with the myriads of vascular rami of the
lungs); the required changes in the blood of the fœtus are produced,
just as the changes called for in the pulmonic blood, are produced by
the peculiar arrangement of that part of the animal economy. When the
arterial blood of the mother has produced the desired effect on that of
the fœtus—it is returned by the decidual veins to the uterine sinuses
applied, like absorbing mouths, to the surface of the decidua, when it
enters into the general venous system of the mother (Magendie; Personal
Observations).
92. Of the two vascular systems, forming the machinery of the
utero-decidual and fœto-placental circulation, (82 and 77,) that of the
former is the smallest and least extensive (See injections in all the
Museums). In point of origin, also, the latter has precedence. The
Umbilical vessels unite the fœtus to the chorion before any regular
placenta is formed outside of the membrane. Up to the tenth week the
decidual vessels are as yet slender, straight, and insulated; while the
umbilical vessels begin already to arrange themselves into minute
cotyledons[21]. The reason of these arrangements is obvious. The embryo
needs growth. This it gets through the maternal blood. But as its
gossamer frame, for the space of two and three months, requires but
little assistance from such a source for the promotion of growth; and as
a large supply of maternal blood, at that early period, would overwhelm,
instead of enlarging, the embryonic fabric, such an arrangement of means
only obtains, in the reciprocal circulation, as is calculated to ensure
the desired effect (Personal Observations).
93. This effect is nutrition. “Considering the power which the Ovulum
displays when it first reaches the uterine cavity, of imbibing matter
for its growth, together with the facility with which, according to
Dutrochet, fluids may be drawn through animal membranes, it is not
difficult to believe that nourishment is directly imbibed from the
vessels of the mother by the circulating fluid of the embryo, through
the fine intervening membranes.” (Mayo’s Outlines of Physiology, p. 437.
3d. Edit.)
94. It is possible, also, that other means may be at play in the
promotion of such an effect (93) in the fœtus, besides the one before
mentioned (91). We may instance as a probable one, lymphatic absorption.
The probable existence of lymphatics in the placenta was admitted by Dr.
Hunter. “It is most probable that it (the fœtus) is nourished by
thousands of small lymphatic vessels which absorb nourishment from the
blood of the mother and carry it along the navel-strings. It is true we
cannot see any lymphatics running upon the navel-string, _yet it is
reasonable to conclude they do_.”[22] Hunter’s conjecture has since been
realized (Chaussier, Fohman, Uttini, Lauth). The second of these
anatomists has delineated them in rich profusion, extending from the
placenta along the funis, leaving the funis at the navel, and directing
their course to the groin (Mayo).
95. Some have ascribed the nutrition of the fœtus to a regular
deglutition and digestion of the amnionic fluid. Many facts render this
opinion probable (Meckel). But there are also facts which would make
nutrition by such a means impossible (Dr. Hunter). 1st. An embryo, at an
early period, cannot be nourished by the mouth. 2dly. The amnionic fluid
is mere water with a vestige only of albumen, the only nutritive quality
in it. 3dly. A fœtus was seen whose intestine, a little below the
duodenum, was impervious and divided through, and the lower end began at
some distance from the higher portion. (Dr. Hunter’s MS. Lect.) 4thly. A
full grown child was brought into the world without head, heart, lungs
or intestines (Dr. Cooper, in Dr. Hunter’s MS. Lect.) 5thly. A kitten
was sent to the Royal Society, full grown, born without either nose or
mouth. (Dr. Hunter, ibid.) 6thly. I have the drawing of a pig (the
preparation of which I exhibited at the Med. Ch. Soc. in 1814,) which
was born, at the proper period, and full grown, without any vestige of
the under jaw, and consequently without either mouth or any passage into
the stomach.
96. Some have thought that the amnionic fluid was absorbed through the
pores of the skin (Osiander), others through the mammæ of the fœtus
(Oken). That the vesicula intestinalis (umbilicalis) contributes to the
growth of the embryo is a great deal more probable (Blumenbach,
Sœmmering, Lobstein, Joerg.) It is also not improbable that the gelatine
of Wharton, contributes to that object (Lobstein). But these are all
conjectures, for the probability or improbability of which as many
arguments and real facts have been alleged on equally unquestionable
authority. “Ce sujet,” observes Magendie, “a souvent exercé
l’imagination des physiologistes, sans aucun profit réel pour la
science.”
97. I am more inclined to believe in the existence of respiration in the
fœtus as an additional means of facilitating growth and entertaining
inherent life (Geoffroy St. Hilaire, Müller). The presence of air,
analogous to atmospheric air, in the amnionic fluid, has been detected
(Lassaigne). I once had in my possession an intact ovum at five months
(30th June, 1826,) which served me for the purpose of studying more
particularly the real structure of the placenta, and which contained,
besides the amnionic fluid, a bubble of air about the size of a small
plumb. Only a portion of this was, through the awkwardness of my
assistant, received in a glass tube containing distilled water, while I
punctured, under water, the membranes in the centre of the bubble. This
portion was afterwards made to pass through a saturated solution of lime
in water, and produced a visible cloudiness denoting the presence of
carbonic acid. The respiration of the fœtus is supposed to be effected
by the cutaneous pores, as in aquatic insects (Geoffroy St. Hilaire). In
addition to which the placenta is looked upon as performing the office
of lungs (Müller). Dr. Edwards’s experiments on the asphyxia of the
_Batraciens_, may serve to throw light upon this question (Breschet).
