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THE
MATRON'S MANUAL
OF
MIDWIFERY,
AND THE
DISEASES OF WOMEN DURING PREGNANCY
AND IN
CHILDBED,

BEING A FAMILIAR AND PRACTICAL TREATISE, MORE

ESPECIALLY INTENDED FOR THE INSTRUCTION OF

FEMALES THEMSELVES, BUT ADAPTED ALSO

FOR POPULAR USE AMONG STUDENTS

AND PRACTITIONERS OF MEDICINE.

By FREDERICK HOLLICK, M. D.,

LECTURER ON PHYSIOLOGY AND FEMALE DISEASES,—

AND AUTHOR OF THE DISEASES OF WOMAN,—

OUTLINES OF ANATOMY AND PHYSIOLOGY

FOR POPULAR USE,—NEUROPATHY,—

AND THE ORIGIN OF LIFE.

ILLUSTRATED BY OVER 50 SPLENDID ENGRAVINGS.

NEW YORK:

PUBLISHED BY T. W. STRONG,

NO. 98 NASSAU STREET.

BOSTON:—NO. 64 CORNHILL.

1849.

Entered according to Act of Congress, in the year 1848,

By FREDERICK HOLLICK, M. D.,

in the Clerk's office of the District Court of the United States for the

Southern District of New York.

The price of this Book is One Dollar.—It may be obtained of all Booksellers, or of T. W. Strong, 98 Nassau-st., N. Y., who will also send it by Post to any part of the country, on receiving One Dollar and the Address.—N. B. All Dr. Hollick's other Books will be sent by T. W. Strong in the same way.

PREFACE.

A short time ago I published a popular treatise on The Diseases of Woman, in the non pregnant state, and in that work I announced my intention of shortly publishing a similar one on Pregnancy and its diseases. This book is the fulfilment of that promise.

Being the first popular, and yet strictly scientific and practical book on Midwifery ever published, its preparation has necessarily been a work of great labour and difficulty. Everything had to be simplified; familiar explanations had to be given of complicated processes, and illustrations had to be designed that could be understood by my readers. Little or no assistance could be obtained from other works on the subject, because they were either designed for professional men; and therefore too technical, or else were too general in their explanations, and too unsystematical, to be of any practical use. I therefore had to write every part afresh myself, and plan a new arrangement; and so difficult was this to do, satisfactorily, that I have twice before completed the whole work, and then commenced at the beginning again, before I was satisfied with my own production.

As it now stands, I trust this treatise answers the purposes for which it was intended. I have taken care to make it so complete, and scientific, that a medical student may take it for his text book; and at the same time I have endeavoured to so simplify it that any female, of ordinary capacity, can fully understand both its explanations and practical directions. All purely technical words have been avoided, or, when absolutely necessary, they have been carefully explained. Every topic connected with the main subjects has been discussed, and the latest information given on every point, and from every source.

Such a work as this has long been needed. Females have been kept in shameful ignorance, of everything connected with their own systems, and of the wonderful phenomena in which they play so important a part. That ignorance has led to untold evils, which can never be corrected till they become more enlightened respecting themselves. Fortunately many of them begin to see this, and they request, in behalf of themselves and their sisters, that such knowledge be no longer withheld. I have been now, for a long time, engaged in this pleasing task of female instruction, both by my Lectures and books, and in my daily communion with them as patients; I am therefore aware both of their great lack of proper information, and of their strong desire for it, and I flatter myself I also know, from experience and careful observation, the best mode of imparting it to them. In fact, I have made it a matter of careful study, not only to render my subject plain, but also pleasing and unobjectionable; so that the most unreflecting shall feel an interest in it, and the most sensitive be able to study it without pain or repugnance.

The object of this book is not to make every woman a professional Midwife, nor to induce her to dispense with proper assistance in her hour of difficulty, but simply to explain to her the nature and manner of child-birth, and the means by which she is to be assisted. This will disabuse her mind of many pernicious errors—make her more patient under her unavoidable difficulties and pains—more docile to what is required of her, since she will see the reason for it—and it will also enable her to avoid much positive suffering, and to render great help, in many cases, to her attendant.—In a case of emergency also, when other assistance cannot be procured time enough, or not at all, it will teach one female how to assist another in delivery, which every one of them ought to be able to do. Very often it happens that a case of this kind occurs, and the Females around, instead of knowing how to help the sufferer, are utterly useless, and even make her worse by their evident terror and ignorance. I have known women die in child-bed, for want of the most trivial assistance, which even a child could understand how to give, though there were elderly females, mothers themselves, around her; but they knew not what to do. Such a state of things is disgraceful to the boasted intelligence of the age, and should be remedied as speedily as possible. Every Adult female, or at least every married one, should be instructed in these things, so that she may know how to regulate her own conduct and how to render useful assistance to others in case of need. Ill informed women are generally as apprehensive of danger as they are incapable of avoiding it; and as regardless of proper advice as they are ignorant of the reason for it.

