diminutive, compared to the mass which constituted the entire Ovum
before it was flattened and pinned to a piece of blue pasteboard
placed in spirits within a glass jar. This preparation, now in the
museum of St. George’s Hospital, exhibits the transparent
involucra and the placental envelope with the intermediate
membranes, imperfectly developed, of an Ovum which I should judge
to have been fecundated about three weeks. At this period of
conception the embryo is generally straight, consisting of that
part which is to be the trunk, terminated, as in this case, by a
round swelling, which is the head. Here the embryo is in reality
straight, and has the appearance of a worm. It is attached to the
inside of the secreting membrane by its abdominal surface without
any visible cord. As illustrative, and that in a very distinct
manner, of this early stage of pregnancy, Fig. 5 is a valuable
specimen.
Fig. 6.
The same remarks apply to this as to No. 5. The embryo is somewhat
more clearly delineated. Its trunk is gently curved forward, and
the tubercular-like rudiments of the extremities appear visibly
marked. This circumstance denotes its age to be of five weeks.
The volume of the transparent involucra is disproportionate to the
embryo itself: yet the placental covering, with its filiform
vessels, bears a still larger proportion to them; so that the want
of equilibrium between the external and internal apparatus of the
Ovum has destroyed, first the growth, and next the life of the
embryo. The preparation is in the museum of St. George’s Hospital,
and like the preceding preparation (5), has been flattened and
pinned to a pasteboard—a mode which, for the _steady_ display of
the peculiarities of the Ovum in both cases, was, perhaps, the
most judicious.
Fig. 7. Ovum denudatum, or diaphanous Ovum.
(About eight weeks after menstruation.)
Its structure is imperfect. It wants the nutritive membranes or
involucra. It is defective also in the arrangement of the inner or
secreting membranes. Hence the great accumulation of fluid within,
and the scanty appearance of the filiform vessels without. The
embryo has consequently been retarded in its development, which is
scarcely greater than that of Ovulum No. 4, although the period at
which the former had been ejected, was nearly twice as long as
that of the latter.
Fig. 8, and 9.
Are also examples of denuded or diaphanous Ova, to which the same
remarks apply as to the preceding specimen. The enlargement of
Ovum 8 is even greater than that of Ovum 9: yet the embryo of the
latter is more advanced and more clearly delineated by nature than
is the case with Embryo 8. We know that these two Ova and No. 7,
are more than two months old from the length of the umbilical cord
as compared to that of the fœtus: for from the second to the sixth
month of pregnancy, the length of the cord is proportionately
greater than that of the fœtus.—(_See_ Meckel and others.)
In examining these denuded or diaphanous Ova, I have been struck
with that small circular spot on their surface, generally of an
opaque colour, which has been called the _cicatricula_, and is not
unlike that which is found in some of the Ova of birds. This spot
is well marked by the artist in the last three specimens, and in
two of the figures of _Plate 3_. I take the _cicatricula_ to be
that part of the _Ovulum_ which adhered to its ovarian nest
(called the _vesicula graafiana_), before it burst from the
Ovarium to pass into the womb consequently on fecondation. It is
to be seen on all the ovula so situated in the Ovaria of women,
and is considered to contain the rudiments of the embryo, which
certainly begin from a little straight line that may be distinctly
seen in the _cicatricula_.—(_See_ Meckel, Adelon, Geoffroy St.
Hilaire, Prevost, &c.)
REMARKS.
This class of human Ova throw no inconsiderable light on the
progress of fœtal intro-uterine life. They prove that the embryo,
called into existence by the mysterious act of fecondation (the only
point that _is_ mysterious about the process of generation according
to Cuvier) may, and will, and does live independently of the
mother,—with a life wholly its own, and that it derives from its
parent growth only, or accretion of substance, as I stated in my
preliminary observations. The museum of the Royal College of
Surgeons supplies a most striking illustration, and I may add,
corroboration of this opinion.
No. 3448 is a single spherical denudated diaphanous Ovum about six
inches in diameter, without the slightest appearance of any
placenta, filiform or cotyledonous vessels, or other of the
nutritive involucra or membranes. The secreting or amnionic
membrane, is capable of containing more than six ounces of fluid;
yet the embryo is not larger than an embryo at one month. When this
specimen was sent by Mr. Lugar, of Richmond, to the College, Mr.
