Part 2
11. It is with the view of contributing to the common stock of new and interesting information on this all-important question, that I bring forth the result of my inquiries into the morbid state of the human Ovum, and its structure under circumstances of premature expulsion. If such inquiries have led me to adopt the improved notions of the more modern physiologists and anatomists in these matters (which I have professedly studied, and have had the most ample opportunities of studying for many years); they have, likewise, enabled me to detect some of the oversights of those observers, and to add a little to what has already been brought forward; while, at the same time, they have induced me to join that class of writers who dismiss, as inconsistent with facts, the theories and assumptions of olden times, whose strongest authority has been their mere repetition.
12. The ideas which are now entertained respecting fecundation, after the successful congress of the two sexes, in the human species—respecting its seat—respecting the first origin, station, and rudimental creation of the embryo—respecting the journey of the latter into the womb, its sojourn in that cavity, and the various metamorphoses it undergoes therein, up to the period fixed for its projection into the WORLD, may be comprised within a small number of propositions. I shall support those propositions by references to facts, or the quotations of competent authorities, and the allegation of anatomical discoveries. But as the object of the present work is to illustrate abortion, and not the complete life-circle of the fœtus, I shall stop the number of my propositions at the _fifth_ month of its intro-uterine existence. After that period, the various phenomena of fœtal gestation are so uniform, that they afford less matter of interest to the philosopher.
13. CONCEPTION, or that result which follows sexual congress, in virtue of which one, or more individuals, of the same species is called into being, takes place in the ovarium of women. This is doubted by Meckel and others, who look upon all cases of ovaric gestation (see Plates IX. and X, A. and B.) as mere accidents, and as only proving that if conception has not before taken place in the womb, it _may_ take place in some other part connected with it; but the point has been set at rest by the more recent experiments and microscopical observations of Professor BOER, of Kœnigsberg. I adopt his conclusions. Their correctness is corroborated by the interesting experiments of Prevost and Dumas, although these experimenters admit not that fecundation takes place in the ovarium.
14. The intended receptacle of the embryo is the OVULUM. An ovulum exists in all the vesicles of Graaf, which the ovarium of a woman, who has reached maturity, contains.
15. Viewed by means of a powerful microscope, the ovulum is found to consist of a small yellow spherical body, placed within the vesicula Graafiana, with the upper portion of which it is, internally, in contact; so that it does not float freely in the liquid of that vesicle. This contact becomes more and more intimate as the ovulum enlarges, when that part of the capsule of the vesicle which lies over it becomes, in a correspondent degree, thinner.
16. At first, the little yellow body, being rather opaque, is distinctly seen even without a magnifying glass; but as it advances, it becomes more transparent and, consequently, less distinguishable.
17. This little yellow body is a minute spherical mass, with a roughish or slightly granular surface, and is hollow. Its parietes are thick; around them is an envelope of a much thinner texture, which is distinctly seen, owing to a small space lying between it and the surface of the little yellow body, which space is filled with a fluid substance of a peculiar nature.
18. When FECUNDATION takes place, that part of the vesicle of Graaf to which adheres, internally, the ovulum, bursts, and the ovulum escapes with its external envelope, together with a small portion of the liquid peculiar to the Graafian vesicle, and thus it passes into the fallopian tube.
19. Independently of the external envelope, and within it, the microscope has detected, after fecundation, the existence of another covering, completely investing the little spherical yellow body.
20. The ovulum has been traced, after fecundation, into the cavity of the womb, where the external covering (17) becomes what Boer has called “the cortical membrane”, (_cortex ovi_ of the present work,) improperly considered as a uterine production by preceding writers, and denominated the _reflected_ caducous or deciduous membrane.
21. The more intimate covering of the yellow body of the ovulum, that which closely invests its surface, and appears only after fecundation, (19) is afterwards changed into what has been denominated the shaggy chorion: my observations and my plates shew this. Boer, however, professes not to know what becomes of it during the progressive intro-uterine development of the ovulum.