The time, I trust, is fast coming, when every female will be taught, as of paramount importance, everything which concerns her own welfare; and when ignorance will no longer be considered necessary to propriety and virtue, nor useful knowledge incompatible with the most refined delicacy and the strictest morality. I consider it my duty to assist in hastening that time, and I feel much pleased that my previous efforts have been so much commended. This book I hope will be equally acceptable, and, if possible, more useful, than those which have preceded it.

F. HOLLICK, M. D.,

New York

INTRODUCTION.

Parturition, or the expulsion of the perfectly formed human being from the body of its mother, is a most wonderful natural function, for the complete and safe performance of which at the proper time, every requisite is found to exist. Notwithstanding the contrary experience of society, as it now exists, it is well known that extreme suffering, and danger to life, are not necessary nor even probable accompaniments to child-birth; for it is invariably found, when females live under circumstances favourable to their full physical development and health, that it occurs speedily, and with little or no difficulty or pain. Numerous proofs of this could be given in accounts of the Indians, and other uncivilized females, among whom parturition is regarded as an ordinary occurrence, for which no preparation need be made, and about which no apprehension need be felt; such facts, however, are so well known that they only need be referred to here.

As the organization and requirements of society changes, by the adoption of what is called civilization, the condition of woman becomes very different to what it was originally. In many respects her lot is much meliorated, and she has great reason to be pleased with the change, but in other respects she has not been so fortunate.

One great evil resulting from her altered position is, a neglect of proper physical education while young, and of the various requirements for bodily health in after life. In consequence of which she becomes constitutionally weaker, and more sensitive to various injurious influences, which she possesses diminished powers to withstand. This evil increases in proportion as civilization advances, until at last females become so imperfectly organized, and so enervated, that they are utterly unable to fulfil the duties assigned them, and they either die prematurely, or pass their whole lives in suffering and complaint. So universally is this the case at the present time, particularly in cities, that the exempt are very rare exceptions to a rule most lamentably general. Unfortunately, custom and false notions have given this melancholy state the stamp of propriety, and thrown around it the charm of fashion. The suffering invalid is called interesting, and the pale faced debilitated creature, scarcely able to crawl about, is styled genteel, while robust health and physical capability is termed coarseness and vulgarity. So infatuated, and weak minded, have females been made on this point, that I have actually known some of them quite chagrined because people could see they were well and strong; and I have known others quite alarmed for fear that they should look so. A short time ago I knew a lady who, by the adoption of a proper course of training and treatment, passed through her confinement so quickly, and with so little exhaustion, that she was up and travelling about in three days after, not only without inconvenience but with pleasure and advantage. But what was the impression made on her female friends by such a speedy recovery? did they feel quite pleased at it, and desirous that all others should be equally fortunate? No; but quite the contrary! She was actually thought deserving of reprehension, and was stigmatized as vulgar in the extreme. One person even made the remark, that she must be a very common person, and no Lady! Now what a pitiable state of ignorance, and mental imbecility, these females must be in, to be actually proud of their infirmities; and yet they are but like the majority of their sex. If they were not so unfortunate in not knowing their true interests, they would be highly culpable, but as it is they are truly deserving of our pity.

It must be admitted, however, that though civilization has, so far, entailed these evils on women, it has also done much to alleviate them. Many diseases are beneficially modified, and some are even cured, by medical treatment; surgical science has also attained a high point of perfection; and the difficulties attendant on child birth are overcome to a great extent by obstetrical skill. But notwithstanding all this alleviation, these evils are still deplorably great. The utmost scientific skill to which society can ever attain, will do but little towards effectually relieving human suffering, and removing disease, so long as it is entirely devoted to the mere art of curing and palliating as it chiefly is now. Our knowledge of the human system, and of the causes which produce in it disease and deterioration, must be universally disseminated, so that the whole people may see how these evils arise, and how they should live, and conduct themselves, so as to avoid them altogether! or, in other words, science should teach us how to prevent disease and suffering, instead of merely how to alleviate them. Eventually this will be done, and our females will then pass through their travail as easily as their savage sisters do now. Let us hope that time will soon come; and let every one esteem it his duty, who possesses the ability, to hasten its coming, by doing all he can to spread the necessary information to those who need it.

The happy exemption from difficulty and suffering which females enjoy in more uncultivated states of society, and which we believe they will ultimately enjoy universally, does not however obviate the necessity for assistance now, in our state of society, and we have therefore to explain how it can best be rendered.

