CASE OF OVARIAN PREGNANCY* 
G. M. B. MAUGHS, M.D., LL.D., 
Professor Obstetrics and Gyncecology, Missouri Medical College. 
At the meeting of this Society, April 13th, Dr. C. exhibited 
what he claimed was an ovarian pregnancy, which he had 
removed by laparotomy a few days previous. Knowing that if 
correct in his diagnosis he was in possession of the most valuable 
pathological specimen in the world, and that this Society, 
through this particular find of a rosetta stone by one of its most 
worthy members, would be able to do what all the pathological 
museums in the world failed in doing—determine the possibility 
of ovarian pregnancy—and myself believing that such a thing 
had never happened—never would, never could happen—I 
eagerly proceeded to examine it. 
The tumor, much the size, shape and general appearance of a 
gravid uterus of a few weeks, had been laid open longitudinally, 
and its walls further exposed by a cross-incision at the lower 
portion of the cavity containing the ovum. The walls, com- 
posed of peritoneum, muscular and mucous tissue, with blood 
extravasations, were of a pretty uniform thickness of half an 
inch, with a uterine-shaped cavity at the upper or fundal end, 
of what appeared to be the corpus uteri. This cavity, con- 
taining an embryo of eight or ten weeks, was smoothly lined, as 
in normal pregnancy, with the amnion, which terminated at the 
lower end of this cavity, at a constriction in the walls, which I 
thought was the os internum, Below this, in the narrow end of 
the tumor, was an unlined cavity, extending from the os inter- 
num to the terminal end of the tumor, and was, perhaps, three- 
quarters of an inch in length. The sac containing the embryo 
had been laid open, previous to which it must have been as large 
as a hen’s egg. The attachments of the tumor had been cut off1' 
so close that it was difficult to determine their nature. But one: 
fallopian tube could be distinctly made out; and which, as I sub- 
sequently determined by a more careful examination, entered the 
tumor at one of its angles, just behind the upper lateral margin 
*Read before the St. Louis Medical Society, April' 13th, 1890. of the half-formed placenta. There was every appearance of a 
fallopian tube at the opposite angle of the pear-shaped body, 
but this was cut so close that, with the presence of a blood 
infarction in this horn, and without a more minute examination 
than I was able to give it, I am unable to say was a tube, or 
the undeveloped horn of a uterus bicornis. 
This was the general appearance of the tumor upon a careful 
examination, as I held it in my hand. Of course, it was not 
such an examination as I would have made under other circum- 
stances. I, however, satisfied myself that it was not an ovarian 
or tubal pregnancy, and unhesitatingly declared it was a uterus— 
a conviction which I still hold—not a pregnant ovary, but a 
pregnant uterus, and so stating, asked Dr. C. what had be- 
come of the woman. He said she was not doing well. I told 
him she would most probably do worse—would die ; if so, he 
must not fail to make a post-mortem, as this was her uterus. 
She died next morning—no post-mortem, which, under the ur- 
gent occasion, is not less wonderful than unfortunate, as it would 
have proven to this Society the truth or error of my diagnosis 
and statements ; and as by the presentation of this case, this 
Society had become an interested party, it was certainly due it 
that the ordinary means—under said circumstances—of deter- 
mining truth should have been used. For what other purpose is 
this Society ? Is it only for the purpose of hearing crude opin- 
ions, or reports of cases, regardless of the truth or error of the 
reporter’s views, and to send them out to the profession with at 
least the tacit endorsement of the Society, that we meet here once 
a week ? And then a post-mortem in this case would have given 
us the key to a clinical history not less mystical than the tumor 
itself. I may say here, that these opinions and expressions of 
mine that it was a uterus were concurred in by several leading 
members of the Society; and at least one of these, Dr. Coles, an 
experienced and learned obstetrician and gynaecologist, said 
openly that it was a uterus. 