Clift found it attached to a PLACENTAL OVUM, containing a perfect
fœtus of the proper size at four months and a half, with an
umbilical cord nine inches long. The attachment of the two or _twin_
Ova, was by a spot not larger than a shilling, which is still
visible on the smaller or diaphanous Ovum, and was of a bright red
colour at the time of separating the two Ova for the purpose of
making a distinct preparation of the more complete Ovum, marked in
the museum 3448 A.
It appears that the twin Ova were ejected together five months after
menstruation.
That the embryo in the smaller Ovum _lived_ is proved by its size as
well as by the secreting involucrum having enlarged with fluid to
the capacity afore stated. But it did not grow, because
_unconnected_ with the mother; while the twin fœtus properly
encircled by the placental envelopes, which placed it in immediate
communication with its parent, lived as well as acquired growth.
[Illustration:
Plate 2
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
PLATE II.
SPECIMENS OF MISCARRIAGES BETWEEN TWO AND THREE MONTHS.
Fig. 10. Ovum pyriforme externe opacum.
(Eleven weeks after menstruation.)
None of the transparent involucra were visible in this Ovum, when,
after excruciating and prolonged sufferings, it was expelled in
the intact state here represented. The external or placental
envelope invests the entire Ovum, and explains the cause of the
abortion. The artist has seized with much felicity the uneven and
almost cribriform surface of the fleshy envelope, exhibiting
numerous orifices, through which its adherence to the uterine
vascular lining, resulting from the act of fecondation, was
effected.
Fig. 11.
We here see the immediate and direct effects of the peculiarity of
an _entire placental covering_, as represented in the preceding
Ovum (10.). The secreting or inner involucrum (amnion) of that
Ovum, when laid open, was found tinged with blood and the cord
distended by the same fluid which pervaded also the _liquor
amnii_, as well as the fœtus itself. The morbid adhesions,
contracted by the middle membrane with the chorion in consequence
of plethora, are well marked in one part of the drawing by the
artist to whom I carefully dissected the preparation. The chorion
itself is in a morbid state.
Fig. 12. Ovum opacum plethoricum.
(Eleven weeks after menstruation.)
Placental or cortical covering, lying over three-fourths of the
Ovum. A pellucid membrane entirely surrounds the placental
covering to which it adheres. The chorion is thickened, and has
contracted morbid adhesions with the middle membrane. The
transparent or inner involucra are easily separated into four
laminæ, three of which belong to the middle membrane.—(Dutrochet.)
The liquor amnii was of a brilliant red colour—the cord large,
flattened, and the vein ruptured.
Here we see the same direct consequences from the same defects in
the structure of the Ovum which we noticed in Fig. 11. This
abortion was brought to me by a midwife immediately after its
expulsion. I carefully examined and dissected it, and before the
least change could take place in its parts or colour, it was drawn
by Mr. Perry (1827). No hemorrhage followed the expulsion of this
Ovum. The woman had had several children, and miscarried three
times between every two successful pregnancies; whereupon her
general health was greatly impaired.
REMARKS.
These two morbid Ova are represented of their natural size, and were
carefully drawn and coloured as soon after their expulsion as could
be accomplished. I believe they are unique of their kind. At least I
have not seen any such in the various collections I have visited:
neither do I think that they have been mentioned, still less
delineated, by any writer.
It is manifest, that under the various unpropitious circumstances in
which these Ova were placed, growth must have been materially
retarded and ultimately impeded; while life must have ceased
sometime before the Ova were expelled.
Judging from their size and the length of time during which they
lodged in the uterine cavity, these Ova must have acted the part of
parasitic animals upon that organ.
[Illustration:
Plate 3
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
PLATE III.
SPECIMENS OF MISCARRIAGE BETWEEN THE SECOND AND THIRD MONTH.
Fig. 13. Ovum semi-coriaceum.
(Nine weeks after menstruation?)
The external covering has been laid open. It is thick and fleshy.
