PLATE XII.(POLYMENORRHOIC STRATIFICATIONS CONTINUED.)

An oblong mass, rounded at each extremity, one of which is more tapering than the other, and is perforated by an external orifice. Its whole length is 2½ inches, the difference in the circumference at the two opposite ends is as 1:2. The orifice is puckered at its edge: the colour of the mass of a marbled red.

This mass may be carefully unravelled in a weak mixture of alcohol and water, when it is found to consist of several membranaceous oblong pouches, placed one within the other, until we arrive at the centre, which is found occupied by a solid black coagulum of blood, perfectly homogeneous, friable when dried, shining in its fracture, and leaving streaks of a brown red colour on paper, when rubbed over its surface.

The appearance of the mass is here represented as it came away, of its natural size and colour, and by its side is placed the same mass after undergoing the process of careful separation of some of its different investitures or coatings. It should be observed that the orifice which exists at the pointed end of the external membrane corresponds with a similar orifice in each of the different subincumbent coverings. These, in their texture and appearances, differ scarcely from the Dysmenorrhoic pseudo-textile membranes described in a former plate.

C. pseudo-ova: molæ.(vulgo, false conceptions.)

A small, round, and oblong body, shaped not unlike a good-sized Spanish nut, which it resembles in colour even, and smoothness of surface. This led me to adopt the distinguishing appellative of Avellana. It measures about one inch in length, and is wide at one end and nearly pointed at the other.

When expelled it was covered by a tunic, which is easily detached, and is tolerably flexible. The external surface of this tunic is tomentose or lanuginous—the internal surface smooth, almost shining, and in its centre pellicular.

The nut itself, or mole, being cut open longitudinally, exhibits a cavity lined with a thin stratum of coagulated blood, interspersed by pellicles in all directions. On examining the cut edges of the mole, they appear to consist of at least three superimposed layers.

There is no communication whatever between the internal cavity of the mole and its surrounding tunic, and consequently none with external objects.

This is a smaller uterine production than the last, and it differs also in one essential character, that of the surrounding tunic being wanted.

In other respects the resemblance is perfect externally as well as internally, and also with regard to the total absence of any outlet from its interior. The coats are similarly constructed, but the deposition of a bloody stratum on the inner surface is thinner and smoother.

Fig. 4. Mola conchula.

It is the external tunic of this mole that resembles a little shell, and which circumstance induced me to distinguish this species ofMolaby the surnameConchula.

The mole itself is more like a small date, the well-known Egyptian fruit. When just discharged it felt pulpy, yet firm, and I should imagine, from the feeling it imparted to the fingers, that it contained some fluid. That it has a central cavity there can be no doubt, for when compressed, it immediately returned to its former state as soon as the pressure was withdrawn. Having laid open so many of these curious productions, I was unwilling to do so in the present instance.

The tunic in this case was not cut open, but separated by a needle in the direction of what appeared to be arapheor joint running the whole length of the mass in a waved line. When the edges were sufficiently parted, thenakedmole was withdrawn without much effort.

Internally the tunic had a loose lining, dense, opaque, and membranaceous, between which lining and the external coat of the tunic a thin deposition of blood was observed.

This is a highly interesting case ofMola, to which I have given the designating appellative ofMytilusfrom its suggesting, when laid open longitudinally, the idea of that shell (muscle).

It is an oblong mass, broader at one end than at the other, as all these productions of the uterine cavity are found to be. In its external appearance it is fleshy, pulpy, of variegated tints even at the very moment of its expulsion, irregularly smooth, and free from any pellicle or membranaceous covering.

Internally it exhibits an oblong cavity, corresponding in figure, relative breadths, and length to the containing mass, which looks like a thick coagulum at the sectional edges. This cavity, however, is not a mere hollow in the general mass, but looks like an oblong membranous pouch imbedded in that mass. Its interior is lined by an exquisitely delicate and almost fumiform pellicle—lactescent or opalescent. The pointed extremity of this cavity loses itself in the brilliantly red mass of the tapering end of the mole, at neither of whose extremities is there the least semblance of any aperture.

When I laid open this curious mole, its cavity contained a small quantity of clear fluid.

I have for a great many years past been in the habit of arranging into three distinct groups all those adventitious productions, or excretions of the uterine cavity, connected either with irregular menstruation or faulty conception, which authors have described under so many different names. I consider that all such productions are either the result of an organizing effort on the part of the uterus during painful menstruation, or a successive arrangement of coagula of blood pending a profuse or critical menstruation; or lastly a blighted ovum, passed as an originally-imperfect seed into the womb from the ovarium, or which has become imperfect subsequently to its reception within that organ.

To the first of these groups I have given the name of Dysmenorrhoic organizations.

To the second the name of Polymenorrhoic stratifications.

To the third the name of Pseudo-Ova, or Molæ, including what are vulgarly calledFalse Conceptions.

In order to understand the first two appellations, it is necessary that I should state in tills place that they are denominations adopted by me, (in my work on Abortion and Menstruation,) to signify certain modifications of the latter function, which have been considered and treated as diseases, and as such variously denominated by nosologists and others. In the work alluded to, wishing to simplify as well as to rectify the uncertain and incorrect nomenclature generally employed in such cases, I formed, and have ever after used the following scheme of classification.