Anxious to get at the truth of this case—both for our own 
satisfaction and in the cause of science ; a not unnatural desire, 
it will be admitted, on the part of one who for twenty years has 
been professor of obstetrics and gynaecology in a most reputable 
institution (the Missouri Medical College): had I felt indifferent 3 
to such a case, I most certainly would feel unworthy to teach 
obstetrics or gynecology—as soon as I could, on the following 
Tuesday, I went out to the hospital, hoping to find Dr. C. 
and thinking probably I might witness the post-mortem, which 
it never occurred to me, in case of death, would not be held. 
Not finding Dr. C. but learning that his office was on Jef- 
ferson avenue, I went to his office to see him and the tumor, 
when he told me Dr. Bremer had the tumor for microscopic 
examination, but kindly gave me the privilege of examining it. 
I went to Dr. Bremer’s college laboratory ; not finding him in, I 
went to his house, when he told me he had not yet examined 
the tumor, was preparing specimens for the microscope. I now 
made an appointment for the next day with Dr. Engelmann, who 
is thought to know a uterus when he sees and handles it. Next 
day, on my way to the college, according to appointment, I met 
Dr. Bremer on the cars, who told me that he had to attend 
court, but kindly told me where in his laboratory I would find 
the tumor. I met Dr. Engelman and told him Dr. Bremer 
would not be present. This we regretted, and did not give the 
tumor as thorough an examination as we had intended, and 
would have done had Dr. Bremer or Dr. C. been present. 
The tumor was now much contracted and altered in general 
appearance by having been in alcohol several days, but we fully 
confirmed the description I have given, and in addition, in care- 
fully examining the surface with a lens I had taken with me, we 
entirely failed to detect any scars or cicatrices from ruptured 
follicles, corpus luteus, or find any ovarian stroma or ova in the cut 
walls ; and further, with the lens we could see in the lower unlined 
cavity an arrangement of its mucous membrane much like that of 
the arbor vitas of the cervix uteri, which, with the shape, size and 
anatomy of the organ, or tumor, satisfied us that it was what I had 
stated it to be, a pregnant uterus. We, however, in the absence of 
those to whom the tumor had been entrusted, did not feel author- 
ized to make such an examination as might have demonstrated 
this—indeed, were unwi lling to handle it as we wished to do. Then, 
for positive proofs of what it is, we are thrown upon other resources. 
Is it a uterus? To answer this question in the affirmative, as 
we expect to do, to the satisfaction of this Society, it may be 
well first to show what it is not. CLINICAL HISTORY. 
The patient had had several attacks of what was diagnosed 
pelvic peritonitis—pain, fainting, cramps, irregular menstrua- 
tion, hemorrhage—with the passage of a large membraneous 
blood-clot two inches long by one inch broad. On introducing 
the finger into the vagina, a closed sac was found. Upon ex- 
ploring this two and a half inches (this, starting with a vagina 
of, say three inches, gives us five and a half inches), its external 
orifice was found very narrow and cicatrical. (What are we to 
understand by external orifice here, its opening into the vagina, 
or external to this ?) Upon a further exploration of the vagina 
or sac, an inch and a half further (this gives us seven inches), a 
depression was felt, which the speculum showed was penetrated 
at bottom. A probe passed into this an inch (we are now eight 
inches from the mouth of the vagina), the finger in the rectum 
detected a uterus not larger than the thumb, with a cervix like 
the finger. (Now, mount this uterus the size of the thumb, with 
its cervix as long as the finger, on the eight inches given, and 
we have climbed well up to the woman’s chin.) To the right, a 
large tumor the size of an orange was felt. Diagnosis, abnormal 
development of vagina, uterus, etc., with abscess. (A tremen- 
dous diagnosis !) At a later visit, this second horn or cavity of 
the vagina was dilated and found one inch long and half an inch 
broad. (This, while not so large as horns sometimes are, was 
certainly a very respectable size for a vaginal horn ; uteri have 
horns, vaginas have no business with them.) Found the neck of 
the uterus about the size of the little finger; could introduce a 
probe into its mouth. 
