Part 5

As gestation advances, some of those elements are obliterated, and others confounded together.

REMARKS.

I imagine that these Ovula pass away from the womb almost immediately after they have entered it, owing to a tardy or deficient formation of that peculiar lining which the uterine cavity begins to weave for itself from the first moment of a successful copulation, and to some part of which the Ovula are destined to adhere.

The preceding objects are represented of their natural size, and as they lost their colour during the first maceration in water, owing to the great readiness with which the mossy vessels discharge their blood, the colour adopted in the Plate is that which they attain afterwards, and such as it appeared when the artist sketched them. They have in every instance been examined and dissected under water. Such early Ovula are not rare. In the Museum of the Royal College of Surgeons of London there are four such specimens, marked 3432—3—4—5 in red ink on the black varnished cover of the bottles[26]. In Sir Charles Clarke’s collection there are also several. I have likewise examined many of them in Meckel’s magnificent museum; but it is in that of the late Professor Sœmmering that I have been gratified by the sight of not a few beautifully prepared and arranged specimens of this early stage of the human Ovum. Among them were the identical preparations which he selected and arranged in a graduated series of human embryos, and afterwards caused to be delineated and engraved, for his valuable work entitled “_Icones Embryonum humanorum_.”

Fig. 5.

The rudiments of the embryo in this specimen are more than usually 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.

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.

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.

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.