Fig. 16. Ovum pseudo-membranosum.

(Three months and a half after the cessation of the menses.)

There are not fewer than seven membranes, or involucra of some sort or another, in this example of aborted Ovum. Its age is unknown to me, as well as its medical history. I can only judge from appearances, as the preparation speaks for itself. In one point of view, more especially, is the present diseased Ovum particularly interesting to me; for it exhibits the most distinct proof that what I call the cortex of the Ovum, and which others have, without direct evidence, considered as a membrane of the uterus, is, in good truth, a natural covering of the Ovum. It is this very natural covering of the Ovum which is liable, from disease, to become fleshy, opaque, vascular, and lastly coriaceous, thereby cutting short the supply, or accretion of substance to the fœtus, and thus destroying its life and producing abortion. Were it not so, we should not observe, as in the design before us, another membrane external to the one I allude to, as seen at the bottom and on the right of the figure, which is the true caducous or uterine membrane of authors. Its structure is far different from the former; it is of a loose texture,—I was about to say, almost gelatinous, or like a reticulated gauze.

The chorion, in this instance, is thickened nearly as much as the cortex Ovi. A considerable space intervenes between those two involucra; and within this thickened chorion a false membrane is distinctly seen to surround the Ovum. The embryo is advanced to about the third month, but retarded in its growth.

A specimen, analogous to the present, was deposited in 1817, by Mr. Lawrence, in the Museum of the Royal College of Surgeons of London, where it is to be seen marked 3437 C. The involucra are coriaceous, but we have besides, over the nutritive membrane (chorion), not fewer than three false membranes, the result of uteritis post conceptionem. The fœtus has evidently been stinted in its growth, and in size resembles a small insect.

REMARKS.

Instances of additional or pseudo membranes in aborted Ova are by no means of unfrequent occurrence. On one of the shelves in the Museum in Lincoln’s Inn Fields, I observed one marked 3443, in which a pseudo membrane has formed externally to the placenta, pressing on the cotyledons of the latter. The embryo is stinted. Upon another shelf I find No. 3442, with the nutritive as well as the secreting (amnion) involucrum thickened and pergamenous—the coat which they form being one twentieth part of an inch in thickness. The amnion, internally, is lined with a delicate pseudo-membrane. Here, also, although the entire Ovum is of such capacity as to admit about half a pint of fluid, the embryo has not acquired more than the size of an ordinary house-fly. The placenta is compressed and covered by an adventitious membrane, besides its membrana propria.

In Ruysch’s Thes. Anat. VI. Tab. II. Fig. 5, there is represented a specimen of human Ovum, with a pseudo inter-membrane, not unlike my present preparation; like it, too, it exhibits the cord hydropical.

Fig. 17. Ovum uviforme.

(In the third month after the suspension of the menses.)

A uviform abortion is so rare an occurrence that when Mr. Clift first saw the figure of it in the present work, he remarked that it appeared more pictorial than true. The preparation, however, of the size of the design, and as it was sketched by Mr. Perry in 1827, is still in my possession, and I hold it to be most valuable on many accounts.

Under a shower of minute grape-like or granular bunches, is seen suspended that portion of a transparent Ovum, (exhibiting through its diaphanous involucra an embryo bearing no proportion to the magnitude of the Ovum,) which has been denuded of its nutritive involucra. The latter are superimposed to the granular bunches, and are curiously fringed at their margins. They are two in number, and externally to them may be seen the loosely weaved caducous membrane. During three months of utero-gestation, from the moment of conception, has this mass lived—but the embryo has not advanced from what it was at four or five weeks, nor could it. The time was spent by Nature in playfully modelling, forming, and cutting out what would almost appear an artificial plaything; so fantastical it looks.

REMARKS.

There can be no difficulty in understanding how this curious formation came about. The Ovum with its cortex adhered to the ceiling (fundus) of the womb, and contracted an intimate connexion with that organ through its caducous lining. During the first weeks, that external covering, cortex, or membrane, became fleshy and vascular. Plethora took place in consequence, as we have seen in some of the preceding cases of abortion; but, instead of an increased secretion of amnionic fluid, as was the case in the Ova denudata, or diaphanous, of Plate I., the effect has been a dropsical bead-like enlargement of the mossy or filiform vessels of the Ovum. In proportion as these advanced and enlarged, they detached and forced outwardly the coriaceous envelopes, which began to absorb at their inferior edges in that irregular progression which left them as they are now seen, irregularly echancrés. This process of absorption in the outer envelopes of the Ovum, from the first to the fifth month, is what takes place generally, even when they are not morbidly affected in their texture in the way in which they are in the present instance, and is the process by which the placenta is formed. But in order to effect this properly, the mossy or filiform vessels, of nearly three fourths of the circumference of the young Ovum should also become progressively obliterated; while those which remain, mingling with the superimposed envelopes, swell into large blood vessels to assist in the formation of the placenta. Here, however, such a process was impossible, inasmuch as the mossy or filiform vessels, having taken up a morbid action and become distended with the serosity, which kept constantly pouring into them, could not become absorbed to the extent required to form the placental cake, but on the contrary continued to increase in size and number. This operation took place at the expense of the growth and life of the embryo, which is consequently seen to be stinted and undeveloped. Abortion, therefore, was inevitable sooner or later.

The specimen is also valuable, as it affords positive evidence of the mode in which the placenta is formed, for here we actually see the process of absorption of part of the involucra, on which that process depends.

Some who have seen this specimen, confound it with a case of hydatous placenta; and a few similar preparations exist under that name in more than one collection. It is evidently by mistake that they are so styled, as we shall see in a succeeding Plate.

Professor Carus of Dresden, (a name revered by anatomists and physiologists,) here comes to my assistance. That accurate and indefatigable observer, on submitting an entire Ovum, expelled towards the sixth week of gestation, to a powerful microscope, remarked that the greater number of the filiform vessels were diaphanous as well as their ramifications, and that their free extremities terminated into little roundish knobs, not unlike the terminal bulbs of the villosities of the intestines. These bulbous expansions of the filiform vessels of the Ovum adhered so firmly to a superincumbent dense membrane (which Carus calls decidua, but must be the cortex) that they could not be separated from it without tearing some of them^[27]. These very expansions, or roundish knobs then, of the filiform vessels of the Ovum, are precisely those which, from plethora of the involucra lying over them, acquired what, in my specimen, I have called “a dropsical bead-like enlargement,” as represented in figure 17 of an “Uviform Ovum.” Soemmering has also noticed these terminal bulbs of the filiform vessels, which he calls noduli vel vesiculæ, somewhat like hydatids.

In questions of natural history, it is impossible to desire and meet with a more satisfactory corroboration of the explanation of any given fact, than the above observation of Carus affords to my view of the conformation of the “Uviform Ovum.” Nor can a more convincing refutation be required after it, of the doctrine of hydatids in the placenta being the cause of that singular conformation.

There was but a trifling hemorrhage after the coming away of the present Ovum, and scarcely any suffering. During the three preceding weeks the patient had had some slight, colourless, and thin discharge from the vagina.