In consultation with Dr. Glasgow, signs of pregnancy being 
present, this diagnosis was exchanged for one of ectopic preg- 
nancy. A few days after, the tumor was removed by laparot- 
omy and shown to this Society as an ovarian pregnancy. A short 
time after the operation, the abdomen was opened, when, by a 
careful examination, the uterus was found scarcely larger than 
the end of the thumb (uterus infantalis). The tumor, however, 
had evidently changed sides, as it had now gotten to the left 
of this uterus not larger than the end of the thumb, whereas, 
when we first made its acquaintance, it was on the right side. It 5 
was certainly very uncanny in it to do this thing ; but then, with 
such a uterus, mounted upon a neck longer than it should have 
been to be artistic, and ten inches from the introitus vagina, we 
may suppose the tumor w;is gyrating around from curiosity: 
perhaps, looking for the second horn of the vagina. Don’t blame 
it ? What business had the thing with a second horn ? But then 
it may have been for protection, so far was it from home. • 
This diagnosis of ectopic pregnancy, improved and enlarged 
from previous ones, was certainly correct, as far as the preg- 
nancy—the ectopic not so clear. The post-operative diagnosis of 
ovarian pregnancy, if correct, gave us a most rare gem, believed 
by many to be an impossibility ; but here, placed among the 
things not only possible, but actually present: made undeniable 
by this beautiful, fascinating, overwhelmingly illustrated, dem- 
onstrated and illuminated pregnancy ovarian centralis. Gape, 
sinner, and swallow ! Sure enough, right in the center of the 
ovary a home-made pregnancy had found a most fitting cavity— 
where such cavities are unknown—and was certainly doing well 
under the circumstances. 
Now, let us first examine the clinical history which opened up 
this brilliant discovery, together with, or in connection with, 
well-known anatomical and physiological facts; and first, we 
may ask: From whence the hemorrhage? It could not have 
been from the rudimental or atrophied uterus, not larger than 
the end of the thumb. Such a uterus does not, cannot bleed ; 
cannot furnish a hemorrhage, except from a traumatism—does 
not even bleed sufficient to produce the menses—such cases are 
amenorrhoeic. Was the bleeding from the tubes? In a full-sized 
normal uterus, the lumen of the tube is so contracted at the 
uterine mouth that it will only admit the passage of a hog’s 
bristle. Then, how small must it have been in a uterus not 
larger than the end of the thnmb ? Positively not large enough 
to admit the passage of a stream of blood sufficient to produce a 
violent hemorrhage from the vagina. Indeed, had the tubes 
been normal, and from any cause a hemorrhage had taken place 
in them, the blood must have flowed out through the abdominal 
os into the peritoneal cavity, or by its accumulation distended 
the tubes until they ruptured, when the blood would have been 
poured out into the abdominal cavity, intra-peritoneal, or into the 6 
broad ligament, an extra-peritoneal haimatocele. Then, as this 
blood was most positively not from or through this uterus not 
larger than the end of the thumb, it must have been from the 
pregnant tumor; and if I understand the clinical history as 
related, this was supposed to be its source. But as there is no 
connection between the ovary and vagina, or between the ovary 
and the uterus, through which blood could pass, if the hemor- 
rhage was from the pregnant tumor—and it doubtless was—that 
tumor must have been the uterus—could have been nothing else— 
and we more than suspect this was the case. If so, the hemor- 
rhage was most natural in its source, as pregnant uteri do some- 
times bleed; and in such cases, the blood has an old-fashioned 
habit of finding its way into the vagina. 
As, then, the hemorrhage could not have been from a preg- 
nant ovary, and, in this case. could not have been from a tube 
in tubal pregnancy, through a rudimental or atrophied uterus 
not larger than the end of the thumb, we have an additional 
argument against ovariain and in favor of uterine pregnancy, and 
that, too, in a uterus in some way—as uteri are wont to do— 
connecting with the vagina, even if this has a horn. 
The anatomical arguments, or facts, against this tumor being 
an ovary are positively demonstrable. If not, let some one tell 
me what business a fallopian tube has entering an ovary ; what 
enters it for, or how? Neither a fallopian or any other tube en- 
ters an ovary. A fallopian tube does enter this tumor. There- 
fore, this tumor is not an ovary. 
