Fig. 1. Ovum embryoferum in receptaculo interstitiale.

The uterus is enlarged in its general volume and appendages to the size which it more commonly acquires at the second month of pregnancy. The section of its coats shews their increased thickness, and the many hundred orifices of its enlarged blood-vessels. Within the cavity of the womb there was no vestige of any ovum, but in its stead a spongious and woolly membrane was found.

On the upper and outer surface or basis of the uterus, a swelling of a red colour was observed, nearer to the left than to the right side. It was richly streaked with blood-vessels, which gave it the appearance of inflammation. Two lacerations had taken place in the thinnest part of the coats of this eminence or tumour. These lacerations led to a cavity or sac, or cyst, which contained an embryo of from eleven to twelve weeks’ growth: it was regularly enveloped within the two transparent membranes, on the external of which the rudiments of a placenta were found. This embryoferous cyst was separated from the real cavity of the womb; there being no communication whatever between them.

The left Fallopian tube was impervious throughout its whole length.

On opening the body of the patient, who had before borne three children, and had also miscarried twice, and died when she supposed herself two months gone with child, the cavity of the abdomen was found filled with blood.

This case is related by Hendrick in the “archives”, by Horn, Sept. and Oct. 1817; transmitted and vouched to Dr. Breschet of Paris by Professor Carus of Dresden, who sent the drawing, from a lithographic copy of which the present plate is taken.

Fig. 2. Ovum embryoferum in receptaculo interstitiale.

Uterus enlarged; more so on the right than on the left side. A three-lobulated tumour or swelling of the substance of the womb immediately above the insertion of the right Fallopian tube, and on the external surface. Ulceration of the coats of this swelling, which had taken place during life, exhibits to view an excavation or cyst in the interstitial substance of the uterus, containing an embryo which appeared to have acquired a growth of six weeks.

The cavity of the womb had no communication whatever with the fœtiferous cyst. It was found lined with a woolly pseudo-like membrane.

The internal or uterine orifice of the right Fallopian tube was absolutely impervious: that of the left open; but the fimbriated end of the latter was closed, and some serum was found within the tube.

The patient had had several children before: the last time she was pregnant she miscarried at four months. On the present occasion she was not conscious of being with child, as she continued to be regular every month; whereas during every preceding pregnancy her menstruation had ceased. She felt better than usual on the day of her death, soon after which, on opening the abdomen, the above appearances offered themselves to view. There was a large quantity of blood in the cavity of that region.

This case is quoted by Dr. Breschet from a memoir in the Transactions of the Medico-Chirurgical Society of Vienna for 1801, drawn up by Professor Schmidt, and farther vouched by Professor Carus.

REMARKS.

Cases of aberration in the first development and ultimate station of the human embryo like these, were not known to science (according to Dr. Breschet’s statement) before the two preceding instances were laid before the profession. I selected them, therefore, on account of their priority, from among the six cases collected by that indefatigable and highly gifted anatomist, whom I am proud to call a very old friend, in his memoirs on “A New Species of Extra-uterine Pregnancy,” published in the first volume of a very valuable work, edited by himself, Dupuytren, and others, in 1826, entitled, “Repertoire General d’Anatomie et de Physiologie.” The facts are singular, yet authentic in all their particulars. It is, therefore, impossible to deny the existence of another distinct species of pregnancy, extra muros uteri, in which the fœtus is lodged among the interstitial elements of that viscus, and has no communication whatever either with the cavity of it on the one side, or the cavity of the abdomen on the other; unless ulceration or laceration take place.

We may, therefore, reckon four species of erratic gestation, namely:—

The design of the parts, the statement of facts, and all the particulars connected with such cases of gestatio interstitialis, I give on the authority of the respective authors whose names I have mentioned. It has never fallen to my lot to witness a single instance of such anomaly in the mode of propagation of our species. Of the six cases reported by Breschet, the last only fell immediately under his care, at the Hôtel Dieu, in July 1825.

It is to be remarked, that in all these cases the uterus was found enlarged, its cavity filled with some adventitious production of variable texture and not always membranaceous, and the Fallopian tube on the side next to the seat of the embryoferous tumour invariably impervious. The mother dies from internal hemorrhage, in consequence of the laceration of the coats of the cyst containing the embryo. During life menstruation has ceased in some and not in other cases of this description.

The reader will not fail farther to notice the very great difference which appears manifest in the drawing of the present plate, and that of the rest of the plates, from the hand of our artist. Mr. Perry had, in this instance, a very inferior lithographic delineation of the facts only to copy,—instead of having to imitate nature, as he has done in every other instance. The consequence has been, that we see but a feeble, and not always an intelligible, representation of the several interesting points connected with these two cases, the nature of which has been attempted to be explained by Breschet himself, and Geoffroy St. Hilaire, in his report to the Institute of France—but with indifferent success.