discovers in them some imperfection of form.
The resemblance is sometimes greatest to the
deciduous, and sometimes to the permanent
set. In the less perfect forms the crowns only
are developed, the roots being deficient. But
in most cases the intimate texture of the tooth
differs in no respect from the ordinary dental
structure.*

* This is illustrated by Plate 124. of Professor



585

Ovarian teeth are generally found associated
with portions of irregular-shaped bone, in
which they are often imbedded. They may,
however, be attached to the tegumentary lining
of the cyst walls, and more rarely they have
been found connected to portions of cartilage.

Bone. The bones found within ovarian
cysts differ from the ossified portions occa-
sionally observed in the cyst in this respect,
that, while the latter consist of merely
crystalline or amorphous aggregations of
earthy matter, the former, although irregular
in shape, yet exhibit a true osseous structure,
in which may be readily detected the usual
arrangement of concentric lamellae, Haversian
canals, lacunae and canaliculi. Such bones
often bear a sufficient resemblance to frag-
ments of jaws and vertebrae to admit of a
general comparison with those parts of the
skeleton ; but well-shaped and perfect bones
are not found, except in cysts of whose nature
and origin some doubts at least may be enter-
tained.

In fig. 397. are represented several of the
solid structures commonly found in an ovarian
cyst. A long coil of tangled hair, mixed
with lardaceous matter, is seen springing from
a portion of the cyst wall at a part which is
lined by common integument. Here many



Fig. 397




Ovarian cyst containing hair, loose fatty mattir, adi-
pose tissue, selxiceous glands, and hair follicles.
(After Cruveilhier.)

hair follicles are observed, some being empty,
and others containing short hairs. The parts

Owen's " Odontography," exhibiting the microscopic
structure of a tooth, from an ovarian cyst in my
collection. Five other teeth were contained in this
cyst, together with a portion of tegumental struc-
ture, subcutaneous fat, bone, and hair.



586



UTERUS AND ITS APPENDAGES.



of the cyst covered by integument are seen to
be elevated, and it is in the substance of and
beneath such elevations that the fatty tissue
and bones are usually found imbedded, whilst
the teeth have only their roots concealed, their
crowns projecting free above the surface.

Origin of the Solid Contents of Ovarian Cysts.
It has been conjectured that these are ex-
amples of the " foetus in fcetu," or that such
remains may be the product of an imperfect
ovarian conception. To the former of these
suppositions, viz., that such formations result
from a cohesion or intus-susception of two or
more germs, coincidently impregnated, but of
which one only has been perfectly developed,
it may be objected that this view fails altoge-
ther to explain the circumstance that their
formation occurs far more frequently in the
ovary than in any other part of the body ; nor
does it account for the fact that here a parti-
cular class of structures only is developed,
whilst in the case of penetration of germs one
within the other, various portions of a second
foetus, more or less completely formed, and by
no means limited to a certain class of struc-
tures, are found within the body of the first.

The explanation that these are examples of
extra-uterine gestation of the ovarian kind
is equally unsatisfactory ; for even if the pos-
sibility of such a form of gestation be ceded, the
fact alone that hair, teeth, and even bones, con-
tained in cysts of the kind under consideration,
are never found associated with the smallest
trace of the membranes peculiar to the ovum,
would be fatal to this view. But it can be shown
further that such structures are observed in
cases where previous impregnation was highly
improbable, as in the examples where they
were found in conjunction with a perfect
hymen*, or where it was impossible, as in the
case related by Dr. Baillie of a girl aged 12,
whose generative organs were still undeveloped,
but one of whose ovaries was filled with hair,
teeth, and fatty matter.

The two additional circumstances that there
is scarcely any portion of the body, such as
the subcutaneous tissue, the brain, lung, kid-
ney, bladder, and testis, in which similar struc-
tures have not been found, and that such
formations, though most commonly found in
the ovary, are yet not even limited to the fe-
male, but have been also observed in the male,
completes the catalogue of objections to the
argument, in whatever form it may be ad-
vanced, that these productions are in any way
the offsprings of a spermatic force newly ap-
plied to the organisms in which they are
formed.