A second or inner covering is observed equally dense in texture
and opaque; and a third involucrum, lying over the secreting
membranes, (which are seen through a wide slit, bearing at their
upper portion the filiform vessels,) is not only thick, like the
second involucrum, but is actually seen passing from the
transparent into the dense and opaque texture. The artist has
portrayed this circumstance most accurately in his engraving. The
placental cotyledons are at the posterior part of the figure,
mossy, in groups, and some of them covered with their _membrana
propria_. The embryo of this, and of Ovum 15, are not visible.
There can be little doubt but that intro-uterine inflammation,
extended to the involucra of the Ovum, has produced, first, its
morbid change of structure, and lastly, its early expulsion from
the womb.
Fig. 14. Ovum semi-coriaceum.
(Ten weeks after menstruation?)
This is somewhat larger than the preceding Ovum, although of the
same tissue and structure. The withered fœtus is visible through
the opening made in the secreting membranes, and the _cicatricula_
may also be perceived on one part of the inner layer of the middle
membrane, or involucrum, which lies immediately over the amnion.
I attribute both the structural condition, and the untimely
expulsion of the Ovum, to the same causes.
Fig. 15. Ovum omnino opacum, rotundum.
(After the lapse of three menstrual periods?)
The external covering, or _cortex_, is one twelfth of an inch
thick, with an uneven surface, having vascular orifices upon it to
the extent of about three fourths of that surface. The rest is
smooth, shewing that in that part, the Ovum had not contracted any
adhesion, by vascular connexion, to the inner cavity of the womb.
That connexion was accomplished by means of the placenta, which is
seen at the posterior part of the preparation, and appears quite
compact, and one twentieth of an inch thick, judging by the
portion which has been purposely laid open. It is through this
aperture that the _cortex Ovi_ is seen, as described above. On
removing a good portion of this thick cortex, a large cotyledon,
or group of vessels belonging to the middle membrane, is exposed
to view. The middle membrane itself is seen perfectly transparent,
and upon it the _cicatricula_.
I have been the more particular in designating this Ovum as
globular, because the fact of its having such a configuration
assists (with other circumstances) in proving that these solid and
thick general envelopes, found over human Ova expelled from the
sixth to the twelfth, and even fourteenth week, _cannot_ (as
pretended by some) be the so called caducous membrane of the womb.
We have here a thick and solid shell, perfectly round, closely
embracing in every part the lanuginous surface of the Ovum;
whereas the cavity of the womb is never otherwise than triangular
in its shape, or like unto a congeries of triangular vertical
planes, however much the organ itself may be developed. Nor could
any membrane (lining such a cavity) in detaching itself from its
walls, or falling off during abortion, surround in a globular
form, and in so compact a manner, the Ovum, as we see in the
present instance. Here again, slow, insidious, persisting
inflammatory action, must have done the mischief.
REMARKS.
The three preparations here represented of morbid human Ova, or
abortions, are in the museum of St. George’s Hospital, and belong to
Sir Charles Clarke’s collection. They admirably illustrate the
_morbid_ development of the external involucra. Although the
specimens retain scarcely any colour, (as is the case with most of
the morbid preparations not injected,) the artist was directed in
the choice of the colours applied to his drawings, by recent
specimens of analogous abortions, which offered themselves to my
attention in the exercise of my profession, during the six years
that he was engaged in the present work. I regret that I can procure
no data respecting the three abortions delineated in this Plate, nor
have I any positive knowledge of their age—but judging of the latter
by their appearance and from analogy, I affixed that age to them
which seemed to me the most probable.
There are many similar specimens in the museum of the Royal College
of Surgeons, and I have seen some in that of Professor Meckel at
Halle, and of the late venerable Professor Sœmmering, both of whom
honoured me with their friendship. In the first of these three
establishments there is a preparation which in many respects
resembles Ovum 14. It is marked 3447 and was presented by Mr.
Lawrence. Viewed externally, the Ovum in the latter case looks
almost sarcomatous. It has a triangular outline with two short
prolongations at each of the two upper angles corresponding with the
situation of the uterine orifices of the fallopian tubes. The inner
or transparent involucra of the Ovum (which is _bigeminum_) are
covered by the cotyledonous prolongations weaved into a general
placenta with its _membrana propria_, and a coriaceous envelope over
all. The internal cavity is laid open so as to exhibit an embryo in
each half of the Ovum, the one being double the size of the other.