98. The nature of the changes which the blood in the fœtus may be
supposed to undergo from arterial to venous, and the converse, has not
been satisfactorily ascertained. The colour of the blood in the
umbilical vein is something lighter than that in the umbilical arteries
(Mayo). This alleged change is not admitted by others (Meckel). I have
never been able to detect the least difference between the
arterio-umbilical and venous-umbilical blood, in the many cases I have
examined. But the absence of any change of colour does not necessarily
imply the absence of any inherent change in the blood of the two
systems. The globules of the fœtal blood do not resemble those of the
blood of the mother (Experiments alluded to by Dr. Breschet).
99. Connected with the subject of the nutrition of the fœtus and the
changes which take place in the blood of it, may be mentioned certain
recent discoveries[23], which would lead to the belief, that the
function of the placenta is probably analogous to that of the liver
during the intro-uterine life of the fœtus, and that the presence of
bile in the blood of the placenta, discovered by modern chemists, is
necessary to the maintenance of fœtal life (Breschet).
100. It is of the utmost importance to bear in mind the great
distinction which exists between the independence of the fœtus, _quoad_
life, and its dependence, _quoad_ nutrition, in respect to the mother.
The former state is secured by a total separation of the two
circulations (maternal and fœtal). The latter by the close reciprocal
contact of the organs of those circulations. Thence is it that we find
the fœtus to live on, notwithstanding that its connection with the
mother has been partially and sometimes even wholly, severed;—while on
the other hand we cannot help admitting that, albeit this independence,
the influence of the mother over the fabric of her offspring is
unquestionable.
101. Here are two important positions. I have mentioned my experiments
on the intact ova of the genus cat, (59,) to illustrate the first of
them, and Dr. Prevost has since come to my assistance with as strong a
case in further support of it[24]. This gentleman having observed an
ovum still alive in the uterus of a ewe, which was a short time advanced
in gestation, removed it and placed it upon a warm glass plate exposed
to the rays of the sun, and attentively examined it with the microscope.
The beatings of the heart became more lively. He noticed the blood arise
to the surface of the chorion from the fœtus, there ramify plentifully,
and by anastomosing vessels, return to two of the larger trunks which
were the veins of the embryo. He concluded, therefore, that the ovum was
an isolated substance.
102. In proof of the accuracy of the second position, we have equally
strong evidence founded on experiments. Magendie introduced camphor into
the veins of a pregnant bitch, and he found that the blood of the fœtus
had, at the expiration of a quarter of an hour, acquired distinctly the
smell of that drug (Physiology, 2d Edit. 1825). Quadrupeds carrying
young were made to take with their food four ounces of madder-root. The
colouring matter of that substance was found to have passed from the
mother to the fœtus; as all the serum of the blood of the latter, the
urine, the liquor amnii, the teeth and the bones were tinged with it
(Dr. Mussy, 1829)[25]. In 1827, I undertook, at the request of Sir E.
Home, a set of experiments on the human subject, with a view to
ascertain the truth of my second position. Six gravid patients of one of
the lying-in institutions under my direction, who required the constant
use of aperient medicines, were instructed, towards the close of their
time of gestation, to take at night, for a period which averaged about a
week, from ten to fifteen grains of rhubarb in powder. After two or
three days the effect was visible in the colour and smell of the urine
of the patients previous to their confinement, and in one of them, in
the colour and smell of the transpiration also. During the labour care
was taken to preserve part of the amnionic fluid in a cup, the umbilical
vessels were suffered to bleed on the side of the child after their
recision, and the blood set apart so as to separate the serum, which was
obtained in small quantity only.—Lastly, the first urine of the child
was collected in sufficient portions. Each of these secretions appeared
distinctly tinged by the yellow root, and bore the smell of it. When
carbonate of magnesia was mixed with the fluids their colour became
lateritious, and a reddish sediment was thrown down, evincing the
presence of the drug which the mother had ingested. (MS. notes.)
ERRATA.
PROLEGOMENA.— Page iii, Prop. 20, _for reference_ (16), _read_ (17).
Page vii, Prop. 39, _for_ Haygton, _read_ Haighton.
———— idem, _for_ Embryoni, _read_ Embryonis.
Page viii, Prop. 46, 1st line, _dele_ (5).
PLATE III.— Page 9, Exp. of Fig. 13, _for_ membrane proper, _read_
membrana propria, and the same mistake occurs at pages
11, 14, and 26.
The following letter from the artist to whose skill and patience I am
indebted for the principal part of the engravings, and the entire
colouring of the present collection, is inserted in this place, with
the hope of increasing that confidence in the reader, with which it
is desirable that graphic representations of extraordinary or
anomalous objects should be received.
