PRIZE ESSAY.
PRIZE ESSAY.
ON
THE CORPUS LUTEUM
MENSTRUATION AND PREGNANCY.
y
BY
JNO. C. [DALTON, Jr., M. D.
Extracted from the Transactions of the American Medical Association.
PHILADELPHIA:
T. K. AND P. G. COLLINS, PRINTERS.
1851.
o r.. X ' '
851 1
C-L
ON THE CORPUS LUTEUM
OF
MENSTRUATION AND PREGNANCY.
INTRODUCTION.
There exists among medical writers at the present day a very
confused idea with regard to the corpus luteum. Notwithstanding
the endless controversies that have been carried on respecting its
origin, growth, and structure, there is still a great diversity of
opinion on all these points, even among those who have personally
devoted their attention to the matter ; and for the general reader
it would certainly be impossible, from the various accounts which
have been published, to arrive at any satisfactory conclusion. These
contradictory opinions prevailed not only in the earlier epochs, when
Haller* denied positively that corpora lutea were ever to be found
in virgin females, and when Meckelf considered them as glandular
structures, destined to secrete a sort of "fluide generateur," or
female semen ; but even at the present day, when so much addi-
tional light has been thrown on the whole history of generation, a
similar diversity exists ; and the corpus luteum is now described by
different authors as a development of the outer and of the inner
membrane of the Graafian vesicle, as a deposit between the two
membranes, and as a growth external to both. Perhaps the most
debatable question of all relates to its connection with conception
and pregnancy. At an earlier period, this was simply a question
whether corpora lutea ever existed in the ovaries, except as a con-
sequence of impregnation : some writers, with Haller, denying the
* First Lines of Physiology, Am. ed., 1803, p. 430.
■j- Manuel d'Anatomie, vol. jii. p. 730.
b PRIZE ESSAY.
possibility of such an occurrence, while others asserted that they
had frequently observed them in virgin animals and unmarried
women. In later times, however, it became a question of the pos-
sibility of establishing a distinction between true and/a?sg corpora
lutea; i. e., those which resulted from impregnation, and those
which owed their origin to some other cause. Notwithstanding
these differences, however, it has been always reducible to a single
very interesting and important inquiry, viz., whether, from the ex-
istence of a " corpus luteum" in the ovary, it can with certainty be
inferred that impregnation has taken place.
Among those who considered the corpus luteum as necessarily
connected with impregnation, many, like Haller and Meckel, had
no conception of the spontaneous discharge of ova during the
season of heat in the lower animals, and at the period of menstrua-
tion in the human female ; a process which has recently been more
or less generally recognized as a regular and natural function.
Consequently, they regarded the corpus luteum as only resulting
from sexual intercourse, or, at least, from some extraordinary ex-
citement of the generative system. William Hunter, in his plates
of the human gravid uterus, gives drawings of the corpus luteum
as an acknowledged and indubitable accompaniment of pregnancy
alone.
John Haighton,* in a paper on this subject in the Philosophical
Transactions, comes to the following conclusion: "I may then say
that no corpora lutea exist in virgin animals ; and that, whenever
they are found, they furnish incontestable proofs that impregnation
either does exist, or has preceded." He does not, therefore, recog-
nize any distinction between corpora lutea, nor the possibility of
any discharge of ova independent of sexual intercourse. He uncon-
sciously, however, himself furnishes evidence that such discharge
may take place, in his various experiments in which the oviducts
were divided before and after coition ; corpora lutea being found in
the ovaries in both instances. "We should expect,'' he says, " in
the one case to find the full effects of impregnation, and in the other
no traces of it would be seen. Instead of which, the procreative
actions (formation of corpora lutea) are no further advanced where
there has been an opportunity for the passage of the semen, than in
those cases where its passage has been impossible." He attempts
to explain this apparent contradiction by supposing that the ovary
» Phil. Trans., 1797, p. 114
INTRODUCTION. 7
is excited to the expulsion of the ovum by " consent of parts;" the
stimuhis of the seminal fluid in the uterus being sufficient to cause
the rupture of a Graafian vesicle, although its passage to the ovary-
has been interrupted. It apparently does not occur to him that the
assumed connection betvreen the corpus liiteum and a preceding
coition is entirely without proof; and that, without this assumption,
there would have been no discrepancy in the appearances which he
is at so much pains to reconcile.
Cruikshank* also relates an instance, in the human subject, in
which the rupture of a Graafian vesicle was not improbably quite
independent of coitus, without in the least suspecting the true
nature of the case. " I also have," he says, "in my possession the
uterus and ovaries of a young woman who died with the menses
upon her; the external membranes of the ovaria are burst at one
place ; whence, I suspect, an ovum escaped, descended through the
tubes to the uterus, and was washed ofi" by the menstrual blood."
The writer, however, as may be gathered from the context, evidently
supposes that the escape of this ovum was in consequence of coitus ;
since, throughout his paper, he considers the occurrence of a corpus
luteum as direct proof of impregnation.
Velpeauf speaks of the corpus luteum as a growth taking place
"after coition," without alluding to the possibility of its formation
under any other circumstances.
Montgomery! takes much the same view of the matter. He
speaks of the maturation and discharge of an ovum, and the accom-
panying growth of a corpus luteum as taking place "on the occur-
rence of conception;" and, though he acknowledges that bodies
resembling corpora lutea may be produced in the ovary by other
causes, yet the true corpus luteum, resulting from impregnation, may,
according to him, be always distinguished from them. "Such," he
says (p. 240), "is the result of my own observations on a very large
number of bodies, both of women and animals ; and in no one in-
stance did I ever find a true corpus luteum, except as the product
of conception." He gives some marks by which the true corpora
lutea are to be distinguished from the false, but his description, in
this respect, must be regarded as somewhat imperfect. The yellow
matter of the corpus luteum he considers to be surrounded by the
outer membrane of the Graafian vesicle, while its cavity is lined by
the inner, it being enclosed between the two.
• Phil. Trans., 1797, p. 135. f Treatise on Midwifery, Meigs" ed., Philad., 1831.
J W. F. Montgomery, Signs and Symptoms of Pregnancy, London 1837.
8 PRIZE ESSAY.
Dr. Gross* recognizes the occasional existence of false corpora
lutea, which, he says, may be produced without coitus, in conse-
quence of "strong sexual excitement." He concludes, however,
principally following in the track of Montgomery, that the true cor-
pus luteum is good evidence of pregnancy.
Dr. Edward J. Seymour,! though he acknowledges that corpora
lutea occasionally exist without impregnation, inclines to the opinion
that, as a general rule, they are good evidence of its having taken
place. "From these premises, comparisons, and observations," he
says (p. 32), "my opinion has been formed that corpora lutea are
the result of the change which takes place in the ovarium by the
bursting and discharge of the ovum — occurring rarely in virgin ani-
mals, because the bursting of an ovum is not a frequent but only
a possible occurrence, but always following impregnation, and dimin-
ishing as gestation proceeds."
Dr. Blundell| expresses himself on this point with great reserve.
He thinks that, in some of the lower animals, a corpus luteum, " not
to be distinguished from that of impregnation," may be produced
without sexual intercourse, and merely by great nervous excitement;
and he is not prepared peremptorily to decide the question even with
regard to the human female ; but considers, nevertheless, a " fabi-
form corpus luteum, with an . asteriskal cavity," &c. &c., as strong
presumptive proof of impregnation.
J. Miiller§ regards the discharge of ova as a consequence of sex-
ual intercourse, and must therefore hold the same opinion with re-
gard to corpora lutea. " In mammalia," he says, "the separation
of the ovum from the ovary seems to be dependent on the act of im-
pregnation. It has, it is true, been stated that cicatrices of the ova-
ries, resulting from the escape of ova, have been seen in the bodies
of virgins ; but this is certainly no ordinary occurrence."
Dr. Carpenterjl adopts principally Montgomery's description of
the corpus luteum, and his opinion that it is a good sign of impreg-
nation. He has, however, no original observations on the subject.
He also regards as " not improbable," the theory that ova are ma-
tured and discharged, at each menstrual period, independently of
fecundation ; though he thinks, with Dr. Barry, that it is more likely
* S. D. Gross, Elements of Pathological Anatomy, Philad. 1845.
■j" Illustrations of some of the Diseases of the Ovaria, London 1830.
J On Diseases of Woman, Philad. ed. 1840.
§ Miillers Physiology, Philad. ed. 1843.
II Principles of Human Physiology, Philad. ed. 1843.
INTRODUCTION". 9
that the matured ova retrograde and become absorbed, without hav-
ing been discharged.
Dr. Robert Lee* admits a distinction between true and false cor-
pora lutea, or those connected with impregnation and those arising
from other causes. His ideas, liowever, regarding the precise pro-
cess which takes place in menstruation do not seem to be very clear-
ly announced; for, although he considers it probable that about
the menstrual period there is a rupture of the Graafian vesicle, he
nevertheless denies that an ovum is discharged at this time. "That
an ovum," he says, " does not pass from the ovarium during men-
struation is evident from the fact that an ovum is never found but
as a consequence of impregnation, and that conception does not take
place during the menstrual period. "f He describes the yellow mat-
ter of the corpus luteum as situated externally to both layers of the
Graafian vesicle, without anything interposed between it and the
ovarian tissue.
Dr. Robert Paterson has two papers on this subject in the Edin-
hurgh Medical and Surgical Journal, in the first of which (January,
1840) he gives a somewhat extended notice of the distinguishing
marks of "true corpora lutea," i. <?., those consequent on impregna-
tion ; and he concludes that the corpus luteum, provided certain ap-
pearances exist, is "undeniable proof that the individual has been
pregnant." Dr. Paterson describes the true corpus luteum as de-
posited between the layers of the Graafian vesicle. The false he
considers as arising principally either from (1st) a more or less com-
plete filling of a Graafian vesicle with blood independently of im-
pregnation, or (2d) undefined effusions of blood into the substance of
the ovary ; a true apoplexy of the organ. They may, moreover,
arise from re-absorption and puckering of a vesicle, or from various
morbid deposits. He recognizes the spontaneous discharge of ova
only to a limited extent. " The period of menstruation," he says,
"is marked by the prominence of one or more of the Graafian
vesicles, and by their occasional rupture." A more common oc-
currence, however, he thinks to be " simple enlargement of a vesicle,
the increased quantity of fluid in which becomes afterwards reab-
sorbed." Dr. P.'s communications are accompanied by a number of
observations and coloured drawings, illustrative of the difference be-
tween true and false corpora lutea. These, however, do not seem to
• Lectures on Midwifery, London Med. Gazelle, 1842.
t Cyclop. Pract. Med. iii. 444.
10 PRIZE ESSAY.
be quite perfect, as some of his cases, related under the head of
"true corpora lutea," are entirely deficient in evidence of impregna-
tion, and in some of his drawings he designates as mere " puckered
cysts," &c., what are evidently corpora lutea of menstruation, in a
retrograde state.
Dr. Frank Renaud, of Edinburgh, has a highly interesting and
valuable paper on this subject in the London and Edinburgh Monthly
Journal of Medical Science for August, 1845. The plan of the
memoir is somewhat similar to that of Dr. Paterson's, and it gives
by far the clearest and most accurate account of true and false cor-
pora lutea that I have anywhere been able to meet with. Dr. R.
takes much the same view with Dr. Paterson of the processes con-
nected with menstruation, viz., that "towards each menstrual period
the Graafian vesicles become developed," and "sometimes burst."
He does not, however, consider this as a regular and natural occur-
rence ; nor does he describe the false corpora lutea as always con-
nected with menstruation.
It will be observed that a certain proportion of the above writers
speak of the corpus luteum as a sign of pregnancy, without mention-
ing its particular marks or distinctive characters ; Avhile those who
have given a more detailed description of it mention also certain
other bodies, false corpora lutea, which they consider as occasional
morbid or extraordinary growths, varying in their nature, and acci-
dental in their formation.
On the other hand, are a crowd of observers, who, in the earlier
times, met with " corpora lutea" in virgin women or in virgin ani-
mals. Malpighi, Valisnieri, Santorini, Brugnone, Bertrandi, are
all cited by later writers as having borne testimony to this fact.
Neither have others been Avanting, in modern times, to sustain a simi-
lar view.
Dr. John Burns,* indeed, expresses himself somewhat doubtfully
in regard to it. " It has been conjectured by some," he says, " that
the corpus luteum may be produced even without sexual intercourse ;
but this point I cannot determine.'' He does not, however, speak
of the corpus luteum as positively existing in company with any
other uterine production than a foetus or hydatids. " The appear-
ances during life, or after death, which occur from a miscarriage,
may also arise from the expulsion of hydatids ;" in which case
"even a distinct corpus luteum may be discovered." Dr. Burns
• Midwifery and Diseases of Women, James' ed. 1813.
INTRODUCTION. 11
does not here make any distinction between those hydatids '\^■hich
evidently result from a degeneration of the ovum, and those which
are supposed to constitute a true morbid production of the uterus ;
he appears, hoAvcver, to consider them all as belonging to the former
class.
Sir Everard Home, in his two papers on corpora lutea in the Phi-
losopliical Transactions,* denies that there is any difference between
the corpora lutea resulting from impregnation, and those which are
produced independently of any such influence. He gives a very
confused and unsatisfactory account of some observations which he
adduces " in proof" that corpora lutea are not bodies formed in con-
sequence of the discharge of ova, but are the glandular structures
in which the ova are produced ; that they are " formed previous to
and independent of sexual intercourse ; and that, when they have
fulfilled their purpose of forming ova, they are afterward removed
by absorption, whether the ova are impregnated or not." He even
goes so far as to say that physiologists have been led into the error
of " mistaking a corpus luteum in which an ovum is forming for
that which belonged to the ovum of the present conception, and
which, at the time of delivery, has disappeared;" and that it will
be found that " all the preparations of corpora lutea, from the ovaria
of women who die in childbed, actually belong to this new ovum,
not yet completely formed." It is impossible, however, to discover
in either of the papers anything like " proofs" of these extraordi-
nary assertions ; unless, indeed, a drawing may be considered as
such Avhich he gives of a corpus luteum, imbedded in the substance
of an ovary, and containing a very dubious-looking body, which the
writer calls an ovum, but which is entirely unlike the ova, as seen
by other observers, while yet contained within the ovary. The
accuracy of his logical inferences may be estimated from the fact
that he regards the presence of a hymen as proof positive of vir-
ginity.
Sir Everard Home admits that ova do pass from the ovaries ante-
riorly to impregnation, but does not seem to think this an occurrence
which takes place in the human female at any regular period. He
denies explicitly that it has any connection with menstruation ; for,
after relating the case of a girl who died seven days after an ex-
pected menstrual period, and in whom the ovary was found to con-
tain two "corpora lutea," and the uterus an ovum of minute size,
• Pl.il. Trans. 1817 and 1S19.
12 PRIZE ESSAY.
he says, "It is clear, from the case which has just been stated, that
such (menstrual) periods are totally unconnected with the formation
of the ovum, the process of its leaving the ovary, or its impregna-
tion."
Dr. Dewees* adopts, without discussion. Sir Everard Home's view
of the matter.
Dr. Gooch,t though he at first speaks of the corpus luteum as
formed from the rupture of a Graafian vesicle "after conception,"
does not allow that the two are necessarily connected as cause and
effect. "Some persons," he says (p. 87), "will pretend to say,
from an inspection of the ovary, how many conceptions have taken
place, but corpora lutea have been seen in virgins." This state-
ment, however, is entirely unaccompanied by proofs, or by any de-
tailed description of the bodies in question.
Boivin and Duges, in their treatise on Maladies of the Uterus,|
give no very clear description of corpora lutea, nor any decisive
opinion as to their nature. It is merely stated that they have often
been found in " unmarried" females. In the atlas, there is one
figure of an ovary, showing the external cicatrix of a corpus luteum,
but no internal view.
T. Wharton Jones§ recognizes the periodical discharge of ova
from the ovary, but does not consider this occurrence as ordinarily
resulting in the formation of a corpus luteum. He ingeniously
accounts for the supposed fact that every such discharge is " not
followed by a corpus luteum,'' as follows: —
I. The regular and periodical discharge of ova takes place with-
out increased action, and consequently leaves little or no trace.
II. Coitus hurries the maturation and discharge of ova by in-
flammation and exudation, which result afterwards in the corpus
luteum.
III. When coitus coincides with the regular maturation of a
Graafian vesicle, no corpus luteum is formed.
He acknowledges, however, that this is "physiological specula-
tion," and says that, practically, "it would be rash and unwarrantable
for any one to pronounce, from the occurrence of a corpus luteum
in the ovaries, that coitus had taken place."
• System of Midwifery. Pliilad. 1826. V
t Gooch's Midwifery, Pliilad. ed. 1832. ™
J Heming's Translation, London, 1834.
§ London Medical Gazette, vol. xxxiv. p. 625,
INTRODUCTION. 13
Dr. Robert Knox* also tliinks that ova "may often" be discharged
from virgin ovaries, corpora lutea being formed in consequence ; but
he does not look upon this as an established fact. Though he insti-
tutes some comparisons between the true and false corpus luteum,
the distinctions which he lays down are very imperfect, relating
chiefly or entirely to the comparative size of the bodies ; and from
his observations and details he finally draws the following conclu-
sion, viz., that "there is no distinctive character by which the
corpus luteum (of impregnation) may be distinguished from the
miniature (or false) corpus luteum."
The above details will serve to show how various are the opinions,
and how contradictory the statements, which have been brought for-
ward by medical writers on this subject. When, however, it be-
came more perfectly established, from the recent researches of phy-
siologists, that a regular and periodical maturation and discharge of
ova take place, not only in the oviparous animals, but also in all
classes of mammalia, entirely independent of fecundation, and even
of coition, an additional and almost decisive argument seemed to be
afforded to the opinion of those who denied that any peculiar
appearances were produced in the ovary after fecundation which
could be regarded as evidence of that occurrence having taken
place. For, if the ovum is matured and expelled from the ovary
independently of any external influence, and is only fecundated at
the time of its expulsion, or during its passage through the oviduct,
how could this later and accidental occurrence have any influence
on the ulterior changes in the ruptured Graafian vesicle — changes
with which it had no necessary or physiological connection ? It re-
sulted, as was said, not only from analogical inferences, but also
from the observation of nature, that the corpus luteum is formed in
the ovary, after the discharge of the ovum, in the same regular and
uninterrupted manner, whether that ovum becomes subsequently
fecundated by the spermatic fluid, or Avhether, as more frequently
happens, it rapidly loses its vitality, and is destroyed. Such an
apparently superfluous production of ova, destined to perish with-
out ever receiving impregnation, was not without abundant analogy
among the lower orders of organized beings. It had been long
known that the spawn of fishes wxre expelled by the female, inde-
pendently of any direct influence from the male ; and that their
subsequent fecundation depended entirely on the occurrence of
• London Medical Gazette, vol. xxxiii. p. 370.
14 PRIZE ESSAY.
fortuitous circumstances. In the vegetable world, the dioecious
plants presented the same phenomenon ; many thousand germs
being annually produced by the female individual, of which only a
small proportion were destined ever to receive the fructifying influ-
ence of the pollen.
Bischofif* was among the first who announced this theory in a de-
cisive manner. He was first led to a knowledge of the fact by some
appearances which he met with in an experiment on animals in June,
1843, and communicated his discovery in a letter to the French
i^cademy on the 17th of July following. He afterwards brought
the matter before the public in a more extended form. In this work,
Bischoff shows by actual observation that the Graafian vesicles be-
come ruptured without coition, and in the lower animals that the ova
enter the oviduct, and proceed toward the uterus. "Now from all
these observations," he says (p. 45), "it is quite certain that the
ova in mammalia, in the time of heat, no coition taking place, are
detached from the ovary, enter the tube, and perish there ; and that
corpora lutea are formed in the ovaries just as tJiough coition and
fecundation had taken place.''
M. Ndgrierf has also published a work in which he advances some-
what similar opinions. His book, however, is written for the par-
ticular purpose of demonstrating the dependence of the menstrual
function on certain periodical changes which take place in the ovary;
i. e., the successive maturation and rupture of Graafian vesicles. The
spontaneous discharge of ova about the menstrual period is also
alluded to by the author, but is not asserted in so distinct and posi-
tive a manner as the former proposition. N^grier does not, how-
ever, consider the yellow bodies as always produced by the rupture
of Graafian vesicles, but supposes the yellow matter to be deposited
between the coats of the vesicle at a stage of its development prior
to its distension with fluid and final bursting ; the yellow matter,
together with the efi"used blood, becoming afterward rapidly absorbed.
In this respect, he adopts the views of Sir Everard Home, and, like
him, distinguishes two varieties of corpora lutea, viz., the ascending
and the retrograde ; or those which are still entire, and in process
of development, and those which have already become ruptured.
* On the Maturation and Discharge of Ova, independent of Coition ; Oilman's and
Tellkampfs Translation, N. Y. 1847.
t Recherches Anatomiques et Physiologiques sur les Ovaires dans TEspece Humaine.
Paris, 1840.
INTRODUCTION. 15
He imagines, also, with Home, tlie yellow matter to be a source of
nutrition, or " a kind of placenta" for the germ.
Negrier recognizes three principal stages of the development of
the Graafian vesicles {travail vSsiculaire).
I. The formation of simple, small, globular vesicles, filled with
serosity [vesicides primaires).
II. A deposit of gray matter between the walls, accompanied by
a folding up of the vesicular parietes, and absorption of the contained
fluid {bourses grises).
III. Enlargement of the whole vesicle, alteration of the colour
from gray to yellow {vesieules jaunes, or corpora lutea of other writ-
ers), renewed secretion of serosity, distension and rupture of the vesi-
cle. Respecting the connection of corpora lutea with impregnation,
his opinions are the same as those of Bischoff. " I cannot, however,"
he says (Avant-propos, p. xv.), " share the opinion of Dr. Paterson,
when he makes a distinction between the vesicular cicatrices, of true
and false. They are all essentially cicatrices, consequent on the
rupture of a perfectly developed vesicle, whether or not there has
been any fecundation of the ovum which escaped from it ; and, if the
remains of these organs do not always bear a perfect resemblance
to each other, it is because the rupture of the vesicle does not always
take place in exactly the same manner ; because the blood, effused
from the open vessels, is variable in quantity ; and because the
delicate membranes of the vesicle are sometimes more extensively
lacerated, the yellow matter being, in consequence, more readily
dissolved by the extravasated blood, and disappearing as the clot
becomes absorbed."
This account, by Negrier, of the development of the Graafian
vesicle and formation of the corpus luteum is somewhat complicated,
and is, moreover, entirely opposed to the views entertained by most
other writers, as well as to those which will be advanced in the pre-
sent memoir. M. Raciborski,* in his work on Spontaneous Ovula.
tion, or the " ponte p6'iodique spontan<5e," adopts the more simple,
as well as more probable theory that the corpus luteum is a forma-
tion which takes place altogether subsequently to the rupture of the
vesicle. That part of his work which relates to ovulation is intended
to establish the fact of the independent discharge of ova, and its con-
nection, in the human female, with menstruation. His views, also,
lead him to deny the existence of any distinguishing peculiarity in
• M. A. Raciborski, de la Puberte and de TAge critique, Paris, 1S44.
16 PRIZE ESSAY.
the corpus lutcum of impregnation. " Some authors,'' he says (p.
511), " have attempted to show a distinction of true and false cor-
pora lutea ; the first of which, according to them, are met with only
after a preceding conception. Notwithstanding all the efforts which
have been made to establish this distinction, we are far from being
prepared to acknowledge it. Numerous observations upon animals
have convinced us that, whether the rupture of the follicles is, or is
not, accompanied by coitus, or by fecundation, the appearance of the
lesions which result is, in both cases, absolutely identical."
But the writer who has treated this subject in the most brilliant,
decisive, and convincing manner is, beyond all others, M. Pouchet.
His views were first advanced in a memoir published at Paris, in
1842, entitled " Theorie Positive de la Fdcondation." It appeared
again, five years later, considerably amplified, and accompanied with
elegant illustrations, under the folloAving title : " F. A. Pouchet,
Theorie positive de I'ovulation spontande, et de la fecondation des
mammiferes et de I'espece humaine : Paris, 1847;" a work which
for comprehensiveness of design, brilliancy of style, and energy and
conclusiveness of argumentation, has been rarely equalled among
the productions of medical literature. In this work, M. Pouchet
supports his views by the unconscious testimony of a multitude of
earlier writers ; by many observations made by himself both on the
human subject and on the lower animals ; and by the analogies of
function between various classes of animals, already known to exist,
or for the first time demonstrated by himself. He establishes, in
the course of his book, the following principal propositions : —
I. That in all classes of mammalia ova are produced spontaneously
in the ovaries.
II. That they are expelled spontaneously at regular intervals, in-
dependently of coition.
III. That in the human female they are so expelled at each men-
strual period ; this period corresponding to the rutting season of
animals.
IV. That the ova are, and can be, fecundated only after their
expulsion from the ovary ; the various solid membranes, by wdiich
they are protected previous to this expulsion, opposing a complete
obstacle to the access of the spermatic corpuscles, the actual con-
tact of which is indispensable to the impregnation of the ovum.
V. That in all probability the part where fecundation usually
takes place is the cavity of the uterus or the lower part of the
Fallopian tube.
INTRODUCTION. 17
The fact announced in the fourtli proposition, viz., that ova can
be fecundated only after leaving the ovary, he considers as evident,
not only from the interposition of the ovarian integuments between
the ova and the spermatozoa, but also from the circumstance that
contact with the seminal fluid does not produce the effect of impreg-
nation on immature ova, but only on such as have arrived at a cer-
tain degree of development ; and that this maturity and complete
development of the unimpregnated ovum correspond in time pre-
cisely with its discharge from the Graafian vesicle.
The proofs of the third proposition, that the discharge of ova
takes place in women at the menstrual period, are, with him, almost
entirely drawn from analogy ; as he gives but few direct observa-
tions on the human female bearing on the connection between ovu-
lation and menstruation. These observations consist only of some
microscopic observations on the menstrual fluid, which he shows to
be entirely analogous to that discharged by mammalia during the
season of heat. Strict analogical inferences, however, may he in
some cases as reliable as direct observation; and, as the writer him-
self expresses it, "The difficulties which oppose themselves to obser-
vations on this subject, with regard to the human female, compel us
here to rely upon analogy ; but in this instance, the analogy is so
evident that it is impossible not to acknowledge it."
M. Pouchet's views, however, regarding the corpus luteum are
the same with those of Bischoff and Raciborski. "At the time,"
he says (p. 185), " that physiologists, influenced by entirely theo-
retical views, believed that ova were expelled only after fecundation,
since corpora lutea were occasionally discovered either in women or
in animals where no reproduction had taken place, some naturalists
pretended that, in these cases, there had been no emission of ova,
and that the corpora lutea in question were difi"erent from those
which owed their origin to ova capable of impregnation. At the
present day, this distinction, which never was anything more than a
scholastic subtlety, can no longer have an existence.''
" Since, by these labors, the fact of spontaneous ovulation has
been demonstrated, it must now be superfluous to point out the futi-
lity of the distinction between true and false corpora lutea ; they
are all produced by the same processes ; they have all discharged
ova before presenting themselves under the aspect which they assume
after that occurrence. And whether the ovule which they have ex-
pelled docs or docs not become fecundated, whether or not it under-
18 PRIZE ESSAY.
goes the transformation into an embryo, all have, nevertheless, the
same form and the same structure.''
It is the object of the present paper to shoio that this conclusion
of 31. Pouchet is entirely erroneous ; that the corpus luteum of
pregnancy is different from the corpus luteum of menstruation ;
and that it may, under ordinary circumstances, he readily recognized
and distinguished from it.
In the following pages, however, I shall regard the five principal
propositions of M. Pouchet as definitely established by the observa-
tions and arguments contained in his treatise ; for probably nothing
which could be here brought forward would add any very material
weight to the evidences there presented.
Nevertheless, the reader will undoubtedly discover, among the
following observations, many collateral proofs of the theory of
spontaneous ovulation, to which it will not be necessary to direct
his attention particularly.
It will readily be comprehended that the difference hereafter to
be established between the corpus luteum of menstruation and that
of pregnancy is not an essential or fundamental difference. Since
the regular and periodical rupture of the Graafian vesicle and dis-
charge of ova, at the time of menstruation, are here recognized, as
well as the fact that corpora lutea are always formed in the ovaries
as a consequence of such rupture and discharge, the differences
alluded to must necessarily be owing only to variations in the sub-
sequent changes in the ruptured vesicle; the most important parts
in either case still remaining and preserving their original relations.
The principal fact, therefore, to be established in the present me-
moir may perhaps be more accurately stated as follows : That the
presence of a foetus in the uterus induces certain modifications in
the growth and progress of the corpus luteum, by which, during a
certain period, we can be enabled to decide with certainty that preg-
nancy has existed ; and that these modifications follow a regular
course of progression and retrogression, by which we can estimate,
in a proximate manner, the period to which pregnancy had advanced
at the time of death.
The importance of this subject, particularly in a medico-legal
point of view, is too evident to require notice.
In order to present the necessary facts and arguments to the
reader in the most convenient form, the following paper will be di-
vided into three parts.
INTRODUCTION. 19
The first will embrace the history and description of the corpus
luteum of menstruation.
The second will contain that of the corpus luteum of pregnancy,
a comparison of the two, and an inquiry into the nature of the dif-
ferences between them.
The third will contain some similar observations on the lower
animals, with certain conclusions to be derived therefrom.
TAET I.
CORPUS LUTEUM OF MENSTRUATION.
OBSERVATION I.
Appearance of the catamenia during the course of acute dysentery ; death on
the following day — A Graafian vesicle in one ovary recently ruptured and
filled with blood — Other Graafian vesicles in active development — Remains
of preceding corpora lutea — Decidua already nearly separated from the ute-
rine surface.
M. K., set. thirty-four, an inmate of the Insane Asylum at South
Boston, was attacked with dysentery on Friday, August 9th, 1850,
and died on the following Wednesday. She had been in the hospi-
tal about three months, suffering from a mild insanity, from which
there were fair hopes of her recovery. The nurse stated, in general
terms, that the patient's catamenia had been regular since her en-
trance. They made their appearance at about the regular period,
on the day preceding death ; so that Dr. Stedman, the physician
of the asylum, was induced to hope for a favourable change in her
disease. They ceased again, however, the same night or the follow-
ing morning, and were not to be seen on the day of death.
The autopsy was performed on Wednesday, and the uterus and
ovaries were taken out and given to me on the Friday following.
There was no menstrual fluid seen in the vagina. There was much
inflammatory alteration of the mucous membrane over nearly the
whole extent of the large intestine.
The uterus was three inches long, two and a quarter broad, and one
and three-sixteenths thick. On cutting open the organ, it was found
to contain a flattened triangular mass, corresponding by its sides and
angles to the shape of the uterine cavity, which it entirely occupied.
It was of a dark red colour, but assumed a brighter hue after a few
moments' exposure to the air. Its texture was soft and friable,
while at the same time it showed some disposition to tear in strips,
like coagulable lymph. It had also a finely granulated appearance.
22 PRIZE ESSAY.
The greatest thickness of the mass was at its lower extremity, where
it approached the internal orifice of the cervix uteri. Here it was one-
sixteenth of an inch thick. Superiorly, it terminated in a thin edge.
The whole was very loosely adherent to the uterine parietes, from
which it could be easily separated, leaving the uterine surface white,
tolerably smooth, and perfectly firm. Under the microscope, it
showed the following appearances : 1st. Blood-globules, rather pale,
but not materially altered in size or shape. 2d. Columnar epithe-
lium (from the oviducts). 3d. Irregularly roundish bodies, rather
larger than blood-globules, and covered with very distinct granules.
There were no other forms, besides these, discovered in its texture.
The right ovary was an inch and a half in length, of a yellowish-
white colour, firm and condensed in texture, and much puckered by
cicatrices. Near its uterine extremity, and on its posterior aspect,
there was a rounded prominence, about as large as the end of the
little finger. This prominence, or tumour, was considerably reddened
externally. It was soft and yielding, giving to the fingers quite a
distinct sense of fluctuation. The ovarian coats were unnaturally
thin all over the prominence, and at one spot the tunica albuginea
was wanting ; and its place occupied only by a thin, smooth mem-
brane (peritoneum), through which appeared the dark red colour of
the interior. This spot was nearly semicircular in shape, and rather
less than a quarter of an inch long, by a little over an eighth of an
inch broad. Its edges were quite sharply defined, looking as if the
tunica albuginea had been ruptured. About its centre was a very
minute perforation, which allowed a little dark blood to flow out on
compressing the tumour, but which was too small to be distinctly
seen otherwise.
On dividing the ovary longitudinally, at the point of rupture, a
cavity was opened, situated immediately beneath, of an ovoid shape,
and measuring five-eighths of an inch in its long diameter. (See
Plate I, Fig. 1.) It contained seven or eight drops of very dark,
thickish blood, and a very dark, almost black coagulum. The coagu-
lum lay loose in the cavity, except just at the point of rupture, where
it was slightly adherent to the investing membrane. The walls of
the cavity were composed of a single, firm, semi-transparent, vascular
membrane, with a smooth internal surface, which could be readily
stripped off entire from the cut surface of the ovary. There was no
distinct membrane external to this, though irregular, vascular-look-
ing strips of cellular tissue could still be raised by the forceps.
CORPUS LUTEUM OF MENSTRUATION. 23
There was no yellow matter anywhere, and no puckering of the
membrane.
There -were two other well-developed Graafian vesicles in this ovary
filled with clear fluid ; one of them nearly as large as the bloody
cavity just described.
The right oviduct was free and pervious throughout. It contained,
particularly toward its ovarian extremity, some thick whitish fluid,
which under the microscope showed only nucleated columnar epithe-
lium.
The left ovary was of about the same size as the right, and simi-
larly seamed and puckered. It had upon its surface two Graafian
vesicles, filled with clear fluid ; the larger of them about the size of
a small hazelnut. It also contained one or two soft, granulous-look-
ing, thin, compressed, yellow bodies, the remains of former menstrua-
tions. These were entirely similar, both in their gross and micro-
scopic characters, to the other retrograde corpora lutea, hereafter to
be described.
The left oviduct was pervious throughout, and contained white
fluid like that in the ri";ht. There was nothing else remarkable about
the uterine organs.
This case has several points of interest. In the first place, the
condition of the patient, and the circumstances under which she was
living, are such as almost to preclude the idea of any sexual inter-
course having taken place. Probably we should never be able to
meet with a case where, in the human female, the rupture of a Graa-
fian vesicle, independent of coition, could be more certainly estab-
lished than in the present instance.
It is probable that the patient's illness had not caused any very
great disturbance in the periodical return of the menstrual function,
since it was stated that it had heretofore been regular, and that its
return at that time was only " a little" in advance of the expected
period. Still, as the menstrual flow lasted only during one day, it
is impossible to say whether this corresponded to the earlier or later
part of its regular period of duration. The persistence of the ova-
rian function, notwithstanding the grave disease under which the pa-
tient was laboring ; the fact that the vesicle was burst, and filled with
blood, but had not yet commenced its transformation into a cor-
pus luteum ; and the coincidence in time between the rupture of the
vesicle and the separation of a decidua from the internal surface of
the uterus, are all circumstances which deserved particular notice.
24 PRIZE ESSAY.
OBSERVATION II.
Death from cholera during menstruation — Excessive hemorrhage into a Graa-
fian vesicle — Decidua (probably) expelled — Old corpora lutea in the opposite
ovary.
J. C, a married 'woman, thirty-eight years of age, died at the
Cholera Hospital in Boston, Sept. 3d, 1849, after an illness of
twenty hours. Her general health was stated to have been good.
At the autopsy, the vagina was smeared with a dingy red secre-
tion. The OS uteri was rather open, and purplish in colour. The
cavity of the cervix contained a little adhesive secretion. The uterus,
generally, was of natural appearance, and measured three inches in
length, two in breadth, and one in thickness. Its internal sur-
face was quite smooth, firm, and pale, without any appearance like
the formation of a decidua ; but was smeared with a reddish fluid,
like that of menstruation.
The right ovary was enlarged to six or eight times its natural size.
It was ovoid in shape, and two and a quarter inches long ; the other
measurements in proportion. It had the aspect and feel of a serous
cyst, capable of containing one ounce of fluid ; but the red colour of
its contents showed through at the thinner part of its walls. It was
filled with a dark, tolerably firm, recent-looking bloody clot, inter-
sected by one or two very delicate enclosed (false) membranes. The
whole clot could be easily turned out, leaving a very red smooth lin-
ing membrane, with several spots of complete ecchymosis on its sur-
face. The clot occupied nearly the whole of the organ ; the proper
structure of the ovary being reduced to a very small proportion of
the whole.
The right oviduct was somewhat convoluted. Its ovarian extremity
was closed and adherent to the ovary. It could, however, be easily
dissected off", without opening the cavity of either. The oviduct was
distended so as to contain a drachm, or more, of thinnish, dingy-red
fluid similar to that in the cavity of the uterus. Its internal surf\ice
was natural, and it was pervious throughout, except at its ovarian
extremity.
The left ovary was one and three-quarters of an inch long. It
was of a natural form and colour, and had several cicatrices on its
surface. Internally, it contained one or two small, old-looking cor-
CORPUS LUTEUM OF MENSTRUATION. 25
pora lutea. The left oviduct was free from adhesions. Its internal
surface was smeared with a small quantity of whitish fluid secretion.
The amount of hemorrhage in this case was so great as perhaps
almost to constitute a morbid appearance. It shows, however, the
connection between the ovarian hemorrhage and menstruation, and
the expulsion of the decidua ; which, a comparison with other cases
will show, had probably been recently thrown off, leaving the uterine
surface smooth and firm. It should also be remembered that the
patient's "general health" was said to be good ; so that the devia-
tion from a normal condition was not probably very essential.
OBSERVATION III.
Sudden death in consequence of an extensive burn — A Graafian vesicle in
each ovary filled with blood, and the internal surface of the uterus soft and
shaggy.
M. M., a remarkably healthy-looking and well developed young
woman, unmarried, twenty years of age, died at the Mass. Gen.
Hospital, January 29th, 1848. Three days before, she had suffered
a very extensive burn in consequence of the bursting of a camphene
lamp, by which the skin was more or less completely destroyed over
the greater part of her face, neck, body, and arms. She suffered but
little pain after the first day, and finally died collapsed, and partially
comatose. No information was obtained regarding her menstruation.
At the autopsy, it was found that the inner surface of the larynx
was extensively scorched, and oedematous. There was also some
pneumonia of the right lung. The uterus was of natural size : three
inches long, by two broad. Its mouth was transverse, and sufficiently
open to admit the end of the little finger. The cavity of the uterus
was filled with an abundant reddish, very tenacious secretion. Its
internal surface was soft, and somewhat shaggy. Both Fallopian
tubes, easily laid open through their whole extent, contained a thick,
yellowish, opake fluid.
Both ovaries were remarkably large. The left had on its surface
an irregularly oval spot, three-fourths by three-eighths of an inch in
size, where the investing membranes were depressed, thin, and red ;
very distinct from the remainder of the surface, which had its usual
thick, yellow, opake appearance. More than half the substance of
3
26 PRIZE ESSAY.
the ovary was occupied by a roundish cavity, situated immediately
beneath the above-mentioned spot, and filled with a firm, pretty adher-
ent coagulum, dark red internally, more yellowish externally. The
lining membrane of the cavity, immediately external to the coagulum,
was of a dull red and brownish colour, and opake. It was mode-
rately adherent, but could be raised and separated entire. External
to this were cellular layers, which could only be raised in strips, the
outermost of which were intimately connected with the ovarian tissue.
The opposite ovary had a similar spot on its surface, and a bloody
cavity underneath. The coagulum here was rather less firm than
the other, and had a fresher appearance. The surrounding mem-
brane could not be so easily traced.
The history of this, case being somewhat imperfect, it does not
afibrd any direct proof of the connection between ovarian hemorrhage
and menstruation. A comparison with other observations, however,
makes it probable that menstruation had either just terminated, or
was suppressed by the accident which resulted in death. The case
is somewhat remarkable, like the last, for the large amount of blood
efi'used within the Graafian vesicle, and shows, moreover, the con-
nection of the ovarian hemorrhage with the softening of the uterine
surface.
OBSERVATION IV.
Piapld death from cholera — A Graafian vesicle filled with blood, and just
commencing the transformation into a corpus luteum — Softening of the
uterine surface.
E. D., unmarried, thirty-six years of age, died at the Cholera
Hospital in Boston, Sept. 11th, 1849, after an illness of eighteen
hours. No information was obtained regarding the patient's men-
struation, but she was stated to have been in her " usual health"
until the period of attack.
The vagina was smeared with a moderate quantity of the ordinary
starchy secretion of cholera. The uterus measured three and three-
eighth inches in length, one and seven-eighths in breadth, and one
and a quarter in thickness. It was firm and pale anteriorly, but
posteriorly had rather a tumefied appearance, and in its posterior
wall it contained a fibrous tumour, a quarter of an inch in diameter,
CORPUS LUTEUM OF MENSTRUATION.
27
near Avliicli the uterine substance was somewhat reddened and soft-
ened. Elsewhere it was natural The os uteri was small and round,
the cervix pale, firm, and empty. The internal surface of the body
of the organ was much softened and reddened to the depth of three-
sixteenths of an inch. It was, in fact, converted for that depth into a
dark purplish red, soft, shaggy coat, in which numerous slender, wavy
fibres were distinctly visible, projecting toward the interior. This
reddened coat was suflSciently tender to be scraped off with consider-
able readiness by the edge of the knife, leaving the uterine surface
pale, and somewhat uneven. It was confined to the body of the
organ, and did not descend at all into its neck.
The right ovary was one and seven-eighth inches in length. Nearly
half of it was occupied by a loose, fluctuating tumour, having much
the appearance of a serous cyst, only the red colour of its contents
showed through. It was roundish and bulging, and at its most
prominent part showed a small abraded spot, but nothing like a well-
marked cicatrix. Internally, it presented a cavity which was filled
partly with a thin bloody fluid, and partly with a tolerably firm,
adherent coagulum, from which the red
colouring matter had not yet been com- °' '
pletely absorbed. The walls of the cavity
consisted apparently, at its bulging ex-
tremity, of the thinned and distended
coats of the ovary, but at its deeper part
of a yellowish, well-defined layer of mo-
derately firm consistency, and irregularly
folded and convoluted, like the convolu-
tions of the brain. This yellow layer
had a thickness at the deepest part of
the tumour, of one-sixteenth of an inch ;
but it gradually became thinner as it ap-
proached the surface, until it appeared to
blend with the coats of the ovary.
The left ovary, one and a quarter inches long, contained three or
or four moderately developed Graafian vesicles. There was nothing
remarkable about cither oviduct.
Commencement of formation ol
the corpus luteum.
28 PRIZE ESSAY.
OBSERVATION V.
Corpus luteum of menstruation of about two weeks' date — Another, in the oppo-
site ovary, in a retrograde condition — Softening of the uterine surface.
M. H., a servant girl, aged twenty-two, of a plump and healthy
aspect, died at the Cholera Hospital, in Boston, Sept. 16th, 1849, after
an illness of but little over thirty hours. In the recorded history of
her case, it was stated that she had "menstruated" two weeks pre-
viously, but no account was obtained of the exact time at which the
flow commenced or terminated.
At the autopsy, the vagina was found smeared with a starchy secre-
tion. The OS uteri was rather open. The cavity of the cervix con-
tained a very little glutinous secretion, and its internal surface showed
one or two distended follicles beneath the lining membrane. The
body of the uterus was empty and of natural appearance ; firm and whit-
ish. Its internal surface was softened to the depth of three-sixteenths of
an inch, and converted into a loose, vascular, shaggy texture, in which
fine zigzag vessels, intermixed with whitish fibres, were distinctly
visible, forming very much the same appearance as that described in
the preceding observation. The uterus measured three inches in
length, one in thickness, and one and three-quarters in breadth.
The left ovary, one and three-quarter inches in length, contained
at one extremity a roundish, ovoid tumour, measuring five-eighths of
an inch in its long diameter. It was composed of a light-yellow ex-
ternal layer, strongly folded and convoluted, and enclosing a fibrinous,
semi-translucent coagulum, stained with some remains of the colour-
ing matter.
The yellow wall of this corpus luteum was invested by a delicate
external membrane, with which it could be enucleated entire from
the ovary. Its texture was friable and granular. On superficial
examination, it appeared to contain some bundles of fine vessels, pro-
ceeding from without inward ; but on closer inspection they were
seen to exist only in the interstices between the convolutions, where
they had been accidentally exposed in making the section ; in the
same manner as the vessels of the pia mater may be exposed, dipping
down between the convolutions of the brain. The substance of the
yellow wall itself contained no vessels.
The tumour formed by this corpus luteum had just firmness sufiicient
to allow its contour to be felt through the ovarian texture ; but it
CORPUS LUTEUM OF MENSTRUATION.
29
had very little resistance, and might easily have been crushed be-
tween the thumb and finger. Before being cut open, it even gave an
indistinct and deceptive sense of fluctuation.
The following represents the ovary, of natural size, cut open lon-
gitudinally.
Fig. 2. Fig. 3.
Corpus luteum of menstruation
about two weeks old.
Corpus luteum of menstruation of
about six weeks.
The opposite ovary was of natural size and appearance. It con-
tained at one spot, immediately beneath its surface, a small flattened
cavity, a quarter of an inch in diameter. The cavity had no bloody
contents, but was surrounded by a thin wall, of a dull yellowish
colour, Avhich showed indistinct appearances of being more or less
convoluted. This wall was surrounded by a thin delicate membrane,
with which, like the other, it could be enucleated from the substance
of the ovary. A drawing of it is given above (Fig. 3).
The ovaries also contain several Graafian vesicles in active deve-
lopment. Both oviducts were in a natural condition, and contained
only a little whitish fluid.
OBSERVATION Yl.
Corpus luteum of menstruation, three weeks from the termination of the men-
strual period — at its maximum of development — Five others, in difi'erent
stages of retrogression — Uterine surfiice soft, but pale.
L. E. B., a factor}'' operative at Lowell, unmarried, twenty years of
age, was attacked with hsemoptysis on Friday, June 28th, 1850, at
30 PRIZE ESSAY.
eight P. M., while walking in the street, and died the next morning
at four. The uterus and ovaries were taken out at the autopsy, and
sent to me by Dr. J. 0. Dalton, Sr., by whom the following par-
ticulars, relating to menstruation, &c., were also ascertained.
The girl had been in perfectly good health for many months, and
had menstruated for the last time just three weeks previous to her
death. This last fact was ascertained of the patient's landlady, who
had inquired particularly concerning it of the girl's sisters, imme-
diately after her death. The sisters worked in the same mill, and
boarded in the same house. It was undoubtedly meant that the girl
had ceased menstruating just three weeks before ; since it was also
remarked that she was then "within a week of her time." The body
generally "appeared somewhat exsanguious, and the lungs very much
engorged. No tubercles, but one old ulcer, as large as a shagbark,
lined with false membrane, at the right apex ; near which was a strong
pleuritic adhesion. Other thoracic and abdominal organs healthy."
The uterus was empty, and of natural appearance externally. Its
internal surface was pale, but softened to the depth of about a quarter
of an inch, exhibiting distinctly the velvety, shaggy appearance al-
ready described.
The right ovary was one inch and seven-eighths in length. Its
surface was generally smooth, and pale yellowish in colour, and
showed only here and there a very few fine superficial vessels. Its
outer extremity presented a rounded tumour, about the size of the end
of the finger, imbedded in the substance of the ovary, but projecting
slightly from its posterior surface (Plate I. Fig. 2). It was globular
in shape, and had but little solidity, feeling as if it might easily be
crushed between the thumb and finger. The surface of the ovary,
over the tumor, was quite vascular, showing many red and blue ves-
sels. At about its most prominent part was a cicatrix ; i. e., a small
oval spot, very slightly depressed, about one-twentieth of an inch in
length, where the tunica albuginea was entirely wanting, and its
place supplied by a thin, delicate, transparent membrane, which al-
lowed the pale reddish colour of the contents of the tumour to show
through.
On making a longitudinal section of the organ, through the cica-
trix, the corpus luteum was exposed (Plate I. Fig. 3, a). It was
three-quarters of an inch in its long diameter, and nearly one-half
an inch in depth. It consisted of a thin, pale, reddish-yellow, irregu-
larly convoluted wall, enclosing a solid, semi-transparent, fibrinous
coagulum, which showed in various parts remains of the red colour-
CORPUS LUTEUM OF MENSTRUATION. 31
ing matter of the blood. There was no empty cavity. The wall
was thickest at the deepest part of the tumour, and grew gradually
thinner as it approached the surface and the situation of the external
cicatrix, where finally it was entirely wanting ; showing conclu-
sively that the rupture of the Graafian vesicle had taken place at
this spot.
The relative proportions of the convoluted wall and its contents
are represented in the drawing. The wall itself was not lined by
any membrane, but was in immediate contact with the fibrinous coagu-
lum. Externally, it was invested by a thin, semi-transparent, vas-
cular membrane, with which it could be readily enucleated from the
substance of the ovary, leaving a smooth and somewhat vascular
surface of condensed cellular tissue. This investing membrane was
intimately connected with the substance of the yellow wall, and
could not readily be separated from it; so that, when raised in strips,
portions of the wall adhered to it. The interstices of the convolu-
tions were vascular, but no vessels could be detected in the substance
of the yellow wall itself.
Toward the uterine extremity of the ovary, there was another
yellow body (Plate I. Fig. 3, b), much smaller than the first, situ-
ated immediately beneath a minute transparent cicatrix on the sur-
face, which was surrounded by a slight vascularity. The colour of
this body was a much more decided yellow than that of the first.
It appeared to consist of a wall, the opposite sides of which were
nearly or quite in contact, owing to the absorption of the contained
coagulum. The wall also showed some indications of a convoluted
arrangement ; but the whole body was so small, and its texture so
friable, that it was difiicult to establish this point distinctly.
At a short distance was situated another yellow body, similar in
character to that last described, only much smaller.
The left ovary was one inch and five-eighths long. It showed
on its surface several cicatrices, both shallow and depressed, and
contained three very small, obsolete yellow bodies, like those de-
scribed as found in the right ovary.
Both ovaries contained many Graafian vesicles, in different stages
of active development, but neither showed anything else at all re-
sembling a corpus luteum.
Both oviducts were free and natural in appearance throughout.
32
PRIZE ESSAY.
OBSERVATION VII.
Corpus luteum of menstruation of about the same date as the preceding — Soft-
ening of the uterine surface.
E. B., a •widow, thirty years of age, died at the Cholera Hospital
in Boston, August 20th, 1849, after an illness of ten and a half
hours. No information was obtained regarding her menstruation,
but she was "as well as usual" till the period of her attack. The
abdomen, externally, showed many scars of pregnancy.
The uterus was somewhat "bombde" posteriorly, and had rather
a softish feel. It was empty. Its internal surface was much soft-
ened and reddened to the depth of three-sixteenths of an inch, hav-
ing undergone the same change already described in previous obser-
vations. The internal surface of the cervix uteri was pale, and had
but little of the adhesive secretion in its cavity ; but one or two
follicles, distended with this secretion, could be seen beneath its
mucous membrane. The uterus measured three and a quarter inches
in length, and two and a quarter in breadth. (The subject was
large and stout.)
The right ovary was one inch and three-eighths long ; generally
white and natural in appearance. One
Y[cr, 4. end of it was occupied by an ovoid tu-
mour, not very firm to the touch, the
dull reddish colour of which showed
through the integuments of the ovary.
A section of the ovary showed the tu-
mour to be three-quarters of an inch
long, by nearly half an inch deep. It
consisted, like the others, of a yellow
convoluted wall, which enveloped a
homogeneous, opaline, greenish, fibrin-
ous-looking coagulum, which still pre-
sented, in spots, some traces of the
colouring matter of the blood.
The point of rupture is not seen in this drawing ; probably because,
in making the section, sufficient care was not taken to cut through
the cicatrix.
Corpus luteum of menstruation
of about three weeks.
CORPUS LUTEUM OF MENSTRUATION.
33
OBSERVATION VIII
Death during tlie menstrual period — Corpus lutcum of the last menstruation
commencing to diminish in size — Graafian vesicle not yet burst — Decidua
just separated from the uterine surface.
C. M., a married -woman, thirty years of age, died at the Cholera
Hospital in Boston, August 23d, 1849, after an illness of four days.
She was said to have had her usual health till the time of the attack.
The uterus Tvas rather large, particularly in proportion to the
size of the patient, Avho was small and slightly built. It measured
three and three-eighths inches in length, tAvo and a half in breadth,
and one and a half in thickness. It was much bulging posteriorly,
and had altogether a tense, stiff, swollen aspect and feel. The os
uteri was widely open. The cavity of the cervix was filled with an
abundance of tough, tenacious secretion, strongly coloured with blood.
The vagina, also, and external organs were smeared with a bloody
fluid.
The internal surface of the body of the uterus was quite pale and
smooth, without any appearance of the softening elsewhere described;
but its cavity contained a flattened triangular mass, like that men-
tioned in Observation I,, of a reddish-gray colour and loose texture,
having no appearance of an organized structure, nor any attachment
to tlie walls of the uterus. It had evidently taken its shape from
that of the uterine cavity, its two upper angles corresponding to the
orifices of the oviducts. Its longitudinal diameter was a little over
one inch ; its transverse, at its widest part, something less.
The left ovary, one and a half inches in length, had a natural
colour and appearance externally. At
the uterine extremity of the organ was
a spot where the integuments were
thinned, and the reddish colour of the
corpus between showed through. The
tumour was ovoid in shape, but had
very little firmness, or resistance to the
touch. It consisted of a thin, yellow,
very irregular, convoluted wall, and
an internal greenish, semi-transparent,
fibrinous clot, stained with some re-
Corpus luteiim of menstruation of
mams of red colourmg matter. There nearly four weeks.
34 PRIZE ESSAY.
"was no strongly-marked cicatrix on the surface of the ovary. The
accompanying drawing (Fig. 5) represents the ovary and corpus
luteum, of the natural size. The left oviduct was empty and pale
internally.
The right ovary, of about the same size as the left, presented
several Graafian vesicles, moderately developed. The right oviduct
contained, in its uterine half, a considerable amount of thickish,
bloody fluid ; otherwise it was natural.
OBSERVATION IX.
Death just at the termination of a menstrual period — A Graafian vesicle
prominent, and on the point of bursting — Corpus luteum of the preceding
menstruation, in a retrograde condition — Seven others, quite atrophied and
obsolete — Uterine surface pale, but soft.
Mrs. a., a widow, forty-five years of age, a patient of Dr. W. H.
Thayer, was attacked suddenly with apoplexy, Oct. 14th, 1850, at
5 P. M. ; and, after" lying insensible for sixteen hours, died on the
following morning. Mrs. A.'s youngest child was about twelve
years of age. Her husband had been dead ten years. Her maid-
servant, an intelligent girl, reported to Dr. Thayer that Mrs. A.'s
catamenia had been regular at intervals of four weeks, from com-
mencement to commencement ; and that they always continued a
week, accompanied with much pain in the pelvic region, sometimes
so great as to oblige her to keep her bed for a day. Her last cata-
menial period closed on Sunday the loth, the day before her attack,
as Mrs. A. had herself told her. She was in general well acquainted
with the course of her mistress's catamenia, as she washed her linen,
and was also a kind of confidential servant.
At the autopsy, Oct. 16, twenty-five hours after death, a hemorrhage
of about three ounces was found in the substance of the right hemi-
sphere of the brain, and another, much smaller, in the right optic
thalamus. The cerebral substance was much softened in the imme-
diate neighbourhood of each coagulum. There was also considerable
hypertrophy of the left ventricle of the heart, but the other organs
were healthy. The stomach contained much undigested food.
The uterus was quite large, measuring three and a half inches in
length, and two and a quarter in its transverse diameter. Its walls
CORPUS LUTEUM OP MENSTRUATION. 35
"were proportionably thick, but natural in texture. It was empty.
Its internal surface was rather pale, but quite soft, shaggy, and
velvety in appearance. The os uteri was transverse, wide, and much
fissured.
The left ovary was an inch and five-eighths long. It contained
two large and somewhat prominent Graafian vesicles, with clear fluid
contents. One of them was particularly distended and prominent;
being covered, over a considerable part of its surface, by peritoneum
alone. On the anterior surface of the organ was an irregularly
oval spot, three-eighths of an inch long, where the tunica albuginea
was wanting. Immediately beneath was a corpus luteum, the bright
yellow colour of which showed through the peritoneal coat. There
was also a black speck upon its surface, which marked the spot where
the rupture of the vesicle had taken place. On making a section of
the ovary, through this black spot, the corpus luteum was exposed,
of a somewhat flattened, oval shape, three-eighths of an inch in
length, and a little over a quarter of an inch in depth. (Plate I.
Fig. 4.) It consisted, like the others, of a bright yellow, pulpy,
friable wall, thickest at its deepest part, and gradually thinning off
toward the situation of the rupture ; strongly folded upon itself, and
destitute of vessels. It enclosed a little, very dark, moderately
firm coagulum, which was easily removed, having no organic connec-
tion with the yellow wall. The Avail itself was not lined by any
membrane, but vfas in immediate contact with the coagulum. When
put upon the stretch, it Avas not more than one-twentieth of an inch
in thickness; but, when allowed to remain folded up, appeared some-
what thicker. It could easily be enucleated entire, and externally
had the same relations to the investing membrane and the substance
of the ovary as in the preceding cases.
The same ovary contained two other old corpora lutea, one of
them about a quarter part the size of the first, the other still
smaller. They were both, in their general characters, similar to
the first. The larger had also a small black spot on its surface,
marking the situation of the rupture ; and a section being made at
a little distance from this spot, the foldings of the wall were dis-
tinctly seen to radiate from it.
The right ovary was one and three-quarters of an inch long. Its
section discovered a yellow body, about a quarter of an inch in
length, much flattened, and containing a little very dark blood.
There were also four others, perfectly distinguishable, but diminish-
ing successively in size ; all superficially situated beneath shallow
36 PRIZE ESSAY.
or moderately depressed cicatrices. The two smallest, alone, con-
tained no noticeable remains of blood. They were all similar in
structure, but the smaller were whiter, and of a less decided yellow,
than the larger. There were no other remarkable appearances.
Both oviducts were quite natural. They contained only a little
opake, whitish secretion, which, under the microscope, showed an
abundance of ciliated epithelium.
Everything makes it probable that, in this instance, the largest
corpus luteum was the result of the last menstruation but one, and
that the most prominent vesicle on the left ovary was just upon the
point of bursting when the patient suffered her attack of apoplexy.
So far this case, together with the preceding, would go to sustain
the opinion of Pouchet and Raciborski, that the ovum is discharged
in the human female, not during, but at the termination of, the men-
strual period.
OBSERVATION X.
Death from inflammation of the brain of several ■weeks' standing — Corpus
luteum of menstruation thirty days after the termination of the menstrual
period — Three others still more obsolete — No prominent Graafian vesicles —
Uterine surface only a little softened.
M. A., a married woman, twenty-nine years of age, who had had
one child four years ago, entered the Almshouse Hospital at South
Boston, June 10tli,1850, suffering from symptoms resembling chorea.
They consisted in a capricious, semi-involuntary, twisting motion of
the right arm and hand, and some disposition to a drawing up of
the left leg. There was also an almost constant, slow winking
motion of the right eyelid, accompanied by a sinister leering expres-
sion of the countenance, as if the patient were partially idiotic or
hysterical. The intelligence was rather dull, but otherwise not
much altered.
She was treated with antimonials, low diet, and blisters to the
back of the neck ; afterwards by carbonate of iron and full diet.
Under this treatment she improved much, and on the 29th of
June, being to all appearance well, was discharged from the Hos-
pital and sent to the Almshouse. Two days afterward, however,
she returned, suffering under a fresh attack, much more severe than
CORPUS LUTEUM OF MENSTRUATION. 37
the former. This time she had lost much of her muscular power ;
and lay nearly prone on the floor of the ward, apparently unable to
rise, and very stupid. After much urging, she managed to raise
herself from the ground with the assistance of a chair, but had
great difficulty in doing so. There was some paralysis of the left
side, and a want of control over the muscles of the right. She was
treated with purgatives and counter-irritation to the head and spine,
but sunk into a deeply typhoid condition, and died on the 12th of
July.
The nurse reported that the patient was menstruating at the time
of her first entrance into the hospital, and continued to do so June
10th and 11th. On the 12th, the discharge returned slightly, and
then finally ceased. The nurse was positive that she had had no
menstruation since, as she must have known it, if such had been the
case. There was found much inflammatory softening of the right
hemisphere of the brain, and of the right corpus striatum ; some
also of the right optic thalamus and of the left hemisphere.
The uterus, of about the normal size, was somewhat retroverted,
and inclined to the left side of the pelvis, where it was confined by
numerous old, organized, bridle-shaped adhesions. It was empty.
Its internal surface was quite vascular and a little pulpy, but much
less so than in some of the preceding observations, as the pulpy
portion at its thickest part did not exceed one-sixteenth of an inch.
The right ovary was one inch in length ; white, firm, and covered
with cicatrices. It contained two yellow bodies. (Plate I. Fig. 5).
The larger Avas flattened from without inward, and contained within
the yellow wall an appreciable amount of reddish fibrin which could
be easily separated from its cavity. This body was a little over a
quarter of an inch in its long diameter. It was situated immedi-
ately beneath a strongly depressed cicatrix on the surface of the
ovary. On very minute examination traces of the convoluted
arrangement of its walls were visible.
The second body was irregularly globular in shape, and much
smaller than the first. Its centre was occupied by a radiated cica-
trix, which no longer contained any noticeable amount of coagulum.
The right ovary also contained one more very minute yellow body,
too small to show any definite structure. There was also one more
in the left ovary, but nothing else in either that presented any ap-
pearance like that of a corpus luteum.
There were but very few Graafian vesicles to be seen, and these
were small and of an inactive appearance.
38 PRIZE ESSAY.
The right oviduct was much convoluted, and confined by adhe-
sions. The fimbriated extremity was entirely adherent to the ovary,
enclosing an oval space on the surface of the organ five-eighths of
an inch long. The oviduct was somewhat distended, and contained
about half a drachm of thickish, brownish-red fluid, approaching to
bistre in its colour. The internal surface was vascular, and stained
by the brownish fluid ; otherwise natural. The left oviduct was
adherent like the right, but empty and collapsed. It was imper-
vious in two or three spots, toward its uterine extremity. But the
right was pervious throughout.
OBSERVATION XI.
Absence of catamenia for over two months — Corpus luteum of last period very
small — Four others, quite obsolete — No softening of uterine surface.
M. S., unmarried, twenty-three years of age, died at the Massachu-
setts General Hospital, Aug. 26th, 1850, of tubercular meningitis.
She entered the house Aug. 18th, at which time her intelligence
was so much afiected, that she was unable to give any account of
herself. Her sister, however, reported that she had had no cata-
menia for two months, and none appeared while she was in the hos-
pital ; making, in all, a period of two months and eight days that
the catamenia had been absent.
At the autopsy, the substance of the brain was found somewhat
softened, with a rather copious eff"usion of serum into its cavities,
and an abundance of minute, whitish, opake (tuberculous) grains,
scattered through the meshes of the pia mater between the convolu-
tions ; more particularly at the base of the brain. The pleurae were
also sprinkled with tuberculous granulations, without the existence
of any considerable collection in the pulmonary substance. The
liver and spleen also showed an abundance of similar tubercles in
their interior.
The uterus was rather small and firm. Its neck was conical, and
its mouth small and perfectly circular. The cavity of the organ
contained a moderate quantity of transparent mucus, slightly tinged
with red. A part of its internal surface was rather vascular, but it
was everywhere smooth and firm, and of its natural consistency.
CORPUS LUTEUM OF MENSTRUATION. 39
The right ovary was one and a half inches in length, and of the ordi-
nary yellowish-Tfhite colour. Its surface showed several shallow, bluish
cicatrices, none of which had a very recent appearance. The ovary
contained four old corpora lutca, the largest of which was three-six-
teenths of an inch in diameter, and entirely similar to that described
in the preceding observation, except for being smaller. (Plate II. Fig.
1.) It consisted of a delicate, flattened, thin, yellowish-white wall,
destitute of vessels, and enclosing a thin fibrinous coagulum, which was
still somewhat coloured with blood. Traces of a convoluted arrange-
ment of the yellow wall were quite evident on close inspection. It
was neither lined nor surrounded by any membrane that could be
demonstrated, but was immediately in contact with the fibrinous clot
internally, and externally appeared closely connected with the ova-
rian tissue.
The remaining yellow bodies in the ovaries were smaller, but
otherwise similar. The left ovary also contained one, very small.
Both ovaries contained many Graafian vesicles, varying in size from
a quarter of an inch or less to three-eighths of an inch in diameter.
Both oviducts were free and pervious throughout. They con-
tained a moderate quantity of thick, whitish, opake fluid, like that
met with in Observation I. There was nothing else remarkable.
From the foregoing observations we can deduce a more or less
complete history of the corpus luteum. In the first place, it is cer-
tain that, in connection with the appearance of the menstrual period,
a Graafian vesicle arrives at maturity, protrudes from the surface of
the ovary, ruptures, and becomes filled with blood. Sometimes this
process takes place in each ovary at the same period. It will even
hereafter be seen that two vesicles may become ruptured simulta-
neously in the same ovary. During the final enlargement of the
vesicle, and its protrusion from the ovarian surface, it strongly dis-
tends the albugineous coat, the fibres of which become separated and
pushed aside to such a degree that this tunic is at last wanting over
a spot of considerable size ; and the vesicle is covered, at its most
prominent part, by peritoneum alone ; so that, at the time of the
rupture, it is only the peritoneal coat which becomes lacerated.
The precise period, during the catamenial flow, at which this rup-
ture takes place, does not seem, as yet, to be definitely ascertained.
The inherent difficulty of making these observations in the human
subject, and the rarity of opportunities for examining the ovaries of
healthy women, who have died by violence or after a rapid illness,
40 PRIZE ESSAY.
oppose great obstacles to our arriving at a correct conclusion on this
subject. The difficulty, too, of estimating the influence which even
a short illness may have had on the exact period of rupture is so
great, that many further observations will be necessary, in order to
determine with certainty so nice a point. Perhaps this period is
not, even in the ordinary course of nature, invariable ; and if we
are to rely on such information as we already possess, this would
seem to be the most probable supposition. Bischoff,* Pouchet,t and
Raciborski| all agree that the ovum is discharged regularly, only
at the termination of the menstrual period, and this opinion is cer-
tainly sustained by Observations VIII. and IX. of the present paper.
Dr. Robert Lee§ also relates the case of a woman who died " while
menstruating." The uterus and oviducts were lined with menstrual
fluid, and on one ovary was a large, projecting, Graafian vesicle,
having over it an abrasion of the peritoneum. On the other hand,
there are not wanting abundant observations of Graafian vesicles
ruptured during the menstrual flow. Such an observation by
Cruikshank, recorded in the Philosophical Transactions, 1797, has
already been alluded to. Dr. Lee|| gives an instance of a Graafian
vesicle filled with blood, death having taken place during menstrua-
tion, and cites other similar ones from Gendrin. Bischoff^ states
that he has opened the bodies of four females, dead suddenly during
menstruation. Three of them presented, in one of the ovaries, a
vesicle burst and filled with blood ; in the fourth, there was remarked
only a vesicle not yet ruptured. It would therefore appear that
the rupture takes place sometimes earlier and sometimes later, but
that it always has an intimate relation with the appearance of the
catamenia.
Another remarkable variation in the appearance of the vesicle at
this period depends upon its larger or smaller size at the time of rup-
ture, and the greater or smaller quantity of blood effused. In Ob-
servation I., this quantity was very moderate, as may be seen by
reference to the drawing. In Observation III., it Avas much larger;
and in Observation II., it was so excessive as to be estimated at about
one ounce. This variation may probably be explained by the differ-
ence in the age of the subjects, and in the condition of the vascular
system generally, whether of full health, of plethora, or of deficiency
of vascular action. It also depends, without doubt, to a certain ex-
• Op. cit., p. G2. t IljiJ- P- 244. { Ibul. p. 414.
§ London Med. Gazette, Nov. 5th, 1S4-2. || Ibid.
TT Op. cit., p. 50.
CORPUS LUTEUM OF MENSTRUATION. 41
tent, on the greater or less activity of the uterine organs in particu-
lar. Whatever may be its cause, it is, perhaps, not more remarka-
ble than the differences which are observed in the size of the ovaries
themselves, or of the other internal organs. It will hereafter be
seen, in another division of this paper, that the size of the vesicles,
even in the same ovary, is not always the same at the period of their
full development, those which are matured and ruptured not always
being the largest.
Another point which still remains somewhat doubtful relates to
the period at which the hemorrhage takes place ; whether it occurs
before or after the time of rupture. From some of the accompany-
ing observations, it would seem probable that it succeeds to, and is a
consequence of, the bursting of the vesicle ; since we have seen the
vesicle, at a late period, very large and prominent, with its contents
still clear and unmixed with blood. Pouchet,* however, states that
the ovum is pushed from the bottom of the vesicle toward the surface
by a gradual hemorrhage beneath its inner membrane (membrana
granulosa) ; and that the vesicle is, in this way, already filled Avith
blood, before the final rupture takes place. This matter must be
considered as still uncertain. Pouchet's opinion may, no doubt, re-
ceive support from some observations in which the vesicle has been
found filled with blood without presenting any lesion of its peritoneal
coat. It must, however, be remarked that, though the albugineous
tunic remains for a long time deficient at the spot where the protru-
sion of the vesicle took place, yet the peritoneal coat is very rapidly
reproduced ; consequently, no perforation might be visible in this
membrane, only a very short time after the occurrence of the rupture.
The rupture of a Graafian vesicle, with hemorrhagic effusion into
its cavity, as accompaniments of menstruation, have been recognized
by some writers, who are, nevertheless, unwilling to acknowledge
that an ovum is at the same time discharged. Dr. Robert Leef con-
siders it probable that " all the phenomena of menstruation depend
on, or are connected with, some peculiar changes in the Graafian
vesicles, in consequence of which an opening is formed in their peri-
toneal and proper coats." Notwithstanding this, he denies explicitly
that any ovum passes from the ovarium during menstruation, but ap-
pears to consider this process, when it does occur, as excited by the
stimulus of the seminal fluid. Dr. PattersonJ entertains a similar
• Page 138. f Cyclop. Pract. Med. iii. 4 J 4.
J Edinburgh Med. and Surg. Journal. Jan. iS40.
4
42
PRIZE ESSAY.
opinion, except that he does not think the rupture of the vesicle at
the time of menstruation a constant, but only an occasional occur-
rence. This, indeed, is a matter in regard to which we must be con-
tent, at present, to rely on other evidences than direct observation ;
for I am not aware that any one has yet seen, in the human female,
an unimpregnated ovum in the oviduct, and recently discharged from
a vesicle. It appears, however, contrary to all known physiological
analogies to suppose that the vesicles should be ruptured for any
other purpose than that of discharging their contents. It is conceded
on all hands that the human ovum, as well as that of the lower ani-
mals, exists in the vesicle previously to impregnation. Thus in a
young girl, ten years of age, dead at the Female Orphan Asylum,
January 9th, 1851, of perforation of the stomach, I was able to
discover three ova in one ovary, and one in the other. No doubt
many more might have been found, but that the vesicles were very
friable, and many became ruptured in the process of separating them
from the ovary. The vesicles, containing the ova above mentioned,
were all in an inactive condition, not at all prominent, but situated
entirely beneath the albugineous tunic.
The regular tumefaction, also, and rupture of the vesicle take
place in both the human species and the lower animals in a manner
entirely analogous ; and since we know from direct observation that,
in the latter, this process terminates by the discharge of an ovum, it
is certainly unreasonable to suppose that it should have any other
object in the former.
Shortly after the rupture of the
fig. 6. vesicle, the formation of the corpus
luteum commences. In order, how-
ever, to understand distinctly the
manner in which this body is pro-
duced, it will be necessary to recall
the anatomical relations of the ve-
sicle and its neighbouring tissues.
The Graafian vesicle, in its ordinary
quiescent condition, consists of a
simple globular sac, filled with a
transparent, albuminous fluid. It
is not very closely connected with
Cell-like bodies of the mernbrana granu- ^^^ ^^^^j^^ substancC, and by a little
lofsa. (Each division of the scale is . , .
1-iooth of a millimetre, or about .0004th manipulation Can bc removed entire ;
of an inch.) whcn it appears as a smooth, dia-
CORPUS LUTEUM OP MENSTRUATION. 43
phanous cyst, usually with several distinct blood-vessels ramifying
over its surface. It is said to be lined by an inner membrane,
the memhrana granulosa, composed of minute, granular, cell-like
bodies, similar to those Avhich, collected in a more compact mass
round the ovum, constitute the proligerous disc. These bodies are
of a flattened form, and nearly circular in outline Avhen isolated,
but when crowded together they are compressed into more or less
angular forms. They have altogether the appearance of cell-nuclei
rather than of cells, and frequently exhibit a very distinct nucleolus.
They are undoubtedly to be regarded as a kind of epithelium, lining
the serous surface of the Graafian vesicle.
The membrana granulosa, however, is so exceedingly delicate that
it is very easily broken up, and detached from the internal surface
of the vesicle by the necessary manipulations ; so that, in ordinary
dissections, it is seen only as a collection of soft, whitish, membran-
ous flocculi, which give to the fluid of the vesicle an appearance of
turbidity. External to the vesicle are a number of irregular vascu-
lar laminae of cellular substance, which can only be raised in strips
and fragments, varying in size and thickness. These cellular layers
have sometimes been described as a third tunic of the Graafian vesi-
cle, membrana cellulosa (membrane celluleuse, Pouchet) ; but they
appear rather to belong to the tissue of the ovary, and to form a sort
of nidus, or bed for the reception of the vesicle.
When the ovum is expelled, the proligerous disc, and probably
a considerable portion of the membrana granulosa, are expelled with
it. The proper membrane of the vesicle then begins to become
hypertrophied ; the hypertrophy consisting in a peculiar growth of
soft, yellowish, friable substance, which takes place most abundantly
at the deepest part of the vesicle, and becomes thinner and thinner
as we approach the vicinity of the cicatrix. As this new growth
proceeds, the membrane of the vesicle becomes, at the same time,
folded upon itself in all directions, so as to present innumerable con-
volutions and anfractuosities, which give a radiated appearance to
its cut surface. This peculiar arrangement seems to be a necessary
consequence of the increased nutrition of the membrane, which is,
at the same time, confined nearly within its original limits. We see
the same thing take place in other tissues of the body under similar
circumstances, as in varicose veins, enlarged ureters, &c. The gray
substance of the brain, during the first five months of foetal life, pre-
sents a smooth surface, without any trace of convolutions. As it
afterward increases rapidly in extent, the cranial cavity, at the
44 PRIZE ESSAY.
same time, not enlarging In proportion, it becomes necessarily folded
upon itself, in order to accommodate its increased bulk to a propor-
tionally smaller cavity. The valvulse conniventes of the small intes-
tine are another example of the same thing. These are not present
during the greater part of foetal life, the mucous membrane being
then of the same length as the muscular coat. But, as it afterward
grows more rapidly than the latter, it is thrown into folds which
project into the cavity of the intestine. It is the same process which
gives rise to the formation of the corpus luteum. At the same time
that the hypertrophy of the vesicular membrane proceeds, the blood
eifused within its cavity also undergoes an alteration. Its fluid part
is absorbed, and afterward the coagulum loses by degrees its colour-
ing matter, becoming paler and paler, in proportion to the time which
has elapsed since the rupture of the vesicle. The vascularity of the
neighbouring parts also increases, or, at least, does not diminish,
and at the end of about three weeks from the termination of the
menstrual period, the corpus luteum has attained its maximum of
development. Its situation is then marked by a concentration of
vessels on the surface of the ovary, and by a globular or ovoid
tumour, about the size of the end of the finger, which causes a slight
prominence externally. The cicatrix is not always strongly marked
at this period, and may consist only of a small, bluish, transparent
spot, indicating a separation of the ruptured peritoneum. The
tumour, though well defined, is soft and yielding, and does not give
to the touch the impression of a very highly organized body. It
does not now contain any cavity, properly speaking; but its centre
is occupied by the solid, semi-transparent, gray, or greenish coagu.
lum, more or less mottled with red. The coagulum is in immediate
contact with the inner surface of the yellow wall, but can be sepa-
rated from it by a little manipulation, as the two have no organic
connection. Thewall itself still forms the smallest part of the tumour,
as it is very thin ; not more than one-eighth of an inch thick at its
deepest part, when allowed to remain folded up ; but if the convo-
lutions are unfolded, it is seen to be, in reality, much thinner.
The point of rupture of the vesicle is still very well marked on a
section of the corpus luteum, provided the incision be made accurately
through the external cicatrix ; for at that spot the yellow wall ter-
minates, and the central coagulum is in immediate relation with the
peritoneal coat. If a horizontal section be made, and the coagulum
removed from over the point of rupture, the sinuosities of the yellow
wall may also be seen radiating from it as a centre.
CORPUS LUTEUM OF MENSTRUATION.
45
Fig. 7.
Cells from the wall of the larger corpus
luteum in PI. I. Fig. 3 (same scale).
The new growth or deposit of yellow matter, when examined under
the microscope, is seen to consist of an abundance of peculiar, irregu-
larly-shaped, granular cells, varying in size, and sometimes enclosing
minute, opaline, yellowish globules,
like oil. The contour of the cell-
wall can, in most cases, be com-
pletely traced throughout ; but, in
some instances, it is indistinct at
certain parts of the circumference.
There are also to be seen, in the
field of the microscope, a few oil-
globules, similar to those in the in-
terior of the cells; but for the most
part of larger size. The cells are
rendered paler by acetic acid, and
their (oil}^) granules and globules
become more distinct, but no proper
nucleus is visible.
Dr. Frank Reuaud* has given an excellent description of these
cells. He is disposed, however, to regard the oil-globules as the
" nuclei" of the cells, whereas they do not have at all the appearance
characteristic of ordinary nuclei, but seem to be rather a production
of the cell itself. Indeed, the oil-globules evidently increase in quan-
tity in proportion as the cells become atrophied and disappear.
According to the present observations, the yellow matter is essen-
tially a growth of the proper membrane of the Graafian vesicle.
Much difference of opinion, however, has prevailed among writers
with regard to this point, some asserting, as above, that the new
growth consists in a hypertrophy of the outer membrane (Knox,
Pouchet), others that it is a development of the inner membrane (De
Baer), others that it is deposited between the two (Montgomery),
and others that it is external to both (Lee). A part of this discre-
pancy, no doubt, arises from confusion and misunderstanding as to
what membranes are designated by the terms "inner" and "outer."
Dr. Montgomery, for instance, f could never have spoken of the
inner coat of the Graafian vesicle as a " strong white cyst," if, under
the name of the "inner coat,'' he had intended to designate the
membrana granulosa. Some writers, indeed, recognize the cellular
• London and Edinburgh Monthly Journal of Medical Science, August, 1845.
f Op. cit. p. 226.
46 PRIZE ESSAY.
laminae, already spoken of, lying external to the outer membrane,
as a proper tunic of the vesicle. In reality, they cannot be so con-
sidered ; and when we take into view the exceedingly friable nature
of the "membrana granulosa," it appears most correct to describe,
with Raciborski, only one proper membrane of the Graafian vesicle,
the "ovisac" of Barry, the '■^ vesicule ovulifere" of Pouchet.
This is the membrane, which, by its development and consequent
folding up, forms the corpus luteum. That the yellow wall is not
lined by any second membrane, I have made certain by frequent ob-
servations. At the same time, it must be remarked that, after a
longer period of time, the enclosed coagulum, flattened and com-
pressed, and deprived by absorption of all its colouring matter, may
present a deceptive resemblance to a true membrane ; particularly
as at advanced periods, and in the corpus luteum of pregnancy, it
becomes more closely adherent to the yellow wall. Dr. Robert Lee,
in his Lectures on Midwifery, published in the London Medical G-a-
zette, even gives two drawings of corpora lutea (of pregnancy), in
which, in accordance with his ideas, there are demonstrated two distinct
membranes within the yellow wall. These must certainly have been
formed accidentally, by an artificial separation of the central coagu-
lum into laminae. In the corpus luteum of menstruation, and also
in that of pregnancy, if of recent date, it is easy to demonstrate the
entire absence of any real lining membrane.
Externally the corpus luteum is invested with an extremely thin,
transparent, vascular membrane, to which it is intimately connected,
and which sends prolongations between the convolutions of the yel-
low matter. This layer, indeed, seems to form rather a memhra^ious
surface than a distinct tunic, and cannot be stripped off without
bringing with it torn fragments of the yellow matter. It is, in fact,
the outer surface, merely of the membrane of the vesicle, the new
growth having sprouted from its internal aspect, toward the cavity
of the vesicle. External to this, are the vascular layers of cellular
tissue, which have already been described as surrounding the Graafian
vesicle, and forming a nidus for it in the ovarian tissue, previous to
the time of its complete development.
The substance of the corpus luteum is not vascular, though minute
red vessels may often bo seen, apparently running into the yellow
matter, from without inward. A close examination, however, shows
these vessels to exist only in the interstices of the convolutions, where
they have penetrated from the vascular network on the external sur-
face of the body.
CORPUS LUTEUM OF MENSTRUATION. 47
It lias been already shown that the development of the yellow
matter commences soon after the rupture of the vesicle has taken
place. The strange theory regarding these bodies, entertained by
Sir Everard Home, and afterwards adopted by N^grier, viz., that
the yellow matter is deposited before the rupture, that it is intended
to aflford nutrition to the ovum, and that, consequently, corpora lutea
are only one stage of the ascending development of the Graafian
vesicle, must certainly be regarded as entirely erroneous. It is dis-
proved in the most positive manner by several of the accompanying
observations. We see, for instance, in one case the Graafian vesicle
large, prominent on the surface of the ovary, distended with serosity,
and apparently on the point of rupture, while the vesicular membrane
has, as yet, undergone no change.
Secondly, we have Graafian vesicles, freshly ruptured and filled
with blood, with the vesicular membrane equally unaltered as before.
Thirdly, beyond this period we have corpora lutea in all stages of
retrogression ; but wherever the deposit of yellow matter has taken
place, the vesicle contains blood, and has evidently been ruptured.
The only exception to this rule is in the case of some very small
corpora lutea, which have already been long subjected to the pro-
cess of absorption, and in which it is therefore difficult to recognize
the remains of the coagulum.
It is not, however, necessary to rely entirely on the accompanying
observations, to disprove the theory above alluded to. N^grier himself
refers to the cases " communicated to him by Dr. Ollivier D'Angers,"
of two women who committed suicide during a menstrual period. In
each case, one ovary presented a bloody ruptured vesicle (" rupture
vesiculaire saignante"), containing a soft and recent coagulum. But
nothing is mentioned, in either case, about any alteration of the in-
ner surface of the vesicle. In the three cases by Bischoff, already
referred to, of recently ruptured vesicles, there is no mention made
of any yellow deposit being visible. There is also another exceed-
ingly interesting case of the rupture of a vesicle during menstruation
reported by Dr. Myddleton Michel in the Charleston, S. 0. 31edical
Journal (quoted in the Amerhcan Journal of 3Iedical Sciences, July
1848). It was that of a woman who was executed for murder. She
had been imprisoned several weeks previously to the execution, and
had undoubtedly been deprived of sexual intercourse. At the ex-
amination, the OS uteri was found "open, tumefied, and dripping with
blood," and its inner surface coated with blood, and " congested" at
its upper part. The right ovary contained a number of vesicles in
48 PRIZE ESSAY.
process of development, containing clear fluid. The left liad a rup-
tured vesicle on its anterior surface, with its orifice partially closed
by a bloody coagulum. The membrana granulosa (examined by the
microscope) also protruded through the opening. The cavity of the
Graafian vesicle was filled with coagulated blood. Its tunic was very
vascular, and " had not yet hegim to fold, to form the corpus luteum."
The precise period during menstruation at which death took place
in this instance was not ascertained with certainty.
Ndgrier, however,* gives one observation on this point which is not
very easily explained. He describes very accurately a recent corpus
luteum of menstruation found by him in an ovary which, as he says,
did not present on its surface " any trace of rupture." With regard
to this, I can only say that I have not met with a similar case, and
that it is contrary to the experience of most other observers.
After the end of the third week from the close of menstruation,
the corpus luteum passes into a retrograde condition. It diminishes
in size ; and the fibrinous coagulum becomes absorbed, and loses still
farther its colouring matter. The diminution of the size of the body
takes place more particularly in a certain direction ; so that, from
having a globular or ovoid form, it becomes collapsed and flattened,
either laterally or from within outward. In consequence of this
flattening, the corpus luteum at this period may appear to vary con-
siderably in size, according as the section has been made in the plane
of its compressed surfaces or perpendicularly to them. Thus, in Ob-
servations IX. and X., both of which give specimens of corpora
lutea four weeks after menstruation, the apparent size of these bodies
is very diff"erent. But, if we consider that one has evidently been
cut across, while the other was probably divided in the plane of its
compression, the diff'erence will not appear so striking. Still, it is
undoubtedly the case that these bodies do not, in all instances, be-
come atrophied with the same rapidity, and that more or less varia-
tion is apparent in this, as in most other physiological operations of
nature. It is certain, too, that the effused coagulum does not always
lose its colour with the same readiness ; since, in some of the draw-
ings which represent corpora lutea of four weeks or over, the clot is
even redder than in Observation VI, where it is represented at the
termination of the third week.
The colour of the yellow wall, however, during the early part of
the retrograde stage, instead of fading like that of the fibrinous
• Op. cit. page 22.
CORPUS LUTEUM OF MENSTRUATION.
49
Fig. 8.
clot, becomes more strongly marked. From the dull yellowisli-red
hue, similar to that of recent lymph, -which it had at first, it assumes
a brighter and more decided yellow, and contrasts, therefore, more
strongly with the neighbouring tissues. This yellow hue of the cor-
pus luteum has been attributed by various writers to an alteration
in the colouring matter of the efi'used blood, similar to that which
takes place in the neighbourhood of old apoplectic clots. Pouchet*
so considers it, and Raciborskif entertains the same opinion. A
microscopic examination of the corpus luteum at this period, how-
ever, demonstrates that this colour depends principally on the pre-
sence of oil, which is seen in larger or smaller globules, and having
the same yellowish tinge which is presented by the whole body when
viewed by the naked eye. The oil-globules, in fact, which, at an
earlier period, were seen in small numbers and of minute size, and
for the most part enclosed within
the irregular granulated cells, have
now become large and abundant, so
as to occupy nearly the whole field,
while the cells themselves have dis-
appeared, or are with difficulty dis-
tinguishable. Everything leads us
to believe that the cells are a forma-
tion destined to produce the oil, as
a gland its secretion ; and that, when
they have accomplished this purpose,
they disappear and are replaced by
the ordinary fibrous tissue of the
ovarian stroma.
As the corpus luteum diminishes in size, the yellow matter becomes
softer and more friable, and shows less distinctly the markings of its
convolutions. At the same time, it is more intimately connected
with the neighbouring tissues, so that it can be less readily enu-
cleated from the ovary. The central coagulum is no longer any-
thing more than a faint, whitish, stellate cicatrix ; while the yellow
matter itself often also assumes a stellated, triangular, or other
similar form, and pursues constantly a retrograde course, which ter-
minates finally in its obliteration. When the corpus luteum, how-
ever, has reached this advanced stage of retrogression, it appears
to become comparatively stationary, and its alterations proceed less
Oil-globules from the smaller corpus
luteum in PI. I. Fig. 3 (same scale).
• Page 14G.
t Page 437.
50 PRIZE ESSAY.
rapidly than at an earlier period ; so that it may remain for some
months afterward as a minute, faint, obsolete, yellow spot, imbedded
in the ovarian substance. In the case of Mrs. A., Observation IX.,
seven of these obsolete yellow bodies were distinguishable, besides
that resulting from the last rupture of a vesicle, the oldest of which
probably dated from a period of eight months. In general terms,
then, it may be stated that a period of six to eight weeks is sufficient
to reduce the corpus luteum of menstruation to an insignificant, soft,
thin, compressed sac, measuring less than a quarter of an inch in
its longest diameter, and with its opposite walls nearly or quite in
contact ; but that after this time it remains more quiescent, and that
a period of eight months sometimes elapses before its final and com-
plete destruction.
There is good reason to believe that, in connection with the pro-
cesses of menstruation, a peculiar change takes place in the internal
surface of the uterus, which results in the formation and separation
of a decidual membrane. Pouchet,* indeed, considers the regular
monthly formation and discharge of a decidua as satisfactorily estab-
lished. Dr. Robert Leef states that the uterine decidua is a thing
of frequent occurrence in unmarried females, and does not consider
its presence as the slightest evidence of the existence of pregnancy.
He cites also Drs. Baillie and Blundell in support of the same
views. The last-mentioned writers, however, are not disposed to
consider the formation of a decidua, unconnected with pregnancy,
as a regular physiological phenomenon, but rather as an occasional
appearance, dependent perhaps on difficulty of menstruation. In
reality, however, it is very probably a process which recurs spon-
taneously somewhere about each menstrual period.
The mucous membrane of the uterus, in its ordinary inactive
condition, presents a smooth, pale surface, of considerable firmness.
It does not have the appearance of a distinct membrane, but rather
of a membranous surface, owing to the softness of its structure,
and its intimate connection with the subjacent uterine tissue. It
is only occasionally that we can succeed in raising with the forceps
very thin, delicate strips, which in reality appear to be rather
portions of epithelium than of the mucous membrane itself. At
this time, it is difficult for the eye to distinguish any peculiarities of
structure, but when, at certain periods, the membrane has become
swollen and hypertrophied, numerous, very minute, whitish, wavy
• Page 249. f London Med. Gazette, vol. xxxi. p. 412.
CORPUS LUTEUM OF MENSTRUATION. 51
or zigzag lines may be seen running from the inner part of the sub-
stance of the uterine parietes, and terminating on its free surface.
In the ewe, these lines are much more distinctly seen, particularly
at those spots where the cotyledons are afterward to be developed.
These appearances, together with the remaining parts of the uterine
mucous membrane, are described at length by C. B. Reichert in the
first number of Muller's Archiv for 1848.* According to him,
these whitish lines arc the glandular ducts or tubuli of the uterine
mucous membrane ; which open upon its free surface, and are lined
by a continuation of its epithelium. After conception, this portion
of the membrane becomes much hypertrophied ; the tubuli are
lengthened, and their orifices, destined afterwards to receive the
villi of the chorion, become visible on the surface. The membrane
increases also in vascularity, and becomes soft and spongy, and
finishes by being transformed into the decidua vera, and at last
expelled from the uterus. This change has also been recognized by
other writers as taking place after conception, and Dr. Carpenterf
even states that it "occurs whether the ovum reach the uterus or
not, it being probably invariable in cases of extra-uterine preg-
nancy."
The preceding observations, however, make it probable that this
formation accompanies the regular processes of menstruation, whe-
ther the ovum be fecundated or not. It will be noticed that, in all
the foregoing cases except four, viz., Obs. I., II., VIII., and XI., there
existed more or less softening and sponginess of the uterine mucous
membrane. In two of these four cases, Obs. I. and VIII., a decidual
membrane had just been separated, or was nearly so, and was found
in the cavity of the uterus. In Obs. II., it had very probably been
expelled from the organ, and in Obs. XI. all the functions of the
generative system had been suspended for more than two months ;
a circumstance which accounts satisfactorily for the absence of any
alteration in the mucous surface of the uterus. In Obs. X., in which
the softening existed, but only to a slight degree, these functions
had been arrested for a period of about four weeks.
The separation and expulsion of the decidual membrane seem to
take place about the time of the rupture of the Graafian vesicle, that
is to say, toward the termination of the menstrual period. After this
* Ueber die Biklung der liinfalligen Hilute der Gebiir mutter, und deren VerhiLltniss
zur placenta uterina.
t Principles of Human Physiology, p. 579.
52 PRIZE ESSAY.
separation, the internal surface of the uterus is left firm, pale, and
smooth. It soon recommences, however, to become hypertrophied,
and in the course of a short time it presents a soft, velvety, shaggy
alteration, extending to the depth of three-sixteenths or a quarter
of an inch, and showing very distinctly the whitish, wavy, or zigzag
tubuli, intermixed with numerous fine blood-vessels, extending to-
ward the free surface of the membrane. The decidual membrane
is, in this way, in process of preparation during the descent of the
ovum through the tubes, and while it is yet unprepared to make any
vascular connection with the walls of the uterus.
PAET IT.
COHrUS LUTEUM OF PREGNANCY.
OBSERVATION XII.
Corpus luteum of pregnancy about the end of the second month.
R. D. L., a married woman, twenty-nine years of age, died in Boston
on the 28th of April, 1851, under the following circumstances. She
sat down to the tea-table with her family, in perfect health, on the
evening of Friday the 25th. While they were at tea, a notorious
quack, a Thompsonian, who had already been at the house in the
early part of the afternoon, returned ; and Mrs. L. left the table,
and went up stairs to her chamber in company Avith him. She was
known to have previously resorted to this man for the purpose of
procuring abortion.
After remaining for some time in the chamber with Mrs. L., the
Thompsonian left the house, but Mrs. L. kept her bed, and, in fact,
never left it from that time till her death, which took place on the
Monday following. On Saturday she was quite ill, and on Sunday
so much worse that her friends insisted on discharging the Thomp-
sonian and calling in other advice. Dr. M. S. Perry was accord-
ingly sent for. On arriving, he found Mrs. L. exceedingly collapsed,
and presenting marked signs of peritonitis. There was so much
disturbance of the intellectual faculties that the patient was unable
to give any account of herself ; but her appearance and symptoms
were so characteristic that Dr. P. at once concluded that abortion
had been produced. He sent for Dr. C. E. Buckingham, who in
the evening visited the patient with him, and concurred entirely
in his diagnosis. There was no reaction of the system at any time
after Dr. P. was first called, and the patient died on Monday about
11 A. M.
The friends of the woman were convinced that abortion had been
produced; and there were various other suspicious circumstances,
54 PRIZE ESSAY.
besides those above related, which were testified to at the inquest.
Owing to the absence of her husband, there were reasons why Mrs.
L. should wish to have the fact of her pregnancy concealed. The
verdict of the coroner's jury was that she came to her death in con-
sequence of an abortion produced by the above-mentioned Thomp-
sonian.
At the autopsy, which was performed on the day succeeding
death, the body generally presented an appearance of perfect deve-
lopment and full health. There were no marks of disease except
such as were quite recent. These consisted in a moderate peritoneal
effusion, and in some inflammation of the mucous membrane of the
stomach, oesophagus, and larynx, rendering it probable that the
patient had swallowed some irritating drug, a portion of which had
found its way into the air-passages.
The uterus was much enlarged. It measured four and a half
inches in length, two and three-quarters in width, and one and three-
quarters in its antero-posterior diameter. Its increased thickness
was caused by the bulging of its posterior face, which had a nearly
globular form, while the anterior face was hardly more rounded than
in the natural condition. There was some bright vascularity about
the posterior face and fundus of the uterus, but not of an inflamma-
tory appearance. The Fallopian tubes were also very vascular.
On cutting into the uterus from behind, its cavity was found to be
entirely occupied by the reddened and hypertrophied mucous mem-
brane, and a fibrinous-looking granular substance entangled with it.
The walls of the uterus were of their natural colour and consist-
ency, so far as regarded their muscular substance, but the mucous
membrane was exceedingly hypertrophied and reddened, presenting
all the appearances met with in the ordinary formation of decidua,
in connection with menstruation, but in an infinitely greater degree.
The decidua was continuous with the muscular substance, and could
not be very readily separated from it ; though the line of division
between the two was very well marked, owing to their difi"erence in
colour; the latter being pale, the former dark red. The decidua
was composed of a multitude of fine softish fibres, easily seen by the
naked eye, which lay in a parallel position, and projected into the
cavity of the uterus ; hanging from its internal surface like the hair
from a bear skin. On the posterior wall and a little to the right
side, the decidua was much thicker than elsewhere, and was here
continued into a moderately firm, stringy, fibrinous-looking mass,
which enclosed a multitude of minute granules. This mass hung
CORPUS LUTEUM OF PREGNANCY.
55
down freely into tlie cavity of the cervix, and before opening the
uterus, miglit be made to protrude from the os externum by com-
pressing the uterus in the hand. Its lower extremity "was soft,
sloughy, and grayish ; but its upper part still firm, red, and fresh-
looking.
Examined by the microscope, it was evidently composed of the
villi of the chorion, a part
of which had remained, after Fig. 9.
the expulsion of the ovum,
still entangled with the mu-
cous membrane of the uterus.
The villi presented somewhat
the appearance of membran-
ous tubes, of various sizes,
terminating by a single or
double cul-de-sac, and some- .
times having lateral dilata-
tions or processes. With
high powers, an appearance
was seen as if the villi con-
tained minute cells, or as if
the tubes were lined with a
delicate epithelium.
There was no blood in the uterine cavity, except at one spot on
its posterior aspect, near the fundus, where there was a roundish
cavity about the size of a pea, in the substance of the chorion and
decidua, which was filled with very dark, but fresh-looking blood.
There was nowhere in the uterus any appearance of a defined
placental attachment.
The right ovary, an inch and a quarter in length, was yellowish
white externally, with several slender, old adhesions to its surface.
It contained no corpora lutea, with the exception of a single yellow
'point, too small to show any definite structure. There were a num-
ber of Graafian vesicles beneath the albugineous tunic, varying in
size from one-eighth of an inch diameter downward; but none pro-
jecting on the surface of the ovary, or at all visible from the outside.
The left ovary, considerably thicker than the right, showed on its
posterior surface a slightly depressed spot, over which was attached
a long, slender, organized, bridle-shaped adhesion, and in the neigh-
bourhood of which a yellow colour showed through from beneath the
fibrous coat. On makinjr a lonffitudinal section through the de-
Villi of the chorion.
56 PRIZE ESSAY.
pressed spot, a corpus luteum was exposed, measuring seven- eighths
of an inch in length by one-half an inch in depth. It consisted of
a light-yellow, thin, convoluted external layer, and an enclosed,
colourless, firm, fibrinous mass, with a central cavity containing a
few drops of limpid fluid. The relations of the central coagulum,
the yellow wall, and the investing membrane were the same as in all
the corpora lutea previously observed. (See Plate II. Fig. 2.)
This ovary contained another corpus luteum, situated directly
beneath the albugineous tunic, three-eighths of an inch long, but
very narrow, and much compressed, the yellow matter very thin and
friable, and incapable of being separated whole from the ovarian
tissue. The walls of this corpus luteum were nearly in contact, and
its contents colourless.
There was also another yellow spot, much smaller than the last,
and very indistinct in structure, but which, apparently, was also an
old corpus luteum of menstruation.
The left ovary contained but few Graafian vesicles which were
visible, and those of very small size.
Both oviducts contained an abundance of thick, opake, yellowish
fluid, consisting mostly of ciliated columnar epithelium.
The period of pregnancy in this case was estimated, first, from
the size of the uterus; and, secondly, from the fact that the placenta
had as yet assumed no regular shape, while, at the same time, its
future situation was sufficiently well marked by an unusual develop-
ment of the villi of the chorion at one spot, and their adhesion to
the uterine surface. It will at once be observed, on comparing the
corpus luteum in this case, with that of Obs. X (Pi. I. Fig. 5),
how great is the diff"erence between them. The latter, of only four
weeks' date, is already considerably advanced in the process of atro-
phy; while the former, nearly or quite twice as old, has still retained
all its activity, and is, indeed, increasing in size, notwithstanding
that sufficient time has elapsed for the colouring matter of the coagu-
lum to be completely absorbed. The difi"erence will be still more
striking if we compare it with PI. II. Fig. 1, in which the corpus
luteum is of nearly the same date with the present.
CORPUS LUTEUM OF PREGNANCY. 57
OBSERVATION XIII.
Corpus luteum of pregnancy about the termination of the fourth month.
.4
E. S., a fine, healthy-looking gu'l, twcntj-one years of age, died
at the house of Mr. A., in Boston, on Wednesday the 7th May, 1851.
She had been employed in Mr. A.'s family as a seamstress since the
previous winter, living in the house during the week, but going away
on Saturdays to her cousin's in Pleasant Street, and returning to
Mr. A.'s on Monday morning. She had been for some months re-
ceiving the attentions of a young man who was reputed to be en-
gaged to her. None of her friends suspected anything to be wrong
"with her until Monday evening, May 5th, when her cousin, with
whom she had been spending Sunday as usual, perceived the odour
of tansy in the room which she had occupied; whereupon it occurred
to her that the girl might have become pregnant, and used the drug
for the purpose of producing abortion.
On Tuesday she was in good spirits, and engaged in her ordinary
employment throughout the day. She took leave of the family as
usual, and went up stairs to her room about half past nine o'clock,
P. M. Soon afterward, the family were alarmed by a scream, and
on going up stairs, found the girl stretched on the floor by the side
of her bed, insensible, and in violent convulsions. Dr. Samuel
Morrill was immediately called, and I also saw her soon after.
There Avas a strong odour of tansy in her breath, and, on searching
the room, a two ounce phial was found in the pocket of one of the
girl's dresses, still containing 5v of the oil of tansy. The mug from
which she had drunk the oil was also found, with several drops re-
maining on the bottom. It was subsequently ascertained that she
had purchased the phial full of oil of tansy a few days previously.
She remained totally insensible, with violent convulsions at short
intervals, till a quarter past 2, A.M., when she died.
At the autopsy, made May 7th, ten hours after death, there were
found some marks of congestion of the brain. The stomach and
upper part of the small intestine contained an abundance of oil of
tansy. On first opening the body, the odour of tansy was powerfully
exhaled from the cavity of the peritoneum, from the interior of the
heart, and from the cut surface of the pectoral muscles.
The uterus was enlarged so that its upper edge was two inches and
three-quarters above the level of the symphysis pubis. It was also
5
68 PRIZE ESSAY.
slightly inclined to tlie left, and lay in a somewhat diagonal position,
so that its left edge was considerably nearer the abdominal parietes
than the right. Its external surface was generally yellowish-gray,
mottled, in some situations, with large bundles of red vessels, but
without any inflammatory appearance. The vascularity of the
oviducts was also quite moderate.
The uterus, unopened, weighed one pound. Its length, including
the neck, was six inches and a quarter. Length of neck, measured
internally, was one inch and three-eighths. Breadth of uterus, four
inches and one-eighth. The amnion and chorion were in contact.
The placenta was perfectly formed, circular in shape, three inches
in diameter. The cord was five inches long, very slightly twisted
from left to right. It was well covered with gelatinous matter.
The umbilical vesicle still existed as a delicate, flattened, pellucid
sac, three-sixteenths of an inch in diameter, situated beneath the
amnion, on the internal surface of the placenta, at a distance of
three-quarters of an inch from the insertion of the cord. In its
centre there was a yellowish, granular, opake spot. A single fine
red vessel ran from the insertion of the cord to the vesicle, and then
branched over it in minute ramifications.
The foetus, a female, was nearly six inches in length. Its surface
was smooth, without sebaceous covering or hair. Skin transparent,
and everywhere marked by an elegant vascular network. It showed
also very distinctly the numerous hair follicles as minute, opake,
white specks. The muscles were contracted, and the limbs rigid.
Umbilicus situated a little above pubis. Middle point of body
situated nearly midway between umbilicus and lower end of sternum.
Head voluminous. Mouth widely open. Tongue well formed. Eye-
lids in contact ; not to be separated without forcibly tearing epider-
mis. Pupils widely dilated. Nostrils open. Pupillary membrane
complete. Fingers and toes completely formed, and nails distinctly
visible.
External genital organs distinct. Clitoris projecting far beyond
nymphte.
The liver came down nearly as low as pubis. The kidneys and
STipra-renal capsules were equal in size : kidneys pale and lobulatcd ;
capsules dark red.
The large intestine was destitute of either transverse or longitudinal
bands.
Ossification of the ribs was sufficiently well advanced. Consider-
CORPUS LUTEUM OF PREGNANCY. 59
able ossification of ilium; none of ischium or pubis; none of cal-
caneum ; none of ossicula auditus.
The foetus was, therefore, estimated to be about four months old.
The left ovary, which hung doAvn a little lower than the right,
had, on its outer extremity, a small conical prominence, where the
fibrous coat was wanting, and its place supplied by peritoneum alone.
There was a slight appearance here of a cicatrix, visible only on
close inspection. No unusual vascularity here or at any other part
of the ovary. Beneath this prominence, the corpus luteum could
be felt through the ovarian tissue tolerably firm and well defined,
and having the form of a sphere, compressed laterally, much like
that of the crystalline lens. On dividing the ovary longitudinally
through the prominence, the corpus luteum presented a nearly cir-
cular section, seven-eighths of an inch in its long, and three-fourths
of an inch in its short, diameter. (Plate II. Fig. 3.) The convo-
luted wall was of a dull yellow, considerably less brilliant than in
the preceding case, and decidedly thicker, as it measured, at its
deepest part, a little over three-sixteenths of an inch in thickness.
The space enclosed by the yellow wall was occupied by a fibrinous,
colourless, reticulated coagulum, which possessed a few minute
vessels. This central coagulum was much compressed laterally ;
for, though it presented a cut surface of about half an inch in diame-
ter, it had hardly more than one line in thickness. There was no
cavity nor fluid anywhere.
Both ovaries were carefully divided in every direction, but only
one other body was found bearing any resemblance to a corpus
luteum, and that was so small and imperfect as to be hardly recog-
nizable. There were many Graafian vesicles in the interior of each
ovary, varying in diameter from three-sixteenths of an inch down-
ward, but none at all prominent on the surface. Both ovaries were
quite healthy.
On comparing this case with that detailed in Obs. XII., it will
be seen that the corpus luteum has increased in development. The
convoluted wall has become thicker, and has begun to lose its bril-
liant tinge; the fibrinous coagulum has become more compressed
and absorbed, and the central cavity, if any had existed, is com-
pletely obliterated. At the same time, it is interesting to observe
that the old corpora lutea of menstruation, of which three existed
in the preceding case, have now been reduced to one. They have,
in fact, successively disappeared, while the corpus luteum last formed
has continued its development under the influence of pregnancy.
60 PRIZE ESSAY.
OBSERVATION XIV.
Death at the termination of the seventh month of pregnancy — One ovary de-
stroyed by disease, the other containing tvro corpora lutea — A blighted ovum
in the corresponding oviduct, and a seven months' foetus in the uterus.
M. M., a married woman, thirty-two years of age, stout and full-
blooded, died suddenly at Lowell, on Tuesday, December 17th, 1850.
She was the mother of four children, the youngest of whom was
two years and a half old. At the time of her death, she considered
herself to be seven months advanced in pregnancy, expecting to be
confined in the middle of February, 1851.
Her husband, who performed duty as a night-watchman, left his
wife on Monday, the 16th, at 11 P. M., apparently in perfect health.
She had then retired to bed, but talked to him, just before he left,
in her ordinary cheerful manner. He passed his watch, and returned
home next morning at 5 A. M., and, on going up to his wife's cham-
ber, found her lying on the floor, warm but quite dead. There were
no appearances of any disturbance in the room. The husband im-
mediately gave the alarm, and a physician was called; but there
were no signs of life.
At the autopsy, next day, there were no marks of violence to be
seen, with the exception of some slight bruises on the right knee,
and the right side of the head and face, which slie might easily have
received in falling. All the internal organs were in a state of marked
congestion, and the blood was everywhere fluid. No other lesion,
however, was discoverable anywhere, Avith the exception of a change
in one of the ovaries, and one or two serous cysts in the liver, which
could not, in any way, account for death.
The uterus, of a natural grayish-yellow, and dull-red colour, was
in the median line. Its upper edge was half an inch above the
level of the umbilicus (subject lying on the back). It was covered
for the upper third of its anterior surface by the transverse colon
and great omentum. It measured eleven and one-fourth inches in
its long diameter, and eight and one-eighth inches in its transverse.
It weighed, unopened, a little less than seven pounds. The thick-
ness of the uterine parietes, at its fundus, was three-eighths of an
inch. The cervix uteri, two inches in length, was plugged by a mass
of colourless, tenacious secretion. Its lower extremity was lax and
soft, admitting the little finger with ease; but its upper part was
CORPUS LUTEUM OF PREGNANCY. 61
contracted and impassable. The os uteri and upper portion of the
vagina •svere of a purplish colour; the rest of the vagina being of a
light rosy hue.
The chorion and amnion were in contact ; and the amniotic fluid
something over one pint in amount. The placenta was situated at
the lower and anterior part of the uterus, a short distance from the
uterine orifice of the cervix. The cord measured nineteen inches
in length. The foetus, perfectly formed, weighed, together with one
inch of the cord, three pounds. It had no cadaveric rigidity. Its
skin was of a reddish colour, and had a thin covering of sebace-
ous matter. There was rather an abundance of dark hair on the
scalp. The nails projected, in many instances, quite to the ends of
the fingers; in others, not so far. They were all very soft. The
eyelids were in contact, but not adherent. There was some opacity
of each cornea. Both testicles had descended into the scrotum, but
could be pushed back nearly into the cavity of the abdomen.
There was no mark of violence or disease about either the uterus
or foetus.
The right ovary, situated immediately beneath the liver, was
almost entirely converted into an encysted tumour, nearly globular
in shape, with thin, tough, membranous walls, and about the size
of the foetal head. It weighed, unopened, a little less than one
pound. It contained a mass of yellowish-white fatty matter, re-
sembling lard in appearance and consistency. There were also a
few drachms of thickish, dingy-yellow, oily fluid, with a fetid odour.
Intermixed with the lardaceous matter, was a large quantity of long
and short, dark-coloured hair; most of it, like the fatty matter,
entirely unconnected with the internal surface of the cyst. This
surface was, for the most part, smooth and glistening, like a serous
surface; but at one spot it assumed the appearance of skin, becoming
whitish-opake, and provided with follicles, from which short hairs
projected into the cavity of the cyst. At one spot underneath this
scalp-likc surface, was a considerable mass, like adipose tissue, and
beneath that an irregularly-shaped piece of bone, hard, white, and
surrounded by periosteum. There were two other, much smaller
cysts, filled with transparent, gelatinous fluid, and a little of what
appeared to be the remains of genuine ovarian stroma ; but there
were no normal Graafian vesicles, nor any other appearance natural
to the organ.
There were no appearances of old or recent inflammatory action
anywhere about the ovary, but all the surfaces externally were
62 PRIZE ESSAY.
smooth and normal ; only the oviduct and its fimbriated extremity
were of a lively red colour.
The left ovary, one inch and a half in length, was pale, and of
natural appearance externally. On one of its lateral surfaces there
was a small oval-shaped spot, where the albugineous tunic was Avant-
ing, and which showed a faint yellowish coloration. (Plate II. Fig.
4.) The centre of this spot showed a faint linear cicatrix, very
slightly depressed, from which radiated a few red and purple vessels.
The corpus luteum, situated immediately underneath, caused a slight
prominence externally, and could be readily felt as a roundish, well-
defined tumour, not hard, but still having considerable resistance.
Its section, of an oval form, showed the body to be somewhat com-
pressed from within outward. It was half an inch in length, and a
quarter of an inch in depth. It consisted of a central, whitish,
radiated cicatrix, surrounded by a thick, softish, elastic, and strongly
convoluted wall. The relative proportion of these parts is exhibited
in the drawing. (Plate 11. Fig. 5.) No distinct communication of
the central cicatrix with the exterior could be detected; probably
owing to the abundant growth of the convolutions, which had re-
duced this communication to a linear cicatrix, easily missed in making
a section of the ovary. The thickness of the wall was considerably
less on its superficial than on its deep aspect. Its colour was a
faint yellowish-white, not much unlike recent lymph, and very diff"er-
ent from the bright yellow hue of the corpus luteum of menstruation,
at an advanced period. It showed an abundance of fine red vessels
converging from the exterior, which had at first the appearance of
being situated in the substance of the wall, but which, on close in-
spection, seemed only to penetrate the interstices of the convolutions.
Externally, the corpus luteum was invested by an exceedingly thin,
transparent, vascular membrane, to which it was intimately attached,
and with which it could be readily separated from the rest of the
ovary; but, in performing the separation, several irregular strips of
cellular tissue were raised with it.
Near the other extremity, and on the opposite surface of the
ovary, was another spot similar to that already described; i. e., a
space where the fibrous tunic was wanting, and in which there ex-
isted a faint yellowish coloration, and a noticeable concentration of
vessels. Immediately beneath, was a second corpus luteum, abso-
lutely similar to the first except in being a little smaller as the
section was made, i. e., seven-sixteenths of an inch long, by a quarter
of an inch deep. The central cicatrix here had a verv distinct
CORPUS LUTEUM OF PREGNANCY.
63
Fis. 10.
Left ovary of M. M. — Second
corpus luteum.
communication Avith the exterior. The Avhole appearance of this
corpus luteum indicated the same stage of
development with the former.
The left oviduct Tvas quite free and
pervious throughout. On cutting it open,
there Avas found, at a distance of three
inches from its fimbriated extremity, a
soft, greenish-yellow mass, about the size
of a hazelnut. Externally, it Avas quite
smooth and soft, and without any appear-
ance of organization ; but toward its cen-
tre it had considerable firmness and a
more ruddy colour, and showed some fine
red vessels, ramifying in its substance.
Altogether, it had much the appearance
of a slough of cellular tissue, which had
not yet become quite disorganized and
difiluent. At one spot it had distinct
vascular connections with the internal surface of the oviduct; but
could easily be separated, leaving some shreds of the slough-like
material adhering to the spot. There was no particular vascularity
or other alteration of the mucous membrane of the oviduct in its
immediate neighbourhood, but only some unevenness of surface at the
point where the tumour had adhered.
There were absolutely no Graafian vesicles on the surface of the
ovary, but several were situated beneath the albugineous tunic,
along the free edge of the organ, varying in size from an eighth of
an inch in diameter, downward. The ovary was carefully divided
in every direction, but nothing else like a corpus luteum was any-
where to be met with.
It will immediately be seen how much this corpus luteum differs
in appearance and description from those heretofore delineated, as
existing in company with an unimpregnated uterus. This case is
particularly interesting from the fact that two ova had evidently
been discharged from the left ovary at about the same time, and had
both been fecundated. One, however, contracted adhesions to the
oviduct and became blighted after a very short period of develop-
ment ; while the other proceeded to the uterus, and underwent the
ordinary changes of uterine growth. This woman had evidently a
constitutional tendency to arrest the progress of the ova through
the tubes, since very much the same thing had previously happened
64 PRIZE ESSAY.
on the right side. For we must certainly regard these encysted
tumours of the ovary, containing bones, fat, and hair, as the result
of degenerate ova, which have become arrested at the ovary, either
before or after their impregnation.
This case also makes it evident that it is not any particular change
in the ovum itself, which gives a peculiar character to the corpus
luteum of pregnancy, but the condition of the uterine organs gene-
rally ; for we have here two perfect corpora lutea, though only one
of the ova had become developed. If it were otherwise, as the
ovum became blighted, its corresponding corpus luteum would have
been atrophied simultaneously with it.
OBSERVATION XV.
Corpus luteum of pregnancy in the eighth month.
C. H., a woman, thirty years of age, evidently advanced in preg-
nancy, died at the Cholera Hospital in Boston, August 8th, 1849,
after an illness of fifteen and a half hours.
The uterus came up nearly to the level of the umbilicus. It was
pear-shaped, and inclined to the right side, so that full two-thirds of
the organ lay to the right of the median line. It had a dull reddish
vascularity on its external surface. The fluctuation of the liquor
amnii could be readily felt through the uterine walls, as well as the
head and limbs of the foetus. The uterus measured nine and a half
inches in its longitudinal diameter, and six and a half in its trans-
verse. The thickness of its walls, divided through the middle of its
anterior surface, was three-eighths of an inch. The os uteri had a
rounded, tumefied appearance, and a dark purplish colour. The
cavity of the cervix was filled Avith tenacious secretion. The attach-
ment of the placenta was at nearly the middle part of the anterior
uterine wall, but a little to the left of the median line. It was
nearly circular in shape, and five-eighths of an inch in thickness.
The chorion and amnion were in contact, and the amniotic fluid
about fourteen ounces in amount. The cord was twenty-two inches
in length.
The right ovary, one inch and three-quarters long, contained a
corpus luteum, situated at one extremity of the organ. This body
CORPUS LUTEUM OF PREGNANCY.
65
11.
was irregularly ovoid in shape, measuring nine-sixteenths of an
inch in lenp^th, and half an inch in depth. It consisted of a firm,
yellowish-'wlntc, -well-organized looking substance, -which showed fine
red vessels converging towards the centre. It had no cavity, but
its centre was occupied by an irregularly elongated, firm, opaline
coagulum, closely connected with the rest of the body. Externally,
there Avere the same layers of cellular tissue previously described.
The colour of this body was a much less decided yellow than is
often seen in "false" corpora lutea. It differed from them also in
several other respects, as follows : —
I. Its globular form, and firm, resisting feel.
II. Its organized appearance internally.
III. There was, on the surface of the ovary, at a spot corresponding
to the corpus luteum, a well-defined, strongly-depressed cicatrix.
The ovary also contained a firm, opake, whitish body, in the situ-
ation indicated in the drawing, much smaller than the corpus luteum,
and not exhibiting any of its peculiar
structure; apparently a morbid growth.
The left ovary was two inches in length,
but very slender and much atrophied. It
contained a small, globular, whitish, opake
body, like that mentioned as occurring in
the right ovary (morbid). There was no-
thins; else remarkable about the uterus or
appendages.
The foetus, a female, measured fourteen
inches in length, and weighed, with one
inch of the cord attached, three pounds
five and a-half ounces. There was no ca-
daveric rigidity. The skin was of a rosy
hue, rather thick and tough, and covered,
over a great part of its surface, with fine,
white, short hairs. The scalp was covered with fine dark hair, a
quarter of an inch long. The nails reached nearly, but not quite,
to the ends of the fingers. The umbilicus was situated an inch
above the pubis, and three-quarters of an inch below the middle
point of the body. The eyelids were in contact, but easily sepa-
rated. There was slight opacity of each cornea. There was no
pupillary membrane.
The foramen of Dotal was a quarter of an inch in diameter, but
could be completely covered, from the left side, by its valve. The
Corpus luteum of pregnancy
in ihe middle of the eighth
month.
6Q PRIZE ESSAY.
arterial duct appeared like the continuation of the pulmonary trunk,
•while the right and left pulmonary arteries seemed to be only small
branches.
There were no valvule conniventes in the small intestine, and
the large intestine was quite round and smooth, unmarked by either
transverse or longitudinal bands. It was distended with dark green-
ish meconium from the ilco-coecal valve to within an inch of the
anus. The kidneys were lobulated externally, and rather more
bulky than the supra-renal capsules; but the length of the two bodies
was the same, viz., one and one-eighth inch.
There Avere three points of ossification in the sternum. The cal-
caneum had one point of ossification, well advanced ; and the astra-
galus also one point, just commenced. The axis had one point of
ossification in its body, and another in the odontoid process.
The foetus was therefore, in all probability, seven months and
a-half old.
OBSERVATION XVI.
Corpus luteum at the termination of pregnancy.
E. S., a healthy woman, about twenty-seven years of age, a pa-
tient of Dr. Samuel Cabot, was taken with labour pains on Wednes-
day, February 19th, 1851; only five days before her full time,
according to the patient's reckoning. After labour had continued
eight hours, rupture of the uterus took place, and the woman died
five days afterward.
The uterus and ovaries were given to me by Dr. Cabot.
The body of the uterus was five inches and a half long, and its
anterior wall a little over one inch in thickness. The cervix uteri
was two and one-eighth inches in length, and thoroughly dihated. The
OS internum was distinctly marked by a slightly projecting ridge,
viewed internally, at the lower extremity of the uterine body. The
rupture was transverse, three and a half inches long, and situated
just at the junction of the body of the uterus with the cervix. The
edges of the rupture were everted, and retained in the everted posi-
tion by a deposit of recent lymph ; which was also abundant all over
the peritoneal surface of the uterus. The right ovary was plentifully
CORPUS LUTEUM OF PREGNANCY.
67
12.
covered Avith lymph, but, on stripping off tliis deposit, the cicatrix
of the corpus luteum could be
readily distinguished on the free
edge of the organ. Immediately
beneath, the body itself was indis-
tinctly perceptible to the touch.
On cutting it open, the corpus
luteum was seen to be of an indefi-
nite, light-yellowish hue, but little
contrasted with the remainder of
the organ. The central coagulum
was very scanty, having been re-
duced to a thin white cicatrix.
In the above drawing, the walls
of the yellow body are shown very
much folded in, at one spot. This
is in consequence of the first sec-
tion, from which the drawing was
taken, not having been made di-
rectly through the centre; but an-
other section, more successfully performed, showed its whole surface
occupied by yellow matter, thrown into minute folds.
There was no other appearance of corpora lutea in either ovary,
nor any prominent Graafian vesicles.
Corpus luteum at the termination of
pregnancy.
OBSERVATION XVII.
Corpus hiteum of pregnancy nine ■weeks after delivery.
A. G., a married woman, twenty-six years of age, died in Boston,
Sept. 20th, 1850, of irritant poisoning. In early life she had shown
some symptoms of insanity, but of late years her health had been
good. A fortnight previous to her death, she had lost an infant
child, seven weeks old, and since that time had been much depressed
in spirits, and had not had her usual appetite, but had not been
otherwise indisposed. She left her home soon after breakfast on
the mornin"; of the 20th, and in the afternoon was found in the sta-
tion house of the "Western Railroad, evidently very sick, and unable
68 PRIZE ESSAY.
to give any account of herself. She was immediately removed to
the Massachusetts General Hospital, where she arrived at half past
four P. M. She was then much nauseated, with lividity and cool-
ness of the skin, swelling of the lips, and a very rapid and feeble
pulse. She could neither speak nor swallow. She rapidly became
more and more collapsed and insensible, and died in a little less
than two hours after her entrance.
At the autopsy, next day, the stomach was found excessively in-
flamed. It was somewhat contracted and collapsed, and contained
six ounces of a dark red, bloody-looking fluid, which was thickened
by holding in suspension a large amount of light reddish flakes, like
those seen in the discharges of dysentery. The parietes of the
stomach generally were exceedingly thickened, so that its anterior
wall, near the pyloric extremity, measured three-eighths of an inch
in thickness, and about the cardiac extremity nearly a quarter of an
inch. This abnormal thickness was entirely owing to infiltration of
the submucous cellular tissue, of a slight reddish tinge, nearly uni-
form throu2;hout the organ. The mucous and muscular coats were
unchanged in thickness.
The internal surface of the stomach was of an intense purple red
throughout the middle third of the organ, where the mucous mem-
brane was thrown into numerous transverse and longitudinal folds.
In the great pouch the mucous membrane was of a dark slate colour,
and had, at the same time, a finely granulated appearance, owing to
its surface having been strongly corrugated and thrown into minute
folds, of an opake gray colour. There Avas also, at this part, much
dark purple and black ecchymosis, situated in the substance of the
mucous membrane, as well as beneath it. There was, besides, some
redness of the small intestine, and much submucous infiltration and
ecchymosis about the larynx and upper part of the trachea; as if
some of the poison had accidentally found its way into the air-pas-
sages. There were no other morbid appearances of importance.
The woman was known to have had corrosive sublimate in her pos-
session previous to leaving home.
The vagina Avas smeared, at its upper part, with a little leucor-
rhoeal secretion. The uterus, much reduced in size, was only a little
larger than in the ordinary, unimpregnated state. The os uteri was
transverse, purple, and much fissured. The internal uterine sur-
face showed considerable dark-coloured redness, but was otherwise
unaltered.
Both ovaries showed many Graafian vesicles in process of develop-
CORPUS LUTEUM OF PREGNANCY. 69
ment, but no sign of any recent rupture. One of them had also a
very small and ancient-looking body, situated immediately beneath
a depressed cicatrix, which was the only thing like a corpus luteum
to be found in the ovary. The colour of this body was very similar
to that of the ovarian tissue. Its section was slightly oval, about a
quarter of an inch in diameter, and presented an opake, whitish,
central mass, external to which traces of a convoluted structure
were visible on close examination. The whole aspect of the body,
however, was obsolete and inactive, and its markings quite indistinct.
OBSERVATION XVIII.
Corpus hiteum of pregnancy nine months and a half after delivery.
C. L., a married woman, twenty-six years of age, a patient of
Dr. G. N. Thompson, died in Boston, June 24th, 1850. She was
the mother of three children, the youngest of whom, a healthy boy,
was nine months and a half old. The patient had not menstruated
since the birth of this last child.
She was confined on the eighth of September, 1849, without any
unusual occurrence. Two or three weeks after delivery, she was
attacked, from some unknown cause, with salivation, followed by
great irritability of the bowels, so that she had ten or twelve dis-
charges daily; often bloody and mucous in character. These symp-
toms were at first controlled by remedies ; but not long afterward
the irritability of the bowels again returned, her strength and
flesh failed, and the skin became excessively pallid. She improved
again under tonic treatment, but afterward failed a third time;
anaemia, emaciation, weakness, and irritability of the bowels being
the most prominent symptoms. She had also a moderate cough,
not frequent or troublesome. During the latter part of her life,
the discharges from the bowels were not bloody nor mucous, but fluid
and greenish. The intelligence was not affected.
At the autopsy, there was some sub-acute pneumonia of the poste-
rior surface of both lower pulmonary lobes. There was also consi-
derable ulceration of the lower part of the small intestine, and the
mucous membrane of the larfjre intestine was finelv (rranulated and
70
PRIZE ESSAY.
roughened throughout its extent.
There were no other remarkable
appearances.
The body of the uterus was pale, and natural in size and consist-
ency; but there were some morbid appearances about the os and
the upper part of the vagina. The cervix and os uteri were con-
siderably swollen, with an oedematous aspect, and a dark red and
purple colour internally. The external parts of the os and upper
portion of the vagina were equally dark coloured, and covered with
large patches of a whitish, semi-opake exudation. The internal
surface of the body of the uterus was lighter coloured. It was
finely reticulated over the greater part of its extent, but there was
a spot on its posterior wall which was smooth, and of a cicatrix-like
appearance. The internal surface of the uterus was natural in con-
sistency.
Fi2. 13.
Fif'. 14.
Left ovary of C. L.
Corpus luteum of pregnancy-
nine months and a half after
delivery.
Both ovaries were rather large. They were pale, like the other
organs, and entirely destitute of vascularity. Both presented exter-
nally several very shallow, bluish-looking cicatrices, but the left had,
in addition, on its anterior surface, two puckered, strongly depressed
cicatrices. (Fig. 13.) On making a longitudinal section, there was
found, immediately beneath the deepest of these, and evidently con-
CORPUS LUTEUM OF PREGNANCY. 71
nccted with it, a solid body, having a nearly circular section. (Fig.
14.) This body was little or not at all distinguishable in colour from
the rest of the ovarian tissue, and might easily have been overlooked
in a hasty examination. On close inspection, however, it was seen
to be imbedded in the substance of the ovary, from which it was
separated by a sufficiently distinct line of demarkation. It contained
in its centre a body rather whiter and more opake than the external
parts, while the latter, on minute examination, presented indications
of being traversed by radiating lines. The whole body was similar in
consistency to the rest of the ovary, and could not be felt at all from
the outside. It had no yellow nor red coloration in any part.
Both ovarieis contained many Graafian vesicles in an inactive con-
dition, but no other body than that described having any resem-
blance to a corpus luteum.
Both oviducts were natural in appearance and free from adhe-
sions.
There can be no doubt that, in the first periods^ the corpus luteum
follows the same course of development, whether the discharged
ovum becomes impregnated or not. Together with the rupture of
the vesicle, the same efi'usion of blood takes place in either case, fol-
lowed by a gradual absorption of the colouring matter of the clot, and
hypertrophy and folding up of the membrane of the vesicle. When,
however, the ovum becomes impregnated, and continues its growth
in the uterus, the corpus luteum, instead of reaching its maximum of
development at the end of three weeks, and afterward undergoing
a rapid process of atrophy, continues to develop itself for a con-
siderable period, and does not, in fact, become very decidedly retro-
grade until after the termination of pregnancy. At the same time
the ordinary periodical processes of the ovary are suspended. No
new vesicles protrude themselves from its surface, and even those
which, at the time of conception, happened to be more or less promi-
nent, appear again to recede and become concealed beneath the al-
bugineous coat.
The difference in the progress of the corpus luteum, however, re-
lates not only to its size, but also to its general characters and
aspect. The external wall becomes much thicker in proportion to
the central coagulum, and at the same time acquires a firmer and
more highly organized structure. Moreover, the colour, both of the
convoluted wall and of the central coagulum, constitutes an import-
ant means of distinction. It has been shown that the corpus luteum
72 PRIZE ESSAY.
of menstruation retains the bright yellow colour of its walls till the
whole body has become much reduced in size ; and that the coagu-
lum in its interior also remains more or less stained with red till a
late period. In other words, the substance of the corpus luteum
diminishes more rapidly than its colour fades. On the other hand,
if pregnancy occurs, the circumstances are reversed. The colour
both of the wall and the coagulum fades rapidly after the first tAVO
months, while the substance of the yellow body continues to increase ;
consequently, during the greater part of gestation, the corpus luteum
of pregnancy will be distinguished from that of menstruation by the
dull hue of its convoluted wall, and by the absence of colour in the
central coagulum.
The occasional existence of a central cavity in the coagulum, con-
taining clear fluid, is a circumstance which has been noticed by seve-
ral different authors. It does not seem to be an essential or even an
ordinary appearance ; since, among the eighteen observations on the
human female which have been detailed in the preceding pages, we
have met with it but once (Obs. XII). It is probably occasioned
by an early closure of the rupture in the Graafian vesicle, by which
the serum of the effused blood is retained in its interior, instead of
being expelled through the aperture by the contraction of the co-
agulum.
It is difiicult to ascertain with certainty the exact period of preg-
nancy at which the corpus luteum attains its maximum of develop-
ment. It certainly constitutes a very perceptible tumour so late as
the middle of the eighth month, and most of the older writers agree
that it is to be found a short time after delivery. Dr. Robert Knox
has drawn up a table of measurements of the corpus luteum at dif-
ferent periods of pregnancy, collated from various reliable authori-
ties, which was published in the London Medical Grazette.
The table is as follows: —
CORPUS LUTEUM OF PREGNANCY.
73
Br. Knox's Table of Measurements of the Corpus Luteum.
No. of day 8 after
Name of
Lon^ diame-
Short diameter
Thickness of
Diameter of
impregnation.
reporter.
ter m lines.
in lines.
" glandular
part."
" central
cavity."
5
Home
9
G
1^
8
"
9
6
li
46
Lee
9
-'h
1
6
62
"
6
^
1
3
62
Clarke
H
8
3
70
Montgomery
7
6
93
"
-J
Ci
2^
3
108
Keever
9
7
2
4^ and 2i
1' 8
Knox
7
6
155
W. Hunter
H
7
4iand 1^
186
Rosderer
6
5
3
2
186
Montgomery
6
5
3
2
186
Home
n
4i
1
4
201
Lee
6
4i
1
3
280
Rffiderer
7
4
280
Montgomery
6
5
289
W. Hunter
6
5
285
Knox
4
2§
IJ
li
It appears probable from this table that the period of the greatest
thickness of the convoluted wall, the structure which constitutes the
most characteristic portion of the corpus luteum, continues from the
beginning of the third to the end of the sixth month, and that the
entire bulk of the corpus luteum is also the greatest between nearly
the same periods. After delivery, the corpus luteum rapidly dimin-
ishes ; though its characteristic structure is still to be distinguished
for many months by close inspection.
The corpus luteum of pregnancy, then, differs from that which is
merely the result of menstruation in several important particulars.
I. It arrives more slowly at its maximum of development, and
afterward remains for a long time as a very noticeable tumour, instead
of undergoing a process of rapid atrophy.
II. It retains a globular, or only slightly flattened form, and gives
to the touch a sense of considerable resistance and solidity.
III. Internally, it has an appearance of advanced organization,
which is wanting in the corpus luteum of menstruation.
IV. Its convoluted wall, particularly, attains a greater development,
this portion measuring sometimes so much as three-sixteenths to one-
fourth of an inch in thickness, while in the corpus luteum of menstrua-
tion it never exceeds one-eighth, and is almost always less tlian that.
This difference in the thickness of the convoluted wall is one of the
6 '
74 PRIZE ESSAY.
most important points of distinction. It will be much more striking
when viewed relatively to the size of the central coagulum.
V. The colour is not, by any means, so decided a yellow, but a
more dusky and indefinite hue.
VI. If the period of pregnancy is at all advanced, it is not found,
like the corpus luteum of menstruation, in company with unruptured
vesicles in active process of development.
The preceding histories and observations will serve to show how
very imperfect are some of the marks which various writers have
heretofore laid down as distinguishing "true" from "false" corpora
lutea. Dr. Montgomery* gives seven characteristics by which, he
says, the "false" or "virgin" corpora lutea may be recognized.
" I. There is no prominence or enlargement of the ovary over
them."
This is manifestly incorrect, for the corpora lutea of menstruation
often cause a noticeable protuberance on the surface of the ovary,
as may be seen in Observations II., IV., V., VL, and VII.
" II. The external cicatrix is almost always wanting." According
to the present observations, an external cicatrix is always present in
the corpus luteum of menstruation, and in fact must necessarily be
so, since these bodies result from the rupture of a vesicle, in the
same manner with the corpora lutea of pregnancy.
" III, There are often several of them found in both ovaries," &c.
This is, no doubt, a very important distinction, since we never find
more than one corpus luteum of pregnancy at a time, unless in cases
of twins ; and then the two corpora lutea are evidently of the same
date, and have the same aspect, while the co-existent corpora lutea of
menstruation are usually in many difierent stages of retrogression.
"IV. They present no trace whatever of vessels in their substance,
of which they are, in fact, entirely destitute, and of course cannot
be injected."
According to the present observations, the distribution of vessels
in the two difierent kinds of corpora lutea is the same. In both, the
substance of the convoluted wall itself is non-vascular; and the
vessels exist only in the interstices of the folds. This fact is very
easily demonstrated in a corpus luteum of menstruation when com-
pletely developed, as the convolutions are here pretty easily sepa-
rated from each other ; but in the corpus luteum of pregnancy the
new growth from the internal surface of the vesicle has been so
• Signs and Symptoms of Pregnancy, p. 245.
CORPUS LUTEUM OF PREGNANCY. 75
abundant, and the convolutions are consequently pressed so firmly
together, that it is not always easy to decide whether a section has
divided the substance of the wall, or only by accident passed between
two convolutions; particularly as we have not so strong a contrast
in colour, to assist us, between the yellow wall and red vessels, as
exists in the corpus luteum of menstruation.
"V. Their texture is sometimes so infirm that it seems to be merely
the remains of a coagulum," &c. This is frequently a good distin-
guishing mark.
"VI. In figure they are often triangular, or square, or of some
figure bounded by straight lines." This has already been seen to be
an appearance frequently presented by the corpus luteum of menstrua-
tion, at an advanced period of atrophy.
" VII. They never present either the central cavity, or the radi-
ated or stelliform white line which results from its closure." This
last distinction is so exceedingly incorrect that it is difiicult to under-
stand how it could have been laid down by such an observer as Dr.
Montgomery. The corpus luteum of menstruation always presents
a central cavity, i. e., a space included by the convoluted wall, which
space is filled by a coagulum ; and as the whole yellow body becomes
atrophied, the coagulum is transformed into a radiated or stelliform
cicatrix, more or less coloured with blood, according to the rapidity
with which the absorption of the hsematin has proceeded.
There can be no doubt, therefore, of the existence of certain
distinct and reliable marks by which the corpus luteum may be
recognized as a sign of pregnancy, and distinguished from all other
appearances, either morbid or physiological, to be met with in the
ovary. The length of time which elapses before its disappearance
is alone sufficient to show that it is a peculiar and distinctive phe-
nomenon. It has been demonstrated, in the foregoing pages, that the
corpus luteum of menstruation becomes atrophied in a very short
space of time. Other observations, also, bear testimony to the same
fact. N^grier,* who considers all corpora lutea as identical, says
that the remains of the ruptured vesicle diminish successively with
so much regularity that we " can appreciate the loss of voliime
which takes place from one month to another." "It is in accordance
with such facts that I have been able to calculate that five to six
months are sufficient to reduce the most voluminous corpora lutea to
the size of a grape-seed; and that after two years a bluish stain is
often the only vestige that remains."
* Page 79.
76 PKIZE ESSAY.
Raciborski* states also that a period of four to six months is suffi-
cient to reduce the corpus luteum to an insignificant remnant ; " a
simple slate-coloured or yellowish trace."
Notwithstanding this, when the menstrual periods return with
reo'ularity, new corpora lutea are so rapidly produced that we meet
with many of them of different sizes in the same subject. Thus,
in Obs. X. we have four of these bodies, in Obs. VI. six, and in
Obs. IX. so many as eight, co-existing in the same ovaries. On
the other hand, the corpus luteum of pregnancy, after a certain
period has elapsed, is found alone. It has outlived all vestiges of
the vesicles previously ruptured, and no new ones have come for-
ward to form fresh corpora lutea. If, however, the yellow body of
menstruation were entirely similar to that of pregnancy, produced
every month, and yet remaining nearly undiminished for the greater
part of a year, we should find, in almost every female dead between
the ages of fifteen and forty-five, the ovaries crowded with promi-
nent solid tumours which could not fail to be recognized on the most
superficial inspection. Pouchet would then never have been obliged
to account for the failure of older observers to discover corpora
lutea in the ovaries of virgins. f " If certain physiologists (De
Graaf, Morgagni, Haller), not having been favoured by circum-
stances, never discovered corpora lutea in the virgin females of
mammalia, we cannot, nevertheless, at the present day deny their
existence," &c. These observers could hardly have failed to dis-
cover them if the corpora lutea of menstruation continued perma-
nent for any length of time. It is this very circumstance of their
rapid atrophy and disappearance, joined to the fact that almost all
grave diseases check the ovarian processes for some time previous to
death, that prevents our meeting more frequently with specimens of
these bodies at ordinary post-mortem examinations. Pouchet him-
self gives some observations which of themselves establish partially
the distinction above alluded to. One of them he adduces while
speaking of the proofs of the regular maturation and discharge of
ova in virgins. " In the case of a young woman," he says, " twenty
years of age, I had the good fortune to discover together Graafian
vesicles and their contents in all stages of development and retro-
gression. This woman had never borne children, and presented all
the marks of virginity. The ovaries presented on the surface of
their fibrous tunic many very noticeable cicatrices, vestiges of
* Page 436. t Page 125.
CORPUS LUTEUM OF PREGNANCY. 77
obsolete Graafian vesicles wliicli had previously discharged their
ovum. In the interior of the organs were to be seen many anfrac-
tuosities, which were probably merely Graafian vesicles which had
been more recently ruptured. This appeared probable from the
condition of their internal membrane, which was of a brownish
colour, and appeared no longer to be in an active condition. Finally
there existed, near the surface of the organs, eight vesicles, in dif-
ferent stages of development, and varying from one-half to one-
sixth of an inch in diameter. Their internal membrane was like a
mucous surface, ruddy and very vascular," &c. &c.
This girl's menstruation and ovulation had evidently, therefore, as
Pouchet supposes, gone on in an uninterrupted manner till near the
time of her death. Why, then, if the menstrual corpus luteum lasts
as long as that of pregnancy, did he not find many yellow bodies in
full development, instead of mere "anfractuosities" with a "brown-
ish-coloured and inactive-looking internal membrane?" The same
remark may be made with regard to other similar observations, as
those by Bischoff already referred to (op. cit. p. 50), and those by
Dr. Seymour, when he says, " I have examined ovaria in many in-
stances; many had ova (Graafian vesicles) ready for impregnation
large, projecting, vascular: yet no corpora lutea were visible." In
these subjects, the development of the vesicles had evidently suf-
fered only a very recent arrest, and yet the corpora lutea had be-
come so much diminished as to escape observation.
On the other hand, it cannot be doubted that the corpus luteum
of pregnancy does remain, throughout the period of gestation, too
bulky and remarkable an object to be very readily overlooked. This
is established by the testimony of many other observers, as well as
by that of the foregoing cases. Raeiborski,* indeed, not recogniz-
ing any difference between the two classes of yellow bodies, goes
so far as to deny positively that the corpus luteum is ever visible at
the termination of pregnancy. "We are," he says, "at a loss to
understand the grounds upon which most of the writers on midwifery
and legal medicine have laid down the presence of a corpus luteum
in the ovaries as the sign of a recent delivery. The process of
ovulation having been suppressed during the period of pregnancy,
the pretended corpora lutea, which are only different forms of the
anatomical marks of preceding ovulations, have had more than suf-
ficient time to become entirely effaced, and we never meet with
• Page 436.
78
PRIZE ESSAY.
anything more than feeble traces of them in women who die after
delivery."
The direct testimony, however, of many reliable authors, such, for
instance, as those quoted in Dr. Knox's table, is certainly not to be
outweighed by a sweeping assertion like the foregoing; particularly,
as many of the descriptions are accompanied with drawings. Mont-
gomery gives quite a number of coloured plates of the corpus luteum
at different periods of pregnancy; and states, with regard to the
time of its disappearance,* that he has met with it "distinctly visi-
ble so late as the fifth month after delivery." Dr. Lee, in his "Lec-
tures on Midwifery," already referred to, gives two wood-cuts of
corpora lutea; one of them in the second month of pregnancy, half
an inch in length, and the other in the fourth month, nearly seven-
eighths of an inch in length.
William Hunter, also, in his plates of the gravid human uterus,
gives two representations of the corpus luteum. One, at the begin-
ning of the fifth month, is three-quarters of an inch in length, and
nine-sixteenths in depth ; the other, at term, is nearly circular in
section and half an inch in diameter.
Fig. ]5.
Fi- 16.
William Hunter's plate of the human corpus
luteum, at the lx;ginningof the lil'ih monih.
William Hunter';* plate of the human corpus
luteum at term.
• Op. cit. p. 227.
CORPUS LUTEUM OF PREGNANCY. 79
The foregoing account of the corpus luteum of menstruation and
pregnancy must be considered as differing, to some extent, from all
the observations hitherto published. Sulficient, however, has al-
ready been said in a previous part of the treatise to show the dis-
crepancy which has existed among authors on the subject, and to
demonstrate the justice of Raciborski's remark, that " science has
so far possessed only vague ideas, or rather assertions altogether
false on the nature of the alterations which merit the name" of
corpora lutea. A memoir by Dr. Frank Renaud, however,* has
already been mentioned as containing much the best account of
these bodies heretofore published. That writer, nevertheless, does
not acknowledge the regular and periodical discharge of ova and
formation of corpora lutea ; consequently, those bodies which he
designates as " false corpora lutea" he does not regard as necessa-
rily connected with menstruation. "The theory," he says, " that
would indicate each menstrual period to be co-existent with the
secretion of a small yellow body in the ovaries requires facts much
more imperative than any yet advanced." He therefore thinks it
best to "receive with caution a theory that requires so much show
of ingenuity for its establishment."
Dr. R. also lays down one or two points of distinction between
"true and false" corpora lutea which it would be impossible to
admit, according to the observations in the present paper. He
states, for instance, that " the yellow secretion of the false corpus
luteum is contained within the inner ovisac ;" but that " true corpora
lutea are always to be found located between the proper tunics of
the Graafian follicles, or, in other words, between the two ovisacs."
In reality, the situation of the yellow matter in the two bodies is
the same ; it varies only in amount, and in some peculiarities of
intimate structure.
Another distinction of Dr. Renaud is that the true corpus luteum
is vascular, while the false is destitute of vessels, and cannot be in-
jected.
Reasons, however, have already been given for believing that the
distribution of vessels is the same in both bodies, though they are
certainly often more distinct to the eye in the " true corpus luteum,"
owing to the dull colour of the yellow matter and the greater depth
of its anfractuosities.
Neither does Dr. Renaud, in his memoir, give any such regular
• Edinburgh Monthly Journal of Med. Science, Aug. 1S45.
80 PRIZE ESSAY.
and detailed comparison of true and false corpora lutea as could be
called a demonstration of the difference between them. Indeed, it
was only by a reference to previous observations of my own that I
was enabled, on meeting with Dr. R.'s paper, to recognize its great
superiority, in point of accuracy, to the numerous other accounts,
whose conflicting statements have involved this subject in so much
confusion. How otherwise, indeed, could one ever be enabled to
discriminate in a case like this, where the facts are so obscure and
the opinions of authors so various? It is only by arranging a
detailed history of the corpus luteum, and by oiFering the proofs
together with the assertions, that we can ever expect to settle the
question in a manner satisfactory to the general reader.
PART III.
OBSERVATIONS ON ANIMALS.
It so frequently happens that a great deal of light is thrown upon
obscure portions of human physiology by parallel observations on
the lower animals, that it seems hardly excusable, in a question in-
volving much difficulty, to neglect so obvious a source of additional
information. Consequently, it has been thought best, in the present
instance, to extend our inquiries concerning the corpus luteum into
other classes of the mammalia. Among the best subjects for that
purpose are the cow and the sheep; not only on account of the com-
parative ease with which specimens can be obtained from healthy
subjects slaughtered for the market, but also from the circumstance
that, in a large proportion of these cases, the animal is found to be
more or less advanced in the early part of pregnancy. The writer
having also been favoured by chance in obtaining one or two speci-
mens from the cow at a much later period of gestation, it was thought
too good an opportunity for investigation to be lost ; and he has been
enabled, accordingly, to obtain a series of corpora lutea in their
different stages, which, though not quite complete, will not, it is
thought, be found entirely without value.
The frequency with which the periods of heat recur in these ani-
mals also affords an opportunity of examining an abundance of
corpora lutea unconnected with pregnancy. Indeed, among all the
cases in -which these observations Avere made during the months of
December and January, I never failed to discover these bodies in
the ovary except in a few instances, in which the animals were very
young, and ovulation had evidently not yet been fully established.
The exact periods at which the venereal excitement returns is not
very easily ascertained. The butchers and drovers vary a little in
their account of it; some stating the interval, in the cow, to be
about six weeks ; others about four weeks. In the sheep, during
cool weather, it is said to be even less than that. I am informed,
82 PRIZE ESSAY.
however, by Col. Jacques, of Medford, who has been for many years
an extensive breeder, that the cow, if kept from the bull, is at heat,
for twenty-four hours, as often as once in two or three weeks through-
out the year. With regard to the sheep, he is not so positive, but
thinks that the periods return about as frequently as in the cow.
For our present purposes, indeed, it is not necessary to ascertain
these intervals precisely. It is sufficient to know that they are very
short, in order to comprehend how rapidly the corpora lutea become
atrophied and disappear, unless their ordinary course of development
is modified by the occurrence of pregnancy.
OBSERVATION XIX.
A Graafian vesicle recently ruptured — Corpus luteum of the preceding ovula-
tion retrograde — Eight others quite obsolete.
I OBTAINED the uterus and ovaries of a healthy cow, slaughtered
for the market, December 12th, 1850. The uterus was empty, and
there was nothing of note discovered in the tubes.
One of the ovaries was of the usual size, and without any remark-
able appearance externally on a superficial examination. There
were quite a number of Graafian vesicles to be seen, not prominent,
but easily detected at various spots immediately underneath the
peritoneum. On close examination; an opening was discovered on
one of the lateral surfaces of the ovary leading into the interior of
a Graafian vesicle. The walls of the vesicle had collapsed at the
surface of the ovary, and the edges of the aperture having conse-
quently been brought in contact, the opening was not at first notice-
able. On distending the vesicle, however, with a blowpipe, it became
very distinct, of an oval form, with thin sharp edges, and a little
over one-sixteenth of an inch in length. (Fig. 17.) There was no
ragged or lacerated appearance, nor any unusual vascularity about
the rupture, nor any effusion of blood. The vesicle, cut open, was
quite empty, and its walls smooth, shining, and vascular as usual.
It was of a very moderate size — not over a quarter of an inch in
diameter — while very near it was another vesicle, unruptured, half
an inch in diameter. Except for the opening in its walls, the rup-
tured vesicle could not have been distinguished from any other.
OBSERVATIONS ON ANIMALS.
83
The opposite ovary had on its free edge a roundish yellow spot
where the fibrous tunic was wanting. There was no prominence at
this spot, but immediately underneath was a corpus luteum of con-
siderable size, but still evidently retrograde. This body was solid,
with a nearly circular section, five-eighths to three-quarters of an
inch in diameter, and showed very plainly the deep foldings of the
yellow walls, with a white cicatrix in the centre, from which a wavy
line proceeded to the exterior of the ovary indicating the situation
of the rupture. (Fig. 18.) The substance of the wall was softish,
of a bright stone-yellow colour. Its exterior presented a very thin
investing membrane, to which it was so closely adherent that it could
not be separated without tearing open the convolutions, and which
had, indeed, the appearance of a mere membranous surface. Ex-
ternal to this were numerous and dense laminae of cellular tissue.
Fig. 17.
Fig. 18.
Ovary of an unimpregnated cow ; i-how-
ing a reoently-rupf iired Graafian ves^i-
cle, as it appeared distended by the
blowpipe.
Corpus luteum of the unimprenmated cow
at the time of the rupture of the suc-
ceeding- vesicle.
There were also in the same ovary five superficial obsolete-look-
ing bodies, corresponding to coloured spots on the surface. The
largest was three-sixteenths of an inch deep, and of a dingy-yellow
colour, the others successively diminishing in size, and of a brick-
red tinge. They were all of a close, reticulated-looking texture, ■
and without any distinct investing membrane, but immediately con-
nected with the ovarian tissue, so that they could not be enucleated.
84 PRIZE ESSAY.
The larger still showed a whitish or transparent central cicatrix,
but the smaller presented no trace of it.
The other ovary also contained three similar bodies.
There were many Graafian vesicles to be seen, of moderate size
and slightly prominent on the surface.
OBSERVATION XX.
Ruptured Graafian vesicle in process of transformation into a corpus luteum.
A COW was slaughtered December 12th, 1850, of which the uterus
was empty.
One of the ovaries, an inch and a half in length, showed at one
extremity a circular spot, a quarter of an inch in diameter, where
the fibrous tunic was wanting. There was at this spot a slight
eminence, of a very pale yellowish tinge, hardly differing from that
of the rest of the ovary except just at its summit, where it was
deeply stained of a blood-red colour, and about its circumference,
where there was a bright circle of vascularity. The peritoneum
extended completely over its surface. (Plate III. Fig. 1, b.)
On the other extremity of the organ was the yellow protrusion of
a retrograde corpus luteum. This protrusion was of a light yellow
colour and of an oval form, measuring three-eighths of an inch in
its long diameter. The corpus luteum underneath could still be felt
through theovarian parietes. (Plate III. Fig. 1, a.)
On making a longitudinal incision, so directed as to pass through
the centre of each of these spots, a body was found, situated beneath
the first, three-eighths of an inch deep, and of a yellowish-white
colour, like fibrin, hardly differing in tint from the remainder of the
ovarian tissue. It contained a cavity, the proportionate size of which
is represented in Plate III. Fig. 2, b. This cavity communicated
by a wide passage with the exterior of the ovary, where, however,
it was closed by peritoneum, which had been reproduced over the
summit of the prominence. The cavity contained a little reddish
serum and a plug of fibrin, lying loose towards its deeper part, but
•adherent to the peritoneum where it extended over the top of the
passage. There was no lining membrane to the cavity^ but the plug
was in immediate contact with the foldings of the wall which pro-
OBSERVATIONS ON ANIMALS. 85
jected into tlie interior. These convolutions could be readily sepa-
rated and unfolded from the inside. Externally the wall was
adherent to a single thin vascular membrane, with which it could
be removed entire ; and beyond this were the usual irregular layers
of cellular tissue. The corpus luteum at the other extremity of the
ovary was a little over half an inch in depth, and of a bright yellow
colour, slightly tinged with orange. (Plate III. Fig. 2, a.) It was
solid, and of rather a firm consistency; its central cicatrix somewhat
indistinct, but its substance everywhere intersected by streaks of
dense cellular tissue, which appeared to have encroached upon the
. yellow matter. The substance of this corpus luteum had the same
relation to the external parts as in other cases ; only the adhesion
between its proper membrane and the outer layers of cellular tissue
was closer than in the earlier specimens, so that it could not readily be
enucleated. The outer layers were also particularly thick and dense.
The same ovary had on its surface two small brick-red spots, cor-
responding to obsolete corpora lutea of the same colour: the largest
an eighth of an inch deep. The other ovary contained six similar
bodies, the largest, which was yellowish in colour, one-quarter of
an inch in diameter; the others were red, and diminished successively
in size. Both ovaries showed several slightly prominent Graafian
vesicles, the largest three-eighths of an inch in diameter.
OBSERVATION XXI.
Corpus luteum of the cow at Its maximum of development — Eight othera
obsolete.
Uterus and ovaries of a cow slaughtered December 11th, 1850.
The uterus was empty.
One of the ovaries measured one inch and three-eighths in length.
On its free edge was a large yellowish eminence, of a rather firm
consistency, the summit of which was destitute of fibrous covering,
and had the aspect of a protruding fungous growth, invested only
by peritoneum, which allowed the yellow colour of the corpus luteum
to show through very distinctly. (Plate III. Fig. 3.) This fungous
protuberance was of an oval shape, and nearly three-fourths of an inch
in its long diameter. About its base, where the fibrous tunic of the
86 PRIZE ESSAY.
ovary terminated, vras a somewhat distinct constriction. Its centre
showed a distinct, radiated, white line. The sides of the eminence
towards its summit were covered with large red and purple vessels.
On a longitudinal section, the corpus luteum was seen to be of
very large size ; nearly one inch in its long diameter. It was solid,
with a distinct, central, whitish, radiated cicatrix, and strongly
marked convolutions. Its colour was yellowish, with an orange tint.
There were some minute red vessels, ramifying in the interstices of
the convolutions. (Plate III. Fig. 4.)
This corpus luteum had the same relations to the investing mem-
branes as in other cases, ^. e., it was covered externally by a single,
thin, transparent, vascular tunic, to which it was adherent, and out-
side of this membrane were several irregular layers of cellular tissue,
forming a nidus or receptacle for the body. The first membrane
penetrated all the sinuosities of the yellow matter, as the pia mater
penetrates between the convolutions of the brain, while the cellular
layers passed directly across them, in the manner of the arachnoid.
The ovary contained also Graafian vesicles of moderate size,
varying from three-sixteenths of an inch in diameter downward, and
four coloured spots on its surface, marking the situations of obsolete
corpora lutea. The largest of these latter bodies was a quarter of
an inch in depth, and of a yellowish colour. The others diminished
successively in size, and were of a brick-red tinge. They were
similar in texture to those already described in previous observations.
The opposite ovary contained four obsolete reddish-yellow bodies
superficially situated, and many Graafian vesicles, some of which
were moderately prominent; the largest half an inch in diameter.
Nothing else remarkable.
OBSERVATION XXII.
Corpus luteum of the cow, beginning to retrograde — Graafian vesicle in the
opposite ovary very prominent, and near the time of rupture — Eight obsolete
corpora lutea.
Uterus and ovaries of a cow slaughtered Dec. 5th, 1850. The
uterus contained several drachms of a clear, serous-looking fluid,
but no foetus nor any distinguishable ovum.
One of the ovaries was one inch and three-eighths in length.
OBSERVATIONS ON ANIMALS. 87
It was, for the most part, pale externally. Its surface showed some
slight sinuosities, and three small yellowish-red spots, the longest mea-
suring nearly one-eighth of an inch. There were also several trans-
lucent Graafian vesicles, situated immediately beneath the albugineous
tunic, but none so prominent as to distend the peritoneal coat. On
one of its lateral surfaces was a bulky, nipple-shaped protuberance,
of a yellowish colour, and firm, resisting feel. It was covered with
a few small red vessels, but the vascularity was much less pronounced
than in the preceding case. In other respects, it resembled that
last described, except for being considerably smaller. On the sides of
the protuberance the albugineous tunic was much thinned and nearly
transparent, and on the summit it was entirely wanting for a space
of rather more than three-eighths of an inch diameter, where the
surface was very yellow, and had a soft, velvety appearance. The
middle of the summit showed an indistinct, whitish, radiated line,
with small red vessels ramifying from it as a centre. (Plate III.
Fig. 5.)
This protuberance was formed by the projection of a corpus luteum,
which, on a section, was seen to be of an ovoid shape, three-quarters
of an inch in its longest diameter, and of a stone-yellow colour. It
was solid, with a central linear cicatrix, and numerous convolutions
visible throughout its substance. It showed no vessels except a few
occasionally penetrating the interstices between the convolutions.
There were none whatever in the substance of the yellow matter.
As in the cases already described, the yellow matter was closely ad-
herent to a thin, transparent, vascular investing membrane, and there
was no distinct membrane external to this; only irregular laminae of
cellular tissue. (Plate IV. Fig. 1.)
On cutting through the three reddish spots on the surface of the
ovary, there was found immediately beneath each a flattened solid
body, of a nearly brick-red colour, and appearing to the naked eye
composed of areolar tissue. The two larger were nearly three-six-
teenths of an inch in diameter ; the third was somewhat smaller. A
central cicatrix was easily distinguishable. They were tough, and
closely adherent to the adjacent ovarian tissue. They had no dis-
tinct investing membrane, and could not be enucleated from the ovary.
The opposite ovary contained numerous Graafian vesicles in active
development. One of them was exceedingly large and prominent,
nearly three-quarters of an inch in diameter, and protruding strongly
from the surface of the ovary. The tunics of the ovary were very
thin over the whole prominence, and at its summit seemed reduced
88
PRIZE ESSAY.
19.
merely to a layer of peritoneum. A few red vessels ramified over
the surface of the vesicle, which was
filled with a transparent, colourless,
albuminous fluid, holding in suspen-
sion minute whitish flakes and shreds.