The smaller embryo is about as large as a good-sized house-fly. The
cord of the largest embryo is nearly an inch and a half long,
sacculent, and expanding towards the abdomen so as to form the only
covering of that cavity. The cord of the smaller embryo is half an
inch in length and filiform.
I have before me two other specimens of the semi-coriaceous Ovum
obtained in cases of abortion which occurred in the course of my
practice last year: the one in June, the other in December. In the
first case the lady had had several live children, and had also
miscarried often before. In the second case the lady was
primiparous. Both suffered dreadfully—and it is to be remarked, that
the pains experienced by the patient during the process of this
species of miscarriage is always excessive, and the escape of the
Ovum generally followed by violent hemorrhage. Many years ago I
succeeded in saving the life of a patient of high rank, then in the
country, who was sinking under an almost total loss of blood,
consequent on a miscarriage of this kind, in which a large portion
of the semi-coriaceous envelopes had remained behind adhering partly
to the inner orifice of the womb, thereby producing and keeping up
the hemorrhage. In all these cases, the Ovum could not have been in
existence more than three months, reckoning from the cessation of
the menses. They were all nearly of the same volume, but the size of
the fœtus varied in proportion to the greater or less thickness of
the envelopes.
On examining that part of the anatomical collection of the Royal
College of Physicians, in London, which relates to these subjects, I
found a very interesting specimen of the globular and wholly opaque
Ovum, marked 7. G. No. 19. All the involucra, without any
distinction, adhere together most compactly, so as to form a species
of egg-shell of an equal thickness throughout; that thickness being
no less than one third of an inch. The Ovum resembles in size a
large duck’s egg, though more spherical than the latter.
The inscription on the label is, “A Miscarriage at Six Weeks”, but
the embryo appears of no more than four weeks’ growth.
[Illustration:
Plate 4
_Joseph Perry del et Lithog._ _Printed by C. Hullmandel._
D^r. Granville on Abortion
and the Diseases of Menstruation
]
PLATE IV.
SPECIMENS OF MISCARRIAGE DURING THE THIRD AND BEFORE THE COMPLETION OF
THE FOURTH MONTH.
Fig. 16. Ovum pseudo-membranosum.
(Three months and a half after the cessation of the menses.)
There are not fewer than seven membranes, or involucra of some
sort or another, in this example of aborted Ovum. Its age is
unknown to me, as well as its medical history. I can only judge
from appearances, as the preparation speaks for itself. In one
point of view, more especially, is the present diseased Ovum
particularly interesting to me; for it exhibits the most distinct
proof that what I call the _cortex_ of the Ovum, and which others
have, without direct evidence, considered as a membrane of the
uterus, is, in good truth, a natural covering of the Ovum. It is
this very natural covering of the Ovum which is liable, from
disease, to become fleshy, opaque, vascular, and lastly
coriaceous, thereby cutting short the supply, or accretion of
substance to the fœtus, and thus destroying its life and producing
abortion. Were it not so, we should not observe, as in the design
before us, another membrane external to the one I allude to, as
seen at the bottom and on the right of the figure, which is the
true caducous or uterine membrane of authors. Its structure is far
different from the former; it is of a loose texture,—I was about
to say, almost gelatinous, or like a reticulated gauze.
The chorion, in this instance, is thickened nearly as much as the
_cortex Ovi_. A considerable space intervenes between those two
involucra; and within this thickened chorion a false membrane is
distinctly seen to surround the Ovum. The embryo is advanced to
about the third month, but retarded in its growth.
A specimen, analogous to the present, was deposited in 1817, by
Mr. Lawrence, in the Museum of the Royal College of Surgeons of
London, where it is to be seen marked 3437 C. The involucra are
coriaceous, but we have besides, over the nutritive membrane
(chorion), not fewer than three false membranes, the result of
_uteritis post conceptionem_. The fœtus has evidently been stinted
in its growth, and in size resembles a small insect.
REMARKS.