Of these five modifications of the menses, the first four may produce either organized substances, or stratifications in the cavity of the womb; but those modifications, which more commonly give rise to such productions are Dysmenorrhœa and Polymenorrhœa, and from them, therefore, I have borrowed my denominations of the groups.

Having said thus much as to generalizations, I come to speak more particularly of the specimens which I have selected, with a view to illustrate my groups. These, although not numerous, are the most complete of their kind. They have in themselves all the generic as well as the specific characters which distinguish them from every other preparation. Few of those characters, perhaps one or two, are to be met with in other specimens, but in that case the latter are mere varieties of the species I have represented. Membranous organizations,—coagula,—stratifications,—moles,—false conceptions, may vary from one another in some slight point, so as to appear different to different observers; but in the end, and in reality, they can only be referred to the groups I have adopted, and to these therefore I must take leave to adhere.

With respect to the pseudo-ova, or molæ, it would have been an endless task had I attempted to transcribe the smallest part of the long list which ancient as well as modern authors have drawn up of such substances; or had I registered their singular names: most of which imply some anatomical or physiological error. My scheme of classification contains only four species, and I have limited myself to that number because they are the most distinct forms of pseudo-ova or moles I have seen in the course of twenty years’ practice. I have preferred giving them an unmeaning name,—one of supposed resemblance to some well-known object,—rather than to run the risk of misleading people by the use of denominations which must give rise to false notions.

One word more by way of general remarks on these important points before I conclude.

Almost every author who has written on the subject of moles, has differed from his predecessor in the use of that term, applying it to very different productions of the uterus. Some have indiscriminately called by this name the polypi of the uterus; hardened, soft or spungy coagula of blood; carneous masses expelled by the uterus; diseased or deformed ova; and in fact almost any thing in the shape of a mass that has come away from the genital passages of a female after supposed conception, or subsequently to parturition. To embrace so many different substances under one general denomination, is surely wrong, (as Denman said,) and accordingly we find such a practice condemned by many. But asthe difficulty of distinguishing a real mole from an organized coagulum was supposed to be very considerable, no successful attempt was ever made to prevent the confusion which ensues from that practice. Denman himself, for instance, has not been very felicitous in pointing out a distinction between a morbid ovum and a coagulum of blood. That writer assumes that every mole, consisting of a decayed ovum, will be found to present, “notwithstanding the external appearance of a shapelessness of flesh, various parts of a child, &c.,” and also that, “although a coagulum of blood long retained in the womb, may, at the first view of its external surface, appear like organized flesh, the internal part, if cut into, will be found to consist merely of coagulated blood.” Now neither of these positions is exclusively true, for, as may be seen by a reference to plates 11 and 12 of this series, we haveorganizedcoagula without any nucleus of hardened blood, but on the contrary with a centre or cavity lined by a membrane, on the one hand; and we have on the other hand pseudo-ova, or real moles, entirely free from the slightest trace of embryonic rudiment.

What then is the distinction between a real mole and a coagulum, no matter of what species or variety the latter be? It is this: that the former has invariably a central cavity wholly enclosedwithout any opening or aperture; whereas the latter—let it be formed in any way you please, stratified, laminated, concentric, membranaceous, solid, hollow, or with a regular cavity lined by a membrane, no matter,—will be found invariably to have at one of its extremitiesan aperture, either leading straight into the inner cavity, where such an one exists, or simply passing from one membrane or stratum of coagulated blood to the next, until it reaches the innermost, which is also perforated like the rest. This is a striking and important distinction, and I am not aware that it has been noticed or made public by any author before me.

Having been accustomed, for many years, to examine and compare together every uterine production that came away during abortion, or morbid menstruation, whenever an opportunity offered itself to me to do so, either in public or private practice; I was led to make those observations which enabled me to establish the above distinction, and which have afforded me the advantage of selecting clear and well-defined specimens of the two kinds of productions alluded to, and of afterwards submitting them to the strictly correct copying powers of Mr. Perry, the artist. The result of his accurate copies from nature is registered in the present collection of plates.

I may add that such representations are not to be found in the medical literature of either this or of any other country; and that I hope they will be the means, (even if they should fail to do any other good,) of preventing the recurrence of erroneous opinions, which lead to injurious aspersions, and often fatal conclusions.

I need scarcely repeat, at the conclusion of these Explanations, that as the plates are illustrations of the views I entertain respecting abortion, and the diseases incidental to menstruation, formed in the course of, and corroborated by, twenty years’ experience,—the result of which experience I have embodied into a large volume preparing for the press; all the cases which relate to the individual delineations given in this collection of plates, will be found detailed in that work, particularly those connected with the specimens of dysmenorrhoic organizations, polymenorrhoic stratifications, and pseudo-ova.

END.

☞ The Work, in connection with the present Graphic Illustrations, which the Author has been preparing for the press since the year 1826, and to which allusion has been made in the course of the Explanations to the Plates, will be published without delay, entitled as follows:

ONABORTIONANDTHE DISEASES INCIDENTAL TOMENSTRUATION;PRACTICAL COMMENTARIESBY A. B. GRANVILLE, M.D. F.R.S.ETC. ETC. ETC.An Octavo Volume of about Five Hundred Pages.

ABORTION

AND

THE DISEASES INCIDENTAL TO

MENSTRUATION;

PRACTICAL COMMENTARIES

BY A. B. GRANVILLE, M.D. F.R.S.

ETC. ETC. ETC.

An Octavo Volume of about Five Hundred Pages.

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