The other than anatomical arguments that this tumor pre- 
sented here as an ovarian pregnancy is not such, are analogical, 
as there are no observed cases, no preserved specimens, in any 
of the pathological museums in the world, to which we might 
refer to learn how the ovary would conduct itself should it find 
itself pregnant; but this we do know: it has no accommodating 
property whereby its walls might enlarge—hypertrophy, grow 
thicker, more massive—as do those of the uterus, in correspond- 
ence with the growing ovum ; and in cases of distension from a 
cyst or cysts within its substance, we find its walls, or its sub- 
stance beween the cyst and its enclosing tunics, constantly grow- 
ing correspondingly thinner with the growing cyst, until every 
vestige of ovarian stroma disappears, leaving only its coats to invest the distending cyst. That it would do otherwise in disten- 
sion from a growing embryo would be a monstrous suggestion ! 
The walls in this tumor are not thinned by the distension of an 
ovum several times as large as a normal ovary ; therefore, this 
pregnant tumor is not a pregnant ovary, nor an ovary at all. 
Then the reader must await further time to learn just how a preg- 
nant ovary would behave itself. Sorry for this. Had hoped the 
St. Louis Medical Society could point the world to its discoveries 
and its possessions illustrating this much-mooted point—a dis- 
tinction it richly deserves, as it does really produce some curious 
things—and, under the circumstances, this tumor, in its clinical 
history, its diagnosed histology, is one, and certainly not the 
least of its curiosities. 
Then, as it is seen most positively to be not an ovarian, was it 
a tubal pregnancy ? Here, the contradictory facts and theories of 
imperfect observations, and worse deductions by supposed com- 
petent observers, that obscured by Cimmerian mists or misled 
by bog-lanterns the earlier obstetricians—thanks to the labors of 
late gynaecologists, principal of whom is Tait—have disappeared, 
giving us an illuminated highway along which a wayfaring man, 
though a fool, may run without stumbling, if, only, he will not 
run against the sign-posts. 
In the case of tubal pregnancy, our analogical arguments are 
conclusive; while those drawn from actual observation and prac- 
tice are undeniably demonstrative. 
First, the walls of all hollow muscular organs are thinned by 
distension. This is a law to which there is no exception. In- 
flammation or other causes may hypertrophy—thicken—the walls 
of such, but distension, never : instance the gall and urinary 
bladders, intestines, heart, blood vessels, etc. Nor is the uterus 
any exception to this law ; as, in a normal pregnancy, its wTalls 
ard never distended, but grow—increase by a genuine hypertro- 
phy pari passu—with the growing ovum. Its function is to 
accommodate—furnish a suitable*nidus for the development of 
the fecundated ovum, the growing embryo-foetus—and, like all 
other organs, its anatomical structure and physiology are in 
correspondence with its function. 
In a normal pregnane}7-, the uterus is as much distended at the 
third month, when the embryo weighs one ounce and is two or 8 
three inches in length, as at term when the foetus measures 
eighteen inches and with other contained products weighs ten or 
fourteen pounds. But in an abnormal pregnancy, in hydra- 
amnios, or large twins, the uterine walls may be thinned in pro- 
portion to their abnormal distension, like those of a distended 
bladder, even to the point of rupture. 
From all analogy, then, the tubes are never thickened, but 
always thinned, by the distension of a growing ovum ; and, in 
additional proof of this fact, we have the positive testimony of 
all observers, of all gynaecological surgeons and accoucheurs, 
together with the very illustrative cases that have been presented 
to this Society, or that may have fallen under the observation of 
its respective members. 
In tubal pregnancy, the walls are always thinned or distended 
by the growing ovum, until, no longer capable of distension, 
they rupture; and, in the great majority of cases, long before 
the ovum attains the size of this one. The walls of this tumor, 
including their entirety—coats, muscular, mucous tissue and ex- 
travasations, all within the unstretched walls and constituting 
them—are half an inch or more in thickness. Therefore, this is 
not a tubal pregnancy. Admitting that at some points much of 
this thickness of the walls is made up of extravasations, in other 
points it is not, only thickened uterine tissue. 
Furthermore, on this point we have the positive testimony of 
an intelligent observer, who, in this particular, may be claimed 
as an especial witness ; one whose experience on this very point 
is greater than that of any other person, living or dead. Law- 
son Tait, after seeing and examining by operation or post-mortem 
seventy-six cases of tubal pregnancy, says, in his book on “ Dis- 
eases of Women, and Abdominal Surgery,” p. 454, edition, 1889 : 
“ The cause of primary rupture of the tube is chiefly in its 
thinning at thvplacental site.” There is no thinning at the pla- 
cental site in this case ; therefore, this is not a tubal pregnancy. 
Again he continues : “ When distended, either by pregnancy or 
otherwise, the walls of the tube never thicken materially.” The 
walls of this pregnant tumor are thickened materially ; there- 
fore, the walls of this pregnant tumor are not the walls of the 
tube. Again he continues: “Certainly, in tubal pregnancy 
there is no imitation of the muscular walls of the uterus.” In 9 
this pregnant tumor there is a most marked imitation of the 
muscular walls of the uterus ; therefore, the walls of this preg- 
nant tumor are not those of a pregnant tube. 
In this case, then, we may claim the most important witness 
the world has ever produced as our expert, if not a special 
pleader. We hope none will accuse us of having bribed Tait, 
or of having gotten up this case to suit Tait’s views. Surely, if 
Tait’s views in this particular case are to be received as testi- 
mony, we, the jury, are compelled to find for the defendant, 
which is here a pregnant uterus. As physician accoucheurs, 
whose hearts are always responsive to the wail of a defective, 
helpless uterus and its unfortunate possessor, lovely woman, who 
is often compelled to pay with her life the high prerogative of 
perpetuating the race of men—giving birth to man—a privilege 
which a goddess might envy—we dare not, here, to be more than 
a doubting Thomas ; deny after we have both seen and touched. 
To add to the positive proofs given this Society, by seeing and 
handling this uterus defect m, that this tumor is not a pregnant 
ovary or tube, would be an imposition upon your time, if not an 
insult to your intelligence; but let me here remark that, while 
the proofs as to the nature of many tumors—their histology—are 
microscopic, those of a pregnant uterus are macrocospic. 
Not alone obstetricians and gynaecologists, but all physicians 
and surgeons, all of whom are, in fact, both obstetricians and 
gynaecologists, feel assured that they can tell a uterus, gravid or 
non-gravid, by seeing and handling it. To suppose they cannot 
do so, is not alone an insult to their intelligence, but a burlesque 
upon the profession. For what other purpose do they study 
anatomy and physiology but to learn the position, size, shape, 
•construction and function of organs ? And these make the uterus 
what it is, not its histology, seen by the microscope. It has no 
tissues not found in other parts of the body — absolutely none. 
Then, it is not its histology that makes it a uterus ; had such 
been the order of nature or of Nature’s God, it might as well 
’have been of India rubber; indeed, I rather think this would have 
Tteen an improvement: and, as a protection against the rampant 
gynaecology of the present day, I don’t know but it would have 
been well to have encased it in clastic chain-armour. 
I would not give the opinion of a committee of, say, Drs. Mudd, Lutz, Ford, Prewitt, Tuholske, Coles, Engelmann, our 
lady member, Dalton, Dorsett, any three of these, as to 
what a pregnant tumor was, for the combined opinions of Pasteur, 
Virchow and Dr. Kremer—as mere microscopists—highlyas I may 
and do esteem all these ; and all the first-named, andfifty others, 
members of this Society, know quite enough about the micro- 
scope to cast all the microscopic light upon the tumor required. 
But, then, perhaps it may not have been more concerning the 
pregnant tumor the microscopist was expected to throw light on 
than its contents. Possibly, it may have been suspected that 
this thing, with its strange, mystical, mythical, clinical history, 
might be a Colorado beetle, or a mouse. Why not? there are 
both beetles and mice ? And if this had been a beetle, the micro- 
scopist would be at home, and would most certainly have thrown 
a flood of light upon it, pointing triumphantly to the histology, 
and demonstrating, at least, that it was not a human embryo; 
or, had the object been to chase down a swarm of microbes, or 
bacteria, to tell us whether they had tails or were tailless, or 
worked in chain-gangs or isolated. No one equal to the micro- 
scopist ! Had, however, this embryo been that of a mouse, all 
the microscopists in the world, working as microscopists, 
could not have told us whether it would be developed into a god- 
like man, say, Bob Ingersoll, or a long-tailed rat. Why ? 
Because there is no histological difference, save, possibly, the 
blood disks in the two animals. And yet this pregnant tumor 
is to be determined by a microscopist. As well give a man a 
microscope to examine an elephant, to determine whether its 
great ears are not umbrella-shaped mushrooms, as to hand a 
doctor one to determine whether an ordinary uterine-shaped 
organ in the female pelvis, conducting itself as a pregnant 
uterus is known to do, was, indeed, a uterus, or something else ; 
perhaps a man-of-war. 
It will be readily seen that no possible microscopic appearance 
of the tissues by one not an obstetrician or gynaecological sur- 
geon, or anatomist (and the anatomist may be all that is neces- 
sary), no matter how able he may be as a microscopist or honor- 
able as a man, is of the least value in rebuttal of such testi- 
mony as we have here. This will be manifest when it is recol- 
lected that there is no possible organic structure, no tissue, in the uterus, not found elsewhere, the presence and arrangement 
of the utricular gland, perhaps, excepted ; and these do not make 
the uterus what it is, and that no possible amount of muscular 
tissue, striped or unstriped, and mucous tissue, hard or soft, nor 
any combination of them placed elsewhere than in or connected 
with the female pelvis, and having ‘functions to perform other 
than those of the uterus, conld possibly of themselves constitute 
a uterus. 
To admit against the positive testimony, observation, experience 
and practice of such a man as Tait, backed by the unanimous 
experience of all physicians and surgeons, in accord with the 
personal knowledge and experience of each of us, testified to by 
our sight and touch, the statement or opinion of a mere micro- 
scopist, who, perhaps, never in his life saw a case of tubal preg- 
nancy — indeed, in this case, is not supposed to have seen one — 
and this opinion, too, based upon the mere microscopic appear- 
ance or arrangement of tissues, not peculiar to any organ, would 
be to render all human experience nugatory, worthless, and rele- 
gate us back to the times of darkness, when God winked at 
the follies of men because of their ignorance. 
But, if any member of this Society is disposed to waive his 
own knowledge and experience, together with that of the pro- 
fession in general, for those of a microscopist, who finds soft 
tissue vascular engorgement, blood extravasations, infarctions in 
the walls of the uterus, where he may have expected to find only 
firm muscular tissue, let me assure such that the uterine walls 
are not composed of firm muscular tissue, but often of a tissue 
so soft that the uterine sound has been passed quite through 
them and out into the cavity of the abdomen, without the opera- 
tor having used undue force or suspecting what had happened ; 
and this, too, by gynaecologists of experience, and who could not 
be classed with the stolid or ignorant. 
Snom Beck, a great authority, quoted by obstetrical authors, 
from Hodge to Playfair, in the last edition, 1889, says : “The 
mucous membrane of the uterus one-third of its thickness is not a 
mucous membrane, but a softened portion of true uterine tissue.'1'1 
Dr. John Williams, of London, a great authority, quoted 
also by Playfair in the last edition of his Obstetrics, 1889, says 
that the greater portion of the uterine walls are composed of this anomalous uterine tissue. Then, in anomalous cases of this 
■anomalus uterine tissue, thought to compose the greater portion 
of the normal uterine walls, why may we not admit the possi- 
bility of tissue of much the appearance of this, with semi-organ- 
ized blood extravasation ? Surely, such conditions of the walls 
of a pregnant uterus are not unique, and would certainly be no 
evidence that the pregnant tumor was not the uterus; but, on the 
contrary, evidence that it was — not, it is true, a normal condition 
in a normal uterus ; but then, unfortunately, it is not always a 
normal condition, or a normal uterus, with which the obstetrician 
or gynasological surgeon has to deal. And, yet, we may readily 
suppose one not an obstetrician—a mere microscopist—might mis- 
take this condition for something else—perhaps a Bologna sausage. 
