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    Atlas of obstetrics and gynaecology Atlas of obstetrics and gynaecology Document Transcript

    • 17 PREFACE TO THE FIRST EDITION. The numerous works on Midwifery, deal, with few exceptions, besides illustrain the normal state, almost exclusively illustrated and the female genital organs with the development of the ovum and the uterus tions of the pelvis foetus, the obstetric Not only are instruments, and the during' pregnancy, the positions of the operative manoeuvres required and of the the illustrations of the foetal positions, frequently diagrammatic, and obtained by placing the phantom or in its Obstetrics. most in various positions in a but the works themselves afford an insufficient insight into those pelvis, knowledge of the gynoecologist. conditions necessary to complete the be considered dummy in obstetric operations Midwifery must natural relation to the conditions of the other female sexual functions, and pathological changes which occur in the sexual Thus the scientific methods of study require it, and rebel more and more against the continued reign of the obstetric method. The practice which had long ago forced itself upon the obstetrician, also required a knowledge of the so-called diseases of women. and to the various physiological organs, and consequently On in its relation to gynoecology. these grounds, then, that the pathological and physiological conditions sexual organs should be represented in the various phases of their functions, the of the publishers for an atlas of obstetrics often felt the want of an the lecture, at a is useful been anxious to place my lectures. physician, it is in my I had annual course of A mere passing glance so I had long of drawings to illustrate insufficient. lecture leaves behind no fixed impression. the hands of my hearers a collection But such a collection of illustrations who does me, especially as exhibition of enlarged illustrations or of preparations during and even indispensable, but diagram during a to illustrated description of these subjects in The lectures since 1S38. was very pleasing of the demand is And also of great value to the practising not see gynoecological cases every day, and who seldom has the One look opportunity to study the organic changes seen at post-mortem examinations. at an exact and dearly to his has no time. ful faithful drawing, presents the anatomical condition of the parts more mind than far-fetched deductions for the elaboration of which he frequently It moreover starts fresh ideas for future diagnosis and treatment of doubt- individual cases. The and practitioners an illus- restricted to enable the work execution, of the undertaking, to present to students trated guide to obstetrics and gynoecology, was necessarily to be placed within the reach of a sufficiently large circle of readers. In the first place, the number of illustrations must not be too large. and because diagrammatic drawings only illustrate individual G0a49? On this account, views and not the actual
    • Preface. vi condition, I reduced their number a minimum, retaining those only which seemed to I class as diagramhand. indispensable, and of which original drawings were not at the child in the pelvis matic illustrations the majority of illustrations of the positions of are for the most during labour, which are given in various obstetric works, and which dummy in various positions in a phantom or pelvis. In part constructed by placing a which the child might present this way it is possible to imagine 96 or more positions in and student My On not exhaust the infinite variety of nature. still burdened with diagrams, and is whom teacher, Fr. C. Naegele, judgment his the other hand, the prejudiced by is shall never forg-et, I memory of the artificial theories. used frequently to condemn these fancy illustrations drawn with pedantic precision, and to place the unbiassed observation of nature above many a learned text-book. After this, I should have thought it hardly possible at the present time, that dominal we should set up so many, thoracic, shoulder, or abwhich, presentations with sub-classes, phantom, although observation in addition to the he has learnt, The may be demonstrated on a which hardly ever come under acrobatic tricks of this kind are resorted childbed, in some it a question is cases, if the student, if to, the who goes wrong when things do not correspond with the theory not to be condemned. illustrations of operative cause they tend true, not to be deplored, or, in is technicalities, is is compilation of fixed rules of action pedantry of the teachers trammelled by When woman. the living in it not without violent distortions, but to narrow the proceedings are equally injurious in my opinion, be- Such operative manoeuvres should student's self-reliance. be taught on the phantom, and where possible the reasons for which they are performed, explained, because only he them out artificial justly appreciates the reasons for The mere looking manoeuvres can carry at such illustrations the state. I who alone in the present condition of science should be tolerated have therefore omitted operative demonstrations, which, after all only represent individual ideas, and never obtain universal recognition. reason which caused me necessary drawings, I the various illustrations, my own The wishes; number of to limit the the illustrations I exclude would have made the work too expensive. have endeavoured to retain those all in some cases, however, he has, contrary concave mirror knowledge, from hypercritics un- In selecting which have best corresponded lithographer, Herr A. Schiiltze, has in general taken pains to carry out to the stone, exactly reproduce the position of the originals. my to observations on the living as well as the dead subject. illustrations with the to and all, For the same have limited the number of coloured plates and have copied existing plates, as original plates with drawn from demonstrations on a phantom, can at the best but produce rule-of-thumb, not reasoning operators, by who a competent manner. in may this; Lastly, as regards the subjects which I but I thought not wrongly blame have kept me for my it years in my so that No desire, my not transferred the several drawings do not important mistake has resulted, duty to mention it here, in order that it. arrangement of the to for to my plates, I have followed the same course of lectures on gynoecology, and which is fully
    • Preface. vii view on page I have begun with the anatomy of the pelvis ff. and female sexual organs; then follow the development of the ovum, and the maternal genitals during pregnancy. These are succeeded by the pathological changes in the set forth in the tabular l, external genitals, the vagina, the uterus, the Fallopian tubes, the ovaries, coats, the placenta, the foetus and its position, the pelvis as the ovarian, an obstruction to labour and gynoecological instruments, which had, against my wish, to be confined almost exclusively to those used by myself. Here and there deviations have occurred from the general arrangement, caused by the imperaThey do not, however, interfere with the compretive and careful utilization of space. and concluded by a short description of obstetric hension of the original plan by the intelligent reader. I hope this compendium of illustrated gynoecology will by students and physicians, and that it may advance meet with a kind reception the study of that department of medicine which, although so important and necessary to the lives and health of individuals, as well as for the happiness of families, state, and consequently does not yet enjoy that general recognition which it for the good of the can and must claim. DR. ED. MARTIN. Berlin, August Sih, iS6i.
    • PREFACE TO THE SECOND EDITION. The first already edition of the Hand-atlas commenced a new the subject. If I edition have only personal matters to delay the fresh material which it, just was out of print before my completed my task, is it I had knowledge on father's death, but which should be abreast of the latest not because I have allowed but on account of the necessity of a thorough revision of had accumulated with the advance of our profession during the last few years. In the new edition I endeavoured, in the drawings by original ones when possible. of the diagrammatic drawings because At the same time it was it I first was impossible to procure trustworthy originals. many interest of the atlas that as to the diagrammatic instance, to replace the have, however, been obliged to retain some as possible of the original stones should be retained, lest the expenses of publishing, which greater, should have been so raised as to render the circle. It is modern have I for this reason that In addition to first new were already less accessible to a larger of the old drawings have been retained, of which Only where the originals exist. suppressed the many work latter were essential to a proper comprehension without any regard for the occasional use of the old stones. illustrations, my father had already collected a number of original drawings from preparations which he had obtained in the hospital clinic, or in private Besides these, I have been allowed the use of many old and recent drawings practice. by Carl Ruge in the clinic, and I wish here to thank Professor Schroder for the ready assent he gave to this. I also tender my best thanks to my honoured friend Carl Ruge himself for the friendly, and professional, and artistic advice, as well as for the assiduous grew weary of rendering me in designing fresh drawings, and own collection, or from other sources. I have, of course, taken many drawings from many modern text-books, especially those of Spiegelberg and Schroder, from the "Archives of Gynaecology" and from the various periodicals. To assistance which he never selecting others from his Herr Geheimrath Winckel of Dresden, and Herr Dr. G. Leopold of Leipzig, I am especially indebted for the great kindness with which they placed the valuable originals of their latest publications, some of them while still in the press, at my disposal. I have made extensive use of Braune's "Illustrations of Sections from Frozen Bodies," Hyrtl's "Atlas on the Results of Corrosion-anatomy" Virchow's "Tumours" and others. so I have, in the new edition, And increased and improved the topographical drawings of the genitals in the various stages of their development, as well as the microscopical illustrations of their physiological and pathological conditions. The plates illustratino- the pelvic conditions have received an important addition in the collection of stereo- scopico-photographic illustrations of selected specimens from the rich collection of
    • Preface. the Berlin clinic, wlnich made I to reproduce Had year 1872. in the should have been forced to reject ix many not been for the fact that it useful old drawing's to do so, I the pelvic illustrations, especially as in most cases their history all I should have liked was available. Another difficult should be illustrated. me has induced to a was whether or The experience that even not instruments generally, and which, question to retain them. complete armamentarium. It a limited selection was useful in practice was, of course, impossible to furnish even an approach This alone would require a larg-e only given those which have proved useful and trustworthy in atlas. I have therefore our hospital and private and take this opportunity of saying that I by no means criticise by this selection any other instruments. As regards the obstetric instruments, the selection was simple enough, but the gynaecological instruments were not so easily chosen, because every practice, gynaecologist uses different instruments in his daily preference for certain instruments is practice, very prevalent. only to give those which appear to have been I and because individual have, therefore, endeavoured more generally adopted. arranging old and new drawings together, sometimes on the same not always possible to place each in its right place. I must apologise for In ground of insuperable father, although I difficulty. As suppress this by the conviction that naturally as it a rule I have not annexed his schema have adhered to the new to the plate, this it was on the my order adopted by edition. I was induced to we are not able to carry out such a combination as might appear, on account of the great advance and development in midwifery as well as gynaecology. In the place of the schema, therefore, I have inserted a detailed index. cannot refrain from specially acknowledging the perseverance and great pains taken by the artist, Herr A. Schiiltze, in the difficult task of drawing the illustrations Lastly, I and the willingness he displayed in giving effect to my wishes, and those of the pub- lishers. May the atlas in its new form enjoy the same favour it received on its first appearance. A. Berlin, March, 1878. MARTIN.
    • PREFACE TO THE ENGLISH EDITION. When asked to the request number to undertake the translation of Martin's Obstetric Atlas, made of students to me, because I and practitioners I have ventured Women, which I to add several work would be welcome to a large who are unfamiliar with the German language, and in English. illustrations thought might be useful. of the obstetric instruments most readily acceded believed the because no exactly similar work existed of I I from my father's work on the Diseases have also inserted illustrations of some commonly used in this country. FANCOURT BARNES. London, ^Kw, iS8o.
    • CONTENTS OF PLATES. PLATE Fig. I. „ 2. Female pelvis with its I. lig-aments seen from above. throug-h the pelvis to shew the inclination A perpendicular section and median line of the pelvis. ,, 3. ,, 4. View of the right sacro-iliac articulation from behind. The right sacro-iliac symphysis laid open from above. PLATE Fig. ,, ,, ,, pelvis from below. pelvis from above. 3. Transverse section through the symphysis pubis in 4. Transverse section through the symphysis pubis in I. 2. Female Female PLATE Fig. I. „ 2. ,, 3. ,, 4. I. ,, 2. „ 3. ,, 4. Bartholini's „ 3. I. 2. VI. Section of the abdominal cavity of a middle-aged multipara. Section of the pelvis with distended bladder and urethra. Section through the abdomen of a normally-formed woman, bladder empty, the rectum full. PLATE ,, V. glands. PLATE I. IV. External female genital organs. Outlet of the pelvis after removal of the integument. The vulva with the openings of the ducts of the glands. Fig. 2. Posterior wall of the pelvis. month of pregnancy. PLATE „ in. Anterior wall of the pelvis from within. Perpendicular section through the female pelvis. PLATE Fig. advanced pregnancy. advanced pregnancy. Second aperture of the female pelvis, or the so-called largest diameter. Third aperture, the so-called smallest aperture of the pelvis. Fig. I. Pelvis with the soft parts. „ 2. Position of the viscera at the sixth Fig. IL aged 35, with the VII. Perpendicular section of the viscera of the female pelvis. View of the female pelvic viscera from above. 62
    • Contents of Plates. xii PLATE Fig. VIII. Dissection of vagina, uterus, Fallopian tubes, uterine ligaments and ovaries. Well-developed uterus of a foetus at term. the uterus of a mature foetus. 3. Perpendicular transverse section of 4. Perpendicular transverse section of the uterus of a girl aged 7 years. 5. Well-developed uterus of a young woman. 6. Perpendicular transverse section of the uterus from the body of a young woman. ligaments from the body of a woman aged 79. 7. Uterus with broad I. 2. ,, PLATE Fig. ,, ,, ,, „ IX. Internal surface of uterus soon after delivery. Transverse section of uterus one year after delivery. 3. Antero-posterior section through uterus. 4. Broad ligament with Fallopian tubes, and Parovarium, 5. Section through an ovary. I. 2. PLATE Fig. I. „ 2. X. Peritoneal folds of the serous covering of the uterus as shewing the direction and expansion of the retraction of the uterus. Leaf-like arrangement of the muscles of the pregnant uterus. PLATE XL Fig. I. Arteries of the uterus. „ 2. Injected arteries and veins of a pregnant uterus. PLATE Fig. i. XII. Cervical ganglion, sacral and uterine nerves of the PLATE 1. Mucous membrane of 2. Transverse section of the left side of a pregnant uterus. XIII. first day after menstruation. Fallopian tube (middle portion) on the the uterus on the left first day of menstruation. 3. Mucous membrane of the body of the uterus on the third day of menstruation. 4. Fresh corpus luteum from 8 to 9 days old, 8 to g days after commencement of 7. last haemorrhage. Older corpus luteum (5 weeks). Corpus luteum three weeks old. Corpus luteum, seven weeks old. 8. Almost 5. 6. ripe follicle. PLATE 1. 2. 3. XIV. Lymphatic vessels of the non-pregnant normal uterus. Uterus of a sow blood- and lymphatic- vessels. Blood-vessels and lymphatics from the uterus of a virgin aged ; 25. PLATE XV. Fig. ,, ,, Mucous membrane of the bo^ly of the uterus at the fourth month of pregnancy. 2. Placenta and uterus at the middle of the fifth month of pregnancy. Transition of the placental 3. Uterine mucous membrane 7 days after delivery. site in the mucous membrane of the body of the uterus. I.
    • Contents of Plates. PLATE Fig. I. xiii XVI. Female mammary glands. ,, 2. ,, 3. Side view of female breast. Lactiferous ducts and lobuli of the milk g-lands during lactation. „ 4. Two ,, 5. Lobulus of prepared and injected. gland during- lactation (enlarged). lactiferous ducts during' lactation mammary PLATE XVIL Fig. ,, I . 2. ,, 3. ,, 4. Surface of the uterine mucosa changed by the development of the deciduae Vera and Reflexa. Diagrammatic transverse section of a pregnant uterus, a few hours after the embryo has become encapsuled, which apparently took place on the eighth day after impregnation. An ovum laid open at the twenty-first day. Ovum with embryo from the seventh to the eighth week, PLATE Fig. ,, I. 2. „ 3. ,, 4. „ 5. Section of pregnant uterus with mucous membrane developed into decidua at the sixth week of gestation. Section of uterus and placenta of a woman who died in the thirtieth week of gestation. Injected terminal loop of villus from a mature placenta. Placenta from the internal surface. External surface of placenta. PLATE Fig. I. „ 2. „ 3. XVIII. XIX. Pregnant uterus from behind at the commencement of the fifth month. Fundus uteri of a pregnant uterus at the eighth month. Internal surface of uterus far gone in pregnancy after removal of the mucosa developed into decidua, to shew the muscular fibres of the internal surface, and the developed folds of the arbor vitae. PLATE XX. Side view of abdominal cavity laid open after partial removal of the larger omentum in a woman far advanced in pregnancy. PLATE XXL Fig. I. ,, 2. „ 3. ,, 4. Human Human Human Human embryo embryo embryo week. month. at the sixteenth week. ovum at the fifth month and a half. at the ninth at the third PLATE Human embryo, funis, of pregnancy. XXII. and placenta with its membranes, at the sixth lunar month
    • Contents of Plates. xiv PLATE Fig. ,, „ ,, ,, „ XXIII. Internal org-ans of an embryo before birth. FcEtal circulation. 3. Side view of cranium of a newly-born child. 4. Cranium of a newly-born child, seen from above. 5. Meconium seen under the microscope. 6. Vernix caseosa under the microscope. I. 2. PLATE XXIV. Section of a normally-formed pregnant woman about twenty-five years old, after death from hanging. PLATE XXV. Fig. ,, I. 2. Uterus with foetus Uterus with foetus in first head presentation. in first breech presentation. PLATE XXVI. Fig. ,, ,, „ Section of the frozen body of a woman in labour, during the period of expulsion. Section through the parturient canal after removal of the child. 3. The engagement of the head. 4. Commencing expulsion of the head. I. 2, PLATE XXVII. ,, 3. ,, 4. The engagement of the head descending Cranium of occipital presentation. Cranium of face presentation. Cranium of breech presentation. ,, 5. Lateral curve of the trunk during labour in breech presentation. Fig. ,, I. 2. first. PLATE XXVIII. Fig. ,, I. 2. ,, 3. ,, 4. Occipital presentation. Face presentation. Brow presentation. Antero-frontal presentation. PLATE XXIX. Fig. I. ,, 2. ,, 3. Uterus with twins in cranial and breech presentation. placenta with twins. Triplet after birth with two embryos arrested in development. One PLATE XXX. Fig. I. ,, 2. „ 3. Inflammation of the mucous and sebaceous glands of the vulva. Abscess of the right Bartholini's gland. Cyst formed by the dilatation of the occluded duct of the left Bartholini's gland.
    • Contents of Plates. XV PLATE XXXI. Fig. „ I. I A. Morbid enlargement of the clitoris. Follicular polypus of the cervix, extended from the vagina by elongation of the stalk. ,, 2. „ 3. Fig. I. ,. 2. ,, 3. Lupus of the labia, the vaginal Lupus of the vulva. orifice and anus. PLATE XXX n. Lupus of the vulva. Broad condylomata of the labia in a pregnant woman, removed Huginer without causing abortion. in two sittings by Urethral excrescence. PLATE XXX in. Fig. ,, I. 2. ,, 3. ,, 4. ,, 5. Malformation and occlusion of the external female genitals in a new-born child. Malformation of the female genitals by growing together of the labia minora and unusual size of the clitoris. The internal organs of generation were normal. Occlusion of the vaginal orifice by malformation of the bands of the labia. Coalescence of the external genital parts as far as the meatus urinarius, in an old woman who had suffered from an intolerable pruritus but had not borne children. Hypertrophic degeneration or elephantiasis of the labia minora and prepuce of clitoris. PLATE XXXIV. Fig. I. ,, 2. ,, 3. Occlusion of the vaginal orifice (atresia hymenea) with displacement forwards of the anal opening in a girl aged 4 years. Narrowing of the vagina in a woman in labour by an ovarian tumour. Acquired partial occlusion of the vagina. PLATE XXXV. Fig. ,, !. 2. ,, 3. ,, 4. Prolapse of the posterior vaginal wall, (enterocele vaginalis). Prolapse of the posterior vaginal wall, (vaginal enterocele). Vesico-vaginal hernia, (cystocele vaginalis). Retro-vaginal hernia, (rectocele vaginalis). PLATE XXXVI. Fig. I. Vagina and uterus divided by a septum. Two-horned uterus and divided vagina in a ,, 2. ,, 3. virgin aged 17. Left horn of uterus developed together with a rudimentary right horn in a sterile ,, 4. Pregnancy married woman aged in the left 34. rudimentary uterine horn, mistaken at first for tubal gestation. PLATE XXXVII. Fig. 1. „ 2. „ 3. ,, ,, „ Rudimentary horn united by a solid band with the fully developed uterine horn enlarged by pregnancy. Transverse section. One-horned uterus from a child. Drawn from behind. One-horned uterus from the body of a woman from six to seven days pregnant for the tenth time; the left kidney was also absent. of divided uterine body indicated by connective tissue and muscular fibrous tissue with simple cervix. 5. Apparently simple uterus with vaginal wall continuous with cervical cavity. 6. Dissected uterus with two horns and simple cervix. 4. Schema
    • Contents of Plates. xvi PLATE XXXVIII. Fig. Cleft uterus with double vagina, in a young woman ag-ed 30. Uterus, divided from vagina, with double os uteri after termination of gestation in Drawn from behind. left half. I. 2. The same preparation opened 3. in front. PLATE XXXIX. 5. 6. Fig. Left obliquity of the uterus. The same uterus dissected shews a cicatrix in the neighbourhood of the internal OS uteri near the left border. Fundus uteri twisted to the right with inflection of the isthmus to the left and forwards. From a single woman over 30 years of age. Fundus uteri twisted to the left, and os uteri constricted, from a girl aged 15 years. Fundus uteri strongly developed to the right. In the neighbourhood of the isthmus Bulky vaginal portion of the above preparation from below, with obliquely I. 2. 3. 4. the uterus is atrophied. situated os uteri. PLATE XL. Fig. ,, „ Anteflexion of the puerperal uterus; on the posterior wall at the placental site is attached a portion of placenta. 2. Puerperal retroflexion; placental polypus on the anterior uterine wall. 3. Retroflexion of the puerperal uterus; lengthening of the anterior uterine wall, on the internal surface of which is situated the uneven placental site. I. PLATE Fig. i. ,, 2. ,, 3. ,, 4. „ ,, 5. 6. XLI. Marked anteflexion of the uterus. Anteflexion of the uterus soon after delivery. Retroversion of the gravid uterus at the fourth month. Retroversion of the gravid uterus at the commencement of the fifth month, with considerable distension of the bladder by retained urine. Distension of the bladder by retained urine, consecjuent on retroversion of the womb. Retroflexed uterus bound down to the rectum by exudation membrane. PLATE XLI I. Fig. Vertical section of uterus. Vertical section of uterus. 3. Vertical section of senile uterus. Hypertrophy of the neck of the uterus. 4. Partial prolapsus uteri. 5. Myoma of the uterus. 6. Carcinoma of the uterine neck. i . 2. PLATE XLI II. Fig. I. Retroflexion of the uterus in a new-born female. 2. Obtuse-angled anteflexion. Obtuse-angled anteflexion. Obtuse-angled anteflexion. Right-angled anteflexion. Right-angled anteflexion. Acute-angled anteflexion. 3. 4. 5. 6. 7.
