opinion, that on reaching the uterine orifice of the tube, the ovulum
found an obstacle in the presence of the inner lamina of the
_decidua_, which latter is said to be projected across that orifice.
This obstacle the ovulum overcomes, Dr. Hunter _supposes_, by pushing
the said lamina forward, and following it close, so at last to make
good an entrance into the womb, surrounded by this inner lamina of the
decidua, which the ovulum compels to enlarge with its own gradual
enlargement, until both fill the entire cavity of the uterus, and the
inner lamina of the decidua comes in contact with itself. It is
impossible to conceive a more improbable operation, or one more
contrary to facts. Yet such is the notion formed by Hunter of an
imaginary membrane, to which he has given the name of reflected
decidua; and so enamoured was he of this notion, that he has not
hesitated to portray in his large work on the gravid uterus a section
of the womb at several weeks after conception, (again purely
imaginary,) representing things as he supposes them to be in regard to
that membrane! Hunter’s notion was gradually converted into an
opinion, which most of his successors have repeated over and over
again, out of respect for him, and without ever inquiring
experimentally into the correctness of it. No one has advanced a
single fact to prove it. There is no such a thing as a _decidua
reflexa_. The improbability of such a process as has been imagined to
account for its supposed existence, has been demonstrated very
adroitly by Dr. Dewees, as skilful and clear-sighted an obstetrical
writer, of the United States of America, as any that have appeared in
Europe. (Comp. of Midwifery, 1824, page 66.) He there shews, that if
we adopt Burn’s description of the _decidua reflexa_, given by that
author in a tone of positiveness, as if Hunter’s notion was a
mathematical proposition, either that membrane must have three,
instead of two, laminæ, as admitted by them, or it must have even a
fourth lamina, namely, one more than has ever been imagined by any
body. But the truth of the non-existence of a membrane formed in the
manner in which the _reflexa_ is said to be formed, is proved by
actual facts. A few will suffice. A specimen of an impregnated uterus
marked 3468 C. Gallery, Coll. Surg. of London, exhibits distinctly a
round ovum naturally suspended within the decidua, as a globe may be
supposed to hang from some point of the inside of an oblong sack. Here
the ovum has pushed no part of the uterine decidua forward. The ovum
has only its natural involucra, and there is a large space between
them and the deciduous lining of the womb. In Dr. Agar’s case, alluded
to before, in the Museum of the R. C. of Physicians, (impregnated
uterus 2½ months,) no decidua reflexa is seen. Specimen 73, in Sir
Charles Clarke’s collection, exhibits an ovulum which has already
penetrated about an inch into the cavity of the uterine decidua,
without pushing any part of it forward. Specimen 75 in the same
collection is another illustration of the same fact. In good truth,
the existence of the decidua reflexa is disproved by facts, and is
moreover rendered inconceivable and inexplicable by the very account
and explanation given by those who contend for that existence. It is
now scarcely admitted by one out of ten Continental anatomists.
There is another physiological fact which we have overlooked—it is
this: That the uterine decidua is always pervious at the uterine
orifices of the fallopian tubes, as well as over the internal orifice
of the cervix uteri. The error thus signalized has arisen from not
knowing that the ovulum comes from the ovarium with a _cortical
membrane_ over the shaggy chorion. It is curious to see how, even
among some of the most skilful of the modern physiologists, their
ignorance of the existence of a _cortex ovi_ has misled them in their
respective descriptions of the decidua or uterine lining. Carus, for
example, has asserted, that the decidua uteri had an opening over the
internal orifice of its cervix. Velpeau and Breschet have denied this
to be the fact, and consider the decidua to be a complete sac, to
which they have ascribed the functions of a serous membrane. Professor
Heusinger confirms the opinion of the two French authors, but denies
that the decidua is a serous membrane. The truth lies between: Carus
described the real decidua, which has three apertures; while Breschet,
Velpeau, and Heusinger evidently refer to the cortex ovi which has no
aperture whatever, when the ovulum enters the cavity of the womb. Well
might Meckel exclaim, “il n’est pas très facile d’expliquer le mode de
formation de la caduque reflechie.” (See specimen 73, 75, 76, 87,
Museum of Sir Charles Clarke.)
