PLATE I.SPECIMENS OF VERY EARLY MISCARRIAGES.
(Four weeks after menstruation.)
This twin Ovulum has lost its outer shell orcortex, within which it originally made its way from the Ovarium into the womb.
The mossy or filiform vessels which, like an efflorescence, surround the present surface of the Ovulum, are, as yet, deprived of that extremely delicate membrane, which at a more advanced period of utero-gestation will cover them, and dipping amongst them, (after the fashion of the inner membranous envelope of the brain,) will separate them into vascular groups or cotyledons, having a single principal trunk in each, and many short and tortuous branches besides, constituting the placenta.
The slit visible in one part of the Ovulum leads to a small cavity from which the embryo escaped. In the second cavity to the left, which is still intact, the embryo is visible when the Ovulum is placed before a strong light.
(Three weeks and a half after menstruation.)
In this specimen of an early miscarriage, the Ovulum exhibits the filiform vessels as in No. 1; but one half of its circumference is denuded of them,and the diaphanous involucra are distinctly visible in that part. They are represented flaccid owing to the escape of a part of the liquor amnii. In size the embryo (which required to be viewed in a very strong light) resembled that of No. 6.
(Three weeks after menstruation.)
A mossy Ovulum, shewing the inner or secreting membrane, within which I could not discover any embryo at the time of the miscarriage occurring. On searching among the coagula consequent on a very extensive hemorrhage, the Ovulum was found flat, and appeared like a confused mass. The liquor amnii had escaped, and probably the embryo along with it. The artist has most skilfully delineated the peculiar turns of the involucra where they have been divided so as to display those marked inflexions which are still more distinctly seen in No. 4.
(Four weeks after menstruation.)
I look upon this as one of the most perfect specimens of mono-embryoferous Ovula at four weeks, I have seen; exhibiting as it does, not only the mossy ornutritive, but also the inner, amnionic, orsecretinginvolucrum, with its peculiar inflected turn, forming asacculumwithin which is lodged the embryo. The nutritive involucrum is separated from the middle membrane by theallantoidcavity, and the middle membrane itself stands aloof from the amnion, owing to thevesicula umbilicalis. The existence of these various elementary parts of the human Ovum in the present specimen, shews its early development, and serves to fix its age, which I consider to be of about three weeks and a half.
As gestation advances, some of those elements are obliterated, and others confounded together.
I imagine that these Ovula pass away from the womb almost immediately after they have entered it, owing to a tardy or deficient formation of that peculiar lining which theuterine cavity begins to weave for itself from the first moment of a successful copulation, and to some part of which the Ovula are destined to adhere.
The preceding objects are represented of their natural size, and as they lost their colour during the first maceration in water, owing to the great readiness with which the mossy vessels discharge their blood, the colour adopted in the Plate is that which they attain afterwards, and such as it appeared when the artist sketched them. They have in every instance been examined and dissected under water. Such early Ovula are not rare. In the Museum of the Royal College of Surgeons of London there are four such specimens, marked 3432—3—4—5 in red ink on the black varnished cover of the bottles[26]. In Sir Charles Clarke’s collection there are also several. I have likewise examined many of them in Meckel’s magnificent museum; but it is in that of the late Professor Sœmmering that I have been gratified by the sight of not a few beautifully prepared and arranged specimens of this early stage of the human Ovum. Among them were the identical preparations which he selected and arranged in a graduated series of human embryos, and afterwards caused to be delineated and engraved, for his valuable work entitled “Icones Embryonum humanorum.”
The rudiments of the embryo in this specimen are more than usually diminutive, compared to the mass which constituted the entire Ovum before it was flattened and pinned to a piece of blue pasteboard placed in spirits within a glass jar. This preparation, now in the museum of St. George’s Hospital, exhibits the transparent involucra and the placental envelope with the intermediate membranes, imperfectly developed, of an Ovum which I should judge to have been fecundated about three weeks. At this period of conception the embryo is generally straight, consisting of that part which is to be the trunk, terminated, as in this case, by a round swelling, which is the head. Here the embryo is in reality straight, and has the appearance of a worm. It is attached to the inside of the secreting membrane by its abdominal surface without any visible cord. As illustrative, and that in a very distinct manner, of this early stage of pregnancy, Fig. 5 is a valuable specimen.
Fig. 6.