    • Contents of Plates. xvii PLATE XLIV. Fig. I. ,, 2. ,, 3. „ 4. ,, 5. Retroversion of the uterus. Obtuse-angled retroflexion of tlie uterus. Retroversion of the uterus. Retroflexion with adhesions to the rectum. Retroflexion with adhesions to the rectum. PLATE XLV. Fig. I. Partial inversion of the uterus in a woman 30, who died three hours after delivery; viewed from above. ,, 2. ,, 3. Partial inversion of the uterus. Partial inversion of the uterus five years after the occurrence of the inversion, with prolapse. PLATE XLVL Fig. 1. „ 2. ,, 3. ,, 4. Inversion of the uterus with prolapse, resulting- from injudicious traction on the placenta. Prolapse of hypertrophied polypoid growth of anterior lip of the os uteri. Polypoid growth of posterior lip of os uteri to a weight of 14 pounds. Elongation of the vaginal portion. PL.TE XLVII. Fig. I. Complete prolapse of the uterus with elongation and hypertrophy of the cervix uteri. ,, ,, ,, ,, Pelvic viscera in prolapse of the uterus drawn from within. 3. Complete prolapse of the uterus following elongation of the cervix. 4. Complete prolapse of the uterus without cystocele, following- prolapse of the posterior wall of the vagina with enterocele and prolapse of the rectum. 5. Complete prolapse of the uterus advanced in gestation, with partial foot presentation of the foetus in multipara, ag-ed 38 years. 2. PLATE XLVII Fig. I. ,, 2. ,, 3. ,, 4. ,, 5. Prolapse Prolapse Prolapse Prolapse Prolapse of the of the of the of the of the posterior wall of the vagina, with sinking of the uterus. uterus with marked enterocele. uterus from marked elongation of the uterus with cystocele. uterus following- prolapse of anterior and posterior vag-inal walls. anterior wall of the vagina with elongation of the uterus. PLATE P'iG. „ ,, „ ,, I. XLIX. Elong-ation of the cervix with prolapse; fibroid growths in walls and cyst at the fundus. 2. Elongation of the uterus which prolapsed into a crural hernia. 3. Perforation of the posterior wall of the cervix with preservation of covering- in a patient who died from peritonitis six weeks after 4. The same cicatrised rupture as in fig. 3, drawn from within. 5. Bladder-polypus or cysto-sarcoma of the mucous membrane of the caused by degenerations of the utricular glands. I. of the uterus, the peritoneal labour. uterine cavity C
    • Contents of Plates. xviii PLATE Fig. I. 2. L. Vaginal portion of cervix with dilated os polypus can be seen. The uteri, through which an intra-uterine polypus, after division of the anterior wall of the uterus, is seen growing from the fundus. ,, ,, ,, in fig. 2, which has grown from the uterine wall. 4. Fibroid tumour of uterine wall, and follicular polypus of the cervical canal. 5. Fibroid tumour in the anterior wall of the uterus, which has grown to the size of a uterus far advanced in pregnancy. 3. Perpendicular section of the polypus, seen PLATE LL Fig. I. „ 2. ,, 3. ,, 4. Polypus of the mucous membrane and underlying uterine tissue which has grown into the uterine cavity from the internal os. Numerous mucous growths in the uterine cavity. Mucous polypus at fundus, growths of mucosa and its utricular glands. Interstitial submucous fibroids the submucous fibroid has grown into the uterine ; cavity. ,, ,, Numerous round fibroids, partly under the peritoneal covering, partly under the uterine mucosa. 6. Fibroid tumour in the wall of the fundus uteri soon after labour. S- PLATE LIL Fig. I. ,, 2. ., 3. „ 4. the posterior wall of the cervix and body of the uterus. in fig. cut through. Interstitial fibroid in the anterior wall of much enlarged uterine body. Section of fibroid seen in fig. 3. Fibroid in The tumour i PLATE I. Cancer of the Fig. I. Adenoma ,, 2. LIII. Fig. ,, „ ,, uterus, with cancer of the anterior wall of the vagina, and the posterior portion of the vaginal cul de sac. 2. Ulcerated uterine cancer. 3. Cancerous destruction of the vaginal portion of the uterus and the vaginal wall between the vagina and bladder. 4. The uterus seen in fig. 3 infiltrated with cancer, together with the Fallopian tubes. PLATE LIV. uteri. Carcinoma uteri. / PLATE Fig. I. ,, 2. ,, 3. ,, 4. LV. Polypoid adenoma of the uterus. Adenoma. Vertical section from the surface. Adenoma. Section from the neighbourhood of Adenoma. Longitudinal section from surface. the pedicle.
    • Contents of Plates. PLATE Fig. ,, ,, „ xix LVI. Diphtheritic endometritis in a woman who died fourteen days after delivery of a dead child, from uterine phlebitis. Retention of a portion of placenta. 2. Thrombosis of the veins in the uterus, and broad ligaments of the preparation drawn in fig. i from within. 3. Inflammation of the lymphatics of the uterus of a puerperal woman. Collum tapyroides 4. Chronic inflammation with thickening- of the cervical mucosa. ectropion of the lips of the os uteri. 1. PLATE LVIL Fig. ,, ,, „ ,, Posterior surface of a puerperal uterus with inflammation of the lymphatics, Fallopian tubes, and ovaries. 2. Section of an ovary from fig. I. 3. Section of a serous infiltrated ovary, as it is frequently seen in metro-lymphangitis. 4. Softened ovary in puerperal metro-lymphangitis. 5. Lymphangitis and thrombosis of the veins of the uterus in a woman who died I. fifteen days after delivery. PLATE LVIIL 2. Simple erosion. Microscopic appearance of foregoing figure. ,, 3. Follicular erosion. ,, 4. Fig. I. ,, ,, Ulceration of the vaginal portion of the cervix and posterior vaginal cul de sac. 5. Non-scirrhous vaginal portion. PLATE LIX. Ectropion of the cervical mucous membrane. Microscopic section of a papillary erosion. Clinically a suspicious, microscopically a non-malignant vaginal portion of the Fig. I ,, 2. ,, 3. ,, 4, 5, 6. „ 7. Fig. I. cervix. Commencing cancer in a prolapsed portio vaginalis. Microscopic appearance of figure 3, plate Iviii. PLATE ,, 2. PLATE Fig. I. ,, 2. LX. Circular rupture of the cervix and expulsion of the portio vaginalis: Vie*v of the above preparation from below. LXI. Transverse rupture of the upper portion of the anterior cervical wall. Longitudinal rent of the cervix. PLATE LXIL Dropsy of the Fallopian tubes. Tuberculosis of the Fallopian tubes. 2B. Right Fallopian tube of fig. 2, slit open longitudinally. ,, 3. Pregnancy in right ovary. „ Fig. I. ,, 2. C2
    • Contents of Plates. XX PLATE Fig. „ I. 2. LXIII. Ovarian cyst with gelatinous contents. cyst as in fig. i, opened in several places. The same PLATE LXIV. Fig. „ „ ,, I. lA. 2. 3. Dermoid cyst. plate, shaped like maxilla bearing two teeth. Hair- and fat-cyst of the right ovary. Adenoid tumour of the breast. The chalky PLATE LXV. Fig. ,, I. 2. ,, 3. ,, 4. ,, 5. Cancer of the breast with cancer tubercles in, and under, the skin of an old woman aged 83. Carcinoma of the breast with retraction of the nipple. Compound mammary haematocyst. Compound proliferating cystoid of female breast with serous contents. Diffused arborescent intracanalicular myxoma of the mamma. PLATE LXVI. Fig. I. ,, 2. Bladder-mole expelled at the fifth month of pregnancy. Bladder-mole from a woman aged 28. ,, 3. Internal surface of the cavity of the ovum with the chorion-villi degenerated into cysts. ,, 4. ,, S- Hypertrophied oedematous chorion villi from a bladder-mole. Hypertrophied oedematous terminal ramifications of the chorion-villi from an ovum the size of a hazel nut. PLATE LXVn. Fig. ,, ,, ,, ,, Microscopical section of a mammary cancer. Arborescent cysto-sarcoma of the mamma. 3. Placental villi. 4. External surface of placenta with multiple blood effusions. 5. External surface of a placenta, with the impressions of old and recent extravasaI. 2. tions. PLATE LXVin. Fig. ,, i. 2. Seat of the placenta at the os uteri. Placenta praevia centralis. PLATE Fig. I. ,, 2. ,, 3. ,, 4. LXIX. Double placenta. Forked insertion of the funis into the membranes at a distance from the placenta. Strangulation of the funis by unusual twisting of the umbilical arteries. Twisting and strangulation of the umbilical cords in twins. PLATE LXX. Fig. I. ,, 2. ,, 3. Twisting of the umbilical cord. Twisting of the cord. Twisting and knotting of the cord.
    • Contents of Plates. PLATE xxi LXXI. Placenta of twins with compressed fcetus. PLATE LXXn. Fig. I. „ la. ,, 2. ,, 3. Abdominal cavity of a woman who had carried a lithopoedion 22 years. The lithoijoedion in fig;, i, removed from the abdominal cavity. Embryo which died from haemorrhage during the fourth month of pregnancy in an uninjured ovum. A lithopoedion which was carried in the abdomen by a peasant woman during 40 years, although two normal pregnancies occurred. PLATE LXXIIL ,, 3. ,, 4. Hydrocephalus with spina bifida. head with hernia cerebri. Absence of head and upper extremities in a fatty twin foetus 24 centimeters lono-. Complete ectopia of the thoracic and abdominal viscera in a female foetus with „ 5. Absence of one of the lower extremities. Fig. I. ,, 2. Foetal cloacal formation. Monopodia. PLATE LXXIV. Fig. I ,, 2. ,, 3. „ . 4. Ruptured congenital umbilical hernia, acrania, cyclopia with proboscis and absence of the superior maxilla. foetus born in foot presentation with hydrocephalus. An encephalous foetus with distended backward cranial cleft. Eyes situated above, ears below. new-born female foetus with coccygeal tumour which should contain another Male A foetus. PLATE LXXV. Fig. I. 2. 3. 4. 5. 6. Growing together of the cranial integument and the placenta. Monstrum sireniforme. Growing together of both lower extremities. Cyclopia with proboscis and hydrocephalus in a twin child. (Hernia cerebri). Sympodia. Incomplete development of the finger, so-called self-amputation. One-headed double monster. Janiceps. PLATE LXXVL Fig. I. Double monster. ,, 2. Skeleton ,, 3. Division of joints by exudation fig. I. membranes. Amputatio spontanea. PLATE LXXVIL Fig. I. ,, 2. Transverse presentation in the uterus laid open during the seventh month of pregnancy. Transverse presentation with prolapsed arm, head to the right, feet to the left, and backwards.
    • Contents of Plates. xxii PLATE LXXVIII. 1-4. Fig. The different stages of spontaneous expulsion. Labour with the body bent double. 5. PLATE LXXIX. Fig. „ Universally-contracted pelvis. Universally-contracted pelvis. I. 2. PLATE LXXX. Fig. Flattened pelvis from rachitis. Antero-posterior contraction of the pelvis from rickets. I. 2. PLATE LXXXI. Fig. Antero-posterior contraction of the pelvis. Section through a spondylolisthetic pelvis. I. 2. PLATE LXXXIL Fig. Transversely-contracted osteomalacic pelvis. I. „ 2. Transverse contraction of the pelvis. PLATE LXXXI IL Fig. Transverse contraction of the pelvis with bilateral sacral anchylosis. I. ,, 2. ,, 3. The same pelvis seen from above. The same pelvis seen from beneath. PLATE LXXXIV. Fig. I. ,, 2. Transverse contraction of the pelvis from early-acquired anchylosis of both sacro-iliac synchondroses. Contraction of pelvic cavity by exostosis of the sacrum. PLATE LXXXV. Fig. I., Obliquely contracted pelvis from anchylosis of the 2. early childhood. Obliquely contracted pelvis from anchylosis of the shewn from behind. left sacro-iliac synchondrosis in „ PLATE LXXXVI. Fig. I. Pelvis spinosa. ,, 2. Contraction of the pelvic cavity by bony cancer. PLATE LXXXVII. Fig. i. ,, 2, „ 3. ,, 4. Lumbo-sacral kyphotic pelvis. Funnel-shaped pelvis. Cleft pelvis seen from the front. Cleft pelvis seen from behind. left sacro-iliac synchondrosis
    • Contents of Plates. xxiii PLATE LXXXVIII. Fic. Pelvic Pelvic 3. Pelvic 4. Pelvic 5. Pelvic 6. Pelvic 7. Pelvic I. 2. a normal female pelvis. a universally-contracted pelvis. of a flattened rickety pelvis. of an obliquely-contracted pelvis with unilateral ilio-sacral anchylosis. of an obliquely-contracted pelvis with lumbo-sacral kypho-scoliosis. of a transversely-contracted osteomalacic pelvis. of a pelvis spinosa. inlet of inlet of inlet inlet inlet inlet inlet PLATE LXXXIX. Fig. I. ,, 2. ,, 3. Front view of a kyphoscoliotic girl complete prolapse of the uterus. Side view of same. Back view of same. who had never PLATE Fig. I. ,, 2. „ 3. „ 4. „ 5. „ 6. The impressions menstruated, and XC. of the foetal head in new-born children. Microscopic section of the above. Cranial impression. Spoon-shaped impression of the cranium. Cranial depression. View of the point of depression in the left side of the foetal head in PLATE XCL Fig. 1. 2. 2A. 3. 3A. 4. 4A. Chamberlain's forceps. Palfyn's forceps. Single blade of Palfyn's forceps. short straight English forceps with leather covering. Single blade of Orme's forceps. Leveret's forceps with head and pelvic curves. Right female blade of Leveret's forceps. A PLATE Fig. ,, 1. 2. ,, 3. „ 4. „ 5. .,, 6. „ „ 7. 8. „ 9. ,, 10. ,, II. XCII. Pelvimeter after E. Martin. Pelvimeter after Collin. Colpeurynter after C. Braun. Fiddle-shaped india-rubber dilators after R. Barnes. Balloon for artificial induction of labour after Tarnier. Shapes of laminaria tents and compressed sponges in various Funis repositor after E. Martin. Funis repositor after Robert. Blunt hook. Key-hook after C. Braun. Smellie's perforating scissors, Blot's perforator. „ 13. Naegele's perforator. „ 12. ,, 14. ,, 15. Trepan-shaped perforator with bayonet socket. 1 repan-shaped perforator after C. Braun. ,, i6. Bone forceps after Mesnard-Stein. sizes. fig-. 5. who had
    • Contents of Plates. xxiv PLATE Fig. I. 2. 3. 4. 5. 6. 7. XCIII. Forceps after E. Martin. Forceps after Nang'ele. Brush forceps after Ideler. Cephalotribe after E. Martin. Cephalotribe after Braxton Hicks. Cranioclast after C. Braun. Combination of perforator and cranioclast after J. Veit. PLATE XCIV. 2. C. Mayer's glass speculum. Sims' speculum. 3. Fig. One-bladed speculum I. after Kristeller. 6. Simons' speculum. Uterine sound. Bullet forceps with clutch hook. 7. Spring- dressing- forceps. 4. 5. 8. Curved 9. 1 Schroder's scissors for incising os uteri. scissors. 10. Scarificator after C. Mayer. 11. Squirt from intra-uterine injections after C. Braun. 12. Sharp curette 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. after Simon. Recamier's curette. Uterine medicator after E. Martin. Bath speculum. Speculum for irrigating the vagina after von Preuschen. Dilator after Greenhalgh. Instrument to introduce sponge tents after R. Barnes. Double knife for the incision of the os uteri after E. Martin. Double knife after Greenhalgh. Knife for incision after Sir James Simpson. Hodges' vaginal pessary. Intra-uterine stem with holder. Spring- stem pessary after E. Martin. PLATE XCV. Complete procidentia Fibroma uteri. Fig. I. „ 2. Fig. I. „ 2. Fig. I. ,, 2. Atresia of vagina. Retro-uterine haematocele. „ 3. Extreme uteri. PLATE XCVI. Occlusion of the vulva. Atresia vagina. PLATE XCVII. retroflexion of the uterus. PLATE XCVI 1 Fig. ,, „ „ ,, 1. Dr. Grigg's uterine dilator. forceps after R. Barnes. 3. Craniotomy forceps after R. Barnes. 4. Crescent speculum after R. Barnes. 5. Pessary for anteflexion of the uterus after Fancourt Barnes. I. 2. Long i
    • Tiif. A' .hirli,is ll„ii,l„ll<,^ II .hin.r.l.Mailii, cii'iv s^diM.:i-.£,n. ^rjnoi. rBrviv
    • . PLATE FIGURE Female Pelvis with ( its From KiwiscKs Atlas of Obstetrics, lumbar vertebra. B.B. Intcrarticular cartilage between the fifth lumbar vertebra and the sacrum. C.C. Sacrum. D.D. Coccyx. E.E. Ilium. F.F. Descending' rami of the pubes. G.G. Ischia. H.H. Femora. Anterior b.li. common C.C. e.e. Erlaiti^cn, I S5 I ) Lumbo-iliac lig-aments. Sacro-iliac lig-aments, under which d.d. lie the sacro-iliac synchondroses. Sacro-coccygeal ligaments. /. Sacro-coccygeal articulation. g.g. Sacro-spinous ligaments. Anterior pubic ligament. Sub-pubic ligament. k.k. Obturator membrane. /./. Capsular ligaments. h. i. ligament. Promontory of the sacrum. FIGURE A I. Ligaments seen from above. A. A. Fourth a. I. II. Perpendicular Section through the Pelvis to shew the Inclination and Median Line of the Pelvis. {^From a Preparation in the Obstetiic Clinic at Berlin). A.B. Horizontal a.a.a. The lines. last three h.g. lumbar vertebras. /'. Promontory c. Sacro-coccygeal articulation. of the sacrum. The curve of the true pelvis. This point is wrongly placed in the drawit should ing on the horizontal line properly stand on the lower margin of The lines runthe symphysis pubis. i.k.l.m. f. Tip of the coccyx. Conjugate diameter of the pelvis. d.f. Antero-posterior diameter of the pelvic d. ; h.e. ning to 7^ are to be drawn edge of the symphysis. outlet. f)./. Diagonal conjugate diameter. FIGURE View a.a. Antero-posterior diameter of the cavity of the pelvis. to the lower III. of the Right Sacro-iliac Articulation from behind. sawn Posterior part of the right ilium b. Sacro-iliac joint laid open, | through. I FIGURE The Right ';. Right ala Ilium Symphysis lateralis of the first sacral ver- tebra. b.b. Sacro-iliac sawn through. IV. a.c. d. laid open from above. Sacro-iliac articulation. Right posterior sacro-iliac ligament.
    • . Taf, Fifi.l. Fig. 4. Fig. Fig. 2. f'v-/ ...'-.•wi^ E yjarlinn lliimhitla a . II .hlfl . i>. .1 . M (ii tin , r ^^^rffSfej,, II
    • PLATE FIGURE II. I. Female Pelvis from below. a.a. Antero-posterior diameter of the pelvic outlet. b.b. Transverse diameter of the pelvic c.c. Right oblique diameter of the pelvic d.d. outlet. outlet. Left oblique diameter of the pelvic outlet. FIGURE II. Female Pelvis from above. a.a. Posterior transverse diameter of the false pelvis. h.b. Anterior transverse diameter of the false pelvis. c.c. Conjugate diameter of the pelvic d.d. inlet. Transverse diameter of the pelvic inlet. e.e. Right oblique diameter of the pelvic f.f. Left oblique diameter of the pelvic inlet. sacro-iliac synchondrosis c.g.g. Right and left is inlet. omitted (The in the f which should be on the Kft drawing). sacro-cotyloid diameters. FIGURE III. Transverse Section through the Symphysis Pubis in advanced pregnancy. FIGURE IV. Transverse Section through the Symphysis Pubis in the non-pregnant state.
    • . Taf. Fj 2- A'. Marlin's llaiulalldH. IIAufl. i:. I. Murlin C^ee, S^ui-ltee.-. ^Wd.ciJMM . Ill JB^,.ti„
    • PLATE FIGURE III. 1. Second Aperture of the Female Pelvis, or the so called largest diameter(7.(7. Transverse diameter of the pelvic cavity. h.l. Antero-posterior diameter of thie pelvic cavity. FIGURE II. Third Aperture, the so-called smallest diameter of the Pelvis. a.a. b.h. Transverse diameter of the third aperture. Antero-posterior diameter of the third aperture. FIGURE III. Anterior Wall of the Pelvis from within. a.a. b.h. Height of the symphysis pubis. Total heights of the pelvis. FIGURE IV. Perpendicular Section through the Female Pelvis. a.a. Height of the posterior pelvic wall from the promontory of the sacrum the coccyx. b.b. Posterior wall of the Pelvis. Height of the true pelvis at the side. to the tip «f
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    • PLATE FIGURE IV. I. Pelvis with the soft parts. ( Drawn from Nature.) a. Psoas Muscles. b. Abdominal Aorta. c. Ascending- d. Vena Cava. Iliac Muscles. FIGURE II. Position of the Viscera at the sixth month of pregnancy. iyDrawn from Nature.) a. Uterus. 1^. Urinary Bladder. (. Stomach. (i. e. Transverse Colon, Liver.
    • T;if. Fi.U. Fk- 4 Fiv.;i, a^ FiO. 2. d A' Miirtiiin Ihiiiilalltm. II .hill, r . I Martin !.{($. ScCxnCxe.. £,-U f/ Snot . ,'B,:,Cn, -
    • PLATE FIGURE V. I. External Female Genital Organs. Mons a. veneris. Labia majora. c.c. Labia minora. (The letter t/with d. Clitoris. Prepuce of the clitoris. 6.d. its indicating line is not printed on the plate). c'. /. Urethral meatus. "-. Vestibulum. //. Hymen. X'. Frenulum. Anus. /. Perinaeum. /. FIGURE II. Outlet of the Pelvis after removal of the Integument. ( AfUr G. L. Kohdt. The male andfemale sexual orga?is, Freiburg, 1844, and Kiwisch, Atlas). Anus. a. b.b. Sphincter ani. e.e. Closing muscle of the vagina, or constrictor ani. d. Clitoris. c. Glans g. clitoridis. Ischio-cavernous muscles. /./. The left bulbus vestibuli injected, by the side of the plexus of veins in the wall of the vagina. h.h. Transversales perinaei. Levator i.i. k.k. ani. • Glutei. FIGURE in. The Vulva with the openings of the Ducts of the Glands. b. Labia minora. Meatus urinarius. c. Numerous small a.a. d.d. follicular openings round the meatus. Openings of the ducts of Bartholini's glands. FIGURE IV. Bartholini's Glands. {A/icr Fr. Tiedemann. On Duverncy's and other glands in woman, Heidelberg). a. Right labium majus. b. Bartholini's (or Duverney's or Cowper's) glands. c. Excretory ducts of the same.