Footnote 4:
It is impossible to desire a stronger or a more beautiful illustration
of the modern theory of fecundation, than we find in the preparation
here alluded to. It is the impregnated uterus (between two and three
months) of a female who died of hydrophobia. Both the ovaria are laid
open. In the left there are no appearances, beyond the Vesiculæ
Graafianæ hardened by the alcohol: but in the right, namely, the
ovarium of that side on which it is supposed that the fecundated
Ovulum entered the womb, (from the circumstance of the placenta being
implanted in that quarter,) we find not only a scar still red on the
surface of the ovarium, but corresponding with it, and beneath it, in
the thickness of the ovarium, a large shallow depression or hollow
from which the Ovulum had escaped, and which is beginning to fill with
the substance that is to constitute the corpus luteum destined to stop
up the gap in the ovarium.
Footnote 5:
Meckel, with many others, entertain still the opinion that the corpus
luteum precedes fecundation—but instead of supposing with Sir E. Home
that it generates an Ovulum, the physiologist of Halle imagines that,
like a _testis_, it serves to secrete a generating liquor—the semen
feminæ. This theory is demolished by Boer’s, Plagge’s, and Messrs.
Prevost and Dumas’s positive observations.
Footnote 6:
This disparity has not been noticed before by writers. Like many other
circumstances, it militates, not a little, against the theory of the
decidua reflexa.
Footnote 7:
Dr. Pockels calls this the Decidua—but in good truth it is the _Cortex
Ovi_—for this good reason, that at so early a period, and even as late
as the end of the first six weeks, the Decidua is many times larger in
capacity than the ovulum, and is never globular like the latter.
Besides, when Ovula of such early periods are thrown out, the decidua
remains behind, and is ejected in its triangular shape, a little
while, and sometimes even a day, after. In other respects, Dr. Pockels
confirms _Boer’s_ more precise description of the “_Structure of the
Ovum_.”
Footnote 8:
The whole of the English physiologists, writers on midwifery, and
lecturers, whether ancient or modern, are entirely silent on this
important stage of embryonic life. They have talked rather loosely on
the subject without the species of life which he must suppose the
embryo to enjoy. He tells us, that even at the end of three weeks the
Ovum is not found in the uterus, but how it exists during that period,
wherever it may be, he has not even alluded to a single reference to
facts or anatomical remarks of their own. Burns, in his work on
abortion, never once alludes to
Footnote 9:
See a very interesting paper on the Structure of the Human Placenta,
by T. Radford, Surgeon, &c. Manchester, 1832.
Footnote 10:
I shall submit to the Profession these curious and interesting
experiments very shortly.
Footnote 11:
Autenrieth, in his “Supplementa ad Historiam Embryonis Humani”, has
given the dimensions of the embryo and fœtus from a week to the 126th
day of growth, with a description of the several parts as they appear
at each period. From these he has drawn several conclusions respecting
the growth of the human fœtus which have been generally adopted.
Soemmering, in his “Icones Embryonum Humanorum,” has also given the
dimensions of the human fœtus, from the earliest period he has seen it
to its full maturity, with plates.
Footnote 12:
“Caput nutans per omne tempus quo in Ovo continetur.” And again,—“Quò
junior embryo, eo major est volumen capitis.” (Soemmering.)
Footnote 13:
This doctrine has been controverted by two more recent
experimentalists, Prevost and Dumas, as far as the chick is concerned.
They assert that the rudiments of the spinal marrow appear before any
other important organ.
Footnote 14:
In describing the figures in Plate I. under the head of “remarks” it
is to be understood that by the expression of “the mossy vessels
discharge their blood” is meant that they present themselves,
immediately after the expulsion of the Ovulum, with very feeble tokens
of the presence of blood at that early period of gestation.