22. The hollow and spherical yellow body of the ovulum corresponds with the yelk or _vitellus_ of the ovum of oviparous animals, and from it all the other several parts of the fœtiferous ovum are derived or formed, as gestation advances, and a progressive development of the parts takes place, from within, without[1].
23. The existence of the cortical membrane is proved in many parts of the present work, but particularly by Fig. 15, Plate III., and Fig. 17, Plate IV. in both of which specimens of abortion, the said _cortex_ had persisted to a longer period than usual during gestation, and had become, consequently, thickened, opaque, fleshy indeed, and the cause of abortion. Figure 15, too, shews strongly the probability of my notion that the thin membrane investing the surface of the yellow body of the ovulum is, in good truth, what has been usually denominated the shaggy chorion.
24. Another proof, amounting to demonstration, of the existence of a cortical covering to the human ovulum, and that of the filiform envelope called the shaggy chorion within it, I find in a striking and beautiful preparation belonging to Sir Charles Clarke, marked 87. We there see a complete cast of the lining (caducous membrane) of the uterine cavity after fecundation, thrown off at a very early period, and with it the ovulum, (of the size of a Portugal grape,) exhibiting the _cortex ovi_, shelly and membranaceous, of a dense texture, yet flexible, which has burst like the pericardium of some seeds, and allows the shaggy chorion beneath it to be seen. It is a curious fact, that even Ruysch has, in his fanciful manner, represented a human ovulum of about three weeks with the cortex burst, yet still _in situ_, and the shaggy chorion beneath it, in every way resembling the specimen of Sir Charles Clarke’s in the Museum of St. George’s Hospital.
25. Even the errors of some of the very able anatomists of the present day come in beautifully to corroborate Professor Boer’s observations of the cortical membrane. Breschet and Velpeau, for instance, state, that within what they (with their predecessors) have looked upon as the decidua in the human ovum, there is a cavity containing a peculiar liquid which, in their opinion, is essential to the nutrition of the fœtus. Now what is this but the very description of the ovulum by Boer (17), proving that there is a cortical membrane in the human ovum?
26. The cortical membrane is destined to be absorbed during the first months of utero-gestation, thus exposing the next membrane to the contact of the uterine lining (decidua), with which a connection takes place in that part where the placenta is to be formed. In that part, however, the cortex ovi is never altogether obliterated, but only made thinner; and, in process of time, it is converted into a mere pellicular envelope, which not only serves to divide the filiform vessels of the chorion into groups or cotyledons in order to form the placenta, but also covers all over those cotyledons or groups of vessels. (Plate I. Expl. of Fig. 1.) I have called this the _membrana propria_[2].
27. While the process or metamorphosis of the ovulum noticed by Boer takes place in the ovarium, in consequence of fecundation, the cavity of the womb does not remain idle, but forthwith sets about weaving for itself a general lining—a sort of pseudo-textile membrane—which extends all over the cavity, descends partly into the cervix, and is _often_, (not necessarily always,) projected even into a great portion of the fallopian tubes.
28. This adventitious lining of the cavity of the womb is formed quite independently of the presence of the ovum, for it has been found in most cases of devious gestation, where the fœtus was _extra muros uteri_ (Plate VIII. IX. X. Fig. 1 and 2, and page 35), and has been found advanced in its progress of formation, while the ovulum was, as yet, on its way through the fallopian tube after fecundation. (Haller, Lobstein, Velpeau, Meckel, Pockels.)
29. To this adventitious lining described by many ancient authors, but by none better than by Harvey, the name of decidua already mentioned (24, 26) has been given by Hunter, because, viewed as a production of the uterus it is caducous and not permanent like its own natural lining; as, however, it is no more caducous than any other of the involucra of the ovum, the denomination is not strictly correct. It is, nevertheless, more generally adopted than that of epi-chorion, given to the same pseudo-membrane by Chaussier.
30. Its mode of formation and its structure have been differently explained by different authors. The explanation offered by Burns runs counter to facts and realities. That author speaks of all the minute steps of generation, with the same confidence as if all had been demonstrated. His imaginings respecting primary and secondary vessels shooting out from the inner surface of the womb to form the decidua must be gratuitous, as no other anatomist or physiologist, either before or after him, has been able to ascertain the reality of such a process.