It has often been a matter of dispute, both with medical men and with moralists, whether Men or Women ought to assist in child-birth. The discussion has called forth a great deal of declamation, but very little has been said to the point on either side. It appears to me, however, that the question may be very easily settled, if it be rightly considered. The first requisite, and the most indispensable, in those who are to assist in child birth is, that they should know how to assist. This is paramount to every thing else. Now, if females really did know what to do in such cases, and were fully competent to do it, I think there is no question but they would be the best assistants, to say nothing of their being the most proper. There are many things experienced by females in such situations, which can never be understood by a man at all, though they are readily appreciated by one of their own sex, particularly if she has been a mother herself. With each other also there would be less disposition and less occasion for reserve in delicate communications, and less repugnance to necessary examination or manipulation, which could therefore be more efficiently practised. In short, if women were undoubtedly equally competent with men in this art, and full confidence was felt in them by their own sex, I think it is evident they would, in every respect, be the most fitting practitioners, and I have no doubt but they would be preferred. The question simply arises then, whether they are so competent? And every one able to judge, who speaks honestly, must admit that very few, if any of them really are so. It has not been possible for them to acquire the requisite information, nor to pursue the necessary investigations, and therefore we cannot expect that they can be equal to those who have. There are some women I know, who have been careful observers, and who have had great experience, that can render all needful help in most cases, but even they are apt to meet with difficulties, which require more skill than they possess to overcome; therefore very few like to depend upon them altogether. It is naturally argued that, as a physician may be needed, it is better to have him at first, and so be ready for every contingency.

That females can make competent Accoucheurs is proved by numerous well known instances, among which I need only refer to Madame Boivin, and Madame Lachapelle, both of whom, as practitioners and as authors, stand in the very highest rank. These ladies are referred to as authorities, and their works are quoted by the most eminent Professors of the day; in fact, on many points, they have surpassed all competitors. Further on in our work we shall have occasion to refer to their labours, the value of which will then be seen.

It is therefore evident that females can officiate, if they are properly instructed, which I think they ought to be, independent of the reasons already given. That they will eventually be competent I have no doubt, and I am proud to throw my mite of instruction in their way to assist in making them so.

In regard to the alledged immorality resulting from the present system of men acting as Midwives, there is much exaggeration, and much unnecessary alarm. That it is, in some respects, indelicate, and only to be justified by necessity is true, but there is no foundation for saying, as some do, that it leads to wide spread Profligacy and Adultery. I should prefer to see females always able to assist each other; but I cannot nevertheless consider the present system a necessary cause of licentiousness.

That females were always depended upon in old times, and are now in certain rude communities, is true, but that is no reason why they should be depended upon under all circumstances. In our present highly artificial state there are numerous causes at work, and numerous difficulties experienced, unknown to more primitive times and conditions, and we therefore require greater skill and more extensive resources. Females have in fact become more in want of help, and less able to assist.

At what time, and in what country, men first began to assist in cases of labour is not recorded. They have done so however for a long time, much longer than most people suppose. In the time of Hippocrates, called the Father of Medicine, who lived more than four hundred years before Christ, it appears that physicians were commonly resorted to. In his writings we find cases described, which show that he was well acquainted with the process of parturition, and even with some of the most difficult operations now practised. The Israelites appear to have employed women, as most eastern nations in fact do at the present day.

Midwifery, however, did not attract much attention, nor make much progress, till about the middle of the sixteenth century, since when it has been studied and practised by the most eminent Physicians and Surgeons, and has arrived at great perfection.

Many new discoveries have been made lately, which enable us to facilitate delivery and ease its pains, so that it is now robbed of many of its former terrors and dangers. Some of these discoveries are of easy application, and promise much future good; I shall carefully describe them all, in the following pages.

F. H.

ILLUSTRATIONS.

[FRONTISPIECE], Eve in the Garden of Eden.