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    • PLATE VI. FIGURE I. Section of the Abdominal Cavity of a middle-aged Multipara. {Normal position of the parts after Pirogoff, III. A. 22. Figure i). {Accompanying W. Braune. Atlas 0/ Topogiaphical Anatomy, Leipzig, 1868). U. Uterus. V. Rectum. r. m. Bladder. Symphysis pubis. P. Promontory of the Sacrum. ^. text ly Mens veneris. Intestines. /'. and appendages were normal and lay between the distended bladder and There were no small intestines behind the uterus. From this it is seen that the uterus always lies between the rectum and bladder even in their most varied degrees of distension and that its position is considerably altered by their variations. The uterus The conitself in this representation lies considerably deeper than in the following. jugate measures 105 millimeters. The uterus rectum. ; FIGURE II. Section of the Pelvis with Distended Bladder and Urethra. {After Pirogoff, II. A. 32. U. Uterus. V. Fig. 20). Tip of the coccyx. (The line in the drawing is drawn beyond the exact tip of c. Bladder. P. Promontory of the sacrum. .S". t. Symphysis pubis. Rectum. {Text of W. Braune). the coccyx). m. Mons veneris. The greatly distended bladder has drawn the peritoneum away from the symphysis a distance of 35 millimeters, and the uterus is drawn backwards and upwards by the stretching of the anterior wall of the vagina. The conjugate measures 102 millimeters. The rectum is empty and contracted. In this case again there are no small intestines to to be seen behind the uterus. FIGURE Section through the III. of a normally formed woman, aged 35, with the Bladder empty, the Rectum fxiU. Abdomen {After Pirogoff, III. A. 21. Fig. li). U. Uterus. r. r. Bladder. c. P. Promontory of the sacrum. .S. m. {Braune, op. cit.) Rectum. (Marked Fin the drawing). Tip of the coccyx. Mons veneris. Symphysis pubis. The section has not gone through the median line of the skeleton, and has not uterus forms here an obtuse divided the urethra and anus, but only the uterus. The angle with the vagina but is not anteflected. No small intestines and rectum. The conjugate measures 1 10 millimeters. lie between the uterus
    • ViO 1 Vis. 2. "^ F. Marlu,„ Hiunlal/u.. 1/ .lull.,. .I..Ua,l,n . IfC S^(vCU-;t.e,. ^U(i c0„M „. . .'Rtr in t
    • PLATE FIGURE VII. I. Perpendicular Section of the Viscera of the Female Pelvis. (Half the Natural Size). {After O. Kolratich, on the Analomy and Physiology of the Pelvic Organs, Leipzig, 1854, aw/ from a preparation of the a. Berlin Anatomy). Sacrum. b. The rectum c. The laid open in its lower part, uterus. The longer anterior lip. The shorter posterior lip. f The bladder. g. The symphysis pubis. h. The vag-ina. /. The urethra. k. The clitoris. /. The septum. m. The anus. n.n.n. The peritoneal covering' d. e. of the pelvic organs. (On the fundus R is written instead of«). Pelvic fascia. 0.0. /. Fascia transversalis. FIGURE View of the II. Female Pelvic Viscera from above. (One-third Life-size). {After Moreau, Practical Treatise of Obstetrics, Paris, 1857. a. The b. The fundus c.c. d.d. e. f g. bladder. uteri. The Fallopian Tubes. The ovaries. The rectum. The abdominal aorta. The ascending vena cava. h.h. The round ligaments. Atlas).
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    • PLATE VIII. FIGURE I. Dissection of Vagina, Uterus, Fallopian Tubes, Uterine Ligaments, and Ovaries. (Two-thirds Life-size). a. Fundus b. Body c. Cervix. k.k. J. Vaginal portion. /./. e. External os uteri. / h.h. Vag-ina, uteri. of the uterus. Anterior lip of Round i.{. Broad ligaments. Fallopian tubes. Fimbriated extremities. m.7n. the os uteri. with posterior rugae. ligaments. Ovaries. 0.0. g. Posterior lip of the os uteri. FIGURE II. Well developed Uterus of a FcBtus at term. (Life-size). b. Body of the Neck of the f. Cervical portion. a. uterus. d.d. uterus. e.e. FIGURE Fallopian tubes. Round ligaments. III. Perpendiciilar Transverse Section of the Uterus of a Matvire Foetus. Life-size). a. b. c. Fundus of the uterus. Body of the uterus. Neck of the uterus. d. e. FIGURE Vaginal portion. Vagina. IV. Perpendicular Transverse Section of the Uterus of a girl aged 7 years. (A/tet A, Kussmaul. On the Absence, Arrested Development, and Double Development 0/ the Wurzburg, 1859). a. Os b. Uterine cavity, shews only a trace of the posterior uterine fold. uteri. c. d. e. Cervical canal. Puckered vaginal portion. Vagina. Uterus,
    • PLATE YIU.—(Continued.) FIGURE V. Well-developed Uterus of a young woman. (Life-size). 6. Fundus uteri. Body of the uterus. c. Opposite the internal os uteri (Isthmus a. d. Cervix. e. External os uteri. Fallopian tubes. /]/. uteri.) g.g. FIGURE Round ligaments. VI. Perpendicular Transverse Section of the Uterus from the body of a young woman. a. Fundus c. Uterine cavity with the convex margins c. Internal os uteri. (The line should point to uteri. d. inwards. Small folds of the cervix (Arbor uterinus.) Vaginal portion. e.e. g.g. Fallopian tubes. the upper border of the cervical cavity.) FIGURE VII. Uterus with Broad Ligaments from the body of a a. 6. Fundus uteri. Body of the uterus. c. d. woman aged Cervix. External os uteri. 79. vitai
    • Taf. IX Fig. 2. fA Pi^.4. t Fie. 3. K.yiiirUi.x IlinHladu.-. II .lull r .l-Mailiii .'WS . S.cfi,at««,. JH, 1 1; cH,, ,.,t . .'Re-, r.n
    • PLATE IX. FIGURE I. Internal Sujface of Uterus soon after delivery at term. (Two-thirds Life-size). {A/ier Moreau, op. citi) a.aa. Cervix Uteri. h.b.b. c.c. d.d.d. Divided wall of body of uterus. Internal surface of lower portion of uterine cavity. Placental site with g'aping- lacerated veins. FIGURE II. Transverse Section of Uterus One Year after delivery. (From a. //. c. the body of a patient Fundus uteri. Walls of the body of the in (After a drawing by Dr. B/inkmann). died of typhus). Internal os uteri. e. /. Posterior lip of os uteri. uterus. Posterior wall of the uterine cavity. Fallopian tubes d.d. who r.p-. Folds of the arbor vitae. the uterine walls. FIGURE III. Antero-posterior Section through Uterus. Fundus <7. uteri. e. b. c. Flattened anterior wall of uterus. d. External os uteri. f. Elongated anterior lip. g. Shortened posterior lip. Posterior uterine wall. Internal os uteri. Vasfinal vault. h. FIGURE IV. Broad Ligament with rallopian Tube, Ovary, and Parovarium. (After Kobelt arid Kiwisch, a. b.b. c. Ovary. Parovarium. d. e.e. Rudiment of obliterated duct of Wolffian f.f. op. cit.) The The cystiform bulbous end of the same. cut Fallopian tube. Fimbriated extremity. body. FIGURE V. Section through an Ovary. (After Kiwisch, op. a.a. cit.) Section through recently ruptured Graafian follicle in a young inner membrane coated with blood. b.b.b.b. c.c.c.c.c. woman. The of the hypertrophied follicle appeared unevenly puckered, and Sections of two follicles some time after rupture (corpora lutea). Follicles in process of development.
    • Taf. [',. Marliirx llaiuladas. ll.AuI'l. n. . I^ Marlin . aeg . S,sfi,u,Ue.. ^U-R . c£Ii.i^, ^Sij-A& X
    • PLATE FIGURE X. 1. Peritoneal Tolds of the Serous Covering of the Uterus as shewing the direction and expansion of the retraction of the Uterus. (After Matthews Duncan. especially at the time band vi. s. On and expansion of the the chief direction of complete evacuation of the pregnant organ. retraction of the uterus, Archiv fiir Gyncekologie, 424, and a photograph of a preparation by the same author). a. Fundus. b. Opposite the ostium internum. c. Bladder. d. Body e. of uterus. Fallopian tubes. FIGURE II. Leaf-like arrangement of the Muscles of the Pregnant Uterus. (After G. von Hoffmann. Morphological researches on the muscles of the uterine body. fiir Geburtshiilfe P. und Frauenkrankheiten, 1 876, s. 448^. Peritoneal covering-, from which the muscular leaves arise and from which they overlap each other. /. //. etc. l.r. Zeitschrifl First, second, etc., Round muscular leaf of anterior wall. ligament. D. Posterior surface of uterus. G. Vascular, or middle layer PI. Placenta. ; under which lies the internal or decidual layer.
    • <#^.
    • Tal.XI. K. Mtirtiirs Hiniiiitdijs IIAuH. V .I.Mai tin 1C6. Sifu^p^e. ^iHl .Du.A . ,'Bivr Cii
    • — PLATE XI. FIGURE I. Arteries of the Uterus. (A/ler Hjril.^ Corrosion-Anatomy ami nsulls, ils JVt «//<;, Unilateral Injection of the Arteries of the Internal Genital 1873. Organs of /"/. XIII.) a Puerperal Woman. Posterior View. a. b. Internal spermatic artery. Inferior branch of the same. c.cb'. Branch c .c Branches . to Fallopian tube. the ovaries, from which large branches run at a to .a . to the abdominal end of the Fallopian tube. The d. inferior division of the internal spermatic, uterus with the superior branch g.g. e, anastomising on the side of the of the uterine artery. Branches of the uterine artery whose ascending branches anastomose on the h.h. side of the uterus with the internal spermatic artery. FIGURE II. Injected Arteries and Veins of a Pregnant Uterus. Anterior View. {After Hyttl, op. The cit. twisted arteries on the outer surface, few in veins. The Plate XV.) number and volume compared with veins converge on both sides into two chief branches once unite into one larger branch of a knotty form. of the entire veins dition of the venous Uterine Artery. b.b. artery, The ' is 5 Varicose con- plaits. of which is untwisted as is that of the vaginal c.c. so-called Corrosion-Anatomy consists in injecting the vessels with a solution of equal parts of The organ after being injected with the above, is hydrochloric acid and water, and the soft parts allowed to corrode away. remain, etched out as it were. F. B. to which at The interwoven arrangement seen to obtain also in the broad ligament. The main branch wax, turpentine, and copaiba. !, {a.a.) the placed The in a solution of from injected portions then
    • r,if. Pi£ . ii. 1 •>/:'• K Mnrlins Ihuulathn: II All 11 r. . . I. Martin.. eXf&. S^aiitee., £iM £I^^M .'B^Eiif.
    • PLATE Cervical Ganglion, Sacral (After Frankenhaiisen. XII. and Uterine Nerves of the The Nerves of the left side of a Pregnant Uterus. Uterus and their terminations in smooth muscular filaments, Jena, 1867^. /. Right Fallopian tube. //. Rig-ht ///. IV. V. VI. VII. VIII. 1. 2. 3. ovary. Right round ligament. Uniting branch of the ovarian and uterine veins. Ovarian vein. Venous ple.xus going to the base of the ovary. Posterior fold of the broad ligament. Peritoneum dissected off and turned up. Hsemorrhoidal nerve. Largest nerve from the fourth sacral foramen going to join the cervical ganglion. Nerve from the third sacral foramen going to the vagina and bladder across the cervical ganglion. 4. 5. 6. 7. 8. Branch from the second sacral nerve to the cervical ganglion. (Sometimes absent). The largest branch to the cervical ganglion, from the third sacral nerve. Small nerve ganglion, attached to the cervical ganglion, from which proceed branches to the hsemorrhoidal plexus. Nerves communicating with each other between the vagina and rectum. Small ganglion, lying on the cervical ganglion, from which branches go to the bladder. 9. 10. 11. 12. 13. 14. 15, 17. 16. 18, 19. Vaginal nerves. The most external branch of the hypogastric plexus entering the cervical ganglion. The artery and vein perforating the middle of the cervical ganglion, frequently giving rise to a large opening of a ring-shaped appearance. Cervical ganglion. Branches running between the vagina and bladder. Nerve from the first sacral ganglion of the sympathetic to the ureter. Communicating branches with the vesical ganglion. Nerves passing into the deep structure of the neck of the womb. Communicating branches between the cervical ganglion and the innermost branch of the hypogastric plexus. (21). 20. Vesical ganglion. 22. 23, 24. 25, 26, Branches of the same, some going to the deep tissues of the uterus, others communicating with the innermost branch of the hypogastric plexus. Nerves from the hypogastric plexus to the ureter. hypogastric plexus and cervical 27, 28. Superficial network of the nerves from the ganglion 29. 30. 31, 32. to the uterus. Branch connecting the cervical and uterine nerves. Entrance of the ovarian nerves from the posterior surface. ganglionic swellJunction of the ovarian and uterine nerves, frequently presenting runs to the round ligament, the other (35) to the ings, whence one branch (34) fundus of the uterus. 33. The nerves to the Fallopian tubes, drawn somewhat too large.
    • Fii.i. Tnr. ||[, 'i-r '^n^*^- He mi'-u Fig 3 f * /•' Mnrt,„ Hnn.lallu^. Il..h,n. f. A. Martin I Fis.2. aC6. SifvM^.c. ^a-f'i . ^u^ . ,«« :',,. I
    • PLATE FIGURE Mucous Membrane (Afler G. Leopold. XIII. I. of the Uterus on the first day after Menstruation. Sludics on the uterine mucosa during menstniation, pregnancy, Archivfiir Gyncecologie, band xi und xii. and childbed. 1877). Mc. Mucous membrane. Ms. Muscular tissue. E. Epithelium of the free surface, still preserved and attached in some parts in others, wanting- or raised up by bleeding from the surface, but still recognisable amidst the sanguineous difbris. Glands, twisted like corkscrews, with dilatation of the lumen, most numerous in the D. middle layer; their openings are narrowed and turned inwards. The cylindrical ; epithelium well preserved, in parts swelled with large nuclei. in part insufficiently injected. G. Vessels, B. Bundle of muscular fibres divided transversely. Z. Conical depressions of the mucous tissue in the funnel-shaped cavities between the limiting muscular bundles. FIGURE II. Transverse Section of the Left Fallopian Tube (middle portion) on the Menstruation. (^A/ter Leopold, op. Z. Thickened bulbous ends of the capillaries. tufts The epithelium first day of cit.") of the swollen mucous membrane, with exuberant partly preserved, partly pushed off the ends of the tufts and mi.xed with blood corpuscles. R. Circular muscle, this like the tufts is interspersed with numberless red and white blood corpuscles, which are principally arranged round the dilated blood-vessels. G. Vessels. FIGURE III. Mucois Membrane of the Body of the Uterus on the third day of Menstruation. {After G. Leopold, op. C. Exuberant, here cit.) and there denuded capillary networks, between which are occasional depressions, the openings of glands. E. The mucous surface in the first stage of desquamation. D. Glands more spiral and broader than in Fig. I. A. The arteries in the deeper layers of the mucous membrane. Z. Depressions of the mucous membrane in the muscular layer. B. Muscular bundles.
    • ) PLATE XllL—(Continued). FIGURE IV. Fresh Corpus Luteum from 8 to 9 days old, 8 to 9 days after commencement of HsBmorrhage. {A/ier Leopold, C. last op. at.) Corpus luteum. F. Follicle, the size of half a split pea. N. Cicatrix, through which the blood-mass glistens. FIGURE V. Older Corpus Luteum (5 weeks). (After G. Leopold, FIGURE op. cit. VI. Corpus Luteum, three weeks old. {After G. Leopold, op. cit.) The reddish-brown tough coagulum is closed in by a strong yellow jagged mem- brane, in the most external borders of which are seen numerous minute extravasations. FIGURE VII. Corpus Luteum., seven weeks {After G. Leopold, op. old. cit.) The coat of the follicle half a millimeter in diameter, encloses a yellowish-grey nucleus containing a small cyst. FIGURE Almost Ripe VIII. Follicle. {After G. Leopold, op. A lilie follicle cit.) of the size of a small bean, with nucleus projects into outer wall of ovary a cyst and has a thin wall.
    • Taf.XIV Fi£.l y-r Ph #'^ 4^^ 'm ^-< ''m Fig. 3. £:^ E.yiurliiiH Ifainlatlas- II AtiH. v. A. Martin vM. S^fUitxe,. XiAK.&Mi.. SmUk.
    • PLATE XIV. FIGURE I. Lymphatic Vessels of the Non-pregnant Normal Uterus. The lymphatics of the normal unimpregnated (After G. Leopold. band Uterus of a Woman uteius. Archivfur Gymkohgie, vi.) aged 30 years. Anterior View. T. Fallopian tubes. 0. Left ovary. Subserous network of lymphatics. Branches to the Fallopian tubes. a. b. FIGURE II. Uterus of a Sow, Blood- and Lymphatic-vessels. {After Leopold, op. H. cit.) Left horn. T. Fallopian tube. L.L. Broad ligament. a. b. c. d.d. e. f Subserous network of lymphatics of uterus. Branch from the same to the Fallopian tube. Subserous network of the lymphatics of the Fallopian tube. Lymphatic ducts between the two layers of muscle. Duct in broad ligament. Ducts of the lymphatics of the Fallopian tube in the broad ligament. FIGURE III. Blood-vessels and Lymphatics from the Uterus of a Virgin aged 25. {Aftet G. Leopold, op. cit.) A. Arteries. V. Veins. Lymphatic vessels with raised endothelial membrane, resting on the margin and on the surface at b. Larger lymphatics, adjoining the blood-vessels. Branch from the lymphatic vessels into the lymphatic loculus. Lymphatic loculi with boundary of the nucleus of the same. and a. b. a, c. d. e.e. at
    • Taf. XV. Ti^.l. Fia.l'. / !: yictrtiini lltiiij.illu^. II AufLij.A.MarUr (lu;. .^sci'iui,-.. ->', n; <rtM,rt. fiS,-/:!',
    • PLATE XV. FIGURE Mucous Membrane of the Body I. of the Uterus at the fourth {After G. Leopold, op. month of Pregnancy. a'l.) The decidua has become more like a network of cavities than a mucous membrane The tubular glands, as far as the under surface of the membrane, have changed into broad cavities, they are almost entirely denuded of epithelium with the exception of a thin basement membrane. The decidual membrane has become with tubular glands. spongy in consistence. Thick masses of interstial tissue lie at irregular distances between the enlarged gland-spaces, and generally contain the larger arteries. The boundary between the mucous membrane and the muscular layer is sharply defined. Mc. Mucous membrane. Ms. Muscle. D. Gland spaces. B. Muscular fasciculus. G. Vessels. FIGURE II. Placenta and Uterus at the middle of the fifth month {Partly diagrammatic after G. Leopold, op. of Pregnancy. cit.) A. Amnion. C. Chorion., J?. Jis. 5". -f- Serotina reflexa. Marginal sinus. B. Serotina with glandular layer. T. Line of demarcation between the uterus and the ovum. M. Muscle. Z. Chorion villi. FIGURE Uterine III. Mucous Membrane 7 days after delivery. Transition of the in the Mucous Membrane of the body of the Uterus. {After G. Leopold, Mc. Mucous membrane with gland-spaces. Ms. Muscles with commencing thrombosis. op. cit.) Placental Site
    • . Taf. Xl Fi'i.2. Fii.l. ['is, 1- -^(B^ A'. Murlin's llnndallus. I/.. lull. u. .1. AJui tin. Clf&. S*ft-u*it^. ^L-bfi.. gJmM- . .'Sj>1/I
    • PLATE XVI. FIGURE I. Female Mammary Glands. (After Jules Cloquel, a. Mucous c. Analomy, &c., Obstetrical Demonstrations, Weiviar, part xi. 1S32J. Nipple. b.b. Human Areola. follicles or the so-called glands of Montgomery. FIGURE II. Side view of Female Breast. (After J. Cloquet, FIGURE op. cit.) III. Lactiferous Duets and Lobuli of the Milk Glands during Lactation. {After P. Dubois, Complete Treatise of the Art of Midwifery, vol. Lactiferous ducts and their dilatations (the indicating line a.a. is i. Paris, 1849.) not attached to one of the letters a.) Anastomoses of the b.b. d.d.d. lactiferous ducts. Connective tissue containing fat. FIGURE Two IV. Lactiferous Ducts diiring Lactation prepared and injected. (After f. Cloquet, Atlas of Anatomy, Paris). a.a.a.a. b. c. d. Lobuli of mammary Commencement glands. a lactiferous duct. Sinus-like dilatation of a duct. Section through the mamma. of FIGURE Lobulus of Mammary Gland V. during Lactation (enlarged). {After P. Dubois, a.a.a.a. b. Single acini. Lactiferous duct. op. cit.)
    • , Tar.:s:vE Fi^. 1. Fi(5 g dvcL E. Marlins Hn „,/,.!/, ,.-,-. H A77/? . n A. Mnr/ I fA ,?;,(', A ^r f lU^, (3^^^ . . 03^.,,<', ,
    • PLATE XVII. FIGURE I. Mucosa changed by the development and Reflexa. Surface of the Uterine of the Deciduse Vera (Life-size). {After Reichert. Description of a premature human ovum in a state of vesicular development. Berlin, 1873). The side anterior wall of the uterus has been divided through the fundus from the and the left vera, triangular border separated and turned back. by the development of the cotyledons, suled, stands plainly out u. u^. 7/. u.c. v.g. o.v. /. /'. l.r. The in left raised surface of the decidua which the embryo lies encap- on the posterior wall. Body of the uterus. Fundus uteri. Margin of the uterus. Cervix uteri. Cut portion of the vagina. Ovary. Fallopian tubes. Infundibulum of the Fallopian tube with the fimbriae. Round ligament of the uterus. u.p. Posterior wall of the uterus. ti.a. Anterior wall of the uterus. u.c^. Os u.l^. q^. d.v. uteri. palmatae on the surface of the mucosa of the cervix uteri. Transverse folds of the mucous membrane of the vagina. Decidua vera, chiefly that portion, not concerned in the development of the raised plateau, on each side of the body with an almost even triangular summit pointing towards the cervix uteri and passing into the marginal furrow. The dark points indicate the orifices of the utricular glands which can still be seen at this period. In the drawing at d.r. the indicating line to the margin of the raised plateau is wantPlicae ing at the d.v^. d.v.a. ;. ».' left side ot the posterior cut surface. Right marginal furrow. The raised plateau of decidua vera pointed and triangular, developed into cotyledons and papillae. The cotyledons in the raised plateau of the anterior uterine wall have become unrecognisable through pressure. Groups of cotyledons of the raised plateau of decidua. The island at the base of the raised plateau in the lower portion of which the embryo lies embedded. The decidua reflexa (embryonic capsule) can just be seen above the level of the raised plateau. i} Papilliform island jutting out at the s.i. Furrows between the islands. apex of the raised plateau.