31. It is probable that the decidua consists of two laminæ, inasmuch as we always find it with one surface perfectly smooth and the other rough. If so, they are most intimately connected. It is at least one-twentieth of an inch in thickness during the first five or six weeks of uterofœtation, when its tissue is found to be more knotty, coarse, and full of short threads, (not unlike a very ordinary mat,) than a purely membranaceous or cloth-like lining would be. It is not until a more advanced period of gestation that the decidua becomes distinctly membranaceous, in which state it lines the entire cavity of the uterus. (Plate IX. and prep. 73, 75, 76, of Sir Charles Clarke’s Collection: also Dr. Agar’s beautiful specimen of impregnated uterus, Mus. Coll. Reg. Lond. Med., and several specimens in the College of Surgeons, particularly Sir W. Blizard’s case.)[3]
32. Into this chamber, then, so lined and so prepared the fecundated ovulum, in the condition described by Professor Boer, is received after its journey from the ovarium through the fallopian tube.
33. The pre-existence of an ovulum in the Vesiculæ Graafianæ, or Ovarian Vesicles—and its metamorphosis, after fecundation (14, 15, 16, 17, 18,) have been amply confirmed by Plagge of Bentheim, who published an account of his experiments and observations, illustrated by figures, in Meckel’s Journal of Physiology. (See also Prevost and Dumas, 3rd memoir.)
34. As soon as the Ovulum has departed from its vesicular nest in the Ovarium, the cavity which remains begins to fill up with a yellow substance, different in texture from the surrounding tissue of the Ovarium, and having, generally, a radiated centre of a whiter colour. This is the _corpus luteum_. (Plate IX., page 30 and 31; also, Spec. 3468 B and C, Gallery College of Surgeons, and Dr. Agar’s case Royal College of Physicians[4].)
35. The presence of _corpora lutea_ in the Ovarium of women, is always an indication that as many ovula have escaped from that organ; but it is not necessarily an evidence that the individual has been impregnated, as ovula have escaped without the congress of the two sexes.
36. It is inaccurate, therefore, to state that a woman has been pregnant because a _corpus luteum_ has been found in one of the Ovaria after death, or to calculate the number of children she has borne from the number of _corpora lutea_ so detected. _Corpora lutea_ have been found in the Ovaria of very young girls, of unmarried women of the strictest virtue, in newly-born female infants, and lastly, in sterile animals, such as mules. (Brugnone, Joer. Roose.)
37. Sir Everard Home’s notion that the _corpus luteum_ was formed first, and that, too, independently of sexual congress, and that the Ovulum was formed afterwards, is disproved by more accurate and recent observers. (Boer, Plagge.) There is reason to believe that Sir E. Home had been too precipitate in his inquiry[5].
38. The Ovulum, on entering the womb, is about the size of a small pea. The cavity, on the contrary, into which it enters, from the very first, is of considerable dimensions. One cannot help being struck at this great disparity in the relative dimensions of the Ovulum and the cavity of the womb. When they first come in apposition, that of the latter is from ten to twenty times greater than that of the former. (See Sir W. Blizard’s case, Royal College of Surgeons, and Spec. 73, 75, 76, in Sir C. Clarke’s Collection[6].)
39. The time at which the Ovulum enters the womb after fecundation is not precisely known. (Meckel.) The fimbriated end of the fallopian tube has been found actually applied to a Graafian vesicle after copulation. (Magendie.) An ovulum, containing the rudiments of an embryo has been observed in the human subject half engaged within the tube, and half still resting on the Ovarium. (Bussieres.) The Ovulum has been detected on its way through the fallopian tube.—(Burns, Haighton, Cruikshank, Prevost, Dumas.) It is said to have been detected in the uterine cavity on the eighth day. (Home.) Although it has lately been the fashion to doubt the accuracy of such a fact, there is reason to believe it to be correct, from the circumstance of M. Bauer’s microscopian examination of that Ovulum and description of its structure corresponding with more recent discoveries. (Boer.) The embryo contained in an Ovulum of a week’s growth has been seen and measured. (Autenrieth _Supplementa ad Historiam Embryonis Humani_.) The Ovulum, until the eighth day, has been observed in the uterus under a gelatinous form by another anatomist. (Walker.) Ovula in the fallopian tubes have also been seen on the eighth day by Prevost and Dumas.