PLATE I.—Lateral Section, of the Female Pelvis, to show the position of the Organs in their natural state, [5]. PLATE II.—Front View of the Female Pelvis, with the External Walls removed, [9]. PLATE III.—The Uterus and its Appendages, [13]. PLATE IV.—Vertical Section of the Womb and Vagina, natural size, [18]. PLATE V.—The Muscular Fibres of the Womb, [23]. PLATE VI.—Muscular Fibres of the Womb, [27]. PLATE VII.—Bones of the Pelvis, [33]. PLATE VII.-a.—Male Pelvis, to show the difference in structure, [35]. PLATE VIII.—Section of the Pelvis, [37]. PLATE IX.—Diameters of the Upper Strait, [41]. PLATE X.—The Bones of the Pelvis viewed from below, [45]. PLATE XI.—The Direction of the Pelvis, [49]. PLATE XII.—Section of the Uterus, with the Ovum and appendages, at about one month, [65]. PLATE XII.-a.—Female Breast, [77]. PLATE XIII.—Breast about the Fourth Month, [90]. PLATE XIV.—Womb, at about the third, seventh and ninth months, [99]. PLATE XV.—Primipara, or the First Pregnancy.—Woman who has borne children before, [101]. PLATE XVI.—Mode of performing the Ballotment, to detect Pregnancy, [107]. PLATE XVII.—At the end of the Fifth Month, [111]. PLATE XVIII.—The neck of the Womb in a first pregnancy, and in a female who has borne children before, at the end of the seventh month, [116]. PLATE XIX.—Fœtus in the most usual position, [121]. PLATE XX.—Fœtus in the next most frequent position, [125]. PLATE XXI.—Presentation of the Pelvis, or breech, [129]. PLATE XXII.—The position of Twins, as most usually observed, [133]. PLATE XXIII.—End of the Ninth Month, [135]. PLATE XXIV.—The Fœtal head, [147]. PLATE XXV.—Diameters of the Head, [151]. PLATE XXVI.—Attitude of the Fœtus, [153]. PLATE XXVII.—Head just entering the upper strait, [173]. PLATE XXVIII.—Head lower in the Pelvis, [177]. PLATE XXIX.—Head beginning to Rotate, [181]. PLATE XXX.—Rotation of the Head, [183]. PLATE XXXI.—Head in the right anterior occipito iliac position, [187]. PLATE XXXII.—Delivery in a breech presentation, [194]. PLATE XXXIII.—Anterior posterior position of the head, [195]. PLATE XXXIV.—The chin just passed in presentation of the face, [200]. PLATE XXXV.—Presentation of right shoulder, [205]. PLATE XXXVI.—Descent of shoulder, [206]. PLATE XXXVII.—Descent of shoulder, [207]. PLATE XXXVIII.—Trunk descended, [208]. PLATE XXXVIII.-a.—State of the parts at beginning of labor, [215]. PLATE XXXIX.—Manner of supporting the perineum, [233]. PLATE XL.—Standard form of Pelvis, [271]. PLATE XLI.—Masculine Pelvis, [271]. PLATES XLII, XLIII, XLIV, XLV.—Deformed Pelves, [275]-[279]. PLATE XLVI.—Head fixed in a narrow pelvis, [282]. PLATE XLVII.—Case of Tumor, [289]. PLATE XLVIII.—Case of Polypus, [293]. PLATE XLIX.—Limbs cut off by the Cord, [301]. PLATE L.—Forceps, [346]. PLATE LI.—Head extracted by Forceps, [353].

TABLE OF CONTENTS.

PART I.
MIDWIFERY.

PLATE I.

Lateral Section, or side view of the Female Pelvis, to show the position of the Organs.

A. The Bladder.
B. The Womb.
C. The Vagina.
D. The Rectum.
e. The Right Ovary.
f. The Right Fallopian Tube.
g. The Os Tincæ, or Mouth of the Womb.
h. The Meatus Urinarius, or Mouth of the Bladder.
i. i. The Small Intestines.
j. j. The Back Bone.
k. The Pubic or Front Bone.
l. The Right External Lip, or Labium.
m. The Right Internal Lip, or Nymphæ.
n. The Hymen.
o. The Opening through the Hymen.
q. The Perineum.
p. The Clitoris.

(This of course shows the half of all the single Organs and the right one only of those that are double.)

Plate I.

Lateral Section, or side view of the Female Pelvis, to show the position of the Organs in their natural state.

PLATE II.

Front View of the Female Pelvis, with the External Walls removed.

A. The Bladder.
B. The Womb.
D. The Rectum.
e. e. The Ovaries.
f. f. The Fallopian Tubes.
i. i. The Small Intestines.
r. r. The Round Ligaments.

Plate II.

Front View of the Female Pelvis, with the External Walls removed.

MIDWIFERY.

SECTION I.

POSITION, STRUCTURE, AND FUNCTIONS OF THE ORGANS AND PARTS OF THE FEMALE BODY CONCERNED IN GENERATION AND PARTURITION.

To understand the subjects treated upon in the present work, it is necessary to have at least a general acquaintance with the structure, position, and special uses of the principal organs and parts of the female system. A complete acquaintance, so far as our knowledge extends, would be advisable, but is not absolutely required, and could not with convenience be given here. The following explanations therefore, chiefly taken from my book on the Diseases of Woman, are merely sufficient for the present occasion, and for reference—full details being reserved for a separate and complete work, now preparing, on the Philosophy and Physiology of the Reproductive Functions.

CHAPTER I.

POSITION OF THE ORGANS AND PARTS.

