570 



UTERUS AND ITS APPENDAGES. 



but is calculated to mislead by suggesting the 

 idea that the so-called " true " corpus luteuni 

 is a totally different body from the " false," 

 whereas these terms actually represent the 

 same body, only in different stages of growth 

 or decay. But practically it becomes a ques- 

 tion how far it may be possible to determine, 

 from the physical appearance of the follicle, 

 whether impregnation has taken place. And 

 this question is a very important one, espe- 

 cially in its obstetric and forensic bearings. 



From the account already given of the 

 several stages of growth and decay of the 

 ovisac, it will have been seen that the yellow 

 colour is common to all these alike, with the 

 exception only of the earliest and the very 

 latest stages. It alone, therefore, can afford 

 no distinctive evidence upon the subject. 

 But, in combination with other signs, the yel- 

 low colour, by its extent, may be made avail- 

 able to distinguish those cases in which im- 

 pregnation has occurred ; for when this is 

 the case the ovisac, as stated, continues to 

 increase in thickness ; a greater abundance of 

 yellow deposit takes place in its tissues ; the 

 follicle, instead of shrinking and disappearing 

 in the course of one or two months, continues 

 to be visible for fourteen or fifteen months. 

 It acquires a new coat which lines its cavity, 

 or else this cavity is entirely closed by a coa- 

 gulum which becomes organised and solid ; it 

 presents the convoluted appearance which 

 gives it a resemblance to the cerebral convo- 

 lutions, and this convoluted condition gra- 

 dually passes into one which is characterised 

 by the presence of rays proceeding from a 

 centre. Finally, the whole body constitutes 

 a resisting and more or less solid mass, 

 which can at once be detected by the touch, 

 before the ovary is opened. The distinctions, 

 therefore, are chiefly those of degree : the 

 greater solidity ; the greater thickness of the 

 yellow walls ; their more marked convolutions ; 

 the long persistent cavity, round or oval at 

 first, and subsequently stellate ; the milk-white 

 membrane lining the cavity, when the latter 

 exists, or the white dense mass occupying its 

 place, resulting from the transformation of the 

 clot. These last characteristics of the so- 

 called true corpus luteum, viz., the cavity lined 

 by the white membrane or the solid white 

 centre, as well as the large central stellate ci- 

 catrix, may be regarded as absolute and not 

 comparative distinctions, for they are not 

 found in the follicle in process of involution 

 when impregnation has not taken place. 



With regard to scrofulous tubercles, which 

 have been often enumerated among " false 

 corpora lutea," it is probable that some of the 

 conditions of the ovisac. now described have 

 been hastily set down to this score, without 

 sufficient examination ; for although scrofula 

 may possibly affect the ovary, as it does 

 the testis, yet a formation there of distinct 

 scrofulous tubercles, unless they are abundant 

 in other parts of the body, is, I am satisfied, a 

 rare, if not an unknown, occurrence. No doubt, 

 however, need at any time exist as to the 

 nature of such bodies, since, if the bright yel- 



low colour of the ovisac is not sufficiently 

 marked, as in those cases where they have be- 

 come pale, and more nearly approaching the 

 buff 1 colour of tuberculous matter in general, 

 the microscope will at all times determine 

 the question, for in respect of composition 

 there is nothing in common between tuber- 

 culous matter and the ovisac in any of its 

 natural stages of growth or decay. 



Setting aside morbid states, nothing is ever 

 seen in the perfectly healthy ovary except the 

 stroma and ovisacs or Graafian vesicles in 

 different stages of development or decline. 

 These may be arranged in three series : 



Ascending Series. 



1. The simple undeveloped ovisac, before 

 it has acquired an indusium from the stroma 

 of the ovary, or from the walls of an already 

 developed follicle, in which it may be formed. 

 It requires at this time the microscope for 

 its examination (Jig. 373.). 



2. The ovisac after it has acquired its outer 

 capsule, by union with which it has become a 

 Graafian follicle. 



3. The Graafian follicle of the size of a hemp 

 seed, or rather larger. It contains oil gra- 

 nules in the coats of the ovisac, but not yet 

 in quantity sufficient to produce a yellow 

 colour. In this state numerous follicles are 

 seen in sections of every healthy ovary during 

 middle life (figs. 370. and 372.). 



4. The follicle when it is approaching the 

 surface of the ovary. It is enlarging, and 

 its inner coat or ovisac has now a yellow 

 colour. 



5. The ripe follicle which is about to rup- 

 ture and discharge an ovum. It is always 

 found at the surface of the ovary, projecting 

 often to a distance of 3-4?'". It is covered 

 by numerous veins, and in the centre of the 

 most prominent part the coats of the follicle, 

 as well as the ovarian coverings, are thinned 

 and partly absorbed. Their thinness permits 

 the contents of the follicle to be partly visible, 

 and thus is produced a brownish red colour 

 at this spot. The follicle contains blood or 

 a bloody fluid, and sometimes a clot. The 

 cavity is of considerable size, 4-6"'. The inner 

 coat is of a bright yellow colour, and ex- 

 hibits slightly wavy folds (figs. 380. and 381.). 



6. The follicle which has already ruptured. 

 An irregular lacerated opening extending $-2'" 

 is perceptible in the centre of the attenuated 

 part, through which the ovum, together with 

 that portion of the membrana granulosa which 

 lay beneath the seat of the rupture, has es- 

 caped, or is about to escape. The follicle is 

 beginning to collapse. Its walls, no longer 

 distended, become folded into numerous 

 small plaits, producing, on section, the ap- 

 pearance resembling cerebral convolutions. 

 The cavity is consequently diminished. It 

 is empty, or contains a little bloody fluid or 

 a clot (fig. 385.). 



Descending Series. A. Not pregnant. 



7. In the follicle which has recently burst, 

 shrinking has commenced. The yellow ovisac 

 is much plicated. The cavity contains a clot 

 which is becoming pale, and exhibits under the 