Instances of additional or pseudo membranes in aborted Ova are by no
means of unfrequent occurrence. On one of the shelves in the Museum
in Lincoln’s Inn Fields, I observed one marked 3443, in which a
pseudo membrane has formed externally to the placenta, pressing on
the cotyledons of the latter. The embryo is stinted. Upon another
shelf I find No. 3442, with the nutritive as well as the secreting
(amnion) involucrum thickened and pergamenous—the coat which they
form being one twentieth part of an inch in thickness. The amnion,
internally, is lined with a delicate pseudo-membrane. Here, also,
although the entire Ovum is of such capacity as to admit about half
a pint of fluid, the embryo has not acquired more than the size of
an ordinary house-fly. The placenta is compressed and covered by an
adventitious membrane, besides its _membrana propria_.
In Ruysch’s Thes. Anat. VI. Tab. II. Fig. 5, there is represented a
specimen of human Ovum, with a pseudo inter-membrane, not unlike my
present preparation; like it, too, it exhibits the cord hydropical.
Fig. 17. Ovum uviforme.
(In the third month after the suspension of the menses.)
A _uviform_ abortion is so rare an occurrence that when Mr. Clift
first saw the figure of it in the present work, he remarked that
it appeared more pictorial than true. The preparation, however, of
the size of the design, and as it was sketched by Mr. Perry in
1827, is still in my possession, and I hold it to be most valuable
on many accounts.
Under a _shower_ of minute grape-like or granular bunches, is seen
suspended that portion of a transparent Ovum, (exhibiting through
its diaphanous involucra an embryo bearing no proportion to the
magnitude of the Ovum,) which has been denuded of its nutritive
involucra. The latter are superimposed to the granular bunches,
and are curiously fringed at their margins. They are two in
number, and externally to them may be seen the loosely weaved
caducous membrane. During three months of utero-gestation, from
the moment of conception, has this mass lived—but the embryo has
not advanced from what it was at four or five weeks, nor could it.
The time was spent by Nature in playfully modelling, forming, and
cutting out what would almost appear an artificial plaything; so
fantastical it looks.
REMARKS.
There can be no difficulty in understanding how this curious
formation came about. The Ovum with its _cortex_ adhered to the
ceiling (fundus) of the womb, and contracted an intimate connexion
with that organ through its caducous lining. During the first weeks,
that external covering, _cortex_, or membrane, became fleshy and
vascular. Plethora took place in consequence, as we have seen in
some of the preceding cases of abortion; but, instead of an
increased secretion of amnionic fluid, as was the case in the Ova
denudata, or diaphanous, of Plate I., the effect has been a
dropsical bead-like enlargement of the mossy or filiform vessels of
the Ovum. In proportion as these advanced and enlarged, they
detached and forced outwardly the coriaceous envelopes, which began
to absorb at their inferior edges in that irregular progression
which left them as they are now seen, irregularly _echancrés_. This
process of absorption in the outer envelopes of the Ovum, from the
first to the fifth month, is what takes place generally, even when
they are not morbidly affected in their texture in the way in which
they are in the present instance, and is the process by which the
placenta is formed. But in order to effect this properly, the mossy
or filiform vessels, of nearly three fourths of the circumference of
the young Ovum should also become progressively obliterated; while
those which remain, mingling with the superimposed envelopes, swell
into large blood vessels to assist in the formation of the placenta.
Here, however, such a process was impossible, inasmuch as the mossy
or filiform vessels, having taken up a morbid action and become
distended with the serosity, which kept constantly pouring into
them, could not become absorbed to the extent required to form the
placental cake, but on the contrary continued to increase in size
and number. This operation took place at the expense of the growth
and life of the embryo, which is consequently seen to be stinted and
undeveloped. Abortion, therefore, was inevitable sooner or later.
The specimen is also valuable, as it affords positive evidence of
the mode in which the placenta is formed, for here we actually see
the process of absorption of part of the involucra, on which that
process depends.
Some who have seen this specimen, confound it with a case of
hydatous placenta; and a few similar preparations exist under that
name in more than one collection. It is evidently by mistake that
they are so styled, as we shall see in a succeeding Plate.