REMARKS.
I have ventured to rescue this interesting case, which my readers will find most ably detailed by the late Dr. Clarke (a truly philosophical obstetrician) in the first volume of the transactions of the Society for improving Medical and Surgical Knowledge, from the very imperfect and indistinct representation given of all its most important details by the artist employed on the occasion. Three plates accompany the original paper, professing to be delineations of the preparation, as seen anteriorly, posteriorly, and laterally; and I have no hesitation to assert, that the fine arts must have been at a very low ebb indeed (as far as anatomical subjects are concerned) in those days, if such were the productions of the pencil and the graver at that time. When I say that it is next to impossible to distinguish in the plates any of the parts referred to in the narrative, and that the important details exhibited by the preparation itself, are not only indistinct, but faulty and deficient in design, I may be deemed to have advanced sufficient grounds for offering to the public a far more accurate and perfect picture of this highly instructive and almost proverbial case. Such is my first reason for introducing it in this place. My second reason is, that it is marvellously adapted to advance my object in publishing the present graphic illustrations of abortion—for it affords me not only some curious facts respecting the formation of the impregnated Ovum, but also a contrast to the preceding and two following species of fecundation extra muros uteri. Thus the present work will contain a striking and well authenticated specimen of each of the four kinds of impregnation that occasionally takes place in some part or other of the uterine system of woman beside its cavity.
Dr. Clarke’s preparation being still in existence, and in the collection of his worthy successor and brother, I requested permission to have a front and lateral view of it made by Mr. Perry; and I fearlessly challenge a comparison, first between the old and the present engraving, and next between these and the preparations themselves, which may be viewed in the Museum of St. George’s Hospital. I have described the parts as I found them in the preparation in question, which I have again, for the fortieth time, examined this day, January 23d, 1833.
Dr. Clarke, in his account of this case, says, that the substance in the cervix was gelatinous in the recent state, and that within the uterine cavity it is the decidua which we observe. The Doctor afterwards remarks that such decidua is always formed in the cavity in question, whether the fœtus gets into it or not; but his own description of another and even more important case of tubic gestation, which occurred at St. Bartholomew’s Hospital and was carefully examined by Mr. Abernethy, gainsays the assertion; for it is there stated, “that in the cavity of the uterus nothing remarkable was found”; and in my own case of Ovarian gestation, “no production whatever” was found within the cavity of the enlarged uterus.
From the state of the right Ovarium and the appearances and situation of the corpus luteum, we gather two probable facts. First, that the actual seat of the Ovulum is the place occupied afterwards by the corpus luteum, which fills the vesicula Graafiana considerably enlarged subsequently to fecundation. The fecundated Ovulum escapes from the Ovarium by bursting through the coats of the said vesicula Graafiana, which is generally found close to the periphery of the Ovarium. Secondly, that the process by which the breach made in the structure of the vesicle (or egg-nest) by the escape of the Ovulum is restored, is cicatrization, and that much time is not required for such a restoration.
Does not the first of these probable facts explain the acute pain which many women feel in the course of the first week subsequent to successful coition,—which some experience even for some time after,—and which is by all assigned to that part, of one or the other of the iliac regions, which corresponds to the situation of the Ovarium? Indeed, I have known Ovaritis of a very serious nature to follow shortly after impregnation.
Plate 10
Joseph Perry del et Lithog. Printed by C. Hullmandel.
Dr. Granville on Abortion
and the Diseases of Menstruation