The uterus is about double the size of its unimpregnated form; but neither the enlargement of its cavity, nor the shortening of its cervix, corresponds to this general increase of outline, which is due rather to the thickening of its walls. Nay, the cervix is unusually long even for an unimpregnated uterus. In it, as well as within the upper cavity, we observe some adventitious production, differing so far from each other in appearance, that the one, (that of the cervix,) is flocculent and of small texture; while the other is composed of broken flakes, or thickish laminæ, of a smooth, compact, suetty substance. This corresponds in its visible character with the adventitious coating cast off by the uterus two or three weeks after successful copulation, whenever the Ovum has been blighted in its development during that period. In my collection, in that of St. George’s Hospital, and of the two Royal Colleges, there are specimens of this species of production, which by most writers is looked upon as the decidua.
Proceeding with our description of the parts as they appear in the preparation, we find that the middle third of the whole length of the right fallopian tube is lacerated, being also in that part, pouchy and larger than usual; that a fecundated Ovum is lodged within the portion of the tube in question, which has acquired sufficient development to shew all its component parts; and that a fœtus with its navel string is contained within the transparent membranes or involucra of that ovum. The membranes are two in number, and as the drawing beautifully represents them, accurately separated in the preparation. Now, according to the common doctrine, the outer of these involucra, being the chorion, ought to have the shaggy or filiform vessels which are said to characterize that membrane. Nothing of the kind, however, is here seen, nor any vestige of them. But externally to this outer transparent membrane we have the cortex Ovi, which has contracted adhesion by means of branches of vessels, indistinctly made out in the preparation, owing to the dried clots of blood with which they are interspersed. These clots of blood are the remains of the accumulation of that fluid around the Ovum, which led to the laceration of the tube, and with it to the fatal hemorrhage that inundated the abdomen and produced death. I have not hesitated a moment in colouring these clots as blood in the drawing, although in the preparation, as is generally the case, they look brown instead of being of a bright red.
Both ends of the fœtiferous tube are made to appear pervious, by the insertion of bristles.
The rudiments of the inferior extremities in the fœtus are well marked; the cord is of the length of the fœtus, which is itself about half an inch long, and coiled up anteriorly.
Turning now the preparation to examine the ovarium of the same side, as it lies open before us, we find the vesicula Graafiana (the nest) from which the ovulum escaped into the tube, quite evident. The centre of that nest, itself yellow in colour, presents a white radiated scar or cicatrix, which must have formed subsequently to the escape of the ovulum, and during the period between that escape and the death of the patient. This yellow substance with its scar is the corpus luteum of the authors.
The left appendages of the uterus were sound.
The side figure represents a front view of the tubic seat of the fœtus.
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.