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AUG 14 1899



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JULY, 1898.

Original Articles.


THE YEAR 1897-98.


By superfetation we mean the impregnation of an ovum which has been discharged from an ovary at a time when the uterus already contained another impregnated ovum discharged at a preceding period of ovulation. If superfetation has occurred, the female genital apparatus therefore must contain two or more embryos of different ages, developing from ova discharged at different periods of ovulation.

Supposed cases of superfetation in women have been reported from time to time in medical literature; not many, but perhaps two or three cases on an average for a number of years; certainly enough had all of those cases reported been well authenticated, and well investigated by all means at our disposal, to settle the question whether superfetation does indeed occur in the human race. However, most reports of cases of supposed superfetation are so meager, indefinite and incomplete that it is not to be wondered at that they have not been accepted as conclusive evidence. An attempt to settle the question by a microscopic examination of the embryos, the placentæ, etc., has, as far as I have been able to see, never been made.

Far from accepting the occurrence of superfetation in the human race as an established fact, many authorities even deny the possibility of its existence. Kleinwaechter (1), in his article on superfeta

Chicago Medical Society, May 25, 1898.

tion, after discussing the subject, finally dismisses it with the following words:

"The whole claim as to superfetation, however, collapses, because the base on which this alleged occurrence rests does not exist. As soon as pregnancy has occurred, ovulation ceases. Superfetation, therefore, is a physiological impossibility. However, even if ovulation did take place, superfetation nevertheless could not occur, since the sperma, in consequence of the plug of mucus in the cervix, cannot reach the ovum. This plug of mucus which forms in the cervix, the proliferation of the mucosa of the uterus, the fusion of the decidua reflexa with the decidua vera, which takes place in the twelfth week, make it impossible, even if an ovum should be discharged from the uterus, that it could come into contact with the sperma deposited in the vagina."

If Kleinwaechter's points were well taken, it would indeed take the most convincing testimony to even admit the possibility of superfetation. However, his points are not well taken.

I do not think that there are many competent judges to-day who still believe that the plug of mucus, as found in the cervical canal in pregnancy, will be a serious obstacle in the path of the spermatozoa, the less so since a plug of mucus is also frequently, if not always, found in the cervix of the nonpregnant uterus. The claim as to the absolute, unconditional nonoccurrence of ovulation during pregnancy is likewise incorrect. It certainly appears that nonovulation during pregnancy is the rule, but there are now cases on record which show beyond a doubt that ovulation does occasionally take place during pregnancy in the lower mammalian animals as well as in the human being.

The third point raised by Kleinwaechter, that with reference to the fusion of the reflexa and the vera at the end of the third month, is also radically wrong. But if it were true, it would, even from the strictest point of view, only exclude superfetation after the third month of gestation. But a true fusion of the reflexa and vera does not take place, as was first maintained by Minot (2), who described how the reflexa degenerates early and becomes nothing but an almost structureless hyaline membrane. I have myself been able to confirm this view of Minot, and have described some of my observations in connection with the degeneration and nonfusion of the reflexa with the vera in a paper published quite recently (3).

Ovulation during pregnancy in a cow has been described by Pouchet (4), likewise in an excellent manner including a full micro

No. 1.

scopical examination by Christopher (5), who, while making some experiments on a cat, discovered that it had in each horn of its uterus two almost fully developed kittens, and also two ripe Graafian follicles in each ovary. A microscopic examination of these follicles showed that, according to their position and contents, they were undoubtedly ripe follicles, ready to burst within a short time. Christopher's article contains sketches of a section of one of these ripe follicles. That these drawings are perfectly correct, I have had a

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M. Hargag ad not deb.
Camera drawing. Leitz obj. No. 1; eyepiece, No. 3.
a, Decidua serotina.

b, Intervillous space with chorionic villi.

c, Chorion.

d, Amnion.

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chance to convince myself since my friend, Dr. W. S. Christopher has kindly placed the section from which the drawings were made at my disposal. There can be, I think, no doubt that this section is from a ripe Graafian follicle, including a normal mature ovum.

Cases of actual superfetation in the lower animals have been recorded by Frank (6) (horse, cow and sheep), and by Jepson (7) in a cat.

It must, of course, be a great rarity that we should have a chance to observe ovulation during pregnancy in a woman. Slavjansky (8) reports such a case in a tubal pregnancy. But his report shows

some very contradictory features, so that it can hardly be accepted as beyond criticism.

However, a case which stands the proof of severe criticism has recently been reported by Professor G. Cosentino (9), director of the gynecological and obstetrical clinic at Catania. The history, etc., of Catani's case in brief is as follows: "A woman in the sixth month of pregnancy died of heart disease. The ovaries were subjected to a careful microscopic examination, and in them were found follicles in all stages of development. Also one ruptured follicle of a diameter of 15 m.m. with ragged margins and a rich arterial and venous network surrounding the theca folliculi. Between the granular layer and a lot of detritus a perfectly mature ovum with all of its elements was found."

From the above quotations there appears no doubt left that ovulation during pregnancy does occasionally occur, and the alleged main reason why superfetation should be a physiological impossibility does not exist.

The supposed cases of superfetation which I have attempted to examine microscopically to prove that they were indeed examples of superfetation occurred in the practice of Drs. D. Spaulding, Frank T. Andrews and Chas. J. Whalen. To these gentlemen I am under great obligation for permission to make use of their material. Case No. 1. Occurred in the practice of Dr. D. Spaulding, who furnished the following history: Mrs. H., 47 years of age, wife of a shoemaker, and married when she was 20 years old; has given birth to thirteen (13) children at full term. Six are still alive and well, except the youngest but one, which is slightly rachitic. Since 1893 she has had two miscarriages. The first one was brought on in the second month of gestation, presumably in consequence of a fall; the second one occurred in the second or third month of gestation, likewise following a fall. This second abortion took place about a year and a half after the first one. After the first abortion, Mrs. H., who had always been regular previously, now menstruated every two weeks, losing a good deal of blood. These frequent menses ceased during pregnancy. Before the last pregnancy occurred, which terminated by the expulsion of two embryos, Mrs. H. last menstruated at the beginning of January, 1897. She has had an umbilical hernia for several years.

About the beginning of August, 1897, I (Dr. Spaulding) was called to see Mrs. H., whom I found in great distress. I prescribed

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