The discovery of the fact that a tegumen-
tary structure forms the basis out of which
many of these products spring, appears to carry
us a step further towards comprehending the
mode in which some at least of the solid con-
tents of ovarian cysts are formed, by exhibiting
a connecting link between structures which
are elsewhere naturally associated, but it ob-
viously fails to satisfy any inquiry as to the

* Royal Coll. of Surg. Pathol. Collect, prep. No.
2625.



nature or quality of the cell-force which de-
termines the development of such products.

Fcetus, more or less perfect, contained in the
Ovary '(?) OvarianGcstation. Graviditas Ova-
ria. Few facts in physiology have been more
readily assumed without sufficient examina-
tion than that the foetus may be developed
within the proper structures of the ovary, and
so constitute a form of extra-uterine gestation.

So long as it was generally believed that the
coitus was the efficient cause of the escape of
the ovum from the ovary, and that therefore
the act of impregnation preceded that of ovu-
lation, there was nothing in such a belief to
challenge inquiry as to the probability of the
ovum being first impregnated, and still by some
mischance detained within the proper struc-
ture of the ovary, where it might become de-
veloped. But more accurate views of the
nature of ovulation and of the true seat of
impregnation have led to a stricter inquiry
regarding the seat of supposed ovarian gesta-
tion.

Among the earliest to call in question the
accepted views upon this subject was M. Vel-
peau, who, previously a believer in ovarian
gestation, laid before the Philomathic Society,
in 1825, four examples supposed to be of this
kind. An expression of doubts as to the pos-
sibility of this fact on the part .of many mem-
bers led to a more perfect dissection of the
parts, in which examination MM. Blainville
and Serres were appointed to assist. It was
ascertained with certainty that three of the
tumours were external to the ovary. With
the fourth more difficulty was experienced ; but
at length, after isolating the Fallopian tube,
which was sound, the detritus of conception
was found to occupy a special sac between the
peritoneal and proper coat of the ovary, which
was entirely distinct.

In the following year, M. Geoffrey St.
Hilares, in a report upon the subject of Bres-
chet's Memoir upon " Interstitial " Extra-
Uterine Gestation, expressed his entire disbe-
lief in the ovarian variety, and the same views
have been advocated by M. Pouchet in his
work on Spontaneous Ovulation, and in this
Cyclopaedia by Dr. Allen Thomson *, who
has there stated the general objections to the
doctrine of an ovarian form of gestation.

The cases which appear to favour the belief
in ovarian gestation may be divided into two
classes, viz., those in which the embryo is yet
small, and is contained in a sac of mode-
rate size, which has not yet contracted adhe-
sion with adjacent parts ; and those in which
the foetus has attained or approached to full
growth, and the sac by which it is surrounded
has already contracted adhesions.

All the examples that I have had the oppor-
tunity of dissecting, or of seeing examined,
have been of the latter class, and of these it
may at once be said that nothing can be
learned from them which could determine,
with any degree of accuracy, so difficult a ques-
tion as that under consideration.

* Vol. ii. p. 456.



OVARY (ABNORMAL ANATOMY).



The impediments to such determination
which recur again and again in these cases are
the following. It is easily ascertained that
the sac containing the foetus is external to the
cavity of the uterus, and is in some way or
other connected with some portion of the in-
ternal generative organs ; the Faliopran tube,
ovary, and broad ligament of one side being
chiefly involved in the tumour, while the cor-
responding parts of the other side may remain
free. Dissection may serve to unravel these
parts to a certain distance, beyond which
nothing satisfactory can be determined, on ac-
count of the alteration which the tissues have
undergone both in form and arrangement ;
the hypertrophy of some, and the wasting or
blending together of others, rendering further
research fruitless for the object in view.

To these impediments, other and still greater
difficulties are generally superadded. These
arise from the death of the foetus, which often
takes place several months or even years pre-
vious to that of the mother. In the decom-
position which follows, the harder parts of the
contents of the sac fall asunder, and make
their way by fistulous openings into surround-
ing viscera, whose surfaces inflame and give
rise to serous and fibrinous effusion, while in
the few 7 hours which succeed to the final de-
struction, the parts decompose so rapidly that
the post-mortem examination, however early
it may be made, often reveals nothing but a
semi-putrid mass perfectly unsuited to the de-
termination of a difficult anatomical question.

