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.
[Illustration:
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: