A contribution to the sectional anatomy of advanced extrauterine gestation / by D. Berry Hart and J.T. Carter.

  • Hart D. Berry (David Berry), 1851-1920.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: A contribution to the sectional anatomy of advanced extrauterine gestation / by D. Berry Hart and J.T. Carter. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    We have here what may he termed a slow displacement of the placenta. At first it lay in the Fallopian tube, but the growing ovum has slowly pushed it up (a i)rocess attended with blood extravasation) from pelvis to abdominal cavity, until at last its upper edge is about 10 inches from its original site. Part of this is due to growth of course. The uterus also has had its cervical portions elongated in the same way to 3 inches. These sections have an important bearing on the Classificaiion of extrauterine gestation. Much has been written, and little really demonstrated, on this point. The Tubal variety is undoubted; the Tubo-ovarian has also been demonstrated; but the Ovarian is a very doubtful form. The Subperitoneo-pelvic or Intra-liga- mentous variety of Dezeimeris, Tait, and Worth, is demon- strated in the second specimen, which also shows the ovary thinned out on the posterior lamina of the broad ligament. The presence of the ovarian structure in the cyst wall of an extra- uterine gestation has been brought forward as evidence of its being the Ovarian variety: it more probably shows that it is Sub- peritoneo-pelvic. The chief interest centres on the anatomical nature of abdominal gestation. The second case shows that this can be extra-peritoneal, a fact never hitherto demonstrated, although strongly contended for by Tait. We do not deny that we may have either a partial extra-peritoneal and intra-peritoneal variety, or an entirely intra-peritoneal variety, but we ask for actual proof of such. If it be urged that a purely intra-peritoneal form must exist because placenta has been found attached to the uterus and intestine, we answer that in the cadaver shown (Plate II.) the placenta has been attached to the portion of uterine wall where the peritoneum is stripped off; or it might have been attached to the other abdominal viscera, but yet carrying a layer of peritoneum before it, be still extra-peritoneal. We therefore hold that the following varieties have been demonstrated, viz.,—Tubal, Tubo-ovarian, Subperitoneo-pelvic, Sub- peritoneo-abdominal. An Abdominal variety, partly intra-peii- toneal and partly extra-peritoneal, is probable; a purely Intra- peritoneal variety has yet to be accurately demonstrated, and the same holds good as to the Ovarian variety. Hitherto we have always regarded the peritoneal cavity as the site specially chosen by extrauterine gestation for its develop- ment, but we must now more closely scrutinize such in the Hght of this and similar cases. We defer at present full consideration of the changes on the placenta, but give a brief account of the results so far. It has often been thought that the moot points in the structure of the placenta might be cleared up by an examination of the placenta in advanced extrauterine gestation. Here, it is argued, we have the peritoneum taking the position of the serotma of the