For this purpose the cases of the former
class can alone suffice. Here the parts are
small, and as yet comparatively unchanged, and
admitting of dissection. The results of four
such examinations have just been given. The
following additional examples, which are se-
lected from the best recorded cases supposed
to be ovarian, will suffice to exhibit the class
of evidence upon which a belief in this species
of gestation is demanded.

Cruveilhier* has described and figured a
case in which the entire skeleton of a four
months' foetus f is seen hanging external to a
sac, occupying the seat of the right ovar} 1 , in
which it is supposed to have been once con-
tained. The sac said to be in the inner and
lower pan of the ovary is lined by a serous
membrane. The two external thirds of the
pouch were filled by a spongy areolar yellowish-
white mass presenting all the characters of
placental tissue. The outer half of the sur-
face of the ovary was enveloped in a cartila-
ginous shell. No attempt appears to have
been made to trace the entire outline of the-
ovarian tunics, or to show the condition of
the ovarian ligament, or of the Fallopian tube
of the same side. The latter, indeed, is not
mentioned, but from the representation of the
parts it appears to be blended with the cyst,
.so that this is quite as likely to have been
an example of tubal, or ovario-tubal, as of

* Anat. Pathol. livr. xxxvi. pi. vi.

f Said in the description to be between one and a
half and two months, at which time, however, no
such complete skeleton is ever seen.



587

ovarian gestation. The fact also that the cyst
had apparently burst and permitted the escape
of the foetus when it had attained the size
which is seldom exceeded in tubal cases, lends
additional probability to this view.

Dr. Granville * has published a case, accom-
panied by drawings, which he regards as an
" undisputed case of purely ovarian foetiferous
ovum." The uterus is considerably enlarged,
but empty. " The left ovariura presented a
large swelling which contained within its own
covering an ovum bearing a foetus with all its
appendages, of about four months' growth.
The ovarian covering burst in three places, and
allowed the protrusion of the ovum, whereby
the adhesion of the placenta to the inner sur-
face of the ovarian envelope was torn asunder,"
causing death by haemorrhage. A blood-ves-
sel, the size of a large crow-quill, which pene-
trated the dense portion of the tumour, was
ascertained to be a branch of the left sper-
matic artery, and a smaller and much shorter
vessel, arising from the tumour, was found to
communicate with the spermatic veins. " The
corresponding Fallopian tube was perfectly
sound and loose, particularly at its fimbriated
extremity, which had no connection whatever
with the embryoferous tumour in its neigh-
bourhood. Like its fellow tube, it was psr-
vious only from its loose extremity inwards to
about half its length. " A placental mass with
distinct cotyledonous vesicles connects the child
with the inner covering of the ovarian cyst.
The secreting or transparent involucra are
quite distinct. The cortex ovi is almost wholly
absorbed, as it ought to be at such an advanced
period. The foetus is perfect." In the expla-
nation of the plates mention is made of" frag-
ments of the corpus luteum which surrounded
the ovum, and was broken to pieces by the
enlargement of the foetus. Some of these
fragments adhere to the inside of the ovarian
coats, others are among the placental cotyle-
dons." No account is given of the ligament
of the ovary, nor of such a dissection of the
parts having been undertaken as would satis-
factorily prove that the sac containing the
foetus was not a cyst attached to the ovary.
But the evidence in favour of ovarian gesta-
tion consists chiefly in this, that the foetus-
bearing cyst occupied the region of the ovary,
and was independent of the Fallopian tube.
Nevertheless this case constitutes the nearest
approach to the form of gestation which it
claims to represent with which I am acquainted.

In the same work (Graphic Illustrations f)
is contained a description and representation
of a second case termed " ovum foecundum in
receptaculo ovarico." " Through a transversal
aperture in the left ovarium are seen the re-
mains of some membranes, three in number
at the least, lining a cavity which measures
transversely one inch and a quarter, and about
an inch vertically." The preparation belonged
to Sir C. M. Clarke, who assured Dr. Gran-
ville " that a small embryo hung pendulous

* Phil. Trans. 1820, and Graphic Illustrations of
Abortion, Plates X, A, and B.
t P. 27. pi. viii.



