OVARY (ABNORMAL ANATOMY). 



The impediments to such determination 

 which recur again and again in these cases are 

 the following. It is easily ascertained that 

 the sac containing the foetus is external to the 

 cavity of the uterus, and is in some way or 

 other connected with some portion of the in- 

 ternal generative organs ; the Faliopran tube, 

 ovary, and broad ligament of one side being 

 chiefly involved in the tumour, while the cor- 

 responding parts of the other side may remain 

 free. Dissection may serve to unravel these 

 parts to a certain distance, beyond which 

 nothing satisfactory can be determined, on ac- 

 count of the alteration which the tissues have 

 undergone both in form and arrangement ; 

 the hypertrophy of some, and the wasting or 

 blending together of others, rendering further 

 research fruitless for the object in view. 



To these impediments, other and still greater 

 difficulties are generally superadded. These 

 arise from the death of the foetus, which often 

 takes place several months or even years pre- 

 vious to that of the mother. In the decom- 

 position which follows, the harder parts of the 

 contents of the sac fall asunder, and make 

 their way by fistulous openings into surround- 

 ing viscera, whose surfaces inflame and give 

 rise to serous and fibrinous effusion, while in 

 the few 7 hours which succeed to the final de- 

 struction, the parts decompose so rapidly that 

 the post-mortem examination, however early 

 it may be made, often reveals nothing but a 

 semi-putrid mass perfectly unsuited to the de- 

 termination of a difficult anatomical question. 



For this purpose the cases of the former 

 class can alone suffice. Here the parts are 

 small, and as yet comparatively unchanged, and 

 admitting of dissection. The results of four 

 such examinations have just been given. The 

 following additional examples, which are se- 

 lected from the best recorded cases supposed 

 to be ovarian, will suffice to exhibit the class 

 of evidence upon which a belief in this species 

 of gestation is demanded. 



Cruveilhier* has described and figured a 

 case in which the entire skeleton of a four 

 months' foetus f is seen hanging external to a 

 sac, occupying the seat of the right ovar} 1 , in 

 which it is supposed to have been once con- 

 tained. The sac said to be in the inner and 

 lower pan of the ovary is lined by a serous 

 membrane. The two external thirds of the 

 pouch were filled by a spongy areolar yellowish- 

 white mass presenting all the characters of 

 placental tissue. The outer half of the sur- 

 face of the ovary was enveloped in a cartila- 

 ginous shell. No attempt appears to have 

 been made to trace the entire outline of the- 

 ovarian tunics, or to show the condition of 

 the ovarian ligament, or of the Fallopian tube 

 of the same side. The latter, indeed, is not 

 mentioned, but from the representation of the 

 parts it appears to be blended with the cyst, 

 .so that this is quite as likely to have been 

 an example of tubal, or ovario-tubal, as of 



* Anat. Pathol. livr. xxxvi. pi. vi. 



f Said in the description to be between one and a 

 half and two months, at which time, however, no 

 such complete skeleton is ever seen. 



587 



ovarian gestation. The fact also that the cyst 

 had apparently burst and permitted the escape 

 of the foetus when it had attained the size 

 which is seldom exceeded in tubal cases, lends 

 additional probability to this view. 



Dr. Granville * has published a case, accom- 

 panied by drawings, which he regards as an 

 " undisputed case of purely ovarian foetiferous 

 ovum." The uterus is considerably enlarged, 

 but empty. " The left ovariura presented a 

 large swelling which contained within its own 

 covering an ovum bearing a foetus with all its 

 appendages, of about four months' growth. 

 The ovarian covering burst in three places, and 

 allowed the protrusion of the ovum, whereby 

 the adhesion of the placenta to the inner sur- 

 face of the ovarian envelope was torn asunder," 

 causing death by haemorrhage. A blood-ves- 

 sel, the size of a large crow-quill, which pene- 

 trated the dense portion of the tumour, was 

 ascertained to be a branch of the left sper- 

 matic artery, and a smaller and much shorter 

 vessel, arising from the tumour, was found to 

 communicate with the spermatic veins. " The 

 corresponding Fallopian tube was perfectly 

 sound and loose, particularly at its fimbriated 

 extremity, which had no connection whatever 

 with the embryoferous tumour in its neigh- 

 bourhood. Like its fellow tube, it was psr- 

 vious only from its loose extremity inwards to 

 about half its length. " A placental mass with 

 distinct cotyledonous vesicles connects the child 

 with the inner covering of the ovarian cyst. 

 The secreting or transparent involucra are 

 quite distinct. The cortex ovi is almost wholly 

 absorbed, as it ought to be at such an advanced 

 period. The foetus is perfect." In the expla- 

 nation of the plates mention is made of" frag- 

 ments of the corpus luteum which surrounded 

 the ovum, and was broken to pieces by the 

 enlargement of the foetus. Some of these 

 fragments adhere to the inside of the ovarian 

 coats, others are among the placental cotyle- 

 dons." No account is given of the ligament 

 of the ovary, nor of such a dissection of the 

 parts having been undertaken as would satis- 

 factorily prove that the sac containing the 

 foetus was not a cyst attached to the ovary. 

 But the evidence in favour of ovarian gesta- 

 tion consists chiefly in this, that the foetus- 

 bearing cyst occupied the region of the ovary, 

 and was independent of the Fallopian tube. 

 Nevertheless this case constitutes the nearest 

 approach to the form of gestation which it 

 claims to represent with which I am acquainted. 



In the same work (Graphic Illustrations f) 

 is contained a description and representation 

 of a second case termed " ovum foecundum in 

 receptaculo ovarico." " Through a transversal 

 aperture in the left ovarium are seen the re- 

 mains of some membranes, three in number 

 at the least, lining a cavity which measures 

 transversely one inch and a quarter, and about 

 an inch vertically." The preparation belonged 

 to Sir C. M. Clarke, who assured Dr. Gran- 

 ville " that a small embryo hung pendulous 



* Phil. Trans. 1820, and Graphic Illustrations of 

 Abortion, Plates X, A, and B. 

 t P. 27. pi. viii. 