    • PLATE XVU.—(CoiitmuciI). FIGURE II. Diagrammatic Transverse Section of a Pregnant Uterus, a few hours after the Embryo became encapsuled, which apparently took place on the 8th day after impregnation. {^After Reichert, op. cil.) ;/.' /. u.' i.^ SI. dva. dv. dv} ua. up. as above. Dendritic and netlike furrows running- between the primary cotyledons. /.v. Vesicular shaped embryo. a.s.p.^ Marginal zone of the embryo; villi partly in process of ramification. Free wall of the embryo. M. Layer of mucous membrane of uterine wall, especially the portion not connected with the decidual structure which receives the blind endings of the mucous glands. p.^up."^ Primary and secondary papillae in the cotyledons of the raised plateau of decidua /.v.^ /.v.^ vera. d.r. X. e.m. vt.e. Region of decidua reflexa with the basilar wall mostly free from villi. Near the cicatricula of the ovum at its free wall, where the lips of the marginal zone grow together over the ovum. Embryonic lemma (investing membrane). Coste's embryonic macula. FIGURE An Ovum (After laid open R. Wagner, Icones III. at the 21st day. Physiologict. a. The chorion completely surrounded with b. Leipzig, 1 839). Amnion. c. d. villi. The vesicular umbilicalis. The embryo with the allantois. FIGURE Ovum with Embryo from the 7th to the 8th week. {_After a.a. h.b. d. e. f. R. Wagner, op. cit.) The deciduous membrane, and that part which adheres to the wall of the uterus (membrana decidua adnexa). That portion of the decidual membrane which directly surrounds the ovum, the socalled c. IV. membrana decidua reflexa. The cerium, chorion, dotted with The amnion opened. The vesicula umbilicalis. The embryo. villi.
    • PLATE XVIII. FIGURE I. Mucous Membrane developed into Decidua at the 6th week of Gestation. Section of Pregnant Uterus with {A/ier Coste. a.a. b. General and Special History of the Development, 6^c., of the Human Species). Muscular and vascular layer of the uterus. Internal surface of the mucosa developed into decidua, which by the removal of the muscular layer allows the utricular glands to be plainly seen. FIGURE Section of Uterus and Placenta of a II. Woman who died in the 30th week of Gestation. {After Al. Ecker, Icones Physiologicce. a. Root of umbilical b. Amniotic layer of the c. Leipzig^ 185 i). Chorion. cord, and its insertion into the placenta. funis. d.d. Foetal portion of the placenta. e.e. Uterine wall. ff. Villous branches, forming the stroma of the placenta. g.g. Decidual membrane. h.h. Prolongations of decidua into the placenta. i.i.i. Spiral- or corkscrew-shaped uterine arteries. i.p. Artery, entering the placenta. k.k.k.k. Extremely dilated uterine veins. FIGURE III. Injected Terminal Loop of Villus from a Mature Placenta. (Magnified 350 times). {After Ecker, op. a. b. c. d.d. e. cii.) which has been removed from the chief portion of the villus. Prolongation of epithelial covering stretched through the vascular spaces of the placenta as continued into the denudations of the same. Arterial branch. Epithelial covering, Terminal loop returning as a vein. Fine capillary network.
    • <-rll„..- Taf.XWll Ha,,.l..tln.-._ nAiif/. u A. >Tnrl fJltk. S-r^hCUv-t^ ^•iL.r-iM
    • 1
    • PLATE XVUl.^(Coniinned). FIGURE IV. Placenta from the Internal Surface. {A/Ur W. Hunter). vascular branches to the internal surface of the placenta. a. Funis with h. Internal surface of placenta covered with the ex. d. Membrana its amnion and chorion. ovi raised up. Border of placenta. FIGURE V. External Surface of Placenta. a.a. h. c.e. Single lobules of placenta (cotyledons). Funis. Opening's of the so-called marginal sinus of the placenta. d. Marginal sinus opened. e. External surface of chorion spotted with decidual remains.
    • PLATE FIGURE XIX. 1. Pregnant Uterus at the commencement of the 5th month from behind. (One-third Life-size). [ After W. Hunter). a. Body h. Cervix, hanging to the uterus like a cone. c. External os d.d.d. of uterus widened into a spheroid. uteri, studded with small swollen mucous glands. Vagina. FIGURE II. Fundus Uteri of a Pregnant Uterus at the 8th month, (One-third Life-size). {After W. Hunter). a. b.b. Anterior smooth wall denuded of peritoneum. Posterior wall arched prominently upwards, denuded of peritoneal covering, to shew the enlarged vessels, especially the veins. FIGURE III. Internal surface of Uterus far gone in Pregnancy after removal of the Mucosa developed into Decidua, to shew the muscular fibres of the internal surface and developed folds of the Arbor Vitse. (One-third Life-size). {After W. Hunter).
    • T.-if. XIX fc>- ^S^- ^ ^ A /',' /- 71'''^ ^"* 'f' 1 -l '^- 1 ^^O' f^ Martins Handatlas. //Jufl.z/- A Maitai Caffc. S^iU^^. £i.tfi.. cSm^ ."B/Tfi.,
    • i
    • Tnf X. . FiE.l. A' Marlins //iJ,n/at/as. H .hiH . r. .1 Muilin CU&. SffUvfew.. Xuti.aXi,^.. tri^tin
    • PLATE XX. Side view of Abdominal Cavity laid open after partial removal of the large Omentum in a Woman far advanced in pregnancy, (One-third Life-size). {A/hr W. Hunter). (.1. li. c. d. e. /.y.f. The uterus advanced in gestation. The right round ligament. The right Fallopian tube. The fimbriae of the right tube pushed forwards. The ascending colon. Coils of intestine. g. Remains h. Right lobe of the I. k. /. of large intestine. liver. Left lobe of the liver. Round ligament of the liver cut through. The diaphragm covered with the pleura.
    • I . Fitf. 3. Taf.XXt FU>. 2. Pi 6. 1. 3 Pio. 4. E.M,n-Nn-.- Hni,,h.H,,.s. UAuf/. a A. Mnrr„< iJIM. S-cPi I'.i
    • PLATE FIGURE Human Embryo XXI. I. at the 9th week, (Life-size). (After Sommering, Kiliatis Atlas of Obstetrics). FIGURE Human Embryo II. at the 3rd month. (Life-size). FIGURE Human Embryo III. at the 16th week. (Life-size). FIGURE Human Ovum at the 5th IV. month and a (Life-size). half.
    • ;if. X. ""^ "->' ^ E.yhirtin« llninlatluH. II Jul'l r A .-J uilui . t'tl6. SilUitf.e. „fitfi c^iii, Xll.
    • PLATE Human Embryo, XXII. Funis, and Placenta, with its Membranes, lunar month of pregnancy. (Life-size). (After Sommering, accompanying Kilian's Atlas). a. Internal surface of the placenta. b. External surface of the placenta. c. Macerated d.e. Amnion f. Funis. villi of the placenta. in folds. at the 6th
    • . T;if. Fi£ . Fig. <; 5. will. Fii.4 ::p Fis.l. / "^-^ w A' Marlin's /Irnidiillun . II .lull n. .1 . . .Mai Un, JlCfi. SiivM^e. , _iiMi-. (iitwl Sii fall
    • . PLATE XXIII. FIGURE Internal Organs of an (After a. Funis. b. Embryo Monau. Umbilical arteries. c. d. I. e. before birth. Atlas). Junction of the umbilical vein with the portal vein. Urinary bladder with urachus. Umbilical vein. f. f'. FIGURE Liver, raised up. Ductus venosus Arantii. II. Festal circulation. (After Hasse, by The vessels Strasser. drawn white contain dark contain venous blood. A. H. Spiegelberg System of Alidivifery, arterial blood, those shaded 1 877) mixed blood, and those
    • PLATE XXIIL— (Continued). FIGURE V. Meconium seen imder the microscope. (A/Ur C. Ruge). This drawing coloured by C. Rug-e could not, for technical reasons, be reproduced in the same way. A lial wooly hair (lanugo) scales, fat globules, lies across between the crystals of cholestearin, fatty epithedetritus, which are coloured greenish- mucous globules and yellow. FIGURE VI. Vernix Caseosa under the microscope. (A/ier C. Ruge). Wooly hair (lanugo) epithelial scales in fatty degeneration, fat globules.
    • PLATE XXIV. Section of a normally formed Pregnant "Woman about 25 years old, after death from hanging. ( W. Btaune, Alias of Topographical Anatomy^ l868. C. U. Body O.u.i. ovum Plate II. A.B.) end of 8th week. Internal os uteri. of the uterus containing at the C.u. Cervix uteri. Bladder. V. d. Clitoris. R. Rectum. V. Entrance to the vagina. c.t. Transverse colon. F.i. Iliac flexure. A. Aorta. V.i. Right common iliac vein. and broad, with a conjugate diameter of 120 millimeters. than that of the male which is 60°. The characteristic of the female vertebral column is the diminished prominence of the promontory compared with that in the male, as well as the marked depth and declivity of the pulvic symphysis. The position of the intestines normal there are none between the rectum and uterus nor between the latter and the bladder. The position of the os uteri low down in the pelvis, as well as the mucous plug emerging from it, correspond with the early period of The The pelvis well developed pelvic inclination is 58°, less : the pregnancy. The decidua vera, is plainly seen inside the muscular layer of the uterus, consisting The gland tubes present punctiform of mucous glands, connective tissue and vessels. openings on the internal surface and can be seen with the naked eye. From above from the anterior wall of the uterus the decidua nal surface of the uterus, until it is markedly gradually increases thin but continuous with the inter- in thickness towards the posterior wall developed in the neighbourhood of the internal os uteri. At the superior thinnest point, corresponding with the middle of the fundus uteri, a fold is formed, the decidua reflexa, which extends downwards as a small membranous envelope of the ovum as far as the triangular extravasation of blood, which is drawn shaded. In the and becomes fully above membrane which forms the external membrane of the ovum and is composed of chorion Iseve and decidua reflexa, only epithelial remains, connective tissue and rudimentary villi are to be found. An undulating delicate boundary line runs up backwards and forwards from the site of the extravasation and divides the chorion frondosum from The chorion portion, plainly distinguished by the drawing and cothe decidua vera. louring, only contains villi and vessels, and indicates the future site of placental formation. To the peritoneum which stretches farther down over the uterus behind than in front, attached a thin layer of fascia with undulating cell-tissue, which allows the separation similar of the rectum and vagina to take place during the dilatation of this organ. is A condition obtains between the bladder and cervix uteri, so that the bladder may be cap- able of considerable distension. The more minute relations of the not recapitulated at Plate XXIV. ovum, which correspond with the eighth week are
    • T;if..XI-. Miirlin's llaiuliidus. II Alill.li. A.^tlaitin.. Cit^^ SdMf^.e^. ^M GJ^Mt.lB/yi&if.
    • . Taf. X-. '^«-- A'. .Martifi's Uaiidiillan . H .lull . i>. . /. .Martin. CTf&. ScKii-tx^c ^Itfi, tOuM^. Uoz-r^u
    • PLATE XXV. FIGURE Uterus with Foetus in {After W. Hunter first head presentation. and H. Fr. Kilian). FIGURE Uterus with Pcetus in I. first II. breech presentation. (After W. Hunter).
    • Taf, XX-1 1m6 :! o.t.-i K Matiiu's Hinidalliin II . lull - r. ./, Marlin I'Uf.. SiPuU.-.s-. i'iH; .'iii-i ^"i^'-ii
    • PLATE XXVI. FIGURE Body Section of the Frozen of a Woman (After in labour during the period of expulsion. Bratine). PL F. Bag- of waters, u. v.p. Af. Left iliac vein. v.i.s. Aorta. Pa. Pancreas. uteri. Internal os uteri. o.i.o.i. Duodenum. a. Rectum. External os H. Bladder. o.e.o.e. Placenta. d. Urethra. r. I. Vena portae. Stomach. L. Liver. FIGURE II. Section through the parturient canal after removal of the child. (After Braune, V. o.e.o.e. Vagina. External os op. cit.) o.i.o.i. uteri. o.t. FIGURE The engagement (Diagrammatic after Schroder. u. Urethra. a. III. of the Head. Text-book of Midwifery. r. FIGURE Rectum. IV. Commencing Expulsion of the Head. (Diagrammatic after Schroder, u. Urethra. a. Anus. 5th edit. p. 162). H. Bladder. iK. Second sacral vertebra. Anus. F. Frenulum. of Fallopian tube. PI. Placenta. C. Cervix. f. Frenulum. Internal os uteri. Opening p. 163). Second sacral vertebra. H. Bladder. r. Rectum. 2,K.
    • if. Fk. XWI ( ^ I'ls-,:' .j: i:.M„rh,i llf,,„iall„s II 'lull ,. I. Mai In, CW-^ &c)Mr.<^.±M- SuaX..^mZlvy.
    • PLATE XXVII. FIGURE I. The engagement of the Pace descending {A/ier Schroder. u. Urethra. (The Text hook of Midwifery, indicating- line first. 5 th edit. p. 178). has been drawn to the pubes instead of to the lying urethra). 2.S'. f a. Second sacral vertebra. Frenulum. Anus. FIGURE II. Cranium of Occipital presentation. (After Hecker). FIGURE III. Cranivim of Face presentation. (After Hecker). FIGURE Cranium of breech • presentation. (After Hecker). FIGURE Lateral Curve of the IV. V. Trunk during labour {After Hodge in Spiegelberg, op. in breech presentation. cit. s. 174). under-
    • 'M. XWI i-ia.2. Fig 4. E Marlin-x llaiulailus // .la/t r. A.Mariii Fifi.l. (.nil, SctUltee-. J'U.fi,.r<M^l I'SxT^ia
    • PLATE XXVIII. FIGURE I. Occipital presentation. (After Olshausen. On the supplementary diagnosis moulding of the skull of the new-born child. FIGURE course of labour by means of the of Clinical Lectures, No. S). of the Series II. Pace presentation. FIGURE Brow III. presentation. FIGURE IV. Antero-f^outal presentation.
    • 'nf f, Marliit's [luiidatlus. II Aul'l. i'.A. Merlin cM. S*fi.i.UA£.. ^i.'Hi.cCJvu.i . XXK. .'ir'^tC-i
    • PLATE XXIX. FIGURE 1. Uterus with Twins in Cranial and Breech presentation. (Two Ova). {A/ler Smellie). FIGURE II. One Placenta with Twins. {After C. Chr. H titer. The Simple Placenta, Marburg, 1842). a.a. Anastomising vessels of the two embryos on the internal surface of the placenta. b.b. Junction of the two amnions with each other. FIGURE Triplet afterbirth with {After a. b.b. V. III. two Embryos arrested D' Outreponl. in development. Obstetric Demonstrations). Placenta which belonged to fully matured foetus. Prematurely dead embryos and their placenta.
    • Tnf. XX, % T K Marlins ilnn(/ul/ci s 11 Aul'l . f. .1 . M (iltui. . KJ ^Xtt,- SAiaxc-. 1M',. cju^l: • ^eit
    • PLATE XXX. FIGURE I. Inflammation of the Mucous and Sebaceous Glands of the Vulva. {A/Ur P. C. Huguier. Genital Organs of Memoir Woman ; o?i the Diseases in the of the Secretory Apparatus of the Memoirs of the National Academy of Medicine, External vol. xv. Paris, 1S50, 4, plate i). FIGURE II. Abscess of the right Bartholini's Gland. {After Huguier, op. FIGURE Cyst formed by the (Vulvo-vaginal Gland). cit.) III. Dilatation of the Occluded {After Htiguier, op. Duct of the left Bartholini's cit.) A. Cystic tumour. B. Introitus vaginae. C. A (The line is protuberance formed by the continued beyond the left orifice). border of the vaginal orifice. Gland.
    • T;,f . XXXl. I ^,*=. ... V ^ -'?.- -*°*A .JW;,fe.-".... ^ /"^ Fse,i_ -'.w K.Martins llaiulullas II Aiill.v .iMuihn rtffe. S-cfvLitxc . ^i-tfl c3vwt. ffl/xiEtii iJ
    • PLATE XXXI. FIGURE I. Morbid enlargement of the {AJ'lcr Clitoris. Atlas of Drawings of Theotetical and Practical Midmfery, 1838). D. W. H. Busch. FIGURE Ia. which has become extruded from the Vagina by gradual elongation of the Stalk. Follicular Polypus of the Cervix, (^After original observation This figure is among a number and Boivin and Dughs, plate of impressions without special reference to them. FIGURE II. Lupus of the Labia, the Vaginal {After Hugtiier, op. A. Hypertrophied left xvii). cit. Orifice plate 3, and Anus. fig. ii.) labium majus. B. Left labium minus destroyed at the base. C. Cicatrised point of arrest of ulceration. D. Meatus urinarius. E. Opposite ulcerating point in fraenum labii. F.F.F. Seat of ulceration with separation of the posterior and vagina. left lateral wall of the G. Internal margin of the ulcer. H. Entrance of vagina. (The indicating line has fallen out of the type, its indicating end should lie over (J). /. Extension of the ulceration to the point of union of the right large and small labia. JJJ. Growth on perinaeum and anus. K. Swelling of left inguinal glands. FIGURE III. Lupus of the Vulva. {Perforating and Hypertrophic Ulcer after Huguier. Region. National Academy of Music. Memoir on Rodent Ulcer of the Vulvo-anal Vol. xiv. Paris, 1849, plate A. A. Enlarged and infiltrated labia majora. B.B. Degenerated labia minora. C. Puckered portion from previous ulceration. D. Growth of perinseal raphe and folds of anus. E.F. Opposite the meatus urinarius and vestibulum. G.G.G. Growths at orifice of vagina. 2, fig. i.)
    • T,if, XXXII. .^^!S^. C ^^^^2^-'. /•; MartniS Iliin.lalUi ^ . II .lull. ! .I.Ahuliu k Hf.. SlIiuC.c. .JS'iMi ,ri,,,.i .'i!.-vlu,
    • . PLATE XXXII. FIGURE I. Lupus of the Vulva. (From an Original Drawing). (Half Life-size). (By the kindness of Dr. Loretit, Director of the Geneial Hospital of Bremen). The history and description of the case are in the " Monatschrift fiir Geburtskunde und Frauenkrankheiten," edited by Cred^ Martin, von Ritzen, von Siebold, band xiii. FIGURE II. Broad Condylomata of the Labia in a Pregnant Woman, removed in two Huguier without causing abortion. sittings by (One-third Life-size). (After H. Lehert. Treatise of Pathological Anatomy, Paris, iSjg). The growths on the prepuce of the clitoris are easily distinguished from those on the The growths round the anus are continuous with those of the vulva, so that large labia. the entrance of the vulva is surrounded by them. FIGURE III. Urethral Excrescence. (Half Life-size). (After Boivin and A spongy growth projects from the meatus Dugh) and displaces the orifice from the right.
    • w
    • . Tnf XXXIII />^ ^ hi k 1-12 4 ^iW W ¥ V^^ Fi£.5. ^..cpWf'Sr^-^'l^ J K Marlins lluudallas llJufl .i: A. .i ,.. ,. 5 7;>^))./ r ClC6. S.-riut!ifc. JiiHl ^0M..t.S3«l'iii.
    • PLATE XXXIII. FIGURE I. Malformation and Occlusion of the External Female Genitals in a new-born chUd. {After Aug. Fr. Giiniher. a. Penis-like clitoris with prepuce Commentaries on Hermaphroditism, Lips. 1846;. and opening, which, however, does not lead into the bladder. h.b. c. Swelling resembling the labia. Body of uterus (cervix uteri ?). d.d. Globular enlargement of the Fallopian tubes. e.e. Fallopian tubes with fimbriated extremities. f.f. (Divided body of uterus ?). Ovaries. FIGURE II. Malformation of the Female Genitals by growing together of the Labia Minora and vmusual size of the Clitoris. The Internal Organs of Generation were normal. {Ajlcr a.a. b.b. c. Gtiil. H. M. Becker. Dissertation on Hermaphroditism, Jena, 1842). The large abnormally developed labia joining together underneath. The labia minora grown together in their lower half. The clitoris measuring 2, 3 centimeters in length with a semi-canal underneath lead- ing to the meatus urinarius. d. The hypcrtrophied prepuce of the glans clitoridis. FIGURE III. Occlusion of the Vaginal Orifice by Malformation of the Bands of the Labia. {After D. W. H. Busch, Atlas). FIGURE IV. Coalescence of the External Genital parts as far as the Meatus Urinarius in an old woman, who had suffered from an intolerable Pruritus but had not borne children. {After Boivin and Dugh. Practical Treatise of Diseases of the Uterus, Paris, 1833. Atlas, plate 40). FIGURE V. Hypertrophic Degeneration or Elephantiasis of the Labia Minora and Prepuce of Clitoris. {After H. Herzog, on the Hypertrophies of I hi External Female Genital Organs, Erlangen, 1842).
    • . [if XXXIV. ^f:^.K- ^':^i "»s.. J, -A. % ^ K.Marlin-a Hanclallus. II .Udl .u. AMarlin. df^. .'?-(:A,ilt-x^. J?i ^^l- JUwo^-. ^xitCivi
    • PLATE XXXIV. FIGURE I. Occlusion of the Vaginal Oriflce (Atresia hymenea) with displacement forwards of the Anal opening in a girl aged 4 years. (Half Life-size). {A/kr Gtisl. Dissettaiio in sistens singularem Aug. Lolze. vagincB. Clitoris. b. Urinary meatus. c.c. Larsre labia. A {After S. Merriman. c.c. atresia in a woman orifice. II. in labour by an Ovarian Tumour. Synopsis 0/ the various kinds 0/ Difficult Parturition with plates, London, 182 b. ct Anal aperture. f. FIGURE a. Occluded vaginal e. Narrowing of the Vagina prater naturam coUocati Small labia. d.d. a. am JencE, 1S27, 4c. tab.) The symphysis divided. The sacrum. The urethra and bladder. 1 ). d. e.e. /./. FIGURE The ovarian tumour. The rectum. The vaginal wall. III. Acquired Partial Occlusion of the Vagina. {After Aug. Ae. fans on. a.a.a. h. c.c. d.d.d.d. The The uterus cut i. k.k. tab. Francof. a.M. 1845-8). off. ligaments. Exudation membranes. Upper Lower f.f h.h. c. off. right Fallopian tube cut The broad e.e. g.g. Diss, in'de atresia vagincB acquisita, portion of vagina dilated into a pouch. portion of vagina with rugae. Sound with cross-bar Sound Neck to to expand the upper part of the vaginal pouch. expand the lower portion of the vagina. of the bladder. External genitals.