588



UTERUS AND ITS APPENDAGES.



from the yet visible rudiment of an umbilical
cord. That embryo, however, is not now to
be seen." The female from whom this was
taken was unmarried, but acknowledged her-
self to be pregnant. The uterus was larger
than in the unimpregnated state. The Fallo-
pian tube was not in the least involved in the
enlargement. The fimbriae were free.

A case which, in the opinion of Dr. Camp-
bell *, " in so far as anatomical accuracy is
concerned, ought to satisfy those who are
still sceptical regarding the reality of ovarian
gestation," is recorded in the Transactions of
the College of Physicians. f From the descrip-
tion and drawing which accompanies it the
following chief particulars are learned. The
uterus, from a woman aged 30 who had com-
mitted suicide, was larger than the ungravid
organ ; its body somewhat globular ; its sub-
stance, except the cervix, spongy. A decidua
nearly \" thick, soft, pulpy, and of yellowish-
white appearance, lined the interior of the
uterine body. The cervix was filled with
gelatinous matter, but not sealed up. The
vessels of the broad ligament and appendages
were remarkably distended ; on the posterior
part of the left ovary, which was considerably
larger than the right, was a round prominence
distinct from the general fulness. The tunics
of the ovary at this point were numerously
furnished with tortuous blood-vessels; and
from careful examination it was clear that
there had not been any aperture in the exter-
nal membrane ; its surface was perfectly
smooth. On dividing the membrane which
covered this prominence, a distinct cyst was
exposed, which contained an ovum. The in-
ternal surface of this cyst was smooth and
polished, its external firmly adherent to the
substance of the ovary. The ovum was sim-
ply in contact with the cyst in two-thirds of
its circumference ; in the remaining third it
was united to it so closely as to be inseparable.
The chorion and amnion were perfectly dis-
tinct, and by the aid of a magnifying glass,
vessels filled with blood were seen ramifying
on the former. A yellowish honey-like mat-
ter filled the amnion, but the embryo could
not be distinguished. Around the ovum for
some distance the ovary was loaded with blood
effused into its substance.

Except for the statement regarding the de-
cidua there is nothing in this account which
would be considered significant of pregnancy
at the present time when a more perfect
knowledge has been obtained of the various
conditions of the ovary in health and disease.
Changing the names employed to designate ..
the cysts, this description would apply either
to a follicle preparing to burst J, or to an in-
cipient stage of cyst formation. To the lat-
ter it approximates more nearly. The smooth
and polished inner surface of the containing
cyst ; the union, " so close as to be insepa-
rable," of the cyst termed the ovum by a third

* Memoir on Extra-Uterine Gestation, p. 33.
t Vol. vi. p. 414. 1820.
j See ante, p. 557.



of its base to the larger one ; the presence of
a honey-like matter filling this inner cyst,
which is represented in the engraving as not
larger than a pea, and the vessels ramifying on
the cyst wall, are all conditions commonly ob-
served in early stages of the morbid follicle.

On the other hand, the following are among
the conditions which oppose the conclusion,
that the ovary was in this case the seat of im-
pregnation, viz., the absence of all trace of an
embryo ; the so-called chorion, entirely want-
ing villi, which, in all known cases of the early
ovum, more or less cover its surface ; the firm
adhesion by a third of its circumference, at a
time when the ovum naturally lies free and unat-
tached even by any part of its little flocculent
villous coat ; the impossibility of accounting
for chorion-vessels, without an embryo to form
them, and still more of explaining how the
seminal fluid could reach the ovum through a
membrane which is described as " perfectly
smooth," and in which, " from careful exami-
nation, it was perfectly clear that there had
not been any aperture ; " the absence of all
mention or representation of any of those
conditions of the walls of the ripe follicles
which in an earlier part of this article have
been shown to be always present in the fol-
licle preparing for or soon after rupture, and
which must have been present in some degree
if this had been a Graafian vesicle containing
an impregnated ovum. These together con-
stitute insuperable objections to this case being
received as one decisive of impregnation in
the ovary, and justify its being regarded rather
as an example of cystic formation, which, ac-
cording to the engraved representation of the
parts, it very accurately resembles ; notwith-
standing that the description of the uterus
and decidua would give a strong bias and in-
deed wish to receive this as a case in which
impregnation had obtained, if the state of the
parts found in the ovary had corresponded
with what is now known to be characteristic
of the structures formed in the earliest stages
of pregnancy.*