40. I have had occasion, within the last two months, to see a perfect Ovulum ejected from the womb fourteen days after a single sexual congress, which had taken place the day after the cessation of the menses. Dr. Pockels (Isis, December 1825,) examined more than fifty human Ova, among whom four had been expelled from the womb between the eighth and sixteenth day after conception. On the fourteenth day the Ovulum is about the size of a Spanish nut. The chorion is surrounded by a thick membrane[7].
41. An Ovulum at three weeks is mentioned by Hunter (Gravid Uterus). At twenty-two days a perfect Ovulum, with the embryo clearly defined, was shewn by Dr. Combe to Dr. Baillie. Blumenbach asserts seeing an Ovulum of the size of a small cherry, which could not have had more than twenty-three days’ existence. M. Ogle’s case, published in the “Transactions of the Society for the Improvement of Medical and Surgical Knowledge”, was one of an Ovulum in Utero at five weeks. These facts contradict Burns’ assertion, that at “three weeks or a month after impregnation no fœtus is in the uterus.”
42. After being safely lodged within the cavity of the womb, the Ovulum continues to grow on its own life-principle, for a while, until its connection with the mother is effected, through the medium of the deciduous membrane, which becomes, at a more advanced period, as it were, a new and additional covering to the Ovulum. The growth of the Ovulum causes the _cortex_ to burst, as happens with the receptacle or cortex of certain seeds, and with the outer shell of the ova of some oviparous animals. (See Plate I., fig. 1, 2, 3, 4.)
43. On the cortex bursting, the lanuginous or fibrillous membrane within it (21) is exposed, when the fibrils will forthwith entwine themselves with the flocculi of the decidua, and thus the Ovulum fastens itself to the uterus by one or more contiguous points. (Carus.)
44. The membrane having these fibrils on its surface, has been called the Chorion—and from the circumstance that these fibrils, both before the cortex which lies over them has burst, as well as afterwards, serve to promote the nourishment of the fœtus, I have styled it, the nutritive membrane or involucrum of the fœtus. It has been so considered by Ruysch, who calls the villous side of the Chorion, “_succosa nutritioni fœtus inserviens_.”
45. The fibrils of the Chorion have generally been considered as filiform vessels. When examined with the microscope, they appear diaphanous and ramiform; some of them terminate into little bulbs like the ampullæ of the villosities of the intestines. These bulbs adhere so firmly to the cortex ovi, that when an attempt is made to detach them, many are lacerated. (Carus.) It is only when the cortex bursts of its own accord that they are set at liberty. (43.)
46. These fibrils, however, are not all vessels. Some are only suckers, others are real vessels. (Carus.) The existence of any vessels among the fibrils of the Chorion has been denied very recently upon the same ground, namely, microscopical observations. (Breschet and Raspail.) But there must be an evident mistake in such observations; for the actual progress of those filiform vessels, and their gradual swelling into large veins and arteries, at an advanced period of fœtation, have been noticed in examining various human ova of different ages. (Lobstein, Velpeau, Dutrochet, and myself.)
47. The nutritive envelope or involucrum, or membrane (Chorion) of the Ovum is bifoliated. I have a beautiful preparation of the transparent membranes of the Ovum, even after regular parturition, which proves this fact. It is probably even trifoliated. (Dutrochet.) A fluid has been found between the two laminæ of the Chorion. (Meckel.)
48. The internal surface of the Chorion is likewise supplied with fibrils, which connect it with the next and innermost involucrum of the fœtus, called the Amnion. Between the fibrils or filiform vessels of the two surfaces, a communication is kept up by small vascular trunks which meander between the two laminæ of the Chorion. (Meckel and myself.)
