OVARIAN PREGNANCY. 253 



the basis of the reports themselves, for they especially the older ones are often 

 too meager to enable one to form a reliable opinion. This is illustrated also by 

 such recent reports as those of Garrard (1916), Martin (1917), Sweeney (1917), 

 and Mills (1917). Although it must be remembered that from the very nature 

 of things it is sometimes impossible to make a report which in itself carries con- 

 viction, it is regrettable that in a number of relatively recent cases, in which such 

 a report apparently could have been made, this was not done. Mills 's case seems 

 to have been an instance of ovarian implantation in a region other than the Graaf- 

 ian follicle, and hence recalls the first case of Granville and the cases of Franz 

 (1902), Norris (1909), Paucot and Debeyre (1913), and perhaps also that of Kouwer 

 (1897 [van Tussenbroek, 1899]). 



Today it is no longer true, as stated by Freund and Thome (1906) and by 

 Sencert and Aron as late as 1914, that authentic cases of ovarian pregnancy 

 belong to the great rarities. Yet the fact that many of our States, as well as many 

 large clinics, have not a single case on their records seems to suggest that the 

 condition is still seldom recognized, a century after Granville observed his first 

 case. Moreover, a number of continental gynecologists and obstetricians, for a 

 quarter of a century, have regarded the occurrence of ovarian pregnancy as un- 

 doubted. Anderson (1917) stated that German writers began to report cases of 

 ovarian pregnancy with some frequency after 1901, and Gilford (1901) also called 

 attention to the fact that continental opinion had long accepted ovarian implan- 

 tation not only as possible, but as proved. Gilford further referred to the often- 

 quoted opinion of Tait that ovarian pregnancy is as rare as "a blue lion or a swan 

 with two necks," and in his article in 1899 also called attention to the opinion of 

 Bland-Sutton that ovarian pregnancy not only has no existence, but that it is 

 impossible. These opinions are particularly interesting in view of the careful 

 reports made by Granville (1820 and 1834) in connection with the two cases 

 which he then and which others since have regarded as cases of undoubted ovarian 

 pregnancy, in spite of the absence of microscopic examination. In view of this 

 lack, it is particularly fortunate that both of these reports of Granville are accom- 

 panied by splendid illustrations by Bauer, which also won him praise and admira- 

 tion and which greatly strengthened his cases. It may be recalled in this connec- 

 tion that Werth (1901) accepted Granville's case recorded in 1820, but said nothing 

 about his second more convincing instance reported in 1834. 



Although there is as yet no agreement as to what constitutes an authentic 

 case, a review of the literature justifies the growing and apparently well-founded 

 belief that in the past too much emphasis has been laid on certain criteria which 

 later experience has shown to be partly inapplicable. It is becoming clear that 

 some cases, formerly excluded for reasons regarded as sufficient, with our present 

 knowledge could no longer be rejected. Moreover, it dotes not seem at all im- 

 probable that some cases listed as tubal really were ovarian in origin. Nor must 

 it be forgotten that not even the entire absence of remnants of the conceptus 

 can positively exclude a case from the category of true ovarian pregnancy. In a 

 number of cases in the literature, and also in our own cases, the clinical history 