* I am enabled to add in a note the following
particulars relating to two of the four cases quoted
above as examples of supposed ovarian gestation,
and of which it may be remarked that neither are
of recent date, the one having occurred thirty-eight
years ago, and the other at least as early* at a
time, therefore, when ovarian gestation had not
been questioned, and the ovarian ovum in man
had not yet been discovered. The preparation, de-
scribed and figured by Dr. Granville as belonging
to the late Sir C. M. Clarke, is now in the possession
of Mr. Stone, by whose kindness a more particular
examination of it has been permitted. For this
purpose, the preparation was recently placed in the
hands of Professor Owen, by whom it was removed
from the bottle, and minutely examined under spirit.
At this investigation, I was also present, together
with Mr. Stone and Dr. John Clarke, and I had the
opportunity of making repeated microscopic exami-
nations of every portion of the ovarian structures.
The result of "the investigation showed that the
structure supposed to be an impregnated ovum con-
tained in the ovary, although it had such a general
appearance as might without this examination have
borne the interpretation which had been originally
put upon it, was nothing else than an ordinary ova-



OVARY (ABNORMAL ANATOMY).



It is not necessary to multiply these ex-
amples, for no additional points of evidence
could be produced which are not contained
in the foregoing cases. They have been
selected from instances related or quoted by
various authors who have been strongest in
their advocacy of the doctrine of ~H strict
ovarian gestation, and they serve to exhibit
the kind of evidence upon which that doctrine
is founded. All the cases which have been
employed to support this view* will be found
on examination to belong to one or other of
the following divisions :

1. Cases of cysts without any embryo, and
in which some supposed resemblance has been
traced between the cyst walls and foetal mem-
branes, without any conclusive evidence of the
presence of these structures being given.

riau cvst. The walls of the sac showed no separa-
tion into distinct membranes, and no trace whatever
of the structures characteristic of either chorion,
chorion-villi, amnion, or decidua could be discovered
in them.

The outer surface of the cyst was so firmly ad-
herent to the surrounding ovarian stroma that it
could only be separated from it by considerable
traction. "The connecting medium was the common
stroma of the ovary. The walls of the cyst, when
Y>ortions were examined by transmitted light, ex-
hibited the arrangement of vessels peculiar to ova-
rian cysts. The little slender depending fragment,
supposed to be a rudimental umbilical cord, and
very faithfully represented by Dr. Granville in Plate
VIII. of the work quoted in the text, proved to be
a narrow flap of the same cyst wall which had been
left hanging from the edge "of the sac where a por-
tion had evidently been originally cut away in order
more fully to display the preparation (the sharp
edge left here by the knife or scissors being very
distinctly seen). Upon transverse section of this
little fragment, no trace of umbilical vessels could
be found in it. '

It should be observed that Sir Charles Clarke
never published an account of this case.

The additional particulars which I am enabled to
give with regard to the last of the four cases quoted
in the text, and described in the Transactions of the
Royal College of Physicians for 1820, are of another
kind. That this preparation was formerly preserved
in the anatomical museum of St. Bartholomew's
Hospital, where the author of the case was also the
lecturer on anatomy, can scarcely be doubted, from
the description, exactly according with it, which
appears in the first edition of the Catalogue drawn
up by Mr. Stanley. (See Description of the Pre-
parations contained in the Museum of St. Bartho-
lomew's Hospital, 1831. Edited by Edward Stanley,
Esq. Preparation 64, series xx. p. 27.) This pre-
paration is no longer contained in the museum ; and
by those who are most likely to be informed upon
the subject, it is not known to be in existence. The
only clue that I can obtain as to its fate is derived
from Mr. Paget, who informs me that, as a step pre-
liminary to the formation of the new catalogue,
printed in two volumes in 1846-51, the entire ana-
tomical collection was carefully reexamined; and
that those preparations which" were found, upon
such examination, not to bear out the descriptions
given of them in the catalogue, or which did not
serve to illustrate any point of interest, were put
aside and condemned. There is, therefore, every
probability that this preparation, which can now
no longer be appealed to in support of the possibility
of ovarian gestation, has been subjected to a similar
ordeal to the former, and with a like result.



589

2. Cases of dermoid cysts containing fat,
hair, teeth, and bones, the nature and origin