Plate I, represents one half of the Female body, supposing it to be cut down the middle, and gives an accurate representation of the relative position of the different organs.

Plate II, represents a front view of the Female body, with the external walls removed, to show the relative position of the organs.

Plate III, represents the uterus and its appendages removed from the body, so that their connections with each other may be seen.

PLATE III.

B. The Womb.—C. The Vagina.—e. e. The Ovaries.—f. f. The Fallopian Tubes.—s. The left broad Ligament, the right one being removed.—r. r. The Round Ligaments.—g. The Os Tincæ, or Mouth of the Womb.

INTERNAL ORGANS.

The Ovaries.—(e. e. Plates I, II and III.)—These are two oval shaped bodies, about the size of an almond nut, placed one on each side, nearly in the groin. They contain a number of small round grains, or granules, called the ovæ, or eggs, which are the germs of human beings, as the eggs of birds are of their particular kind. They are connected with the uterus by two short arms, or prolongations, and are enclosed in the folds of the broad ligaments.

The Fallopian Tubes.—(f. f. Plates I and II.)—These are two Tubes, one on each side, beneath the Ovaries, and extending farther. Each of them has a small passage which opens into the uterus at one end, and opposite the Ovaries at the other. Their use is to convey the impregnating principle to the Ovaries, at the time of conception, and to convey the Ovæ, when impregnated, to the interior of the Womb.

The Uterus, or Womb.—(B. Plates I, II.)—This is a hollow organ, placed between the Bladder, which is in front, and the Rectum, which is behind. It is connected with the Vagina, and opens into it by the small orifice called the mouth of the womb.—(g. Plate I.)—The Uterus is the organ which receives the impregnated ovum, and in which it is developed into the human being. It is connected with the Ovaries by the Fallopian Tubes, and with the Vagina by the Os Tincæ, and is retained in its situation partly by its connections with other organs, and partly by the round and broad ligaments.

The Vagina.—(C. Plate I.)—This is the passage which leads to the Womb from the external opening.

The Os Tincæ, or Mouth of the Womb.—(g. Plates I and II.)—This is the small orifice, opening into the Vagina, by which communication is established with the Uterus from without.

The Bladder.—(A. Plates I and II.)—The Receptacle of the Urine. It is placed immediately in front, on the pubic bone, the Uterus lying nearly on the top of it.

The Rectum, or Termination of the large Intestine. (D. Plates I and II.)—This is situated behind the Vagina, and between it and the back bone.

The Broad Ligaments.—(s. Plate III.)—These are two broad folds of membrane, which serve partly to enclose the Fallopian Tubes and Ovaries, and partly to sustain the Womb in its place. They adhere to the Uterus and to the walls of the Pelvis.

The Round Ligaments.—(r. r. Plates II and III.) These two cords arise from each upper corner of the Uterus, and curving downwards are fixed by their other extremities to the pubic bone. They are partly enclosed in the Broad Ligaments. They assist in sustaining the Uterus in its position, and probably also they strengthen the Broad Ligaments and prevent their rupture when the strain upon them is too great.

Fimbriæ of the Fallopian Tubes.—(t. t. Plate III.) These Fimbriæ are like Tentaculæ, or fingers, springing from the extreme ends of the Tubes, and floating loosely in the cavity of the pelvis. Their use is to clasp hold of the ovaries at the time of conception, so that the fecundating principle can reach them, and also to take up the ovæ when impregnated, and convey them into the Tube, down which they pass into the Womb.

EXTERNAL ORGANS.

The External Lips.—(l. Plate I.)—These are commonly termed the Labiæ externa. They are two broad folds of membranous and adipose substance, forming the portals to the Vulva, or entrance to the Vagina.

The Internal Lips.—(m. Plate I.)—These are two smaller labiæ, sometimes called the Nymphæ, within the first, the chief use of which appears to be to direct the flow of the urine from the urethra.

The Hymen.—(n. Plate I.)—This is a membrane generally found in virgins, which grows over and closes more or less completely the entrance to the Vagina. Use unknown. When it exists there is generally a small orifice through it, by which the menses escape at each monthly period.—(o. Plate I.)

The Clitoris.—(p. Plate I.)—This is a small prominent organ, about the size of a large pea, placed in the upper part of the opening between the external lips, and immediately above the Meatus Urinarius. It is the principal seat of venereal excitement, and is subject to many annoying diseases.

The Perineum.—(q. Plate I.)—The part between the Vulva, or entrance to the Vagina, and the fundament. It is chiefly composed of the muscles belonging to the neighboring parts, and assists very much in supporting the womb.

The Meatus Urinarius, or Mouth of the Bladder, (h. Plate I.)—A small opening by which the urine escapes, placed between the lips, and immediately above the Vulva, or entrance to the Vagina.