Footnote 15:
The consideration of the development of the human embryo in its
minutest parts, progressively watched and carefully examined and
described, as those parts appear in succession, appertains to
transcendant physiology, and would be out of place in these
Prolegomena to a work which is intended to supply my brethren with
practical information, obstetrical as well as medico-forensic. It is
sufficient for my purpose to mention (as I have endeavoured to do) the
forms which the fœtus presents, its different sizes, and the weights
which correspond with those forms. To those of my readers who take an
interest in embryogenesy, I recommend the careful perusal of the
various continental modern authors repeatedly named in these
Prolegomena. Unfortunately, since Hunter and Home, there has not been
a single British practical and experimental physiologist who has
investigated this subject either originally or otherwise. This fact,
not at all flattering to us, is no where placed in so strong a light
as in Breschet’s very erudite and classical memoirs, entitled “Etudes
anatomiques, physiologiques et pathologiques de l’Oeuf duns l’Espèce
humaine” which that indefatigable inquirer has enumerated and analyzed
every statement and experiment made on that subject by upwards of
thirty physiologists, down to the present day; among whom there is
not, since Hunter and Home, a single English name besides that of Dr.
Burns, recorded.
Footnote 16:
See Journal Complementaire, Vol. 6. p. 375.
Footnote 17:
I possess a placenta exhibiting these appearances (78, 79) in so
distinct and beautiful a manner, that it would be a violation of truth
and sincerity, or a sure sign of ignorance, to state that they do not
properly resemble those which are observed in the Chorion of some of
the mammalia. Those are cotyledons. So are these. I shewed the
preparation to Dr. Hugh Ley. He was delighted with it, and instantly
admitted the similarity in question.
Footnote 18:
Observations relatives à la Géneration. Par F. Lallemand. Paris, 1818.
Footnote 19:
Precis Elementaire de Physiologie, 2d edit. Paris, 1825.
Footnote 20:
Dr. Hunter on the Placenta. In Gravid Uterus, page 43, 9th edit. 1794.
Footnote 21:
A complete ovum, with the investing cortical membrane, and the entire
decidua expelled nine weeks and three days after the last regular
menstruation, in the case of a lady recently married, whom I attended
(March, 1833), has afforded me ample opportunity of verifying the
above and most of the previous propositions, through a careful
dissection of the parts under water, and the use of the microscope.
Footnote 22:
MS. Lectures of Dr. Hunter, taken by John Sheldon, 2 Vol., formerly in
the possession of Joshua Brooks, Esq. and now before me (Vol. II. page
485).
Footnote 23:
Communicated to the Philomatic Society of Paris, 1830.
Footnote 24:
Memoires de la Societé de Physique de Genève, T. IV. part 1.
Footnote 25:
American Journal of the Medical Sciences, Nov. 1829.
Footnote 26:
I am thus particular, because there is a second and even a third
series of numbers in this collection, which are differently marked on
the preparations and in the MS. lists, although belonging to the same
specimens. This confusion which has crept in, in spite of Mr. Clift’s
vigilance and endeavours to prevent it, will disappear as soon as that
skilful naturalist shall have been able to complete the laborious task
of making a catalogue _raisonné_, of the museum.
Footnote 27:
See SIEBOLD Journ. für Geburt Shülfe 1827. T. VIII. p. 1–11.
Footnote 28:
The Cases to which this plate refers occurred in the practice of
Sir Charles Mansfield Clarke, Bart., many years ago.
------------------------------------------------------------------------
TRANSCRIBER’S NOTES
1. P. 40, changed “Il n’y a _jamais_ de grossesse Ovarique, dans ce
sens que le fœtus _puisse se developper dans l’interieur de
l’Ovaire_; on connaît des cas de fœtus arrivé _sur_ l’Ovaire; maîs
très certainement l’ovule en était sorti pour n’y rentrer, ni
comme œuf, ni comme embryon.” to “Il n’y a _jamais_ de grossesse
Ovarique, dans ce sens que le fœtus _puisse se developer dans
l’interieur de l’Ovaire_; on connaît des cas de fœtus arrivé _sur_
l’Ovaire; mais très certainement l’ovule en était sorti pour n’y
rentrer, ni comme œuf, ni comme embryon.”.
2. Made the corrections indicated in the ERRATA.
3. Silently corrected typographical errors and variations in spelling.
4. Retained anachronistic, non-standard, and uncertain spellings as
printed.
5. Footnotes have been re-indexed using numbers and collected together
at the end of the last chapter.
6. Enclosed italics font in _underscores_.
7. Superscripts are denoted by a caret before a single superscript
character, e.g. M^r..