    • T,if. Fie XXXV ViA.2 ] ¥i6.4. /',' Miirtiiis llaiu/allus II Aiifl . v. .i M (iitiix . t-liffi Sci'xiU7.c. SuK SHyi..Sij>r(i,'
    • PLATE XXXV. FIGURE I. Prolapse of the Posterior Vaginal Wall. {After R. Frura'p, Surgery. a. Section throug'h the symphysis. c. Bladder. d. Copperplates, Heft. 86, 1841, Taf. 435). Vagfinal orifice. h. (Enterocele Vaginalis). Vagina. Uterus. e. Entrance to the vaginal enterocele. g.g. Rectum. h. Sacrum. f. FIGURE II. Prolapse of the Posterior Vaginal Wall. {After Froreip, op. (Vaginal Enterocele). cit.) Section through symphysis. a. Bladder. Divided vagina. Section through the prolapsed posterior vaginal wall. b. c. d. (Hernia vaginalis postica). Divided uterus. / Entrance to the Hernia rectalis. g. Section through the rectum. h. Sacrum. e. FIGURE Vesico-vaginal Hernia. III. (Cystocele Vaginalis). {After Froreip, op. c. Divided symphysis. Vesico-vaginal hernia. Section through vagina. d. cit.) Stretching of peritoneal folds between Uterus. a. b. e. uterus f. FIGURE Recto-vaginal Hernia. Rectum. IV. (Rectocele vaginalis). {After Froteip, op. a. Divided symphysis. b. Section through vagina. c. Uterus. d. Recto-vaginal hernia with prolapse of the posterior vaginal wall. and rectum. e. cit.) Perinaeum diminished by the pressure of the rectocele. f. g. Rectum. Stretching of the utero-rectal folds.
    • Td XX.WI Fifi.l. xr%^>r --^^ Fi'i.2. /' ^3=*^:. > r^?; f^x ,,;a.^«- .^' ^.^_ .^ -Fin. K -'J-7tl. *"& Mclrlins H„inl„lluH II . lull r -I A MuiUn I. UT- •ScCviu.'.fc, Jj, Hi ,n,i,.t .'S.-rfi,
    • PLATE XXXVI. FIGURE I. Vagina and Uterus divided by a Septum. {A/ier Eistnmarin. Tab. anal, uleri duplicis, ohserv., rarior Argentor, 1752). sistentes. b. Double orifice of vagina. Meatus urinarius. g.g. Double cervix uteri. Double body of uterus. c. Urethra. h.h. Round a.a. d.d. e.e. /./. Double vagina. Double os uteri. i.i. k.k. FIGURE Ovaries. II. Two-horned Uterus and divided Vagina b. c. The vagina cut away. The OS uteri of left side. The external surface of e.e. f.f. g.g. of Uterus developed together with a rudimentary Right Horn {After Rokitansky. married e.e. in a 34. vol. ii. 1842, Oesterreich, Staates, s. 514, and On 1838, vol. 26). Left uterine horn. Hollow cavity of right rudimentary horn, which is connected with the left developed portion by a solid flat band of uterine tissue about 3 centimeters above the external Projecting funnel-shaped vagina. Ovaries. Fallopian tubes. ligament. f. Right broad g.g. Round ligaments. d.d. woman aged Medical Ycar-ho;k. OS uteri. c. III. Handbook of Special Pathological Anatomy, the so-called duplicated uterus in the a. letter uterus. Sterile b. Berol. 1841). (The the cervi.x apparently divided FIGURE Horn 17. in several plates). The two horns of the The round ligaments. The Fallopian tubes. The ovaries. Left aged by one septum. stands instead off d.d. in a virgin Diss, de uleri ac vagina sic die/is duplicitatibus. (After Fr. Schroder. a.a. ligaments. Fallopian tubes.
    • PLAT E XXXVI .—(Continued). FIGURE IV. Pregnancy in the Left Rudimentary Uterine Horn, mistaken at first for Tubal Gestation. {A/hr Hcyfelder a7id Ad. Kussmaul. On Uterus, a. Cervix and doubling up of the Right half of body of uterus. b. the Absence, Mal/otmalion, Wiirzburg, 1S59). uteri. Vagina. e. Right Fallopian tube. f. Right ovary. h. Incompletely developed left uterine horn. Uniting portion in which for a short distance a small canal can be followed from /. c. the right horn. k. /. Left round ligament. Muscular fibres which diverge from the right horn. m.m. Borders of peritoneum dissected off. n. Left Fallopian tube. 0. Left ovary with a large corpus luteum. />. Point of rupture with everted borders. q. Placenta. d. Umbilicus. g. Membrana r. ovi. Female embyro 1 2-5 centimeters long. left round ligament into the body of the
    • PLATE XXXVII. FIGURE Rudimentary Horn united by a solid band with the enlarged by pregnancy. {After J. Chr. Stan. Czihak. Cavity of b. fully developed Uterine Horn Transverse Section. Diss, in de gravidiiate extra nterina, Kussmaul, a. I. Heidelb. 1 824, and Ad. op, cit. s. 124). Cervical canal. Vaginal c.c. d. e. f. left uterine horn. cavity. Decidual membrane. Opening- of tlie left Fallopian tube. Muscular band of union. rig^lit pregnant horn. g. Cavity of tlie h.h. i.i. k. in. n. Peritoneal covering. Muscular layer with numerous divided vessels. Placenta. Funis to which was attached a male embryo at the 6th month of gestation. Right Fallopian tube. FIGURE One-horned Uterus from a II. Drawn from child. (After Pole, Metnoirs of the Medical Society of London, 1794, I. Right horn of uterus alone developed. Right Fallopian tube. c. behind. and Kussmaul, op. cit. s. 22). (Uterus unicornis dexter). Left Fallopian tube. a. d. Left ovary. e. Bladder. f. Vagina with os g. Right ovarian ligament. uteri and vaginal portion projecting FIGURE Onc-hornod Uterus from the body of a tenth time ; into it. III. woman from the left Kidney was 6 to 7 days pregnant for the also absent. {After Chaussier, Bulletin of the Faculty of Medicine of Paris, 1 81 7, and Granville, Philosophical Accompanying text of Kussmaul, op. cit. s. 122). Transactions, for the year 1818. a. b. c. d. Posterior wall of pregnant uterine horn. Right Fallopian tube. Right ovary. Right broad ligament. e. f. g. Undeveloped Fallopian tube ovary, and broad ligament of the left side. Vaginal portion, Vagina. •!
    • . I'iif, 1-1!; 'v: :, XXXI 1 /<rf^i Fij. (; 1^-. ^-- A' Martins lliindattus . II Autl. o. .-I. Mai ate. S*ft.iU^.«'. -Sl-td eJ"->t.iB'>
    • PLATE XXXYU.— {Contmucd). FIGURE Schema IV. Body indicated by Connective Tissue and Muscular Fibrous Tissue with simple Cervix. of divided Uterine {After Kussmaul, op. at.) a. Indication of cervix. e.e. b.b. Indication of uterine horns. c.c. Fallopian tubes. d.d. Ovarian ligaments. Round Ovaries. /./. gf. FIGURE ligaments, Vasrinal cul de sac. V. Apparently simple Uterus with Vaginal Wall continuous with Cervical Cavity. {After a preparation in the Heidelberg Anatomical a. b. c.c. Vagina. Simple cervix. Horns d.d. e.e. of the uterine body. f.f. FIGURE Museum. Kussmaul, op. cit. s. 27). Fallopian tubes. Ovaries. Round ligaments. VI. Dissected Uterus with two Horns and simple Cervix. {After Gravel, Diss, in De superfcetatione conjcctura, Argenlor, 1738. Kussmaul, Accompanying op. cit.) Vagina. Simple lower portion of cervical canal. c.c. Vaginal wall, thicker above, thinner below. d.d. Right and left halves of uterine cavities. e.e. Two protruberances in the neighbourhood of the internal os f. Fundus uteri. a. b. g.g. Fallopian tubes. h.h. Round ligaments. uteri. text,
    • . PLATE XXXVIII. FIGURE I. Cleft Uterus, with double Vagina, in a {After Cassan. young woman aged 30. Anatomical and Physiological Researches on Cases 0/ Double Uterus, Thesis, Paris, 1826). a. b. c.c. d.d. c. Left round ligament. Right round ligament raised up after dividing the layers of the broad ligament. Ovaries. Cysts under the fimbriae of the Fallopian tubes. Fold of peritoneum frequently observed in cases of uterus bicornis between bladder and rectum. FIGURE II. Uterus, divided from Vagina, with double Os Uteri after termination of Gestation in left half, drawn from behind. (After Cruveilhicr) a. a. The two mouths of the uterus. FIGURE III. The same preparation opened {After Cruveilhier). in front.
    • Tiir.wwiii -y K MartiitS Uanclallus II Aullc. .iMartin an, s^aiu,-_e,. ivd <0t4M,. £8^^ei„
    • Taf.WXIX. FlSl, ^1 ' I'* 4 Fie Vie. f Fi^.4-. rTi'BRfr'J'Pi'^ .-I'iVi'i^ Fie. 5. FiE !•: Miirliii's /hiiii/allus- II .lull. I- .IMarlin . (, tite s.-riut--.c. i"Hi cri,,^.ss^&„. J
    • PLATE XXXIX. FIGURE 1. Left obliquity of the Uterus. (After a preparation from a single woman, drawn from behind). a. Unusually developed left fold FIGURE The same Uterus dissected shews a Cicatrix Os Uteri near the FIGURE Fundus Uteri twisted forwards. {After Tiedemami. II. in the neighbourhood of the Internal border. left III. to the right with Inflection of the Isthmus to the left From a single On Duvemey's Glands woman in the a. Inflection to the left FIGURE to the left 1 and positions of the 840). and forwards. constricted. {After Tiedemann, op. FIGURE From a girl aged 15 years. cit). V. to the right. Isthmus the Uterus is In the neighbourhood of the atrophied. {After Tiedemann, op. FIGURE distortions IV. and Os Uteri Fundus Uteri strongly developed and over 30 years of age. Female and the Uterus, Heidelberg, Fundus Uteri twisted of Douglas. cit.) VI. Bulky vaginal portion of the above preparation from below with obliquely situated Os Uteri.
    • Tnf.XI., •*-. ^M"^ 1 ^:
    • PLATE XL. FIGURE I. on the Posterior Wall at the placental attached a portion of Placenta. Anteflexion of the Puerperal Uterus; The patient was delivered by forceps on account of The placenta was expressed, apparently completely. haemorrhage and septic peritonitis, together with site is retardation of the foetal heart. Diphtheritic endometritis and ischuria, terminated fatally on the 14th day after labour. FIGURE Puerperal Retroflexion ; II. Placental Polypus on the Anterior Uterine Wall. {After E. Martin, op. Labour normal and easy. cit.) Followed by profuse bleeding and phlegmasia dolens. Death took place suddenly on the 29th day after labour from pulmonary embolism. FIGURE Retroflexion of the Puerperal Uterus ; the internal surface of which III. lengthening of the Anterior Uterine Wall on situated the tineven placental site. is {After E. Martin, op. The The open. patient died on the loth anterior wall is 27 day after labour cit.) from puerperal diphtheritis uteri. centimeters longer than the posterior wall which is laid
    • Tnf.Xl.l. FiS 2 . Pifi.l Fi4.;i- FiS . 1 /I^Sr. 4s..^ ' Fia.5. ^'^iXa '*»: W ii) Fig. 6. -fel n K /•; Marhns J/.,„.!a,/„ ^ ^ II Allll ?.. / Martin aee. SfftiM«.«.. ^w-fi-. eJx-wt- .^r-t u
    • . PLATE XLI. FIGURE Marked Anteflexion I. of the Uterus. {AfierLe Gendre, Homolographic Surgical Atia/omj, Fan's, 185S). (I. Symphysis. d. b. Bladder. e. c. Uterus. Rectum. Sacrum. FIGURE II. Anteflexion of the TJterus soon after delivery. [A/kr Li Gaidn, a. Symphysis. b. Bladder. c. op. cil.) Rectum. Sacrum. Uterus. d. e. FIGURE III. Retroversion of the Gravid Uterus at the fourth month. (Diagrammatic). FIGURE IV. Retroversion of the Gravid Uterus at the commencement of the fifth month with considerable distension of the Bladder by retained Urine. (Diagrammatic). FIGURE V. Distension of the Bladder by retained Urine consequent on Retroversion of the Womb. {A/ier W. Hunter. a. a. Anatomia uteri gravidi) Abdominal walls divided and turned back. b. c.c. FIGURE Retroflexed Uterus bound down {After Boivin and a. Symphysis b. Bladder. c. Uterus. to the Dugh. Bladder full of urine. Intestines. VI. Rectum by Exudation Membrane. Diseases of the Uterus). Vagina, dissected. Rectum. f. Sacrum. d. e.
    • T,ii. xi,ir. l.M,irhns //„„./al/us 11 .lull ,:.l .Wa/Un I Hr} . ^jCT/i.,i, .«.:.&,
    • PLATE XLII. FIGURE I. Vortical Section of Uterus. {A/ttr F. The WiiickcL Tlu Pathology of the Female Genital Organs photographed A'atiire, Dresden, 1S77). uterine cavity almost is in a straight li/e- size /rem the cervical cavity is more .sliyhily backwards at first, at the middle of the Are placed too low down in the drawin.i,'-, line, i'-shaped, the convexity being- from the internal os cavity the convexity is directed forwards. {o.i. they should be opposite the conve.ity backwards). FIGURE II. Vertical Section of Uterus. {After Winckel, op. FIGURE cit.) III. Vortical Section of Senile Uterus. {After Wiiiekel, op. cit.) Senile atrophy of vag-inal portion, atresia of external os uteri, dilatation of uterine cavity. FIGURE Partial Prolapsus Uteri. IV. Hypertrophy of the Keck of the Uterus. {After Winckel, B. Bladder. op. cit.) Anterior v. ] R. Rectum. h. Posterior lip. A. Cystocele. lip of OS uteri. | FIGURE Myoma of the V. Uterus. {After Winckel, op. A posterior subserous intra-parietal myoma cit.) g^rowing outwards in the anterior wail of the uterus. FIGURE VI. Carcinoma of the Uterine Neck. {After Winckel, op. R. Rectum. The uterus. | cit.) Internal os uteri. involved as far as the internal os uteri and on the posterior wall of the Douglas' pouch is unimplicated. cervix The o.i. is
    • fmUfJ II M . vvr^ T.-if. xVi E,M„rli„-sna,„h,>l.'-^l/ Ml "-^ •^''""-" •-- XLin
    • PLATE XLIII. FIGURE I. Retroflexion of the Tltenis in a new-born female. {Ajlei C. Ruge, Clinical Conlrihulions. Gehursthulfe wid Gymikologie, Zeiischrift fiir R. Rectum. D. Bladder. hand ii. 24, 1877). s. o.i. | Internal os uteri. | FIGURE II. Obtuse-angled Anteflexion. Winckd, {A/tei o.i. T. op. cil.) Internal os uteri. Thrombi in The anterior both walls of the uterus. wall is thicker throughout than the posterior. FIGURE III. Obtuse-angled Anteflexion. {After Winckel, op. FIGURE cil.) IV. Obtuse-angled Anteflexion. {A/ler Winckel, op. The point of curvature is, in Figs. 3 and 4, cil.) beneath the internal os uteri, o.i. FIGURE V. Right-angled Anteflexion. {A//e/ Winckel, op. FIGURE cil.) VI. Right-angled Anteflexion. {A/ler Winckel, op. V. o.e. Vagina. External os I o.i. uteri. | FIGURE cil.) Internal os uteri. Considerable thickening of the anterior uterine wall. VII. Acute-angled Anteflexion. {After Winckel, op. B. Bladder considerably displaced from relation with the uterus. its I o.i. T. cil.) Internal os uteri, Thrombi.
    • Taf. l.i'. FiA !: Mnrl(„->r Jlr„„/,il/:j.i. II .hifl i: . A. .''^arlii •:. CtC&. S^f'uLvt^^e.
    • PLATE XLIV. FIGURE Retroversion of I. {Afhr Winckd, V. Vagina. B. Bladder; op. cit.) JR. its relation witli the cervi. Uterus. thie Rectum. disturbed. o.e. External os 0.2. is Internal os uteri. FIGURE uteri. II. Obtuse-angled Ketroflssion of the Utei-us. {Af/er li. Wiiii-kcl, op. n't.) Rectum stretched and united by adhe- o.c. External os o.i. Internal os uteri. sions to the fundus. uteri. B. Bladder. FIGURE III. Retroversion of the Uterus. {A/Ilt Winckd, op. R. Rectum. v. Vagina. The o.c. cervical canal is External uterine Near o.i. the g^landular tissue of the cit.) orifice. the internal os uteri. markedly .S-shaped, the mucous membrane of the cervix and body of the uterus are degenerated. FIGURE IV. Retroflexion with adhesions to the Rectum. {After Winckd, op. Posterior wall thicker than the anterior. become li. CD. obliterated. Rectum. Douglas' pouch. B. Bladder. cit.) Posterior lip lengthened, anterior Uterine mucosa normal. V. Vagina. o.e. External os o.i. Internal os uteri. uteri. lij) has
    • PLATE XLIV. —(Coufinued). FIGURE V. Retroflexion with adhesions to the Rectum. (A/ief J?. Rectum. £. Bladder. o.e. CD. External os The is o.i. a.a. Vag-ina. V. Internal os uteri. Adhesions. Douglas' pouch. uteri. is bound down to the rectum by two The mucous membrane of the cervi. posterior wall of the uterus thicker than the anterior wall. with cystoid Wi7ickel, op. cil.) follicles. adhesions, and is liyperplastic
    • PLATE XLV. FIGURE Partial inversion of the Uterus in a delivery {From the Pathological Repertory oj ; I. woman aged 30, who died three hours viewed from above. Anatomy ami Physiology, vol. ii. Paris, 1826. after Obstetric Demottstrations, part 8). a. Bladder. b. Projection of anterior uterine wall. c. Projection of posterior uterine wall. d.d. Fallopian tubes e.e. Ovaries. /. Rectum. FIGURE II. Partial inversion of the Uterus. {After Baillie, A Series 0/ Engravings, 2nd edit. London, I Si 2. Surgical Copperplates, Weimar, gth part, 1821). a.a.a. b.b. Vagina dissected from behind. The posterior wall of the cerix dissected to c. d. show the inverted portion of fundus. Inverted body of uterus. Anterior wall of cervix. FIGURE III. Partial inversion of the Uterus, five years after the occurrence of the inversion, with prolapse. (Life-size). {After Boivin and a. Firmly contracted b. Inverted body and fundus of the uterus. ring- of cervic neck. D ugh, op. cit. plate 12).
    • T^if, E. Martin 's Hantla llu s . II . lull. v.. 4. Martin Xl,, .£Hi. ^rti^.SJxvfin
    • Taf.XlAl -tOU ;_.;-,/ K.MaHin's ll.uulalla, II .lull r .LMarl,n tU&. S^Wt*.;..t'.tr, ^lu..t ;b« fin
    • PLATE XL VI. FIGURE I. Inversion of the Uterus with prolapse, resulting from injudicious traction on tho Placenta. {A/ier Boivin and a. The b. Anterior border of the external os Dug}s, op. cit., plate 12). internal surface of the inverted uterus. uteri. FIGURE II. Prolapse of hypertrophied polypoid growth of anterior Half H. {After W. a. successfully by lip Polypoid growth of posterior a. Fundus case by be felt Anterior c. Hypertrophied posterior lip of Os Uteri Afi, who diedfrom hcemorrhage. lip of the os uteri. IV. Elongation of the vaginal portion. (Half Life-size). (After Boivin a. Vaginal portion of cervix 3. c. Anterior and Dugh, op. cit.) Posterior lip of OS uteri. lip (Removed to a weight of 14 pounds. of the os uteri. FIGURE d. Halle, 1828, Tafel 5). III. on a level with the umbilicus. b. lip i. of os uteri extruded from the vulva. E. Martin, of a woman aged uteri to band ligature). FIGURE {From a Os Uteri. Life-sizej. Niemeyer, Zeitschrift fiir Geburtshulfe, Polypoid hypertrophied anterior lip of the uteri. of os uteri. Pedunculated excrescences on the preputium clitoridis. Diagrammatic).
    • ;il- XLMI. Fi£,l. t'iE.i. // , ""^^y gt:-. ) n tr S'^^ ,..4^ V ,t^iWfe«fci^ Vii.2. e-f i-'ia. V'Nii Fifi.J. . i- i/C A' .V/a/-/i/;s lla,ulatlu.s^ II Attfl. u. A. Mart (.%((•. StPiu-tec. ^irft <£3,,,^ . .'B/nfiu
    • PLATE XL VII. FIGURE 1. Complete prolapse of the Uterus with elongation and hypertrophy of the Cervix Uteri. {From a preparation of the Jena Anatomical Museum, accompanying Surgical Copperplates, Weimar, 1822, plate 61). a. c Vag-inal portion of elongated uterus. h. Inverted vagina. /. Bladder. Labia minora. c. d.d. Fallopian tubes. e.e g.g. Fimbriae of the Fallopian tubes. Round ligaments. FIGURE II. Pelvic Viscera in prolapse of the Uterus Accompanying Fig. drawn from within. I. (^From Surgical Copperplates, plate 61). a. Bladder. d.d. Fimbriae of the Fallopian tubes. b. Rectum. e.e. Round ligaments. Ovaries. /./. c.c. FIGURE Ureters, III. Complete prolapse of the Uterus following elongation of the Cervix. (^A/ter Matthew Baillie. A Series a. Meatus b. Inverted anterior wall of the vagina. of Engravings, 2nd edit., c. urinarius. Os d. London, 1812). Vaginal portion. FIGURE uteri. IV. Complete prolapse of the Uterus without Cystocele following prolapse of the posterior wall of the Vagina with Enterocele and prolapse of the Hectum. {After R. Froriep, Surgical Copperplates, plate 388. a. Meatus urinarius. b. Prolapsus uteri with inversion of the vagina. c. Prolapse of the rectum. Accompanying following plate, fig. 2).
    • PLATE XLYU.— {Continued). FIGURE V. Complete prolapse of the Uterus advanced in Gestation with partial foot presentation of the Foetus in Multipara, aged 38 years. {A/ler Wagner in El. v. .Sicbold' s JotirnaJ of Midwifery. Frankfurt on Maine, vol. a. b. c. v. Diseases of 1816, p. 615). Meatus urinarius. Prolapsed uterus with the fcetus in the inverted vagina. Os uteri, from which the right foot of the fcetus is extruded. Women and Childten.