These organs are all placed within, or in contact with, the lower part of the Trunk, called the pelvis. They are all intimately connected with each other, and some of them have most extensive and strong sympathies with almost every other part of the system. So much so is this the case in fact, that probably the great majority of diseases to which females are liable arise, directly or indirectly, from Uterine or Ovarian derangement. Very often the heart, the stomach, or some other organ, though perfectly healthy, is thought to be diseased, and appears to be so, merely from its sympathy with the diseased womb.

CHAPTER II.

STRUCTURE OF THE PRINCIPAL ORGANS AND PARTS.

PLATE IV.

Vertical Section of the Womb and Vagina, natural size.

a. a. a. The solid walls of the Womb cut through. b. That part of the cavity, or hollow of the Womb, which is in the fundus, or top. c. That part of the cavity which is in the lower part, or neck, of the Womb. d. The Vagina. e. e. The cut edges of the Vagina. f. f. The positions of the Fallopian Tubes, which are cut off, and down the passages of which two needles are passed. g. The Os Tincæ, or Mouth of the Womb.

In addition to the general explanation already given, there are some of the Female organs whose peculiar structure requires to be more fully noticed, on account of its important influence on some of the processes hereafter to be described.

THE WOMB.

The external appearance of the womb, viewed in front, and in connection with its appendages, is shown in Plate III. It is placed in the Pelvis, between the bladder and the Rectum, and at the top of the Vagina, as seen in Plates I and II. Its internal structure is represented in Plate IV.

The length of the Womb, after puberty, is about three inches; its breadth at the upper part, or fundus, about two inches; and at the cervix, or neck, about one inch. The cavity in the interior is small, owing to the thickness of the walls, and its form is triangular. The shape of the Womb resembles a pear, somewhat flattened, from before backward. Previous to puberty its size is much smaller, and with those who have had children it often exceeds the dimensions we have given.

The Neck, or narrow part, (c. Plate IV.) is much changed by pregnancy. In virgins it is long and pointed, and somewhat enlarged in the middle. In those who have borne children it is considerably shorter, more obtuse, and less regular in its form. The cavity in the Neck is larger in the middle than at either end, as will be seen in Plate IV.

The Os Tincæ, or mouth of the Womb, also undergoes considerable change from the same cause. In the young person it is merely like a small slit, scarcely to be felt, but after pregnancy it much enlarges, and remains more or less permanently open. The anterior lip, or the one in front, is somewhat larger than the posterior one.

The body of the Uterus is formed of a very dense, gray colored, muscular substance, possessing astonishing contractile power. The interior is lined, like the Vagina, with a mucus membrane, and the whole organ is plentifully supplied with arteries, veins, and nerves.

One of the most remarkable properties of the Womb is that of being able to distend to an extraordinary degree, and then retract again to nearly its original size. The force which it sometimes exhibits during its contraction is very great, being sufficient to separate, and even break, the bones of the mother's pelvis, and paralyze the hand of the operator when introduced. The Muscular Fibres on which this contractile force depends are most obvious during gestation; they then appear very numerous, and very curiously disposed, some of them ramifying in almost every direction, as will be seen by Plates V, VI. It is owing to this that the Womb contracts in every conceivable direction, and thus presses, during labor, on every part of the child's body.

PLATE V.

Figures 1 and 2.

Fig. 1. In this plate represents the Muscular Fibres a little exaggerated, so that they can be more distinctly seen.—a. a. are the orifices of the Fallopian Tubes.

Fig. 2. Represents the natural appearance, the fibres not being quite so distinct, though sufficiently obvious.—a. a. The orifices of the Fallopian Tubes.

In both Figures the Womb is supposed to be turned inside out, its peculiar structure being more readily seen interiorly than exteriorly.

Fig. 1 Fig. 2

Plate V.

The Muscular Fibres of the Womb.

PLATE VI.

Figures 1 and 2.

Fig 1. This represents the appearance of the Fibres externally, and shows how they terminate in the round ligament a. b.

Fig. 2. The lines a. b. represent the direction of the force of the Fundul Fibres; c. d. That of the Circular Muscles of the body of the Uterus; d. e. The combined force of the Muscles.

The dotted lines represent the force reflected by the liquor amnii. The dotted curved lines the direction of the circular fibres of the body of the Uterus.

Fig. 1

Fig. 2

Plate VI.

The Muscular Fibres of the Womb.

THE VAGINA.

