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.
[Illustration:
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.
[Illustration:
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.
[Illustration:
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.
[Illustration:
Plate 8