    • PLATE XL VIII. FIGURE I. Prolapse of the posterior wall of the Vagina with sinking of the Uterus. {Aficr Robert Froriep, Surgical Copperplates). a. Rectum. b. Dilated Douglas' pouch with prolapse of the posterior vaginal wall. (Enterocele cum prolapsu vaginae posteriore). Uterus. f. d. Bladder. e. Symphysis. FIGURE II. Prolapse of the Uterus with marked Enterocele and prolapse of the Uterus. (After R. Froriep, Surgical a. Copperplates, plate 3SS. Accompanying the preceding plate, fig. 4). Sacrum and coccyx. h. Prolapsed rectum laid open. c. Perinaeal body. d.d. e.e. Extremely elongated and thickened cervix. Peritoneal fold between the uterus and rectum. /. Bladder. g. h. i. k. Symphysis pubis. Ovary. Fallopian tube. Urethra. FIGURE III. Prolapse of the Uterus from marked elongation of the Uterus with Cystocele. [After a. 1^. c. d.d. e.e. Rabat Froriep, Surgical Copperplates, plate 417). Sacrum and coccyx. Rectum. Protruded thickened posterior vaginal wall. Extremely elongated cervix. Inverted anterior wall of the vagina. / Bladder. g. Symphysis pubis. //. /. k. Slightly prolapsed body and fundus of the Perinaeum. Ovary and Fallopian tube. uterus.
    • XIAIII '2 !' Marlins H:in,/al/(i.s Pi'i, I II. lull r. I Mailin , (ff. Sffiui-.- '.t;
    • . PLATE XLWUL—(Continued). FIGURE IV. Prolapse of the Uterus following prolapse of anterior and posterior Vaginal Walls. (^After Robert Ftoriep, Surgical Copperplates, plate 416). a. Sacrum and coccyx. I. Rectum. c. Posterior vaginal wall. d. e.e. f.f. g. h. i.i. . /. Uterus unenlarged, laid open at the Anterior vaginal wall. side, with occluded os uteri. Bladder divided into two compartments by the cystocele. Symphysis pubis. Urethra running downwards. Ovary and Fallopian tube. Ureter much dilated by continuous distention from below. Peritoneal fold between uterus and bladder. m. Distended Douglas' pouch. «. Rectum. FIGURE V. Prolapse of the anterior wall of the Vagina with elongation of the Uterus. {From a preparation in the GyncBcological Clinic at Berlin) The uterine walls are considerably atrophied at the fundus there is an intraparietal myoma. An ovulum Nabothi is situated in the cervical canal. The connection between ; the bladder and uterus is loosened by an inversion of the peritoneum.
    • PLATE XLIX. FIGURE Elongation of the Cervix with prolapse ; I. fibroid growths in walls of the Uterus, and cyst at the Fundus. (After Cruveilflier, Pathological Anatomy). (One-third Life-size). a. b. c. Inverted vag-inal wall with thickened epithelial-like epidermis. Lips of OS uteri. Cervical canal much elongated. Uterine cavity. Fibroid tumours in uterine wall. /././. Large cyst, with serous contents, above the larger fibroid. d. e.e.e. FIGURE II. Elongation of the Uterus which prolapsed into a Crural Hernia. (After Cruveilhier, op. cit.) (One-third Life-size). FIGURE III. Perforation of the posterior wall of the Cervix with preservation of the peritoneal covering in a patient who died from Peritonitis six weeks after labour. (After Cruveilhier, a. op. cit.) Cicatrised rupture of the posterior wall. FIGURE The same IV. cicatrised rupture as in Fig. 3, (After Cruveilhier, drawn from within. op. cit.) (One-third Life-size). FIGURE V. Bladder-polypus or Cysto-sarcoma of the Mucous Membrane of the Uterine Cavity, caused by degenerations of the Utricular Glands. {After f. Hope, Principles and Illustrations of Morbid Anatomy, London, 1834, no. 218). similar tumour in 1849, from the anterior wall of the uterus. cystic tumour, larger than a foetal head, was removed by the ligature passed into the uterine cavity. The recovery of the patient, aged 39, was permanent. Before the operation .she had suffered for years from severe uterine hasmorrhage which had rendered her ex- The author removed a The tremely anaemic. a.a.a.a. b.h.h.b. c.c. Uterine walls. Utricular glands degenerated into bladders as large as cherries. Incision into the cysto-sarcoma.
    • Tnl.MJX ..^ ^.fnrt,„s Jt,„ulullu<. >' II AurLi-AMaiUn cm,. S*ft,a{s.e.. ^, I
    • . Fia.:'. PiA, 1. /---^ l(i Via A. ri2..-i. Fi ^ !: Marlius Ihuulallus. II lull . v. A . M a, Mr . 5 eu6.' s^fviitj^. .fim cr(ii..i .'R,.,c,
    • PLATE L. FIGURE I. Vaginal portion of Cervix with dilated Os Uteri, through which an Intra-uterine Polypus can be seen. (^After Cruveilhier, Palhologi'cal Attalomy, Dissected vagina. a.a.a.a. c.c. Vaginal portion. b. d. FIGURE The Polypus, book xi. pi. 6). Hypertrophied follicle. Lower extremity of polypus. II. after division of the anterior wall of the Uterus, is seen the Fundus. (Same preparation as in Pig. 1). growing from (One-third Life-size). {^Afler Cruveilhier, op. cii.) a.a.a. b.b. c. Lips of os uteri which projected vy centimeters below the polypus. Thickened wall of the uterus" with development of vessels. Fibrous polypus which has caused some inversion of the fundus. FIGURE III. Perpendicular Section of the Polypus, seen in Pig. Uterine Wall. a. b.b. 2, which has grown from the Point of continuation of the sarcoma into the tissue of the fundus. Dilated veins in the sarcoma. FIGURE Fibroid Tumour of Uterine Wall, IV. and Follicular Polypus of the Cervical Canal. (One-third Life-size). {After Cruveilhier, op. a.a. The n't. book xiii. pi. 6). dissected wall of the uterus shews vascular developmeht comparable to that seen at the third month of pregnancy. b. d.d.d. e. Fibroid of the posterior uterine wall underneath a thin divided coating. Other fibroids in the uterine walls. Subperitoneal fibroid. /. Follicular polypus of the cervical canal.
    • — PLATE L. (Continued). FIGURE Fibroid Tumour V. in the anterior wall of the Uterus, which has a Uterus far advanced in pregnancy. grown to the size of (One-third Life-size). {After Criiveilhier, op. a.a.a. cit.) Thickened wall of the uterus with dilated vessels. b.b. Internal layer, of the anterior uterine wall covering the fibroid, divided. c.c. Divided fibroid, which contains e.e.e. cavities, d.d., filled with serous fluid. Divided veins in the fibroid partly filled with thrombi.
    • PLATE FIGURE LI. I. Polypus of the Mucous Membrane and underlying Uterine Tissue which has grown into the Uterine Cavity from the Internal Os. (One-half Life-size). {After R. Froriep, Surgical Copperplates, part 8o, a. Polypus within the opened uterine cavity. h. Vertical section of the polypus, consisting of Weimar, 1839). fibres and fine vessels, after mucous membrane, smooth muscular removal. FIGURE II. Numerous Mucous growths in the Uterine Cavity. (Half Life-Size.) (After R. Froriep, a.a.a.a. b. The mucous at.) polypi in the uterine cavity. Vascular mucous polypus opened to display the cavity. FIGURE Mucous Polypus at III. Fundus, growths of Mucosa and {After R. its Utricular Glands. Froriep, op. cit.) FIGURE Interstitial op. IV. the Submucous Fibroid has grown into the Uterine Cavity. Submucous Fibroids ; (Half Life-size). {After R. Froriep, op. cit.) FIGURE Numerous round V. Fibroids, partly under the Peritoneal Covering, partly under the Uterine Mucosa. (Half Life-size). {After R. Froriep, op. FIGURE Fibroid Tumour in the wall of the cit.) VI. Fundus Uteri soon after labour. (One-third Life-size). {After Cruveilhier, Pathological Anatomy, a.a.a.a.a. Through the walls of the uterus b. with large vessels developed by c.c. gestation. book Placental xi.) site. Section through the fibroid.
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    • PLATE LII. FIGURE I. Fibroid in the posterior wall of the Cervix and Body of the Uterus. (One-third Life-size). {Afler C. Wenzel, Diseases of the Uterus, Mainz, 1816, a.a. b.b.b. c.c. pi. 7). Remains of the divided bladder. Divided anterior wall of the uterus. Interstitial fibroid, in the posterior wall of the cervix, which resembled the present- ing head. d. Smaller fibroid protruding into the uterine cavity, "figure The Tumour {After C. a.a.a.a. b.b.b.b. c.c. d. <?. II. in Tig. 1 cut through. Wenzel, op. cit. pi. 8.) Section of anterior uterine wall. Section of posterior wall of uterus in which the fibroid was embedded. Section of the fibroid, shewing numerous open blood vessels. Uterine cavity. Fibroid underneath the uterine mucosa. FIGURE Interstitial III. Fibroid in the anterior wall of much enlarged Uterine Body. (One-third Life-size). {After C. Wenzel, op. a.a. b.b.b. c.c. d.d. cit). pi. lO. Anterior wall of Uterus. False The membrane uniting anterior uterine wall with the abdominal wall. anterior lip of the os uteri divided. Fibroid in posterior lip of os uteri. FIGURE IV. Section of Fibroid seen in Fig. {After C. Wenzel, op. a.a.a.a. a. b.b. c.c. d. cit. 3. pi. ll). Section through the richly vascular uterine wall enclosing fibroid. Cut tissue of the interstitial fibroid. Divided anterior cervical wall. Fibroid in posterior lip of os uteri.
    • !
    • r,ii LiJi. Fis.I. Fig. 3. F ^ Fig. 2. Fig.+ i-f" A' .V/«r/,/, //,„„/„l/a:i II . lull ir.l. Mai lin .iC6, SJi,,i:i,. .Stli.<0M*t.. ,'8Mt:i,
    • PLATE LIII. FIGURE I. Cancel- of tho Uterus, with Cancer of the anterior wall of the Vagina posterior portion of the Vaginal cul do sac. and the (Hali' Life-size). {After Cruvdlhier, op. a.a.a. b.b. c.c. cit. book 24). The indurated bladder. The body of the uterus apparently free from cancerous infiltration. Cancer, in the anterior and posterior vaginal walls, commencing- to break down in front. (/. Lower portion of the vagina. FIGURE II. Ulcerated Uterine Cancer. (^After C. a.a. b.b.b. c.c. d.d. e.e. Waizel, Diseases 0/ the Uteius, Fratikfort, 1816). Uterus laid open from behind. Cancerous tumour of the cervi.x. Thickened Fallopian tubes with adherent Fimbriae. Ovaries. Rectum cut through. FIGURE III. Cancerous destruction of the vaginal portion of the Uterus and the vaginal wall between the Vagina and Bladder. (Half Life-size). {After C. We?izel, op. a.a. b.b. c.c.c. Body cit). of the uterus cut through from the front. Fallopian tubes. Surface of the tumour in the situation of the vaginal portion and posterior wall of the vagina. d.d.d. e.e.e.e. Border of vesico-vaginal fistula infiltrated with cancer. Indurated bladder and urethra laid open from the front. ff. Divided urethra. FIGURE The Uterus, seen in Fig. 3, infiltrated with cancer, together with the Fallopian tubes. {After C. a.a. b. Posterior surface of the body of the down to Left Fallopian tube, bound terminating IV. in ]Vcnul, op. cit). uterus. the posterior surface of the uterus three cyst-like dilatations, d. Adherent Fallopian tube of opposite e. Posterior wall of the vagina. side. c.c.c. by adhesions,
    • . Taf. I, IV. 'S^ , ^^- Vil.2- K Mniiin's <i: Hiini/iilliis. II Aul'l n. . A . M altin. C%£&. Scl'uilAC, Jt'itll, aJviof .'B«eii
    • PLATE LIY. FIGURE II. Careinoma Uteri. Original drawing The whole cancer. mucus. The The f torn, a preparation of the Gynacological Clinic in Berlin, uterus, especially cervical canal is wall of the bladder round about the internal uterine closed, the uterine cavity is Adenoma Adenoma of the Uterus. in invaded with distended with a tirownish I. Uteri. Zeitschnft fiir Geburtshiilfe und Gynakologie, 1877, The glands seen 8 70). also infiltrated with cancerous g-rowth. FIGURE {After Schrodei; is orifice 1 s, 189). horizontal section have walls with cylinder epithelium. band i.
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    • PLATE FIGURE Polypoid Adenoma LV. I. of the Uterus. {After Schrodet, op. cti). Vertical skction through the whole tumour. a. Pedicle. b. A c. (Life-size). The (/. tolerably large vessel running through the pedicle. The dark parts pedicle ramifying inwards, displaying the stroma of the tumour. between the ramifications of the stroma are clearly seen on the cut surface, some small some larger, and are cysts of the size of peas. The lighter and more clearly striped part appears microscopically to be composed of solid connective-tissue and to be free from cysts, but small cysts of the same structure are to be seen by the microscope. The tissue itself has a myomatous character. This portion as far as the next notch towards the The remaining lium. surface is left, is FIGURE II. Adenoma. Vertical section from the {A/Ur Schroder, op. FIGURE III. {After Schroder, op. is To of the Pedicle. cit.) the wall of a large cyst lined with cylindrical epithelium and an excreseen projecting into it, which is also clothed with cylindrical epithelium. neighbourhood of this and the other cysts is surrounded by connective-tissue. At the The surface. cil.) Adenoma. Section from the neighbourhood scence clothed with flattened epithe- covered with cylindrical epithelium. left is the extreme right is the smooth muscular structure of the pedicle with rod-shaped nuclei. FIGURE Adenoma. Longitudinal IV. section from surface. {After Schroder, op. at.) Gland shape, some of which are seen to have a small lumen. with their lumens occluded by pale glistening fatty particles of irregular tubules, apparently solid, but Also glands (a.) (Altered epithelium).
    • Taf. EMarliii's llriiidallus II Aal'Lu A-MalUi. a£6. S^'kMr.e.. S.M Ll <n..jt. .SiiTPw
    • PLATE LVI. MGURE I. woman who died, 14 days after delivery of a dead chUd, from Uterine Phlebitis. Retention of a portion of Placenta. Diphtheritic Endometritis in a (One-third Life-size). {After Crtwcilhicr, a.a.a. b.h.h. c.c.c.c.c. d.d. op. cit., book iv. p. 6). Tumefied inner surface of the uterine cavity covered with exudation. Raised placental site. Veins filled with thrombi and detritus. Infiltration of blood round diseased veins. FIGURE Thrombosis of the Veins in the drawn II. Uterus and Broad Ligaments of the preparation in Tig. 1, from within. {After Cruveilhier, op. cit.) Round ligaments. a.a. Blood clots in the opened veins. Veins filled with ichorous thrombi. b.b.b. c.c.c. FIGURE III. Inflammation of the Lymphatics of the Uterus of a puerperal woman. (One-third Life-size). {After Cruveilhier, op. a. Inferior bk. xiii.) Kidneys. b. a cit. c. vena cava. Aorta. d.d. Ureters. e. Rectum. /. Posterior surface of the uterus g.g.g. drawn out. Lymphatic vessels underneath the peritoneal covering of the uterus seen filled with pus. h.h.h.h. i.i.i. k.k. /./. Lymph cavities and vessels laid open. Exudation masses on the swollen ovaries. Distended lymphatics, in the course of the vasa spermatica, filled with juis. Lyirlphatic glands. FIGURE IV. Chronic Inflammation with thickening of the Cervical Mucosa. Ectropion of the lips of the Os Uteri. {After Boivin and Dugcs, op. cit.) CoUum Tapyroides.
    • Taf.LW E.MlLriin's Hundallu.i. //..luJ'L v. A.A/arliii CXll>- SifilU-Ke,. ^U/vd7i.iM S3«tU. ,
    • PLATE LVII. FIGURE I. Posterior surface of a Puerperal Uterus with Inflammation of the Lymphatios, Fallopian Tubes and Ovaries. (One-third Life-size). {A/ler Cruvcilhicr, op. at. a.a.a. h.h.b. c.c.c. d. e.e. The lymphatic The lymphatic book xiii.) vessels distended with pus, seen through the peritoneal covering. open after removal of the peritoneum. cavities laid Divided lymphatic vessels distended with lymph thrombi. Unimplicated vein cut through. Inflamed Fallopian tube. f. Section of the left Fallopian tube thickened, and shewing its purulent contents. g.g. Ovaries enlarged by infiltration and covered with purulent exudation. FIGURE II. Section of an Ovary from Fig. {After Cruveilhier, op. FIGURE Section of a serous infiltrated Ovary, as it is 1. cit.) III. frequently seen in Metro-lymphangitis. {After Cruveilhier, FIGURE op, cit.) IV. Softened Ovary in Puerperal Metro-lymphangitis. {After Cruveilhier, op. FIGURE cit.) V. Lymphangitis and Thrombosis of the Veins of the Uterus in a 15 days after delivery. {After Cruveilhier, book xiii.) (Half Life-size). a.a.a. b.b.h.b. c.c. d. Lymphatic vessels Lymphatic with pus seen through the peritoneum. after removal of the peritoneum, cavities. Diseased lymphatic glands. in the veins behind the placental e.e. Thrombi f Ureters. g. Kidneys. h.h. filled The lymphatics uncovered Fallopian tubes. site. woman who died
    • TA l.'ll! .)K, Fiii.5. A' MivUn's Ihuuladu.^. ll.hdl.r.A.MuvUit. ace. s,ciiat,xe.^itf;. .:3u.i Si'ii';,;
    • PLATE LVIII. FIGURE I. Simple Erosion. {After C. Ritge and y. The eroded which rests The Pathology 0/ the Vaginal Portion. und Gyncekologie, band ii. 1S78, s. (I.15). Veil, surface is universally covered with a soft simple cylinder-epithelium, The upon an irregularly-formed basement. papillary projections alternating- vtWh smaller points, external appearance that of is evenly covered with cylindrical size of the papillary protruberances much exceeds that of the normal The The epithelium epithelium. papillae. Zeilschrift fur Gehurtshiil/e protruberances. itself all presents varieties in size according to Whilst on the surface it is short and non-ciliated, it its position on becomes more the deli- and the nuclei are nearer the bases of the cells. The stroma of the papillary projections was apparently full of nuclei and vessels. The border between cylinder- and pavement-epithelium is well defined. The basement cylindrical layer of the Rete Malpighi becomes larger and clearer, and furnishes the epithelium which covers the new growth. cate and longer in the depressions, FIGURE II. Microscopic appearance of foregoing Figure. To the right, the pavement epithelium remains intact; to the left, it is beginning to shew glandular depressions. Through the deeper growth of the epithelial glandular canals frequently ramifying backwards. layer originate smaller and longer They may become bulbous at their terminations and present on their inner surfaces secondary fine papillary projections covered with a structure, The apparently completely glandular by segmentation of the more fine tufted cylindrical epithelium. whose further development follicular forms, is not, as far as into follicles occurs can be seen connected with excretory ducts. FIGURE III. rollicular Erosion. {After C. The anterior lip Ruge and J . Veit, op. cit.) shews the projections springing from the terior lip, with the velvety projecting points, presents the For the microscopical appearance, see Plate disease. FIGURE follicles, whilst the pos- more papilliform aspect of the xix. Fig. 7. IV. TTlceration of the vaginal portion of the Cervix and. posterior vaginal Cul de sac. {After C. The tration. part it Ruge and f. Veit, op. cit.). connective-tissue beneath the ulcer presents a well-developed minute-celled The pavement-epithelium of looked as if it the vagina were raised by a blister, at penetrated deeply into the connective-tissue. is still another intact here it and there ; had disappeared. infil- one Glands at
    • i k
    • PLATE LyiU.—(Cotitmued). FIGURE V. Non-scirrhovis vaginal portion. (a. Seen from below, {After C. The external surface smooth. 6. from transverse Ruge and J. sections). Veil, op. cit.) In the cervical canal numerous edges and borders of irregular shape, partly of a hard cartilaginous consistence. Microscopically the con- The epithelium was appeared interspersed with newly-formed glands. pavement-epithelium which sent out irregular thickened conical prolongations into the connective-tissue which was arranged in stripes. nective-tissue
    • PLATE LIX. FIGURE I. Ectropion of the Cervical Mucous Membrane. {A/ler C. Ruge and J. Veil, op. cit.) Glandular depressions are present beneath the surface which is covered with cylinThey have small follicular formations. The tissue is full of nuclei and appears limited between the large masses of glands. drical epithelium. FIGURE II. Microscopic section of a Papillary Erosion. {After C. The Ruge ami J. papillae are differentiated Veil, op. cil.) by the depth FIGURE of the glandular depression. III. Clinically a suspicious, microscopically a non-malignant vaginal portion of the Cervix. {After C. Rage ami J . Veil, op. cil.) The vaginal portion was irregularly conical with apparently a double posterior lip, from which protruded, like a tumour, through the open cervical canal, a mass as large as a hazel nut. The mucous membrane presented cock's-comb-lilvc folds. The external surface was covered with cylindrical epithelium. Numerous depressions of the epithelium in process of development. The connective-tissue abundantly nucleated. In and around the vessels which pass undivided close under the epithelium are scattered well developed The connective-tissue is traversed by large, long gland tubules. nuclear proliferations. FIGURES Commencing Cancer {After C. IV., v., VI. in a prolapsed Portio Vaginalis. Ruge and f. Representations of the same preparation Veil, op. cit.) in figs. 4 and 5, of which the first has been inadvertently retained. The erosion is not deep and consists of warty (cock's-comb-like) protruberances. FIGURE VII. Microscopic appearance of Figure Numerous segmentations of They are large and therefrom. 3, Plate Ivili. the glandular depressions, with the follicular formations proliferate between the bands of connective tissue.
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    • PLATE LX. FIGURE Circular rupture of the Cervix I. and expulsion of the Portio Vaginalis. A Case of Circular Rupture of the Cervix with expulsion of the Portio Vaginalis during Labour. Beitrdge zur GeburtshiUfe und Gynacologie der Gesellschaft fiir Geburtshiilfe {A/let C. Siattdf, band zu Berlin, i. 1872, s. 144.) (Seen from above). The separation occurred spontaneously by a sudden powerful hours' labour, after warm water had pain, after about 24 been injected into the vagina on account The cervical rupture healed without any complications. The annular flat surface of the preparation has a transverse diameter of rigidity of the OS uteri. meters, an extreme diameter through centre is the round its smooth-margined os uteri surface shews plainly the outlines of the arbor hang from the margin of the os about the size of half-a-crown. vitae. The II. of the above preparation from below. external surface is 1 1 and The centiin the inner Several long tags of uterine mucosa uteri. FIGURE View of thickness of from 5 to 6 millimeters, covered by smooth mucous membrane.
