Menorrhœa, (the radical) Menstruation, from μὴν mensis, ῥέω, to flow. A-Menorrhœa, Suspended Menstruation, from α, privative. Dys-Menorrhœa, Painful or Difficult Menstruation, from δὺς difficult. Poly-Menorrhœa, Profuse Menstruation, from πολὺ a great deal. Lego-Menorrhœa, Ceasing, Decreasing Menstruation, from λήγω, to cease. Allo-Menorrhœa, Vicarious (erratic) Menstruation, from ἄλλο, one for another.
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 as the 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 have organized coagula 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 enclosed without 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 extremities an 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.