The same remarks apply to this as to No. 5. The embryo is somewhat more clearly delineated. Its trunk is gently curved forward, and the tubercular-like rudiments of the extremities appear visibly marked. This circumstance denotes its age to be of five weeks.
The volume of the transparent involucra is disproportionate to the embryo itself: yet the placental covering, with its filiform vessels, bears a still larger proportion to them; so that the want of equilibrium between the external and internal apparatus of the Ovum has destroyed, first the growth, and next the life of the embryo. The preparation is in the museum of St. George’s Hospital, and like the preceding preparation (5), has been flattened and pinned to a pasteboard—a mode which, for thesteadydisplay of the peculiarities of the Ovum in both cases, was, perhaps, the most judicious.
(About eight weeks after menstruation.)
Its structure is imperfect. It wants the nutritive membranes or involucra. It is defective also in the arrangement of the inner or secreting membranes. Hence the great accumulation of fluid within, and the scanty appearance of the filiform vessels without. The embryo has consequently been retarded in its development, which is scarcely greater than that of Ovulum No. 4, although the period at which the former had been ejected, was nearly twice as long as that of the latter.
Are also examples of denuded or diaphanous Ova, to which the same remarks apply as to the preceding specimen. The enlargement of Ovum 8 is even greater than that of Ovum 9: yet the embryo of the latter is more advanced and more clearly delineated by nature than is the case with Embryo 8. We know that these two Ova and No. 7, are more than two months old from the length of the umbilical cord as compared to thatof the fœtus: for from the second to the sixth month of pregnancy, the length of the cord is proportionately greater than that of the fœtus.—(SeeMeckel and others.)
In examining these denuded or diaphanous Ova, I have been struck with that small circular spot on their surface, generally of an opaque colour, which has been called thecicatricula, and is not unlike that which is found in some of the Ova of birds. This spot is well marked by the artist in the last three specimens, and in two of the figures ofPlate 3. I take thecicatriculato be that part of theOvulumwhich adhered to its ovarian nest (called thevesicula graafiana), before it burst from the Ovarium to pass into the womb consequently on fecondation. It is to be seen on all the ovula so situated in the Ovaria of women, and is considered to contain the rudiments of the embryo, which certainly begin from a little straight line that may be distinctly seen in thecicatricula.—(SeeMeckel, Adelon, Geoffroy St. Hilaire, Prevost, &c.)
This class of human Ova throw no inconsiderable light on the progress of fœtal intro-uterine life. They prove that the embryo, called into existence by the mysterious act of fecondation (the only point thatismysterious about the process of generation according to Cuvier) may, and will, and does live independently of the mother,—with a life wholly its own, and that it derives from its parent growth only, or accretion of substance, as I stated in my preliminary observations. The museum of the Royal College of Surgeons supplies a most striking illustration, and I may add, corroboration of this opinion.
No. 3448 is a single spherical denudated diaphanous Ovum about six inches in diameter, without the slightest appearance of any placenta, filiform or cotyledonous vessels, or other of the nutritive involucra or membranes. The secreting or amnionic membrane, is capable of containing more than six ounces of fluid; yet the embryo is not larger than an embryo at one month. When this specimen was sent by Mr. Lugar, of Richmond, to the College, Mr. Clift found it attached to aPlacental Ovum, containing a perfect fœtus of the proper size at four months and a half, with an umbilical cord nine inches long. The attachment of the two ortwinOva, was by a spot not larger than a shilling, which is still visible on the smaller or diaphanous Ovum, and was of a bright red colour at the timeof separating the two Ova for the purpose of making a distinct preparation of the more complete Ovum, marked in the museum 3448 A.
It appears that the twin Ova were ejected together five months after menstruation.
That the embryo in the smaller Ovumlivedis proved by its size as well as by the secreting involucrum having enlarged with fluid to the capacity afore stated. But it did not grow, becauseunconnectedwith the mother; while the twin fœtus properly encircled by the placental envelopes, which placed it in immediate communication with its parent, lived as well as acquired growth.
Plate 2Joseph Perry del et Lithog.Printed by C. Hullmandel.Dr. Granville on Abortionand the Diseases of Menstruation
Plate 2Joseph Perry del et Lithog.Printed by C. Hullmandel.Dr. Granville on Abortionand the Diseases of Menstruation
Plate 2Joseph Perry del et Lithog.Printed by C. Hullmandel.Dr. Granville on Abortionand the Diseases of Menstruation