586 



UTERUS AND ITS APPENDAGES. 



of the cyst covered by integument are seen to 

 be elevated, and it is in the substance of and 

 beneath such elevations that the fatty tissue 

 and bones are usually found imbedded, whilst 

 the teeth have only their roots concealed, their 

 crowns projecting free above the surface. 



Origin of the Solid Contents of Ovarian Cysts. 

 It has been conjectured that these are ex- 

 amples of the " foetus in fcetu," or that such 

 remains may be the product of an imperfect 

 ovarian conception. To the former of these 

 suppositions, viz., that such formations result 

 from a cohesion or intus-susception of two or 

 more germs, coincidently impregnated, but of 

 which one only has been perfectly developed, 

 it may be objected that this view fails altoge- 

 ther to explain the circumstance that their 

 formation occurs far more frequently in the 

 ovary than in any other part of the body ; nor 

 does it account for the fact that here a parti- 

 cular class of structures only is developed, 

 whilst in the case of penetration of germs one 

 within the other, various portions of a second 

 foetus, more or less completely formed, and by 

 no means limited to a certain class of struc- 

 tures, are found within the body of the first. 



The explanation that these are examples of 

 extra-uterine gestation of the ovarian kind 

 is equally unsatisfactory ; for even if the pos- 

 sibility of such a form of gestation be ceded, the 

 fact alone that hair, teeth, and even bones, con- 

 tained in cysts of the kind under consideration, 

 are never found associated with the smallest 

 trace of the membranes peculiar to the ovum, 

 would be fatal to this view. But it can be shown 

 further that such structures are observed in 

 cases where previous impregnation was highly 

 improbable, as in the examples where they 

 were found in conjunction with a perfect 

 hymen*, or where it was impossible, as in the 

 case related by Dr. Baillie of a girl aged 12, 

 whose generative organs were still undeveloped, 

 but one of whose ovaries was filled with hair, 

 teeth, and fatty matter. 



The two additional circumstances that there 

 is scarcely any portion of the body, such as 

 the subcutaneous tissue, the brain, lung, kid- 

 ney, bladder, and testis, in which similar struc- 

 tures have not been found, and that such 

 formations, though most commonly found in 

 the ovary, are yet not even limited to the fe- 

 male, but have been also observed in the male, 

 completes the catalogue of objections to the 

 argument, in whatever form it may be ad- 

 vanced, that these productions are in any way 

 the offsprings of a spermatic force newly ap- 

 plied to the organisms in which they are 

 formed. 



The discovery of the fact that a tegumen- 

 tary structure forms the basis out of which 

 many of these products spring, appears to carry 

 us a step further towards comprehending the 

 mode in which some at least of the solid con- 

 tents of ovarian cysts are formed, by exhibiting 

 a connecting link between structures which 

 are elsewhere naturally associated, but it ob- 

 viously fails to satisfy any inquiry as to the 



* Royal Coll. of Surg. Pathol. Collect, prep. No. 

 2625. 



nature or quality of the cell-force which de- 

 termines the development of such products. 



Fcetus, more or less perfect, contained in the 

 Ovary '(?) OvarianGcstation. Graviditas Ova- 

 ria. Few facts in physiology have been more 

 readily assumed without sufficient examina- 

 tion than that the foetus may be developed 

 within the proper structures of the ovary, and 

 so constitute a form of extra-uterine gestation. 



So long as it was generally believed that the 

 coitus was the efficient cause of the escape of 

 the ovum from the ovary, and that therefore 

 the act of impregnation preceded that of ovu- 

 lation, there was nothing in such a belief to 

 challenge inquiry as to the probability of the 

 ovum being first impregnated, and still by some 

 mischance detained within the proper struc- 

 ture of the ovary, where it might become de- 

 veloped. But more accurate views of the 

 nature of ovulation and of the true seat of 

 impregnation have led to a stricter inquiry 

 regarding the seat of supposed ovarian gesta- 

 tion. 



Among the earliest to call in question the 

 accepted views upon this subject was M. Vel- 

 peau, who, previously a believer in ovarian 

 gestation, laid before the Philomathic Society, 

 in 1825, four examples supposed to be of this 

 kind. An expression of doubts as to the pos- 

 sibility of this fact on the part .of many mem- 

 bers led to a more perfect dissection of the 

 parts, in which examination MM. Blainville 

 and Serres were appointed to assist. It was 

 ascertained with certainty that three of the 

 tumours were external to the ovary. With 

 the fourth more difficulty was experienced ; but 

 at length, after isolating the Fallopian tube, 

 which was sound, the detritus of conception 

 was found to occupy a special sac between the 

 peritoneal and proper coat of the ovary, which 

 was entirely distinct. 



In the following year, M. Geoffrey St. 

 Hilares, in a report upon the subject of Bres- 

 chet's Memoir upon " Interstitial " Extra- 

 Uterine Gestation, expressed his entire disbe- 

 lief in the ovarian variety, and the same views 

 have been advocated by M. Pouchet in his 

 work on Spontaneous Ovulation, and in this 

 Cyclopaedia by Dr. Allen Thomson *, who 

 has there stated the general objections to the 

 doctrine of an ovarian form of gestation. 



The cases which appear to favour the belief 

 in ovarian gestation may be divided into two 

 classes, viz., those in which the embryo is yet 

 small, and is contained in a sac of mode- 

 rate size, which has not yet contracted adhe- 

 sion with adjacent parts ; and those in which 

 the foetus has attained or approached to full 

 growth, and the sac by which it is surrounded 

 has already contracted adhesions. 



All the examples that I have had the oppor- 

 tunity of dissecting, or of seeing examined, 

 have been of the latter class, and of these it 

 may at once be said that nothing can be 

 learned from them which could determine, 

 with any degree of accuracy, so difficult a ques- 

 tion as that under consideration. 



* Vol. ii. p. 456. 