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    • PLATE FIGURE LXI. I. Transverse rupture of the upper portion of the anterior cervical wall. {After Spiegelberg, The Maimal of Midwifery, 187S, 605). rent occurred in a universally contracted flattened pelvis during the seventh labour, three hours after the liquor amnii iliac fossa, the The s. had drained Face presentation over the off. lower extremities escaped through the rent into the abdominal cavity. rent passes close under the internal uterine orifice through the whole thickness of the anterior wall of the neck and part of the posterior and right side. serosa has remained over the sound passed On this side the in at a. FIGURE II. Longitudinal rent of the Cervix. {After E. Martin, Zeitschrift fiir Geburtshiilfe unci Fratcenkrankheiteti, 1S75, bd. The uterus of a one portion of which woman who had had is During labour (turning, forceps, cephalotripsy) a longitudinal rupture took place tumour. The folds of the s. 232). three children presents a multiple fibromyoma, included by the right side of the cervix. ently developed rapidly. i. in the left and This portion had apparfinally perforation and side of the cervix opposite the broad ligament were divided and a communication formed be- tween the abdominal and cervical cavities. Underneath the serosa several myomas of the wall of the body of the uterus. size of cherries are seen in the anterior
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    • PLATE LXII. FIGURE I. Dropsy of the Fallopian tubes. (Half Life-size). {Afti-r a. b. c.c. d. e.e.e.e. R. Froriep, Anatomico-pathological Drawings, Weimar, 1836, pi. iv.) Cervix uteri. Uterine cavity. Round litfaments. The left ovary, occluded inwards, laid open. The cavernous dilatations of the left ovary, laid open. FIGURE II. Tuberculosis of the Fallopian tubes and the mucous membrane of the uterine cavity, in a young girl who died of Pulmonary Tuberculosis. The peritoneum appeared free from tubercles. In another part, the original presents a haemorrhage (from a phagedcenie ulcer?) at the disintegrated vaginal portion. (Half Life-size). (After Cruveilhier, op. cit. book 39). The left Fallopian The Fimbriated a. Right h. tube, dilated in its outer half, and filled with a white cheesy mass. e.xtremity was occluded. both ends patent. Fallopian tube more distended than the left ; Ovaries. Uterine cavity laid open with the mucosa infiltrated with tubercles. c.c. d. FIGURE Bight Fallopian tube of Fig. IIb. 2, slit open longitudinally. {After Cruveilhier, op. cit.) a. Unusually developed longitudinal folds of mucous membrane, with tuberculous masses scattered over it. FIGURE Pregnancy III. in right Ovary. (Rather larger than Half Life-size). {After Willigk, Prager Vicrteljahrschrift, 1859, The ovum a.a. b.b. c. d.d. e. f g. h. i.i.i. is about three months band 3, s. 85). old. The anterior uterine wall eight centimeters long. The wall of the uterus 2'6 centimeters thick. The mucous membrane developed into a finely-tufted decidua. The round ligaments. The rigHt ovary protruded through the anterior layer of the broad ligament. The occluded right ovary. The left Fallopian tube. The fimbriated free end of the left Fallopian tube. The sac of the ovum, 7 centimeters long, situated in the enlarged ovary, covered with the folds of the left broad ligament.
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    • PLATE LXIII. FIGURE I. Ovarian Cyst with gelatinous (colloid) contents. (Half Life-size). {After Cruvcilhiet, a. b.b. c. drawn Uterus, Round op. eft.) to the left. lig^aments. Right Fallopian tube. d. Right ovary atrophied. e. Elongated left Fallopian tube. /. Left ovarian ligament. g-g-g-g- Ovarian h.h.h.h. Prominent transparent i.i. k k. cyst. cyst. Evacuated colloidal matter. Distended veins running along the wall of the FIGURE The same Cyst as in Fig. 1, cyst. II. opened in several places. (^Afler Cmveilhier, op. cit.) A. Uterus. h.h.b.b. c.c.c. d. e.e.e. Colloidal mass protruding from the cyst. Patches of blood in the cyst wall. Larger non-ramifying vein Venous networks on in the cyst wall. the external surface of the cyst. f. Cysts in the cyst wall, in areolar arrangement.
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    • PLATE LXIY FIGURE Dermoid Cyst. I. Fat- and Hair-cysts with pieces of bone and teeth from an Ovary. (One-third Life- size). {Afkr a. h.b. c.c.c. d.d.d. e. Cruveilhier, Pathological Anatomy, book .wiii. pi. 4). Fat- and hair-cysts. Covering- of the cyst, in which Single hair-bulbs and Abundant chalky deposits are present. A larger chalk mass with alveolar margin and two FIGURE The Chalky-plate, shaped teeth. Ia. like Maxilla, bearing and Hair-cysts shewn two teeth. in Fig. 1. Taken from the Fat- (Life-size). {After CniveiUuer, op. a. b. t. Chalky plate, Canine tooth. Molar tooth. cit.) like maxilla. FIGURE II. Hair- and Fat-cyst of the right Ovary, as large as a fcetal head, with small colloid The Tumour had caused an incarceration of the Pelvic Viscera. cysts. (One-third Life-size). {After Cruveilhier, op. cit. pi. 5). Mass of tangled e. hair of some length, set free from fat by alcohol. Hair bulbs in the cuticular tissue, which Was developed at three prominences in the cyst wall. Two horny excrescences from one of the cuticular spots. Areolar colloid cyst with fat- and hair-cysts. f. Sound, a. t/. c.c.c. d.d. to raise up bridge of cuticular tissue. FIGURE III. Adenoid Tumour of the Breast. (Life-size). {After Birket, The Diseases of the Breast, London, 1850). fibrous tegument. a. Firm b. The hypertrophic gland substance epithelium. ; the terminal dilatations of which were filled with
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    • PLATE LXV. FIGURE I. Cancer of the Breast with cancer-tubercles in, and under, the skin of an old aged 83. [A/kr mammary Cruveilhier, op. cit . book woman 27). gland degenerated. a. Right b. Left nipple degenerated. c.c.c. d.d. Cancerous tubercles Cancerous tubercles in the skin in the varying in size from a pea to a cherry. sub-cuticular and muscular structures. FIGURE II. Carcinoma of the Breast with retraction of the Nipple, {After Birket, The Diseases of the Breast, London, 1850, pi. ix.) FIGURE Compound mammary hsematocyst. III. (Removed {After Virchow, Morbid Tumours, a. b. c. band i. from, an old woman). 1S63, fig. 50). Nipple. Fibrous indurated and shrivelled portion of the gland. Glandular tissue still remaining, but chiefly seen with dilated vesicles, round which, and in which, the cystoid cavities are present, partly as large round open sacs, partly as The contents consisted of a brownish fluid, from which fine longitudinal fissures. numerous rusty concretions had become universally attached to the wall. Also by microscopical examination, numerous granular brown pigment infiltrations into the partly sclerosed cartilaginous cyst wall of the larger sac. FIGURE IV. Compovind proliferating cystoid of Female Breast with serous contents. {After Virchow, op. cit. fig. 51). have merged by Other shelf-like prominences are seen on the and are remains of septa which previously subdivided them 0. External integument, beneath which are three larger cysts, which progressive atrophy of their septa. walls of the three cysts, before their coalescence. g.g. Remains of original glands, compressed and indurated. At g the remains of the glandular parenchyma are more clearly seen, which partly extend into the neighbouring cyst and penetrates it as far as c.c.
    • . PLATE LXW .—{Coniinncd) FIGURE V. Diffused arborescent intracanalicular (A//er Virchow, op. The lower cit. myxoma fig. of the Mamma. 86). portion seems to be quite solid and thick, but certain lobulated structures are recognisable, which in the section correspond with the masses which have grown to- Above, larger gaps are seen between the walls of the lactiferous dilatations and the intra-canalicular excrescences, which last are easily recognised as such, and stand out clearly in their relation with the tissue of the At the upper part is a larger ectasia laid open. The warty excrescences at cyst wall. its termination appear more isolated. gether and completely fill the lactiferous ducts.
    • PLATE LXVI. FIGURE I. Bladder-mole, from a secundipara aged 39, at the fifth month of pregnancy. expelled with great difllculty, haemorrhage, &c. No ovum was found in the cavity which was filled with brownish It was fluid. (Half Life-size). {Original dtaiving). a.a.a. Decidual covering-. b.b.b. Cysts on the surface protruding- through the decidual membrane. FIGURE II. Bladder-mole from a woman, aged 28, delivered four times at the eighth month, opened, so that the grape-like bladders protrude. (One-third Life-size). {After Boivin, New Researches on the Origin of the Demonstrations, Vesicular Mole, Paris, 1827. Ohslelric Weimar, 1828, partg). FIGURE in. Internal surface of the ca-vity of the Ovum -with the Chorion--vllli degenerated into cysts, after opening of the bladder-mole, expelled by a wom.an aged 24 years, primipara, at the seventh month of the pregnancy. (One-third Life-size). {After Cruveilhier, Pathological Anatomy, a. Remains of embryo hanging to i.) amnion and chorion. Internal surface of the unusually firmly united b. book a thin thread. FIGURE IV. Hypertrophied (Edematous Chorion-villi from a bladder-mole. {After H. Meckel, Verhandlungen der Gesellschaft fiir Geburtshiilfe in Berlin, s. ii. jahrgang, 1847, 133, tafel2, fig. s). FIGURE V. Hypertrophied cedematous terminal ramifications of the Chorion-villi from an the size of a hazel-nut. Ovum (Microscopic). (Two-thirds Life-size). {After Gierse, Verhandlungen der Gesellschaft fiir Geburtshiilfe in Berlin, ii. Jahrg. 1847, s- taf. 3, fig- 13). a. Epithelial covering of the chorion-villi. b. Connective-tissue. c.c. d. Network spaces Nuclei of the filled cells. with serum. 133,
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    • PLATE LXVII. FIGURE I. Mammary Microscopic section of a {Carcinoma smiplex, Waldiycr). H. Bagel, (After Cancer. Ailas of Diseases of Women, Slutlgart, 1876). Connective-tissue stroma. Cancer stroma. Cancer bodies with cancer cells. Cancer body with almost normal gland acinus near a.a.a. b.b.b. b. pears c.c. /'. to to it, from which growth it ap- proceed. Separate normal acini with small lumens. Lactiferous duct, shewing irregular proliferation and raising up of its epithelial cells with irregular branches. In the cancer bodies and proliferating glandular portions is seen an increased small celled infiltration of the stroma. FIGURE II. • Arborescent Cystosarcoma of the (After Virchow, op. cii. fig'. Mamma. 166). To the right is seen a portion of the dilated gland-duct perforated with cavities and ducts (beneath the nipple), in which scattered broad masses of sarcoma are developing from the rounding which externally merge, almost imperceptibly, into the surthe left is the deeper portion full of cavities and ducts, which are filled with large polypoid, often dendritic ramifying excrescences, which in the drawing are partly laid outside. To the left and above, is a large thick knot of lobulated structure, which presents towards the right some scattered foramina (divided ducts). Towards the left it is completely solid. This portion does not belong to the gland but spreads into its fatty capsule and the skin outside, which is in some places almost cominterstitial tissue fatty tissue. To pletely destroyed. FIGURE Placental {After E. Ftci^ikel, On Calcification III. villi. of the Placenta. (Continued from a. h. figs. 2 Archiv fiir Gyncccologie, and 4 of plate band ii. s. vii.) Villous terminations with complete calcification of the capillary branches. Xon-calcified branch of villus with bulbar thickened termination, with abundant tration of round and spindle-shaped granulation been removed by maceration The drawing in a solution of of the villous branch at genital syphilis, also in the b. cells. The infil- epithelial covering has salt. corresponds with the condition found most frequent forms of 373). foetus sanguinolentus. in con-
    • PLATE LXYU.—(Continued). FIGURE IV. External surface of Placenta with multiple blood effusions. {After Cruveilhier, Pathological Anatomy, a.a. Divided blood effusions in the book Placental apoplexy. i6, p. i). cotyledons of the placenta. FIGURE V. External surface of a Placenta with the impressions of old and recent extravasations. (Original Drawing). a.a. b.b. c.c. Old extravasations with umbilicated depressions of the atrophied placental tissue. Openings of old blood effusions in the cotyledons lying deeper under the surface. Recent superficial coagula infiltrating the internal surface of the cotyledon.
    • ( PLATE LXVIII. FIGURE I. . Seat of the Placenta at the Os Uteri, rrom the autopsy in a woman who died after 14 days' haemorrhage with convulsions in the eighth month of pregnancy. Pla- centa praevia marginalis. (Half Life-size). {After Jewel' s Obstetric Plate, no I. Accompanying ' Obstetric Demonstrations. Weimar, part <j. 182S). a. Vaginal cul de b. External os c.c. d. e. sac. uteri. I Blood coagulum. Bag of waters protruding through os uteri. External surface of the separated placenta. i /. Placental site in the uterus turned back. FIGURE II. Seat of the Placenta over the Os Uteri, from the body of a woman who died from uterine haemorrhage in the ninth month of pregnancy. Placenta praevia centralis. (One- THIRD Life-size). {After W. Hunter, Anatomj' of the Gravid Uterus, plate a. b.b. c.c. d. The vagina. The divided os uteri. The placenta lying in The membranes. xii.) front of the child's head.
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    • PLATE LXIX. FIGURE I. Double Placenta. {A/ier Fr. Mauer, Diss. in. a.a. The two halves b.h. Unitingf portion of the c.c.c. d. Cur uno ovo concepto placenta duplicata oriaiur, Jena, 1854, c. tab.) of the placenta. membranes. Uniting umbilical vessels. Funis. FIGURE II. Forked insertion of the Funis into the membranes a. b.b.b.b. c.c. at a distance from the Placenta. Funis. Umbilical vessels passing along the membranes separated from each other. Rent in the membranes through which d.d. e,e. the foetus escaped. Inner surface of the placenta. Outer border of the placenta. FIGURE III. Strangulation of the Funis occurring in prolapse of the Funis by unusual twisting of the umbilical arteries. FIGURE IV. Twisting and strangulation of the Umbilical Cords in twins. {After W. H. Niemeyet, Zeitschrift fiir Geburtshiil/e, i. heft. Halle, 1828).
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    • PLATE LXX. FIGURE I. Twisting of the Umbilical Cord. {After F. Hille, Fifteen Cases of Twisted Umbilical Cord. D. Marburg, 1877, Obs. xi.) (Life-size). The preparation is from a male embryo at the third month ot g-estation, and is mumThe whole of the abdomen is swelled up as in a foetus sanguinolentus. The long diameter of the body measures io"4 centimeters. The funis measures 19-7 centimeters. The funis is twisted throughout with the exception of a portion centimeters in length at the fcEtal end. The twisting-s are so numerous through their whole extent that it is mified. 1 1 almost impossible to count them. There are probably about twenty FIGURE twists. II. Twisting of the Cord. {After F. Hille, op. cit. Obs. ix.) Male embryo at fifth month. Long' diameter 16-2 centimeters. The fontanelles are felt. The cranial bones very soft and easily squeezed together. The left foot is clubbed. The funis is twisted to the right and measures 247 centimeters. The placental end of the cord is much distended. There are three places at which twisting has occurred. The first is at the fcetal extremity of the cord. It is 2-3 centimeters long, 0'2 wide, and presents 5 turns. A second torsion is found at the lower third of the cord, 2-i centimeters in length, 0^25 centimeters in breadth, with 5 turns. At this point it is continuous with a large ribbon-like untwisted portion of cord. At a distance of 1'9 centi- plainly meters from the placental end is a third twisted portion, the smallest, which only presents one turn. This only comes into view when slight traction is made on both ends of the cord. FIGURE in. Twisting and knotting of the Cord. {After f. G. Blume, Cases of Twisting and Strangulation of the Cord, Marburg, 1 869, Obs. ix.) (Life-size). A three months male embryo. After passing along in front of the thoracic wall the cord suddenly makes a bend down to the left, and forwards, to pass round the right side of the neck from the original twist to the left. At this point there is a bag-shaped dilated swelling, compared with the ordinary diameter of the cord. The point where the turn occurs, which lies underneath the first complete coil round the neck, is characteristic by its distinct colour and tenuity in its thickness and breadth. From this point, however, the cord is twisted 4^ times round the neck of the embryo, and on closer inspection is markedly atrophied. It is to be noticed that in the relatively short extent of the third twist coil round the neck are six twists running from right to left, whilst in the whole remaining portion of the cord only one twist is seen and this does not belong to the coils round the neck.
    • I
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    • PLATE LXXI. Placenta of twins with compressed Foetus. {Ftom a a. Macerated female embryo, preparation in the Berlin Obstetric Clinic). at about the 4th month of pregnancy. b. The c. Extravasation of blood in the placenta. d. The membranes placenta of the other foetus, of the dead surviving foetus. a feeble male child, embryo which was born alive at term. originally in the same bag with the
    • i
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    • PLATE LXXII. Abdominal cavity of a FIGURE woman who had I. carried a Lithopcedion 22 years. (One-third Life-size). y. G. {After Walter, Account of a ivomanwho carried a St one- child 22, years in the Abdomen, Berlin, 1778). h. The liver. The round ligament c. Gall bladder. d. Stomach. k. A vessel springing from the large omentum The colon. The jejunum. The left leg of /. A a. e. f g. h. of the liver. i. the back of the child. the lithopcedion. FIGURE The The right leg, The large omentum covering Lithopoedion in Fig. 1, and going to the umbilicus of the foetus. second vessel running from the omentum to the foetal umbilicus. Ia. removed from the abdominal cavity. (One-third Life-size). (After f. G. Walter, a.a.a. b. c. The The incrusted integument drawn back breast. d. e. op. cit.). Right ear. Black hairs of head. Right eye. FIGURE II. Embryo which died from hasmorrhage during the fourth month of pregnancy in an uninjured Ovum. It became encrusted in the Ovum which was not expelled until the eth month. (After Fr. Aem. Knopff. Diss. in. exhibens novum FIGURE A lithopcedii exemplum, fence, 1 845). in. Lithopoedion which was carried in the Abdomen by a peasant woman during 40 years, although two normal pregnancies occurred. (Half Life-size). (After W. Kicser, Lithopadion of Leinscll, Stuttgart, 1854). a.a.a.a. b.b. External surface of the chalky covering with prominences And shrunken membranes, e.e.e. i. k. Tumour of the shrunken lips. Epithelium of the tongue hardened by layers of chalk salt. Right upper extremity. d. Inner surface of the shell. /. e. The m. Right hand with phalanx of thumb cut portion of the chalky covering by the knife. Neighbourhood of the eyes. cut through f through. n. g. Flattened cheek. h. Nose pressed flat. Left fore-arm amalgamated with chalky covering. 0. Left knee. the
    • . . Tcif . LXXin Fi^.l. ri£. 5. n&. 4. ^.f E. Martin's Haiidiillait. IIAuH. p. .1. .Iartiii Clf6 Sif^UUe.. litJ^ Sfn^ .'B^tfi.
    • PLATE LXXIII. FIGURE I. Hydrocephalus with spina bifida in a child born naturally in the in the Obstetric Clinic at Berlin. FIGURE Foetal summer of 1860, II. head with hernia cerebri. (One-third Life-size). {After W. Vrolik. TabulcE ad illuslrandam embryogenesin komtnis el mammalium. Amstelodami, Plate 43). 1849. FIGURE III. Absence of Head and upper extremities in a fatty twin foetus 24 centimeters long. (Half Life-size). (After Sandiforl in W. a.a. The neighbourhood of the breasts is Vrolik, op. at. Plate 49). represented by a pair of folds with an imperfect nipple. b. c. A small longitudinal fissure, which leads to a cul de sac in a fissure of the sternum. Umbilical hernia covered with a delicate skin into which the thin funis is inserted. d. Male e. Right foot with two genitals with empty scrotum. toes. f. Left foot with three toes Heart, stomach, lungs are present and commencing liver, spleen, in the nails. pancreas and duodenum, are wanting. is formed by 10 ribs on each side. thorax which column presents a small moveable bone above the single vertebrae, and 5 lumbar vertebrae. FIGURE last cervical Traces of the The vertebral vertebra- 10 dorsal IV. Complete ectopia of the thoracic and abdominal Viscera in a female foetus with cloacal formation. (One-third Life-size). {After Vrolik, op. b.b. The internal membrane of the enclosing The amnion united the chorion covering c.c. Plate 22). cit. Placenta. a.a. sac is the peritoneum. of the placenta. Umbilical arteries going to the short, almost undeveloped Openings of the ureters. f. Anus surrounded by the sphincter ani. g. Vagina. h. Blind opening representing anus. d.d. funis. e.e. i.i. Two folds of skin representing the large labia. The vertebral column is so bent backwards that the heels touch the occiput.
    • PLATE LXXUl.— (Continued). FIGURE V. Absence of one of the lower extremities. Monopodia. CHalf Life-size, One-fourth Natural Size). {A/Ur a. b. Vrolik, op. cit. Plate 63). Funis half an inch long, torn by the delivery of child by forceps. Large umbilical hernia with very thin walls through which are seen the intestines, c. d. Cleft in the skin, into which a sound can be pushed some Three toes seen on the single left lower extremity. distance. liver and
    • PLATE LXXIV FIGURE I. Ruptured congenital umbilical hernia, Acrania, cyclopia with proboscis and absence of the superior Maxilla. (One-third Life-size). {After Vrolik, op. a. Absence of cranial /'. Proboscis. c. Plate 26). cit. Monoculus. vault. .1 The (/. c.t-. ears grown togfether on account of absence of cranium, Ectropion of abdominal viscera The vertebral column has congenital umbilical hernia which has ruptured. in become markedly curved as a FIGURE Male foetus result. II. born in foot presentation with hydrocephalus. (One-third Life-size). {After Vrolik, op. The extremities are very short, the Plate 35). cit. abdomen large although no FIGURE fluid was contained in it. III. Anencephalous foetus with distended backward cranial cleft. Eyes situated above, Ears below. (One-third Life-size). {After Vrolik, op. cit. FIGURE A new-born female foetus Plate 41). IV. with coccygeal tumour which should contain another foetus. (Foetus in foetu). (One-third Life-size). {After Vrolik, op. cit. Plate 100).
    • Taf.LWIV Fia Fi^ 2. . Fi^.l Fii. / E Martin's Handatlus . II .lufl , .1 .Varlir t5«6. S-cftii,U&. ^w-fi, ,0,«^ . S^fc,. .