Now, as it is perfectly manifest that this tumor is a pregnant 
uterus, let us see if we cannot determine what kind of a uterus 
it was ; and this we are the more anxious to do, that we may 
show that Dr. C.’s surgical blunder was not so great a blunder, 
after all. It was a condition requiring surgical interference, and 
he did perfectly right in removing it; without this, it might have 
ruptured and killed the woman — its rupture would not have been 
from distention, as in the case of a tube, but, from its rudimen- 
tal development—it was utterly unfitted for the function it had 
to perform ; and hence, infarctions, extravasations in its walls, 
and hemorrhage through the vagina, as in uterine hemorrhage, 
the undeveloped pregnant horn of a uterus bicornis ora uterus 
didelphys. All this his examination fully determined, had he 
been able to interpret the facts correctly.’ 
It was not, then, that he did not discover the true condition, 
but that, from its very great rarity, he most naturally misinter- 
preted what he found. Would any of us have done better? 
Let us see. The condition and perplexity he met with in the 
upper part of the vagina — blind sacs and obscure openings — 
were caused by the septem often present in such cases. The 
long, narrow neck may have been common to the two horns, 
and the small uterus, not larger than the end of his thumb, was 
the other undeveloped horp of a rudimental uterus ; while the 
tumor removed, was the pregnant horn, which, on account of 
its rudimental condition, was unable to equally develop with 
the growing ovum. Perhaps, had he mentally removed the horn from the vagina where it was out of place, and stuck it on 
to the uterus, where such things belong, it would have fur- 
nished him the key to a correct diagnosis. 
I have treated his clinical history of the case in the manner I 
have, to show that, without an alphabet for its proper interpreta- 
tion, it is confused, obscure, contradictory, misleading; but, 
with its proper understanding, entirely correct, instructing us 
as to the true condition — indeed, absolutely proven by the inter- 
pretation we have given; and also to show how utterly worth- 
less are clinical histories, if misinterpreted, misapplied — how 
illustrative, when understood. As utterly contradictory, im- 
possible, misleading as it is, when applied to ovarian or tubal 
pregnancy, when placed with a uterus bicornis or didelphys, it is 
in perfect harmony with itself and the conditions, enabling us to 
determine a priori from the cause to the effect, next a p>osteriori 
from effects to the cause, exactly what the conditions were. 
For one, then, I thank Dr. C. for the presentation of this case, 
and indorse his removal of the tumor, not in the manner of its 
removal, but with the best interpretation he was able to give 
the seemingly contradictory symptoms and anomalous condi- 
tions, in the only manner he could have done. Would any of 
us have done better ? I doubt it. 
Now, let me point you to these plates, illustrating these con- 
ditions and this case. 
We have here a diagram of the foetus in the fourth or fifth 
week. We find on either side of the spinal column the Wolffian 
bodies, and between this and the spinal column you have two 
kinds of bodies. On each side of the Wolffian bodies we have 
the Wolffian ducts, which empty into the sinus urogenitalis, and 
on the outer side of these we have the filament of Mueller — 
the ducts of Mueller. This foetus is now asexual — it may be 
either a male or a female ; but, if it be a female, we find these 
filaments of Mueller becoming hollow, until absorption takes 
place in the interior, and they become hollow tubes, and form 
the fallopian tubes. In the next diagram, we have these ducts 
of Mueller uniting with each other at the lower third and form- 
ing the uterus, and the septum extends down through the entire 
uterus and vagina ; there are two of them. That is always 
formed in every human female ; at first, she has two uteri and two vaginae, but, afterwards, the septum is absorbed, and she 
has a single vagina and a single uterus. This condition is what 
is found in the carnivora — the cat and panther. Then, the 
uterus is not perfect in its fundus, but there is a depression left, 
and it is only in the higher forms of animals — the ape and the 
gorilla — that we have the uterus shaped as this is, with a large 
rounded fundus. In the lower forms of human females, the 
uterus still retains this slight depression. It is only the higher 
forms of humanity — in the Caucassian race — that we find the 
perfect human uterus. Now, we have a uterus here that car- 
ries us back through untold aaons to the non-placental epoch. 