The Vagina (c. Plate I.) is a membranous canal, lined with a mucus membrane like the Uterus. By its upper part it is attached to the neck of the Womb, at about two-thirds of its height—so that two-thirds of the neck hang within the Vagina. Below, it terminates in the Vulva, or external mouth. The upper part of the Vagina is much larger than the lower part, particularly in those who have borne children. It is capable of considerable distension, and after retraction, to allow of the child passing down it from the Womb. The external mouth is called the Vulva, and is usually partly closed, in the virgin state, by the membrane called the Hymen, (n. Plate I.) The length of the Vagina is from three to five inches, and its diameter from one inch to one and a half, or even two inches in those who have borne many children.

THE VULVA.

This is the external opening, or mouth of the Vagina, through which the child has to pass at the termination of delivery. The external and internal lips, with the muscular and membranous tissue surrounding it, are all capable of great distension, without injury, to allow of the passage of the child.

THE PERINEUM.

This is the part situated between the Vulva and the Rectum. (p. Plate I.) It is composed of a somewhat dense and firm substance, chiefly muscular, and, like all the other parts mentioned, is capable of great distension. It is important, in many of the manipulations during labor, to be well acquainted with it; and when the child's head is passing the perineum requires supporting, to prevent its being lacerated or broken through, an accident which often happens from want of due attention, and which leads to the most serious consequences.

THE PELVIS.

The Pelvis is that part of the bony structure, or skeleton, of the female, in which the generative organs are placed, and through which the process of parturition is effected. An acquaintance with its natural structure, and with the changes which may be produced in its form and size, by disease and other accidents, is indispensable to those who wish to practise or understand midwifery.

In early life the Pelvis is composed of several bones, many of which, after puberty, grow together. In the adult female it is customary to speak of but four bones, the sacrum, the coccygis, and the two innominata, or hip bones, (see Plates [VII], [VIII].) In the young female these are divided into several distinct parts.

PLATE VII.

Bones of the Pelvis.

The four principal bones, as found in Mature life.—A. A. The Ossa Ilii, or Ossa Innominata, commonly called the haunch, or hip bones.—B. The Os Sacrum, or lower part of the back bone.—C. The extreme termination of the back bone, called the Os Coccygis.

The divisions into parts, as in Early life.—The Ilium, A, on each side, is in three parts; the Ilium, properly so called, marked a. a.; the Pubis, marked b. b.; and the Ischium, marked c. c. The Sacrum is in five parts, marked 1, 2, 3, 4, 5.

d. Is the last bone of the spine, which joins the Sacrum.—e. e. Are the Sockets in which the upper parts of the thigh bones fit, forming the hip joints.—g. g. The two rings, formed by the bones of the Pubis and Ischium, each called the Foramen Magnum.

Plate VII.

Bones of the Pelvis.

PLATE VII.—a.

This represents the Male Pelvis, to show the difference in structure.

The letters correspond with those in Plate VII.

PLATE VIII.

Section of the Pelvis, to show the shape and connection of those parts not distinctly visible in the full view. The section is made down the middle of the back bone, and through the symphysis pubes, in front. The letters correspond with those in Plate VII.

A. The right Ilium.—B. The Sacrum.—C. The Coccygis.—b. The Os Pubis.—c. The Os Ischinum.—g. The Foramen Magnum.—o. shows the manner in which the coccygis is bent back through labor.

These bones are all firmly bound together by a cartilaginous substance, which is placed between where they touch, and is firmly attached to each one. This union is called a symphysis. The one at front which joins the pubic bones is called the symphysis pubis; the two which join the Ossa Illii to the Sacrum are called the sacro iliac symphyses; and that which joins the Coccygis to the Sacrum, is called the Sacro coccygeal symphysis. The two pubic bones are separated a little in Plate VIII, simply to show them better. The reader will bear in mind that they are naturally connected by the cartilaginous substance which forms the symphysis.

These articulations, or joinings, become much softened during labor, and give way a little, but not to any extent sufficient to assist delivery. It is a mistake to suppose that the bones separate at that time. The only part which gives way is the sacro coccygeal symphysis, which does relax, and allows the Os Coccygis to be pushed back by the child's head a full inch or more, thus enlarging the inferior strait.—(See c. and o. Plate VIII.) Sometimes this little bone will be even broken off, when there is great disproportion between the head and the strait. I have heard it snap like a stick breaking. There is nothing serious nor alarming in this, however, unless it be a first delivery late in life, though it may cause some pain at the time, and a little difficulty in sitting for some time after. In young persons the symphysis is soft, and gives way easily, so that they have little difficulty during delivery from this cause; but if a female marry late in life, after it becomes hardened, she may suffer considerably. In this case the coccygis is usually curved inwards considerably, and being firmly fixed the head cannot push it back, and on that account cannot pass, without great difficulty, and with the risk of rupturing some of the soft parts, or breaking the coccygis completely off. There is in fact great difficulty, and some danger, if the first pregnancy takes place late in life.