    • . Taf- Flii Fig. 4. l.X.W. i'i!;.;;. Jl m N Fie i: . Fie. 1' Martin' « llnndnltas U luP v I Marlln . Iffi SvAutxc. i^Utft-. gJmM.- SiiyUiu
    • PLATE LXXV. FIGURE I. Growing together of the cranial integument and the Placenta, Hernia cerebri. Double hare-lip and fissured palate, and ectropion of the Heart in a male foetus at term. (One-third Life-size). {After VroUk, op. a. On the index fing-er of the right the right middle finger there Plate 27). cit. hand was a was a ring-lilce constriction, thread-lilie FIGURE at the tip of appendage. II. Monstrum Sympodia. and sireniforme. (One-third Life-size). {After Vrolik, op. a. Remains of b. Fold of skin containing a the umbilicus, which, as is cit. Plate 65). usual in such cases, only presents one artery. testicle, whilst the genital organs and anus, as is usual in such cases, are absent. FIGURE in. Growing together of both lower extremities. (Half Life-size). ( a. b.b. Cruveilhier, Pathological Plate 6). Club hand. Both legs are completely developed, but are enclosed as the insteps. c. Anatomy, book 40. A The feet have in a common integument as far the soles turned in towards each other. small wart as indication of the external genitals. FIGURE rV. Cyclopia with Proboscis and Hydrocephalus in a twin child. {After Otto. Monstrorum sexcentorum de scrip tic anatomica, Vratislar, 1841, pi. ii. fig. 3).
    • *
    • PLATE hXXV .—(Continued). FIGURE V. Incomplete development of the Finger, so-called self-amputation. (Life-size). (^A/ter Vrolik, op. cit. FIGURE Plate 76). VI. One-headed double monster, Janiceps. (One-fourth Life-size). {After Vrolik, op. On cit. Plate 96). the posterior surface of the head are two other external ears which have together. grown
    • PLATE LXXVI. FIGURE I. Double monster with two heads, four arms, and three legs, which was born immediately after the delivery of a male child at term. The mother, a strong peasant woman, aged 35 (mother of five sons, of which two were twins, and three daughters), was delivered by two midwives. (One-third Life-size). {^AflerJ. G. a. Scrotum without b. Common Waller, Anatomical Observations, Berlin, 1782). testicles. Occluded anus. c. } third of lower extremity with 8 toes (two of which are united by firm connec- tive-tissue). d.d. The common umbilicus, which was about 3 ells long. FIGURE Skeleton of figure 1. II. Double monster with common Pelvis. (One-third Life-size). (After J. G. Walter, op. at.) FIGURE Division of joints in. by exudation membranes. Amputatio spontanea. {After W. F. Montgomery, Study of the Signs, Symptoms, edition and duration of Pregnancy. of Schwann, Bonn, 1839. German
    • Tiif.LXWI K.Mnrliit's HainLallus. II .lull V A Marlin ifl£&- S^PiUt:^^. ^U^. oJ-vuyt. ^.M-ft-w .
    • Taf^ L'XXMI. =.^1 A' MiirlniH linn<liilUis- I! .hill, r .IMurtin CM. S^fvut-.*.. ^Urfv, <£T,i^l SxTEi.,
    • PLATE LXXVII. FIGURE I. Transverse presentation in the Uterus laid open during the seventh month of pregnancy. {Afler H. Fr. Kilian, obstetric atlas.) a. Internal surface of the dissected uterine wall. b. Decidua. c. Chorion. d. Amnion. h. Vagina The laid open. letters do not correspond FIGURE to the drawing. • II. Transverse presentation with prolapsed arm, head to the right, feet to the backwards. (Diagrammatic). left and
    • Taf. LXXVIH. Pii2. li^.3. P^. Murtrn','; JJaitr/afhus. KA^itl I'.AMarrin. Fig. .5. ^cfivi^C/. XUeh^. cAtM.. Qoxj^Ima^.
    • PLATE LXXVIII. FIGURES I— IV. The diflFerent stages of {After Spt'egelberg, spontaneous expulsion. Manual of Midwifery, FIGURE 1878, p. 540.) V. Labour with the body bent double. {After Kleinwachter, contribution to the study of spontaneous expulsion. Band ii., s. in.) Archivfiir Gyndkologie,
    • J
    • Taf. [,XX[X. Vf> 1 .^^- %. *«?> "^ , »; '*^.,.^'»«-' Fig -2. A' .V/i)/7//r.i llt}}itliiliti.i // .liifl.D.. I.Mai lin- iXK. SAiUt^. ^ud. oJiiit . fSjj^Cin
    • PLATE LXXIX. FIGURE I. Universally contracted pelvis. (After a preparation in the obtstetric clinic at Beilin). FIGURE II. Universally contracted pelvis. (^After SchrMer, Manual of Midwifery).
    • r u
    • T:if Fis Fi^.2. K. Marlins Haiulnllui: II .lufl. v. . I. Martui I I. XXX.
    • PLATE LXXX. FIGURE I. Flattened pelvis from rachitis. a. b&. Doubled promontory and diminished depth of sacral Imperfectly developed ilia cavity. with the anterior transverse diameter of the false pelvis almost as long as that of the posterior transverse diameter. FIGURE II. Antero-posterior contraction of the Pelvis from rickets, with unequal sides of the pelvis from scoliosis of the lumbar and sacral vertebrae with projection inwards of the left acetabulum.
    • nil Fi£.I, Fifi.2. A' Martm's llnndnllu . . Il..l„fl. ,..[. .)/„,.„„ i.x.wi.
    • PLATE LXXXI. FIGURE I. Antero-posterior contraction of the pelvis with sinking of the promontory and projection inwards of the acetabula from old-standing rickets. (Pseudo-osteo-malacic pelvis). FIGURE II. Section through a pelvis contracted antero-posteriorly {After H. F. Kilian, Drawings of new forms ofpelves. by spondylolisthesis. Mannheim, 1854, PI. 2.)
    • . Taf.LXXXIl. Pifi.l. Vi€. 2 E.Murhn's Hundallui:. //..-Iiif/r. A. Martin.
    • PLATE LXXXII. FIGURE I. Transverse contraction of the pelvis from projection inwards of both acetabula in osteomalacia in the adult. (Slighter degree of deformity ). FIGURE II. Transverse contraction of the pelvis, through projection inwards of both acetabula so as to bend the rami of the pubes, sinking of the from softening of the bones in the adult. {Advanced stage of deformity.') sacral promontory, resulting
    • . Taf IJOCXni Fifi.l. Fig. 2. K. Martin's llnmlulla.i . II At: fI v A. Martin. Fii.3 (.%((,- S^fiuU^.. ^l+fi. ,c0M*t. ^«ni
    • PLATE LXXXIII. FIGURE I. Transverse contraction of the pelvis with bilateral ilio-sacral anchylosis. (After A. Martin. A transversely contracted pelvis with double ilio-sacral anchylosis recognised dur- ing labour. Berlin, 1870.) FIGURE The same pelvis seen FIGURE The same II. from above. III. pelvis seen from beneath.
    • ; t
    • Taf. LX.1 Fii.l. Fig. 2. v.. Muriiir^ ll„t„luilus. II .Uin r ,1 Mul I, II tlfft. S.iiuitj,*. M . .0-.I..-I .'I?"
    • PLATE LXXXIV. FIGURE I. Transverse contraction of the pelvis from early acquired anchylosis of both sacroiliac synchondroses. (Delivery by perforation and cephalotripsy.) ( After Lamil. Pragel Vierte^ahrschri/t. FIGURE lSS4, II Band.) II. Contraction of pelvic cavity by exostosis of the sacrum. (J. Leydig's case of Caesarian section.) ( After Eli de Haber prces. Fr. C. Naegele, Diss, exhibens casum rarissimum partus, qui propter exestosin in pelvi absolvi non potuit. Heidelberg 1 830. j
    • 1!
    • Taf. Fig. 2. A' Martin s Nrinchtlui; // Jiifl. p. .1 . Martin - LXXXV,
    • PLATE LXXXV. FIGURE I. Obliquely contracted pelvis from anchylosis of the left sacro-iUac synchondrosis in early childhood. (After a specimen in the colleciion of the FIGURE obstetric clinic at Berlin). II. Obliquely contracted pelvis from anchylosis of the left sacro-Uiac synchondrosis, shewn from behind, (After Fr. C. Naegele, the obliquely distorted pelvis. Mainz 1839. Plate 5).
    • I I:
    • Fii.l. Fig. 2. K Martin' >: lUindcltus .11 Aull v A Mailni Tiif^ L.WXM
    • PLATE LXXXVI. FIGURE I. Exostosis of the left ilio-pubic synostosis, pelvis spinosa. (Velten's pelvis of a primipara, spine, taken {After whose uterus was lacerated during labour by from the cadaver and added H. Fr. Kilian. to the Drawings of nnv pelvic forms FIGURE Contraction of the pelvic cavity anatomical . museum at the bony- Bonn. Mannheim 1854. Plate 4). II. by bony cancer in a woman who was delivered for the fourth tim.e without artificial aid of a seven months' foetus. (The pelvis I, From a drawing by Prof. is in Forster. the collection of the Jena lying-in hospital.) Accompanying text of E. Martin, on cancer of the pelvic bones 1 85 I. Bd. Ill Heft 4). as an obstruction to labour. Illus. med. Zeitung, Miinchen
    • . Taf "1. . LXXXVU ^ 4 ''k ": i .©:-' n /i' Marliir.s ItaiuliilluK. II , lull. :i. A. M'ai lin. cars. SiCuvtxe. ^i,tfi,.c0M*t.. JBzi;*«
    • PLATE LXXXVII. FIGURE I. Lumbo-sacral kyphotic (After Hoening, Contribution to the study pelvis. 0/ the kyphotic contracted pelvis. FIGURE II. Funnel shaped pelvis. (After Schroeder, Manual of Midwifery. FIGURE Cleft pelvis seen BandY. front. After C. C. Th. Litzmann, Archiv filr Gynaekologie Cleft pelvis seen 1877^. III. from the FIGURE Bonn 1870^. IV. from behind. {After C. C. Th. Litzmann op. cit.) . Ed. 4 1872/
    • i f
    • Taf.LXXXVUI. t Fi*.l. Fi£.5. Fig- i'i£.6. Fii -t. I- E.ylarlin'H llnmlallus. // .hlH . 7'. .1 . .Mai lin Clfft. S^rviUie,. ^Ufi,.cDu.'t . Sit^CiA
    • PLATE LXXXVIII. FIGURE I. Pelvic inlet of a normal female pelvis. (From a photographic stereoscopic illustration of a preparation obstetric clinic FIGURE in the collection of pelves in the Berlin ) II. Pelvic inlet of a universally contracted pelvis FIGURE III. Pelvic inlet of a flattened rickety pelvis. FIGURE IV. Pelvic inlet of an obliquely contracted pelvis with unilateral ilio-sacral anchylosis. FIGURE V. Pelvic inlet of an obliquely contracted pelvis with lumbo-sacral kypho-scoliosis. FIGURE VI. Pelvic inlet of a transversely contracted osteomalacic pelvis. FIGURE VII. Pelvic inlet of a pelvis spinosa.
    • Tafl.XKXK. A '^-....i^^'
    • PLATE LXXXIX. FIGURE Front- (Figure girl (4//eT 1), Side- (Figiire who had never J . Vdt, 2), and Back- view (Figure menstruated, and Clinical Contribution. who had complete girl of the body of the uterus it was und GjmcBCologie, The broad os uteri stringy appendages from above were plainly The hymen was widely The Diagonal S, o centimeters, Cr. The bd. ii. 118). outside the rima, retroflexed, diverticulum in the prolapsed vagina. 20, s. Kyphoscoliotic aged 14^ years had noticed the prolapse " some time." vaginal wall was completely prolapsed. sides of 3) of a prolapse of the Uterus. Zeitschri/t filr Geburtshiil/e 1877, The I. was ulcerated. 6 centimeters felt. The anterior The whole long, on The bladder long both with a posterior vaginal vault raised a centimeter. dilated, but not ruptured. 8 —6 centimeters. Pelvis remarkably 21, o, Tr. 27, Ext. 14, 5 centimeters. slightly distorted. Spinae
    • TafXC, PiE.l. Fig. 2. d --v»t {/ M: :^^--- -€ A' Martin's lltinilullus. .' II .hifl. r. .1. Marin C1C6. Sf<'iu^^. ^u(l. c0hm. .'Si^-On .
    • PLATE FIGURE On (After Kehrer. ihe impressions of the foeial head XC. I. in new-lont children. Oberhessischen Gescllscha/l fiir Natur- old. 14 Jahreshetichl Kehrer made a trough-shaped impression in the left parietal bone After eight days as it appeared to have healed, he killed it. a. Internal surface. e. of a kitten 4 days External surface. b. da mid Heilkundc). Point of rupture. FIGURE II. Microscopic section of the above impression. At the convex brain-side of the impression are 3 fissures pressed together and open- ing inwards with their edges towards the dura mater. a. b. c. d. e. Parallel and fine fibrous Dura mater. The interlacing, stratum of the pericranium. vascular, and connective-tissue between the edges of the rupture. Lamellee of bone. Crenated edges of the rupture, in the concavities of which are large nucleated cells with finely granular protoplasm. /. Network of bone substance, which has united as a subpericranial layer over the point of fracture. FIGURE III. Cranial impression. {After Dohrn, On the way in which the foregoing head passes through a flat pelvis. Gyniikologie, bd. vi. Premature induced labour universally contracted pelvis. in s. Archiv fiir 82). week of pregnancy in a primipara with a was born in the first position at the end of % the 35th The child hours; the uterus contracting powerfully. Diffused tumour over the right parietal bone. The whole of the left surface. of the denuded and pushed forwards. The parietal bone is under the frontal bone. On the left parietal bone is a furrow 6>, 5 to I, o centimeters broad, beginning near the It takes an almost rightanterior fontanelle and ending beyond the parietal eminence. angled curve forwards and ends between the squamous and coronal sutures. The left parietal bone had been indented by the promontory of the sacrum, this was not caused by projection of the promontory but by sinking of the occiput, so that the parietal prominence impinged on the sacral promontory as it entered the pelvis. cranium is
    • . XC— (Continued) PLATE FIGURE IV. Spoon-shaped impression of the Cranium. (From a drawing by Carl Huge of an observation made in I he Obstetric Clinic at Berlin). The head which was delivered in the first position through a flat pelvis presents a deep furrow in the left parietal bone beneath the frontal bone. The left parietal bone is indented and displays a deep depression involving the parietal eminence slanting from above and behind and running forwards. The depression is about i centimeter in depth with fissures diverging from it over the upper half of the parietal bone. The child was living and was discharged from the hospital with its mother apparently in good health. FIGURE V. Cranial depression. After A. Martin, On diameter. lateral presentations in difficult labour with contraction Zeitschrift filr Geburtshiilfe of the antero-conjugate und Fraucnkrankheiten, 1875, s. 30). The head was in the second position and expelled by very powerful pains. The weighed 3,400 grammes, and was well developed. Cranial bones firm. Sutures narrow. Two centimeters below the right parietal eminence is a dark red depression i, 2 centimeters broad and o, 8 centimeters long with a wide red areola. From this depression a bright red colouration extended forwards towards the coronal suture from which spot it turned downwards as far as the right zygoma. child In this case timely adjustment of the presentation diverted the small anterior half of the cranium into the narrow conjugate (through which the broad posterior half of the cranium could not have passed), and allowed of the passage of the foetal head through the pelvis. FIGURE View On VI. of the point of depression in the left side of the foetal head in figiire 5. the left parietal bone, which mark, about 2 centimeters long, is pushed underneath the right, is a pale depression eminence in the semicircular line. in front of the parietal
    • PLATE XCI. FIGURE I. Chamberlain's Forceps. FIGURE II. Palfyn's Forceps. (One-third Size of Original). FIGURE IIa. Single blade of Palfyn's Forceps. FIGURE A III. short straight English Forceps with leather covering. (After Orme). (One-third Size of Original). (After a Specimen in the Collection of Instruments at the Royal Lying-in Institute of Berlin). FIGURE I IIa. Single blade of Orme's Forceps. a. English lock. (Junctura per contabulationem). FIGURE IV. Levret'a Forceps with head and pelvic curves. (One-third Size of Original). FIGURE IVa. Bight, female blade of Levrets' Forceps. a. i. French lock. (Junctura per axin). Raised borders of fenestrae.
    • 'I'nf. Fio E. Martin' K ffan/S-atlfjs U.Aufl. n.AMartin.. ^^UA/^I xr(. 1 a Sitfe- Sl[4it. d?IC%&-VL,
    • Taf. XCII. /A I^lc43-Un's lidtid-aHu'S JI.AilFL. u.A.Martin. &. h<^'^''f'-i --t^ii^. cSAA^jb, c?3m-&a
    • PLATE XCII. FIGURE I. Pelvimeter after E. Martin. FIGURE II. Pelvimeter after Collin. FIGURE III. Colpeurynter after C. Braun. FIGURE IV. Fiddle-shaped India-rubber Dilators after R. Barnes. FIGURE Balloon for artificial V. induction of labour after Tarnier. FIGURE VI. Shapes of Laminaria Tents and Compressed Sponges in various FIGURE VII. Funis Eepositor after E. Martin. FIGURE VIII. Funis Eepositor after Robert. FIGURE IX. Blunt Hook. FIGURE Key-hook X. after C. Braun. FIGURE XI. Smellie's Perforating Scissors. sizes.
    • PLATE XCll.— (Continued). FIGURE XII. Blot's Perforator. FIGURE XIII. Naegele's Perforator. FIGURE XIV. Trepan-shaped Perforator with bayonet socket of the crown after E. Martin. FIGURE XV. Trepan-shaped Perforator after C. Braun. FIGURE XVI. Bone Forceps after Mesnard-Steln.
    • PLATE XCIII. FIGURE I. Forceps after E. Martin. FIGURE II. Forceps after Naegele. FIGURE III. Breech Forceps after FIGURE Ideler. IV. Cephalotribe after E. Martin. FIGURE V. Cephalotribe after Braxton Hicks. FIGURE VI. Cranioclast after C. Braim. FIGURE VII. Combination of Perforator and Cranioclast after J. Veit.
    • Taf. XCIII. Fii Fi« 1. 3. E.MarUn9 ffandatlas n.Auflo.AMuLrUn CM. SAOA^, gUK,. c5«Ajt. c^c^v
    • raf XC'IV. K.Hardn:,-: HunduHiu-^ If.Au.n. j>. A MaHin. , Si/cfiMja^, S^. dtAik. &civ(lcu
    • PLATE XCIV. FIGURE C. I. Mayer's Glass Speculum. FIGURE II. Sims' Speculum. FIGURE III. One-bladed Speculum, with wooden handle after Kristeller. FIGURE IV. Simon's Speculum, with different sizes of blades, FIGURE 4a and 4b. V. Uterine Sound. FIGURE flgs. • VI. Bullet Forceps with Clutch-hook. FIGURE VII. Spring Dressing Forceps. FIGURE Curved VIII. Scissors. FIGURE Scissors for incision of IX. Os Uteri curved FIGURE at the handle after Schroder. X. Scarificator after C. Mayer. FIGURE XI. Squirt for Intra-uterine injections after C. Braun. FIGURE Sharp Curette XII. after Simon.
    • PLATE XCIY.— (Continued). FIGURE XIII. Recamier's Ciirette. FIGURE XIV. Uterine Medicator after E. Martin. FIGURE XV. Bath Speculum. FIGURE XVI. Speculum for irrigating the Vagina after von Preuschen. FIGURE XVII. Dilator after Greenhalgh. FIGURE XVIII. Instrument to introduce Sponge Tents after B. Barnes. FIGURE XIX. Double Knife for incision of the Os Uteri after E. Martin. FIGURE XX. Double Knife after Greenhalgh. FIGURE XXI. Knife for incision after Sir James Simpson. FIGURE XXII. Hodge's Vaginal Pessary. FIGURE Intra-uterine XXIII. Stem with holder. FIGURE XXIV. Spring Stem Pessary after E. Martin.
    • PLATE XCV. FIGURE I. Complete Procidentia Uteri. {Ayur R. Barnes, A Clinical History of the Medical and Surgical Diseases of Women, Second edition. London, 1878). (Half-size, from a preparation in St. George's Museum). P. Symphysis pubis. B. Bladder. U. Urethra, drawn almost vertically downwards culum of bladder outside the vulva, and O.U. Os to open in front into B', a sacculated diverti- of the procident uterus. uteri. D. Douglas' pouch, extended outside the vulva. O. A. The ovary dragged down. The anus. FIGURE Fibroma {After Large uterus. fibroid tumours, one in II. TJteri. R. Barnes, op. cit.) the anterior, the other in the posterior wall of the The whole was removed by laparotomy by Dr. R. Barnes. centre contains a three month's ovum. The uterus in the
    • PL. XCY, Fig. 1.
    • PL. XCVI. Fig. 1. Fig. 2.
    • PLATE XCVI. FIGURE I. Occlusion of the Vulva. {After R. Barnes, op. cit.) (One-third Life-size). (From a specimen V. OM. in the RadcliflFe Museum, Oxford. Case described by Dr. Tuckwell). Cavity of vagina distended. Os uteri, and cavity of uterus above it also distended. Complete occlusion of vulva. FIGURE II. Atresia Vagiaae. (After R. Barnes, From a preparation in St. op. at.) George's Museum. (Half Life-size). U. Dilated uterus. V. Dilated vagina above the seat of atresia, traversed by B, a piece of bougie. The Fallopian tubes are not dilated.
    • PL. XCVII. Fig. 1. Fi?. 2. Fig. 3.
    • PLATE XCVII. FIGURE I. Atresia of Vagina. {After R. Barnes^ op. cii.) R. Rectum. B. Bladder. U. Uterus. V. Cul-de-sac at vulva. A. Dense tissue in place of vagina traversed by a narrow fistulous tract between V and uterus. FIGURE II. Retro-uterine Hsematocele. {A/ier R. Barnes, U. The A. The haematocele op. cit.) uterus pushed forwards. and the small filling the cavity of the sacrum, bounded above by plastic effusions intestines. FIGURE Extreme III. retroflexion of the Uteriis. (After R. Barnes, op. cit.) (From Nature A section is made through the centre, showing atresia in places of the canal of the uterus.
    • PL. XCVIII. Fi?. 1. Fig. 3. Fig. 2. Fig. 4. Fi-. 5.
    • PLATE XCVIII. FIGURE I. Dr. Qrigg's Uterine Dilator. FIGURE Long Forceps after FIGURE Craniotomy Forceps II. Robert Barnes. III. after FIGURE Robert Barnes. IV. Crescent Speculum after Robert Barnes. FIGURE V. Pessary for anteflexion of the Uterus after Fancourt Barnes.
    • * n
    • UNIVERSITY OF CALIFORNIA LIBRARY Los Angeles This book OMEi) FEB DUE on tlie last date stamped below. 1 8 198^. BIOMED UB. FEB is IpM BIOMED AUG 1 9 1988 AUG 17 1388 REC'B JUL 2 9 APR 1987 1 1988 AUG 1 8 1988 Form L9-52M-7,'61(01437s4)4-Ji