252 STUDIES ON PATHOLOGIC OVA. 



a century ago. This would seem to be true in spite of the fact reported by Norris 

 and Mitchell (1908) that only a single case of ovarian pregnancy was found among 

 44 extrauterine specimens and 58 hemorrhagic cysts contained in the collection 

 of 1,700 gynecological specimens at the hospital of the University of Pennsylvania. 

 At any rate, a careful microscopic examination of all such cases would seem to 

 be indicated in the future in order to determine, if possible, which cases are and 

 which are not conceptual in origin. 



Werth (1887) is said to have collected 12 cases, among which he regarded 

 only that of Leopold (1882) as authentic. Leopold (1899) reported 14. Gilford 

 (1901), in a splendid, succinct review of the literature, gave 28 cases, 16 of 

 which he regarded as undoubted and 12 as probable. Roche (1902) accepted 

 only 12 cases, Flith (1902) accepted 21. Kantorowicz (1904), using the criteria 

 of Leopold (1899), together with a microscopic examination, as a basis, grouped 

 the cases recorded in the literature as certain, probable, and uncertain. . He 

 considered 17 as certain, 10 as probable, and 13 as uncertain. And to the 17 

 cases regarded as certain by him, Kantorowicz then added 2 of his own, basing 

 his decision, however, mainly upon the presence of decidua in the ovaries, thus 

 making 19 cases regarded as authentic by him. Freund and Thome (1906) re- 

 garded 23 of all the cases reported up to that time as certain. Norris and Mitchell 

 (1908) considered 16 as positive, 15 as probable, and 9 as fairly probable. Warba- 

 noff (1909) collected 34 cases and Norris (1909) regarded 19 of those contained in 

 the literature of the previous decade as positive; but Williams (1910), from a 

 critical review of the literature up to 1906, and upon the basis of the criteria of 

 Spiegelberg, regarded only 13 as positive, 17 as highly probable, and 5 as probable. 

 Mapes (1914) collected 30 cases, but wholly from secondary sources, and Lockyer 

 (1917) 42, from the years 1910 to 1917. Of these cases Lockyer accepted 22 as 

 authentic and 20 as questionable and undecided from the evidence available to him. 



This short summary suffices to show that there is as yet no consensus of opin- 

 ion as to what constitutes an ovarian pregnancy. Although this fact finds its 

 explanation partly in our lack of sufficient knowledge, it is due also to the meager- 

 ness of some of the reports. However, if complete disintegration and lysis of intra- 

 ovarian conceptuses can occur, then it must always remain a question of opinion 

 in the future whether some of the cases so reported really were or were not true 

 ovarian pregnancies. This must remain true, no matter how thorough the micro- 

 scopic examination, unless the clinical history or changes in the maternal organism 

 can afford us crucial tests in such cases. 



Anyone who reads far into the literature of ovarian pregnancy must also 

 become aware of the fact that even very recently skepticism has been carried too 

 far. Jacobson (1908), for example, placed the case of Kouwer-van Tussenbroek 

 (a case which finally convinced Bland-Sutton) and that of Webster (1904) in the 

 doubtful class! Furthermore, he also insisted upon the presence of an embryo 

 or fetus as absolutely essential. 



It must be emphasized, however, that even a liberal attitude on the part of 

 a reviewer would not justify him in accepting all cases reported as genuine upon 



