588 



UTERUS AND ITS APPENDAGES. 



from the yet visible rudiment of an umbilical 

 cord. That embryo, however, is not now to 

 be seen." The female from whom this was 

 taken was unmarried, but acknowledged her- 

 self to be pregnant. The uterus was larger 

 than in the unimpregnated state. The Fallo- 

 pian tube was not in the least involved in the 

 enlargement. The fimbriae were free. 



A case which, in the opinion of Dr. Camp- 

 bell *, " in so far as anatomical accuracy is 

 concerned, ought to satisfy those who are 

 still sceptical regarding the reality of ovarian 

 gestation," is recorded in the Transactions of 

 the College of Physicians. f From the descrip- 

 tion and drawing which accompanies it the 

 following chief particulars are learned. The 

 uterus, from a woman aged 30 who had com- 

 mitted suicide, was larger than the ungravid 

 organ ; its body somewhat globular ; its sub- 

 stance, except the cervix, spongy. A decidua 

 nearly \" thick, soft, pulpy, and of yellowish- 

 white appearance, lined the interior of the 

 uterine body. The cervix was filled with 

 gelatinous matter, but not sealed up. The 

 vessels of the broad ligament and appendages 

 were remarkably distended ; on the posterior 

 part of the left ovary, which was considerably 

 larger than the right, was a round prominence 

 distinct from the general fulness. The tunics 

 of the ovary at this point were numerously 

 furnished with tortuous blood-vessels; and 

 from careful examination it was clear that 

 there had not been any aperture in the exter- 

 nal membrane ; its surface was perfectly 

 smooth. On dividing the membrane which 

 covered this prominence, a distinct cyst was 

 exposed, which contained an ovum. The in- 

 ternal surface of this cyst was smooth and 

 polished, its external firmly adherent to the 

 substance of the ovary. The ovum was sim- 

 ply in contact with the cyst in two-thirds of 

 its circumference ; in the remaining third it 

 was united to it so closely as to be inseparable. 

 The chorion and amnion were perfectly dis- 

 tinct, and by the aid of a magnifying glass, 

 vessels filled with blood were seen ramifying 

 on the former. A yellowish honey-like mat- 

 ter filled the amnion, but the embryo could 

 not be distinguished. Around the ovum for 

 some distance the ovary was loaded with blood 

 effused into its substance. 



Except for the statement regarding the de- 

 cidua there is nothing in this account which 

 would be considered significant of pregnancy 

 at the present time when a more perfect 

 knowledge has been obtained of the various 

 conditions of the ovary in health and disease. 

 Changing the names employed to designate .. 

 the cysts, this description would apply either 

 to a follicle preparing to burst J, or to an in- 

 cipient stage of cyst formation. To the lat- 

 ter it approximates more nearly. The smooth 

 and polished inner surface of the containing 

 cyst ; the union, " so close as to be insepa- 

 rable," of the cyst termed the ovum by a third 



* Memoir on Extra-Uterine Gestation, p. 33. 

 t Vol. vi. p. 414. 1820. 

 j See ante, p. 557. 



of its base to the larger one ; the presence of 

 a honey-like matter filling this inner cyst, 

 which is represented in the engraving as not 

 larger than a pea, and the vessels ramifying on 

 the cyst wall, are all conditions commonly ob- 

 served in early stages of the morbid follicle. 



On the other hand, the following are among 

 the conditions which oppose the conclusion, 

 that the ovary was in this case the seat of im- 

 pregnation, viz., the absence of all trace of an 

 embryo ; the so-called chorion, entirely want- 

 ing villi, which, in all known cases of the early 

 ovum, more or less cover its surface ; the firm 

 adhesion by a third of its circumference, at a 

 time when the ovum naturally lies free and unat- 

 tached even by any part of its little flocculent 

 villous coat ; the impossibility of accounting 

 for chorion-vessels, without an embryo to form 

 them, and still more of explaining how the 

 seminal fluid could reach the ovum through a 

 membrane which is described as " perfectly 

 smooth," and in which, " from careful exami- 

 nation, it was perfectly clear that there had 

 not been any aperture ; " the absence of all 

 mention or representation of any of those 

 conditions of the walls of the ripe follicles 

 which in an earlier part of this article have 

 been shown to be always present in the fol- 

 licle preparing for or soon after rupture, and 

 which must have been present in some degree 

 if this had been a Graafian vesicle containing 

 an impregnated ovum. These together con- 

 stitute insuperable objections to this case being 

 received as one decisive of impregnation in 

 the ovary, and justify its being regarded rather 

 as an example of cystic formation, which, ac- 

 cording to the engraved representation of the 

 parts, it very accurately resembles ; notwith- 

 standing that the description of the uterus 

 and decidua would give a strong bias and in- 

 deed wish to receive this as a case in which 

 impregnation had obtained, if the state of the 

 parts found in the ovary had corresponded 

 with what is now known to be characteristic 

 of the structures formed in the earliest stages 

 of pregnancy.* 



* I am enabled to add in a note the following 

 particulars relating to two of the four cases quoted 

 above as examples of supposed ovarian gestation, 

 and of which it may be remarked that neither are 

 of recent date, the one having occurred thirty-eight 

 years ago, and the other at least as early* at a 

 time, therefore, when ovarian gestation had not 

 been questioned, and the ovarian ovum in man 

 had not yet been discovered. The preparation, de- 

 scribed and figured by Dr. Granville as belonging 

 to the late Sir C. M. Clarke, is now in the possession 

 of Mr. Stone, by whose kindness a more particular 

 examination of it has been permitted. For this 

 purpose, the preparation was recently placed in the 

 hands of Professor Owen, by whom it was removed 

 from the bottle, and minutely examined under spirit. 

 At this investigation, I was also present, together 

 with Mr. Stone and Dr. John Clarke, and I had the 

 opportunity of making repeated microscopic exami- 

 nations of every portion of the ovarian structures. 

 The result of "the investigation showed that the 

 structure supposed to be an impregnated ovum con- 

 tained in the ovary, although it had such a general 

 appearance as might without this examination have 

 borne the interpretation which had been originally 

 put upon it, was nothing else than an ordinary ova- 