49. The vascularity of the Chorion is further proved by its diseases, chiefly of an inflammatory character, ending in the thickening of its texture. (Plate III., page 12—Plate IV., page 13—Plate V., page 17—and many other examples in this Work.) There is a preparation in Sir Charles Clarke’s collection which shews the vessels of the Chorion as evidently as if they were injected.
50. But the vascularity of the transparent membranes is proved further by fine injections thrown into the vessels of the ovaria of women; on which occasion a beautiful net-work of minute vessels is rendered manifest, forming a species of vascular ring around the _Vesiculæ Graafianæ_. The same observation has been made by comparative anatomists. (Cuvier, Home, Lobstein.)
51. These facts, demonstrative and corroborative of the vascularity of the Chorion, (45, 46, 48, 49,) explain and account for the reality of that self-existing life-principle inherent in the fecundated Ovum (42), which detaches it from its nest (vesicula Graafiana), enables it to travel through the tube, to grow or expand while thus travelling, and to maintain that same power of growth and development for a short time after its reception into the womb, until its final and effectual implantation on the maternal stock (uterus).
52. The same holds good with regard to the amnion, or inner transparent membrane of the Ovum, which, although normal anatomy has failed, morbid anatomy has succeeded in proving to be vascular. (Plate VI. fig. 20, and Description, p. 19, and Remarks, pp. 20–24.) (Haller, Monro, Chaussier, Meckel.)
53. If it be true that the amnion is a vascular membrane, there is no difficulty in viewing it also as a secreting membrane. Hence the source of that particular fluid, to which the name of Liquor Amnii has been given, and in which the embryo is suspended to the end of gestation. (Plate I. fig. 4, but particularly fig. 7, 8, and 9, and Remarks.)
54. The amnion is a sac formed by the reflected epidermis of the embryo. (Velpeau, Boer, Pockels.) It does not exist before the twelfth day. (Velpeau.) At the eighteenth day it is found as a bladder placed on the back of the embryo, and continuous to it along its edges or sides and at its extremities. (Velpeau.) It has been distinctly seen on the twelfth day. (Pockels.) It is then not a concentric membrane within the chorion, but a vesicle, on the outside of which the embryo rests as on a bed. Until the day in question the embryo is connected to the vesicular amnion at the back, by a cellular transparent membrane. From that time till the sixteenth day the embryo progressively gets into the cavity of the amnion, which before was connected with the chorion by one of its piriform extremities, while the other conical extremity penetrates slowly into the albuminous fluid of the chorion. (Pockels.)
55. While the embryo is within the chorion (nutritive involucrum) and rests on the vesicular amnion, the former membrane, or sac, contains a reddish transparent fluid having the consistency of the albumen of an egg, (54.) with a colourless and very slender membrane crossing it in various directions. (Pockels.)
56. The progressive increase of the Ovulum, from the time of its quitting the Ovarium until it has stationed itself firmly within the womb, has been demonstrated (Magendie, Prevost). In examining, between eight and twelve days after fecundation, the female organs of such of the mammalia as are multiparous at a single gestation, one Ovulum has been found near the fimbriated end of the fallopian tube of one size; a little farther into the tube another of a larger size; and lastly, near to the uterine orifice of the tube, a third of a still larger size; shewing the relative progressive increase that had taken place in such Ovula subsequently to a single act of fecundation, and proportionate to the time employed by such Ovula in travelling to the spot in which they were found. (Prevost, and Dumas’s 3rd Memoir on Generation.)
57. While thus circumstanced, the Ovulum is never connected with the part through which it passes. On plunging that part into water, the Ovulum is found not only to rise to the surface, but to float. (Home, Prevost, Dumas.)
58. What stronger proofs need be required of the existence of an inherent life-principle in the Ovulum, which is, at one time at least, (indeed I suspect throughout the period of gestation,) independent of any connection with the parent mother? (Plate I., and several of the explanations of figures throughout the work.) Yet none of the earlier writers who adopted the Ovarian theory of generation have ever asked themselves this question: What supports the vitality of a fecundated Ovulum after it has left the Ovarium, and previously to its becoming connected with the womb? In fact, the subject had never been mooted, before the more modern physiologists took it up and satisfactorily explained it[8].