Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol. 5: Supplementary Volume
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit36060/657/
OVARY—(Abnormal Anatomy). 
5S7 
The impediments to such determination 
which recur again and again in these cases are 
the following. It is easily ascertained that 
the sac containing the foetus is external to the 
cavity of the uterus, and is in some way or 
other connected with some portion of the in¬ 
ternal generative organs ; the Faliopian tube, 
ovary, and broad ligament of one side being 
chiefly involved in the tumour, while the cor¬ 
responding parts of the other side may remain 
free. Dissection may serve to unravel these 
parts to a certain distance, beyond which 
nothing satisfactory can be determined, on ac¬ 
count of the alteration which the tissues have 
undergone both in form and arrangement ; 
the hypertrophy of some, and the wasting or 
blending together of others, rendering further 
research fruitless for the object in view. 
To these impediments, other and still greater 
difficulties are generally superadded. These 
arise from the death of the foetus, which often 
takes place several months or even years pre¬ 
vious to that of the mother. In the decom¬ 
position which follows, the harder parts of the 
contents of the sac fall asunder, and make 
their way by fistulous openings into surround¬ 
ing viscera, whose surfaces inflame and give 
rise to serous and fibrinous effusion, while in 
the few hours which succeed to the final de¬ 
struction, the parts decompose so rapidly that 
the post-mortem examination, however early 
it may be made, often reveals nothing but a 
semi-putrid mass perfectly unsuited to the de¬ 
termination of a difficult anatomical question. 
For this purpose the cases of the former 
class can alone suffice. Here the parts are 
small, and as yet comparatively unchanged, and 
admitting of dissection. The results of four 
such examinations have just been given. The 
following additional examples, which are se¬ 
lected from the best recorded cases supposed 
to be ovarian, will suffice to exhibit the class 
of evidence upon which a belief in this species 
of gestation is demanded. 
Cruveilhier* has described and figured a 
case in which the entire skeleton of a four 
months’ foetus f is seen hanging external to a 
sac, occupying the seat of the right ovary, in 
which it is supposed to have been once con¬ 
tained. The sac said to be in the inner and 
lower part of the ovary is lined by a serous 
membrane. The two external thirds of the 
pouch were filled by a spongy areolar yellowish- 
white mass presenting all the characters of 
placental tissue. The outer half of the sur¬ 
face of the ovary was enveloped in a cartila¬ 
ginous shell. No attempt appears to have 
been made to trace the entire outline of the 
ovarian tunics, or to show the condition of 
the ovarian ligament, or of the Fallopian tube 
of the same side. The latter, indeed, is not 
mentioned, but from the representation of the 
parts it appears to be blended with the cyst, 
so that this is quite as likely to have been 
an example of tubal, or ovario-tubal, as of 
* Anat. Pathol, livr. xxxvi. pi. vi. 
f Said in the description to be between one and a 
half and two months, at which time, however, no 
such complete skeleton is ever seen. 
ovarian gestation. The fact also that the cyst 
had apparently burst and permitted the escape 
of the foetus when it had attained the size 
which is seldom exceeded in tubal cases, lends 
additional probability to this view. 
Dr. Granville * has published a case, accom¬ 
panied by drawings, which he regards as an 
“ undisputed case of purely ovarian fcetiferous 
ovum.” The uterus is considerably enlarged, 
but empty. “ The left ovarium presented a 
large swelling which contained within its own 
covering an ovum bearing a foetus with all its 
appendages, of about four months’ growth. 
The ovarian covering burst in three places, and 
allowed the protrusion of the ovum, whereby 
the adhesion of the placenta to the inner sur¬ 
face of the ovarian envelope was torn asunder,” 
causing death by haemorrhage. A blood-ves¬ 
sel, the size of a large crow-quill, which pene¬ 
trated the dense portion of the tumour, was 
ascertained to be a branch of the left sper¬ 
matic artery, and a smaller and much shorter 
vessel, arising from the tumour, was found to 
communicate with the spermatic veins. “ The 
corresponding Fallopian tube was perfectly 
sound and loose, particularly at its fimbriated 
extremity, which had no connection whatever 
with the embryoferous tumour in its neigh¬ 
bourhood. Like its fellow tube, it was per¬ 
vious only from its loose extremity inwards to 
about half its length. “ A placental mass with 
distinct cotyledonous vesicles connects the child 
with the inner covering of the ovarian cyst. 
The secreting or transparent involucra are 
quite distinct. The cortex ovi is almost wholly 
absorbed, as it ought to be at such an advanced 
period. The foetus is perfect.” In the expla¬ 
nation of the plates mention is made of “ frag¬ 
ments of the corpus luteum which surrounded 
the ovum, and was broken to pieces by the 
enlargement of the foetus. Some of these 
fragments adhere to the inside of the ovarian 
coats, others are among the placental cotyle¬ 
dons.” No account is given of the ligament 
of the ovary, nor of such a dissection of the 
parts having been undertaken as would satis¬ 
factorily prove that the sac containing the 
foetus was not a cyst attached to the ovary. 
But the evidence in favour of ovarian gesta¬ 
tion consists chiefly in this, that the foetus¬ 
bearing cyst occupied the region of the ovary, 
and was independent of the Fallopian tube. 
Nevertheless this case constitutes the nearest 
approach to the form of gestation which it 
claims to represent with which I am acquainted. 
In the same work (Graphic Illustrations-f) 
is contained a description and representation 
of a second case termed “ ovum foecundum in 
receptaculo ovarico.” “ Through a transversal 
aperture in the left ovarium are seen the re¬ 
mains of some membranes, three in number 
at the least, lining a cavity which measures 
transversely one inch and a quarter, and about 
an inch vertically.” The preparation belonged 
to Sir C. M. Clarke, who assured Dr. Gran¬ 
ville “ that a small embryo hung pendulous 
* Phil. Trans. 1820, and Graphic Illustrations of 
Abortion, Plates X, A, and B. 
j- P. 27. pi. viii.
        

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