The lining membrane of the vesicle
was smooth, transparent, and vascu-
lar, not at all folded or discoloured;
having, indeed, every way its usual
appearance.
The ovary had besides upon its sur-
face five small yellowish or red spots,
each of which corresponded to a flat-
tened reddish body, situated imme-
„ ^ . , , diately beneath, precisely like those
Uvary of aniinimpregnated cow; show- _ "^ ^ ''
ing a prominent Graafian vesicle. m the Other OVary.
OBSERVATION XXIII,
Corpus luteum of a cow about three and a half months pregoant.
This cow was slaughtered Dec. 7th, 1850. One of the uterine cor-
nua contained a foetus weighing a pound and a half. The eyelids of
the foetus were agglutinated. The skin was perfectly naked, and
covered with a fine vascular network.
The ovary corresponding to that horn of the uterus which con-
tained the foetus, presented on one of its lateral surfaces a yellowish
projection, similar to that described in Observation XXII., only not
quite so prominent. Its summit had the same softish, velvety ap-
pearance, Avith a central radiated white line. The substance of the
corpus luteum, however, felt through the ovarian walls, was not so
firm and resisting as in the preceding case, but softish, and even
gave to the fingers an indistinct sense of fluctuation. On making a
longitudinal incision, the corpus luteum was found to be very large,
measuring five-eighths of an inch in depth. It was solid like
the. others, and had a very evident white, radiated, central cicatrix.
Its substance was of a rich, soft, pulpy consistency, and its colour
was a deep orange yellow, very distinguishable from the pale stone-
OBSERVATIONS OS ANIMALS. 89
yellow of the preceding observation. Its relations to the investing
membrane, &c. were the same as in previous cases. (Plate IV., Fig. 2.)
Beside this body, the ovaries contained five obsolete bodies of a
brick-red colour and three of a dingy yellow, the situation of which
was marked by similar spots on the surface. The structure of these
obsolete bodies was the same as has been already described in pre-
vious cases.
There were no projecting Graafian vesicles in either ovary, but an
abundance of them, of moderate size, buried beneath the albugineous
tunic.
OBSERVATION XXIV.
Corpora lutea of cows, from five to six and a half montlis pregnant.
On the 20th of Dec. 1850, I obtained the uterine organs of three
cows which had been slaughtered Avithin a day or two.
The first uterus contained a well formed foetus that weighed a
little over five pounds. The ovary corresponding to the uterine
horn which enclosed the foetus, contained a corpus luteum, ovoid
in shape, of a softish, rich, pulpy consistency, and a deep orange-
yellow colour, and measuring seven-eighths of an inch in length, by
five-eighths in depth. Its section showed plenty of vessels in the
interstices of the convolutions. There was also some vascularity ex-
ternally, on the sides of the tumour.
The ovaries contained also three obsolete corpora lutea of a brick-
red colour, the largest of which was one-eighth of an inch in depth.
There were also several Graafian vesicles, slightly prominent, the
largest a little over a quarter of an inch in diameter.
The second uterus contained a foetus weighing a little less than
ten pounds. The ovary, corresponding to the pregnant horn of the
uteru", contained a corpus luteum of an ovoid shape, rather over
seven-eighths of an inch in length by three-quarters in depth. It
was soft and pulpy, and of a very strong orange-yellow colour.
There was no vascularity externally.
The ovary contained also three obsolete bodies, very small and of
a red colour, and several Graafian vesicles, one of which was slightly
prominent but the others nearly or quite concealed beneath the
ovarian integuments.
7
90
PRIZE ESSAY.
The other ovary was in an extremely inactive condition, though
natural in structure. It presented absolutely no obsolete corpora
lutea, and no Graafian vesicles at all prominent.
The third uterus contained a foetus weighing fifteen pounds. The
ovary corresponding to the pregnant horn presented a soft and pulpy
corpus luteum, measuring one inch in its long, and fifteen-sixteenths
of an inch in its short diameter, and of a deep orange-yellow colour.
There was no vascularity externally. The ovaries contained, beside,
only two obsolete red bodies. There were no prominent Graafian
vesicles, and only a few small ones superficially situated.
Fig. 20.
OBSERVATION XXV.
Corpus luteum of a cow about six and a half months pregnant.
The cow was killed on the 12th of December, 1850. The uterus
contained a foetus weighing sixteen
pounds. The eyelids were still ag-
glutinated, but could be separated
by gentle traction. Hair was just
beginning to show itself on the fore-
head, but the remainder of the skin
was quite naked.
The ovary corresponding to the
pregnant horn of the uterus was
one inch and five-eighths in length.
One end of it was occupied by a
yellowish tumour, on the summit of
which was a nearly circular spot
where the fibrous tunic was wanting,
and the yellow colour consequently
more distinct. The tumour was of
a rounded form and a softish con-
sistency. Its sides were pretty
abundantly covered with red and
purple vessels.
The section of this corpus luteum was solid, but its central cicatrix
was still easily recognizable. The body was of an ovoid shape and
measured one inch and one-eighth in its long diameter. Its sub-
Corpus luteum of a cow about six and a
half months pregnant.
OBSERVATIONS ON ANIMALS. 91
stance was of a strong orange colour, and presented in a high degree
the soft, rich, pulpy aspect, already observed as belonging to the
corpora lutea of pregnant cows. The structure of the body was the
same as in the preceding cases.
The ovaries contained also one obsolete corpus luteum of a red
colour, and five others of a yellowish tinge ; but the latter were all
exceedingly small and very faint. Nearly all the Graafian vesicles
were situated entirely underneath the albugineous tunic. None
observed prominent.
OBSERVATION XXVI.
Corpus luteum of a cow eight months pregnant.
A COW, belonging to Mr. Potter, of Cambridge, was found to be
sick on the morning of Friday, November 29th, 1850. She had
been covered by the bull in the early part of April in the same year,
and had been with young ever since. The animal appeared dull,
seemed to sufi'er from pain internally, and had some coolness of the
ears and horns. She rapidly grew worse, and on Sunday there was
much vomiting and swelling of the abdomen. She died on the after-
noon of Sunday, having a short time before expelled a calf that
weighed thirty-three pounds.
At the examination of the body, on the same day, there was found
very extensive peritonitis which appeared to radiate from a spot on
the surface of the "paunch," or first stomach, corresponding in situa-
tion to a similar spot of ecchymosis in the thickness of the abdominal
parietes. The animal had apparently received a blow in the abdo
men which gave rise to peritoneal inflammation.
The left horn of the uterus, moderately contracted, still contained
the greater part of the membranes belonging to the foetus which had
been expelled. The right horn contained a second foetus, dead, but
quite fresh looking, and well developed. Its weight was forty-two
and a half pounds.
The left ovary was one and a half inches in length. It had no
well marked cicatrices on its surface, but showed at one extremity
a slightly prominent Graafian vesicle, three-sixteenths of an inch in
diameter. There were also numerous others, much smaller, on the
lateral surfaces of the organ. On the free edge of the ovary there
92 PRIZE ESSAY.
was an abrupt prominence, a quarter of an incli in height and three-
eighths in length, of a faint orange-yellow colour. The peritoneum
was continuous over the whole of the tumour, and on its summit
there was a faint, whitish, radiated cicatrix. The base of the
tumour was somewhat constricted, and just at the line of constric-
tion, there existed some purplish vascularity.
On makinor a longitudinal section of the
''■ " ■ ovary, through the remains of the cicatrix,
the whole corpus luteum was exposed, and
the external projection was seen to form
only a small part of the entire body. It
measured nine-sixteenths of an inch in its
long, and three-eighths of an inch in its
short diameter. It consisted of a tolerably
firm, solid mass, of an ovoid shape, and of
an exceedingly rich orange-yellow colour,
which was uniform throughout. There
was no cavity anywhere, but about the
^^ ^ ,_ .u edges of the section might be seen the
Ovary of a cow, eight months o _ o _
pregnant ; showing the promi- marks of previous Compression and fold-
nent portion of a corpus lu- j^j . .^^^ ^ ^^[^^^ narrow, nearly straight
teum. PI • •
line ran irom the most projecting part, a
considerable distance into the interior of the body. The projecting
part appeared to have been folded doAvn toward the lower extremity
of the ovary, and confined in that position by the contraction of
the investing membranes. (PI. IV., Fig. 3.)
The substance of the corpus luteum was of a highly organized
appearance. No vessels, however, were to be seen in it, except
where they ramified in the furrows about its edge. Its relations
to the surrounding tissues were the same as in preceding cases.
The right ovary was one and three-quarter inches in length. Its
surface was like that of the other, showing one Graafian vesicle,
about one-fourth or three-sixteenths of an inch m diameter, and
many other smaller ones. On the free edge of the organ was an
orange-yellow spot like that on the left, only not projecting. The
corpus luteum which was situated beneath was entirely similar to
that in the left ovary, except in being somewhat larger, and in
having near its centre a small, narrow, white, radiated cicatrix,
from which a faint whitish line ran to the external surface of the
corpus luteum, on the free edge of the ovary. (Fig. 22.)
There were no other marks or spots observed on the surface of
the ovaries indicating corpora lutea.
OBSERVATIONS ON ANIMALS.
93
Ovary of a cow eight months pregnant.
It is evident, from the foregoing Fig. 22.
observations, that the formation of
the corpus luteum in the cow is very
similar to that whicli takes place in
the human female ; the diiference
between the two consisting only in
details, while the general plan re-
mains the" same. There is in the first
place, no yellow matter deposited, as
some writers have maintained, pre-
vious to the rupture of the vesicle ;
but, at the time when this occur-
rence takes place, the walls of the
vesicle are smooth and membranousj
presenting indeed altogether their
usual appearance.
Soon afterward, however, a growth
takes place from the inner surface of the cavity, and assumes the
same convoluted form as in the human species. In the cow, however,
this new growth is much more rapid and abundant. It soon com-
pletely fills and distends the cavity of the vesicle, and even sprouts
luxuriantly from its aperture, in the manner of a fungous growth ;
forming a very noticeable protuberance on the surface of the ovary.
The peritoneum is soon reproduced over this protuberance, and the
sides of the tumour are covered with vascularity. The substance of
the corpus luteum, which was at first of a pale undefined hue, like
recent lymph, has now acc[uired a strong yellow colour, and presents
a solid mass of an ovoid shape, with its centre occupied by a pale,
radiated cicatrix, the result of the closino- tofrether of the vesicular
parietes.
The corpus luteum seems to attain this condition in about two
weeks after the discharge of the ovum. After that period it follows
a retrograde course, which is characterized by the following changes.
The central cicatrix becomes more and more indistinct. The yellow
matter changes its colour to a dull yellowish-brown, and afterward
most commonly to a brick red ; though there is reason to believe
that the latter alteration does not invariably take place. At the
same time it contracts a more intimate adhesion with the neighbour-
ing parts, and its investing membrane becomes confounded with the
adjacent areolar tissue; so that at last it appears as a mere spot, or
islet, in the ovarian substance, presenting to the eye a reticulated
appearance, and incapable of being separated from the ovary as an
94 PRIZE ESSAY.
entire body. There are usually several of these obsolete bodies, of
different sizes, to be seen in the ovaries together, provided the ani-
mal is not pregnant ; their situations being indicated by small red
spots on the surface of the ovary.
The difference in aspect between the corpus luteum following an
ordinary ovulation, and that which accompanies pregnancy is not so
striking in the cow as in the human female. This is apparently
owing to two circumstances; first, that in the cow there "is, at the
time of the rupture of a vesicle, but little or no hemorrhage into its
cavity ; and secondly, that the groAvth of yellow matter which takes
place afterward, is so much more rapid and abundant. It will be
recollected that one of the most important distinctions between the
human corpus luteum of menstruation and that of pregnancy was
the thickness of its yellow wall, as compared with the central
coagulum; and since in the cow there is little or no central coagu-
lum, and since the yellow wall always becomes thick enough to fill
the cavity of the vesicle, the above distinction cannot be here
applied. Nevertheless, there is another equally important distinc-
tion which still remains applicable, viz., the longer duration of the
corpus luteum, when its growth is modified by the occurrence of
pregnancy. It has been demonstrated (Obs. XVI.) that, at the time
of the rupture of a vesicle, the corpus luteum of the preceding ovu-
lation has already become distinctly retrograde ; its colour conside-
rably lighter, and its size reduced. Before the new vesicle has as-
sumed entirely the appearance of a corpus luteum, the old yellow
body (Plate III., Fig. 2, a) has become still farther atrophied ; its
cavity entirely obliterated, its central cicatrix indistinct, and the
whole body reduced to not more than a quarter part the size which
it had at the period of its greatest development. (Plate III., Fig. 4.)
It appears, therefore, to be sufficiently well ascertained that, in this
animal, the corpus luteum ordinarily reaches its maximum of deve-
lopment in about two weeks after the rupture of the vesicle, and
that a period of three Aveeks longer reduces it to the condition of a
small, obsolete, yellowish or brick-red spot, without any investing
membrane, and not presenting any of the ordinary characteristic
appearances of a corpus luteum.
On the other hand it is certain, that if the rupture of a Graafian
vesicle is followed by pregnancy, the corpus luteum does not attain
its greatest size till about the middle of the seventh month (Obs.
XXIV. and XXV.); and that at the termination of the eighth month
(Obs. XXVI.) it is still of large size, and sometimes forms a very
remarkable prominence on the surface of the ovary. At the same
OBSERVATIONS ON ANIMALS. 95
time, the obsolete bodies which mark the situations of still older
ruptures gradually disappear from the ovary; so that, toward the
latter periods of gestation, the corpus luteum of the last rupture is
the only body of the kind to be found in the organ. In those cases,
however, in Avliich impregnation has not taken place, it is not at all
unfrequent to find beside the principal body, six, seven, or eight
others, in different stages of retrogression.
The substance of the corpus luteum of pregnancy, also, is always
of a soft, rich, pulpy consistency, and its colour a very deep orange-
yellow; while in the unimpregnated animal its texture is firmer, and
it presents an orange tinge only for a very short period of its exist-
ence; the colour being, for the most part, a very light stone-yellow.
Numerous observations on sheep have demonstrated the fact, that
a similar distinction exists in them between the corpus luteum of
ordinary ovulation and that of pregnancy. The rupture of the
vesicle in this animal, as in the cow, is unaccompanied by any con-
siderable hemorrhage, and the new growth is afterward produced
with a similar rapidity and luxuriance. Its colour is not by any
means so brilliant as in the cow, but is a dull yellowish white. After
the bodies become completely obsolete they present a dusky brownish
spot, without any tinge of red. In the retrograde corpus luteum of the
sheep, there is sometimes to be found a cavity containing a few drops
of clear fluid, and a lining of transparent lymph. This, however, is
only an occasional appearance, and seems to be owing, as in the
human subject, to the accidental closure of the mouth of the vesicle,
before the complete coalescence of the walls in its interior.
With these exceptions, the growth and atrophy of these bodies
follow nearly the same course as that which has already been de-
scribed. At the time of the rupture of a new vesicle, the old corpus
luteum, of a fortnight or three weeks previous, has become much
reduced in size, and considerably paler in hue; while the occurrence
of pregnancy causes it to remain for a long time nearly undiminished
in size, and unchanged in colour.
The microscopic appearances of the corpus luteum are nearly the
same in the cow and sheep; the only difference consisting in the
amount of oil present, which is quite abundant in the former, and
rather scanty in the latter; at least, until a late period of its develop-
ment. There are to be seen, in the substance of the convoluted
wall, an abundance of pale, roundish, or irregularly elongated cells,
faintly granulated, sometimes containing minute drops of oil, and
often, particularly in the early periods, circular or oval nuclei, with
nucleoli.
96
PRIZE ESSAY
Fis.23.
Cells from a corpus luteum of ihe cow,
at its maximum of development. (Obs.
21st.) Each division of the scale is
about .0004 of an inch.
Cells from the corpus luteum of a cow,
six months pregnant. (Obs. 24.)
Same scale.
The nuclei may sometimes be seen floating about the field, unpro-
vided with any cell-membrane. While the corpus luteum is in its
early stages, there is also a large quantity of the spindle-shaped
cells of areolar tissue in process of development, to be seen in inti-
mate connexion Avith the other elements.
As the corpus luteum grows older, the spindle-shaped cells are
less numerous, and the oil, which is evidently secreted by the larger
cells, becomes more and more abundant, as the latter are atrophied
and disappear. Finally, the whole field is occupied by globules of
oil, of various sizes, Avhile the cells are too few, or too indistinct to
attract the notice of the observer.
FiK. 25.
Fig. 26.
Cells from the corpus luteum of an unim-
pregnated ewe, in an early stage of its
development. Same scale.
Cells from the corpus luteum of an unim-
pregnated ewe, which was commencing
to become retrograde. Same scale.
APPEND IX.
Since the foregoing essay was written, and delivered to the Com-
mittee, I have met with the two following passages relative to the
corpus luteum, which contain the same or similar views with those
expressed in the present memoir. The first extract is from a work
by Drs. Kirkes and Baly, published in London, in 1848, and entitled
a '■^Supplement to the SecoJid Volume of 3Iiiller's Physiology.'' I am
indebted to Prof. 0. W. Holmes for calling my attention to the pas-
sage in question. It is as follows : — (page 55.)
" In the figures given by Sir E. Home and M. Bischofi" of corpora
lutea formed under these circumstances (without impregnation), it is
evident that the growth of the yellow substance has proceeded to
such an extent as to protrude from the orifices of the ruptured folli-
cles, after filling their cavities. These are certainly corpora lutea
which could not be distinguished from corresponding bodies of the
same stage of development in the ovaries of impregnated animals.
In the impregnated animal, however, the corpus luteum continues to
increase in size after the orifice in the follicle has closed ; and
whether this is the case in animals which are not impregnated is
doubtful. It is probable that if the ova have not been fecundated,
the state of orgasm of the ovaries and Graafian follicles, which arose
during the condition of heat, subsides, and that the corpora lutea
then, instead of continuing to grow, quickly shrivel and disappear."
" With regard to the human female," the author proceeds to re-
mark, " the limitations with Avhich the rule may be admitted are
greater," and, although he recognizes the fact that corpora lutea
formed in consequence of menstruation are, generally, smaller than
those following pregnancy, no other distinction between them is
mentioned, than their difi"erence in size. Even this is not considered
as altogether reliable, and the author comes accordingly, to the fol-
lowing conclusion. " If, in addition to the foregoing facts and con-
siderations, the varieties in size of the corpora lutea formed during
pregnancy are borne in mind, it will be seen that cases can seldom
occur where the mere presence of one of these bodies can be taken
98 APPENDIX.
as a proof of previous impregnation," (p, 56.) 'The writer, therefore,
does not admit entirely the difference of development in the human
corpora lutea of menstruation and pregnancy as forming a distinction
between them ; and he only considers it as " probable" that such a
distinction exists in animals.
The second extract, however, contains expressions more definite
and satisfactory. It is from Lonc/et's Physiology, Paris, 1850, vol.
ii. p. 88, De la Gdndration.
"At the same time," says Longet, "we must distinguish Uoo
kinds of corpora lutea ; those which result from the cicatrization of
a follicle, after the spontaneous expulsion of an ovum, without any
subsequent conception ; and those which are produced by the same
processes, after the expulsion of an ovum followed by conception and
especially by gestation. Those belonging to the first class rapidly
pass through their different stages, never attain a high degree of
development, are much inferior to the others in size, rapidly assume
the yellow coloration, fade again in a few days, and in the course
of one or two months became retracted and completely concealed in
the ovarian tissue. The second species of corpora lutea, participat-
ing in the congestion and functional activity, which are established
in all the sexual organs during gestation, attain a size sometimes
greater than that of the ovary itself, and pass so slowly through the
different stages of their development and atrophy, that they are
still perceptible at the termination of pregnancy ; they gradually
diminish in size, in proportion to the growth of the foetus, and the
approach of the end of gestation."
The above statements, by Longet, it will be seen correspond en-
tirely with those brought forward in the present essay. They are
given by him, however, altogether under the form of general deduc-
tions ; and the reader is not supplied with any series of observations
which would convince him of their reliability. It is in the foregoing
pages alone, so far as I am aware, that the difference of the two
species of corpora lutea has been absolutely demonstrated ; so that
the distinction between them no longer rests on bare assertion, but
on the evidence of recorded facts.
J. C. D.
EXPLANATION OF THE PLATES.
N. B. — All the drawings were taken from nature, and arc of the
natural size.
The figures in the first two plates are all taken from the human
subject.
PLATE I.
Fig. 1. Graafian vesicle, recently ruptured and filled with blood. (Obs. 1.)
Fig. 2. Ovary of a girl three weeks after menstruation ; showing the promi-
nence and vascularity over the corpus luteum. (Obs. 6.)
Fig. 3. The same ovary cut open; showing the corpus luteum of menstruation
three weeks old.
Fig. 4. Corpus luteum of menstruation four weeks old. (Obs. 9.)
Fig. 5. Corpus luteum of menstruation thirty days old. (Obs. 10.)
PLATE II.
Fig. 1. Corpus luteum of menstruation nine weeks old. (Obs. IL)
Fig. 2. Corpus luteum of pregnancy about the end of the second month.
(Obs. 12.)
Fig. 3. Corpus luteum of pregnancy about the termination of the fourth month.
(Obs. 13.)
Fig. 4. Ovary of a woman seven months pregnant; showing the prominence of
the corpus luteum. (Obs. 14.)
Fig. 5. The same ovary cut open.
PLATE III.
Fig. 1. Ovary of an unimpregnated cow. (Obs. 20.)
a. Old corpus luteum seen externally.
h. New corpus luteum seen externally.
Fig. 2. The same ovary cut open.
a. Old corpus luteum.
b. Ruptured Graafian vesicle in process of transformation into a
corpus luteum.
100 EXPLANATION OF THE PLATES.
Fig. 3. Corpus luteiim of the unimpregnated cow at its maximum of develop-
ment. External vie\Y. (Obs. 21.)
Fig. 4. Same as the above. Internal vievr.
Fig. 5. Corpus luteum of the unimpregnated cow beginning to retrograde.
External view. (Obs. 22.)
PLATE IV.
Fig. 1. Same as the above. Internal view.
Fig. 2. Corpus luteum of a cow about three and a half months pregnant.
(Obs. 23.)
Fig. 3. Corpus luteum of a cow eight months pregnant. (Obs. 26.)
Fig. 4. Corpus luteum of the unimpregnated ewe at its maximum of develop-
ment.
a. External view. )
b. Internal view.
Fig. 5. a. Ovary of an unimpregnated ewe ; showing the aperture of a recently-
ruptured Graafian vesicle, and the prominence of the last corpus
luteum.
b. The same ovary cut open ; showing the last corpus luteum.
Fig. 6. a. Ovary of a ewe, the uterus of which contained a foetus eight and a
half inches in length.
b. The same ovary cut open.
PI I
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PI. IV.
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