This is the uterus of the marsupials — the kangaroo ; this is the 
uterus of the opossum to-day. This is the uterus of a woman 
who bore a number of children. There is simply an arrest of 
development. There is nothing that more conclusively proves 
the evolution of man from animals than this uterus. There is 
no doubt that there was a time when this uterus was the most 
perfect type of sexual development. The woman who had this 
uterus died at forty years of age, after giving birth to a number 
of children. She sometimes conceived in one uterus, and, during 
the pregnancy, menstruated from the other. Sometimes she con- 
ceived in one uterus at one time, and in the other at another time ; 
and gave birth to a child at full term from one uterus, and an 
embryo, perhaps only three or four months old, from the other. 
The next diagram represents a uterus bicornis. This uterus 
is simply an arrest of development. The tubes never united to 
form the fundus of the uterus. The corpus uterus was left 
partially separated, by a failure of the tubes to unite at their 
apex ; that is, in this case, absorption did not take place at all, 
so this patient had two uteri and two vagina?. This diagram is 
from a very interesting case. The patient was thirty years of 
age, and Dr. Mai, a distinguished obstetrician, a professor at 
Breslau, was in attendance on tne case when the patient was in 
labor, and, upon complications or difficulties arising, he called 
in consultation Dr. Fischer, another distinguished professor, of 
the same place. Fischer stuck his finger into this side of the 
uterus, and decided that the patient was not in labor, and was 
not even pregnant. Dr. Mai stuck his finger into the other 
vagina, and remarked that things were progressing all right, that the presentation was all right, but it was a tedious labor. 
Dr. Fischer remarked that Mai must be a fool to say the patient 
was in labor. Mai told Fischer that he certainly was a fool, if 
he did not know that the patient was in labor. Then Fischer 
stuck his finger into Mai’s vagina, and said the patient was in 
labor ; but there had been a wonderful change since he exam- 
ined her a few minutes before. Mai examined the patient again, 
and got his finger into Fischer’s vagina, and then he was amazed 
to find the change that had occurred ; so they had a violent 
quarrel. Meanwhile, the uterus kept at work. 
On this other plate, we have a uterus bicornis, but with an 
atrophied horn, and this atrophied horn was pregnant, and, you 
see very readily, that this horn was separated by an inch and a 
half from the more developed horn. The patient had conceived, 
and, at term, fell into natural labor, and was in labor three or 
four days, when the labor pains ceased, and she got up and went 
about, and continued to do so for five or six months. She died 
of phthisis pulmonalis, and, after death, the foetus was removed, 
and the condition of the uterus discovered. 
This other is the uterus of a lady, in New York, who was 
under the care of a distinguished gynaecologist, one of great 
experience. The patient was suffering with obstruction of the 
bowel; something was pressing on the rectum. On introducing 
the finger into the rectum, this tumor was found pressing the 
rectum against the os sacrum ; and as the patient’s suffering was 
very great during the menstrual period, it was determined to 
remove her ovaries and fallopian tubes, and that was done on 
this side ; as you see, it is quite smooth. And after they had 
removed the fallopian tube and ovary on one side, they looked 
for the ovary on the other side, but did not find it ; but, after 
considerable investigation, they found this other horn of the 
uterus prolapsed, retroverted ; it was a uterus bicornis, and 
this horn was low down in the pelvis. They lifted it up, and 
removed the ovary and tube on that side, also, and the patient 
got along without any accident Our pregnant tumor was, most 
likely, an atrophied horn like this.