9, Warren Street, Fitzroy Square,
January 27, 1832.
DEAR SIR,
In sending you the last of the series of engravings on stone which I
have executed under your directions for your work on Abortion, &c.,
I cannot omit stating, that I have endeavoured, to the best of my
abilities, to copy in every instance and every minute particular the
anatomical preparations which you placed before me and explained to
me as I proceeded in my designs. The figures, in every case, have
been drawn of the natural size, and are perfect facsimiles of the
originals.
It gives me great pleasure to learn that they have given you
satisfaction, and I am not a little flattered at having been assured
by several medical gentlemen of eminence, who have seen my drawings,
that the manner in which they are executed, and the work altogether,
meet with their unqualified approbation.
I have the honour to be,
Dear Sir,
Your obedient servant,
JOSEPH PERRY.
To DR. GRANVILLE,
&c., &c., &c.
GRAPHIC ILLUSTRATIONS
OF
ABORTION
AND
THE DISEASES OF MENSTRUATION.
[Illustration:
Plate 1
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
EXPLANATIONS,
ETC.
PLATE I.
SPECIMENS OF VERY EARLY MISCARRIAGES.
Fig. 1. Ovulum bigeminum lanuginosum.
(Four weeks after menstruation.)
This twin Ovulum has lost its outer shell or _cortex_, within
which it originally made its way from the Ovarium into the womb.
The mossy or filiform vessels which, like an efflorescence,
surround the present surface of the Ovulum, are, as yet, deprived
of that extremely delicate membrane, which at a more advanced
period of utero-gestation will cover them, and dipping amongst
them, (after the fashion of the inner membranous envelope of the
brain,) will separate them into vascular groups or cotyledons,
having a single principal trunk in each, and many short and
tortuous branches besides, constituting the placenta.
The slit visible in one part of the Ovulum leads to a small cavity
from which the embryo escaped. In the second cavity to the left,
which is still intact, the embryo is visible when the Ovulum is
placed before a strong light.
Fig. 2. Ovulum semi-lanuginosum.
(Three weeks and a half after menstruation.)
In this specimen of an early miscarriage, the Ovulum exhibits the
filiform vessels as in No. 1; but one half of its circumference is
denuded of them, and the diaphanous involucra are distinctly
visible in that part. They are represented flaccid owing to the
escape of a part of the liquor amnii. In size the embryo (which
required to be viewed in a very strong light) resembled that of
No. 6.
Fig. 3. Ovulum lanuginosum.
(Three weeks after menstruation.)
A mossy Ovulum, shewing the inner or secreting membrane, within
which I could not discover any embryo at the time of the
miscarriage occurring. On searching among the coagula consequent
on a very extensive hemorrhage, the Ovulum was found flat, and
appeared like a confused mass. The liquor amnii had escaped, and
probably the embryo along with it. The artist has most skilfully
delineated the peculiar turns of the involucra where they have
been divided so as to display those marked inflexions which are
still more distinctly seen in No. 4.
Fig. 4. Ovulum semi-lanuginosum.
(Four weeks after menstruation.)
I look upon this as one of the most perfect specimens of
mono-embryoferous Ovula at four weeks, I have seen; exhibiting as
it does, not only the mossy or _nutritive_, but also the inner,
amnionic, or _secreting_ involucrum, with its peculiar inflected
turn, forming a _sacculum_ within which is lodged the embryo. The
nutritive involucrum is separated from the middle membrane by the
_allantoid_ cavity, and the middle membrane itself stands aloof
from the amnion, owing to the _vesicula umbilicalis_. The
existence of these various elementary parts of the human Ovum in
the present specimen, shews its early development, and serves to
fix its age, which I consider to be of about three weeks and a
half.
As gestation advances, some of those elements are obliterated, and
others confounded together.
REMARKS.
I imagine that these Ovula pass away from the womb almost
immediately after they have entered it, owing to a tardy or
deficient formation of that peculiar lining which the uterine cavity
begins to weave for itself from the first moment of a successful
copulation, and to some part of which the Ovula are destined to
adhere.
The preceding objects are represented of their natural size, and as
they lost their colour during the first maceration in water, owing
to the great readiness with which the mossy vessels discharge their
blood, the colour adopted in the Plate is that which they attain
afterwards, and such as it appeared when the artist sketched them.
They have in every instance been examined and dissected under water.
Such early Ovula are not rare. In the Museum of the Royal College of
Surgeons of London there are four such specimens, marked 3432—3—4—5
in red ink on the black varnished cover of the bottles[26]. In Sir
Charles Clarke’s collection there are also several. I have likewise
examined many of them in Meckel’s magnificent museum; but it is in
that of the late Professor Sœmmering that I have been gratified by
the sight of not a few beautifully prepared and arranged specimens
of this early stage of the human Ovum. Among them were the identical
preparations which he selected and arranged in a graduated series of
human embryos, and afterwards caused to be delineated and engraved,
for his valuable work entitled “_Icones Embryonum humanorum_.”
Fig. 5.