The Pelvis is usually divided into two parts,—the great pelvis, or upper part, enclosed between the wide flanges of the Ossa illii and the upper part of the sacrum; and the small pelvis, or basin, which is enclosed between the lower part of the sacrum and coccygis behind, and the ossa ischii and ossa pubes in front. The basin is nearly cylindrical, larger in the middle, and curved towards the front.

The Straits of the Pelvis.—The bones of the Pelvis, it will be seen, form a kind of broad ring, or cylinder, particularly in the basin; and the straits are two passages, one by which the child passes into the basin from the upper Pelvis, and the other by which it passes out from the basin into the world.

In Plate VIII. the line marked † is the antero posterior diameter of the upper strait, through which the child first passes, called also the brim, or entrance to the Pelvis. The line marked ‡ is the diameter of the lower strait, through which the child passes into the world, called also the outlet of the Pelvis. In Plate VII. the line marked † crosses the upper strait, or brim of the Pelvis.

The diameters of the Pelvis are the distances between the prominent points of each strait, and are four in number for each, those for the upper strait being represented below.

PLATE IX.

Diameters of the Upper Strait.

A B, which extends from the most prominent point of the Sacrum, to the top of the Symphysis pubes, is called the antero posterior diameter, or that from before to behind.—C D, and E F, are called the two oblique diameters; they extend from each sacro iliac symphysis, to the most prominent point of the Os Ilium on the opposite side.—G H, is called the Transverse, or bis iliac diameter, it crosses the Pelvis nearly from one hip joint to the other.

The Sacro Antero posterior diameter measures four inches. The two oblique diameters four inches and a half each. The bis iliac diameter measures five inches.

(By comparing this with Plate VII. the various points will be still more apparent.)

The inferior strait has also four diameters, represented in Plate X.

Plate IX.

Diameters of the Upper Strait.

PLATE X.

The Bones of the Pelvis viewed from below, looking through the inferior strait, to show its diameters.

A B, which extends from the end of the Coccygis to the lower part of the Symphysis Pubis, is called the antero posterior diameter; it measures four inches, like that of the upper strait, but is increased a little by the bending back of the Coccygis.—C D, and E F, are the two oblique diameters, also corresponding to those in the upper strait; they measure four inches, but are increased a little by the giving way of the soft parts.—G H, is the transverse, or bis-ischiatic diameter; it measures four inches.

Plate X.

The Bones of the Pelvis viewed from below, looking through the inferior strait, to show its diameters.

It will thus be seen that the diameters only average from four to five inches, but it must be remembered that the soft parts, and even one of the bones, very readily give way, and thus they are slightly increased.

When we come to describe the form and size of the fœtal child's head, it will be found that its diameters correspond very nearly with those of the pelvic straits through which it has to pass, so that ordinarily labor presents no serious difficulty. If the head be larger than natural, from any cause, or if the Pelvis be too small, or deformed, this mutual adaptation does not exist, and delivery of course becomes difficult, or dangerous, and sometimes impossible. The only obstacle therefore, which can seriously impede the expulsion of the fœtus, or prevent it altogether, is this want of conformity, in size and shape, between its head and the bones of the Pelvis. The soft parts may retard labor considerably, by being contracted or rigid, but can generally be made to give way, either by the efforts of nature or by manual assistance; and the fœtal head can be reduced in size if necessary; but insufficient size, or faulty form, in the bones, is irremediable.

The various causes which produce deformity, or imperfect development, in the Pelvis, and unnatural growth of the child's head, will be stated in a subsequent section. For the present, we have only to do with both in the normal state.

The importance of an accurate knowledge of the structure of the Pelvis, and of the changes which may be induced in it, will now be obvious; neither the theory nor the practice of Midwifery can in fact be understood without such knowledge. It is also frequently of the first importance to know, previous to marriage, whether the pelvis of a young person is so formed that delivery can be safely effected! Inattention to this has sacrificed the lives of many, and caused others to live for years suffering and helpless. In another place we shall give some plain rules and directions by which this important point may be determined.

The floor of the Pelvis.—The soft parts at the bottom of the basin of the Pelvis, consisting of the perineum and various muscles, are called the floor of the Pelvis—the only passage through which is by the Vulva, or mouth of the Vagina. As the head of the child descends to the bottom of the basin, it presses upon this floor, and gradually distends it, until the Vulva is sufficiently enlarged. This delay is advantageous, for if the passage was always large enough, or increased in size without any difficulty, the child would pass too suddenly, and much mischief might often result from its sudden expulsion—such as pulling down of the womb, flooding, and the falling of the child upon the ground.

Direction of the passage of the Pelvis.—In most of the lower animals the passage of the Pelvis is straight, and on a line with the body, the two straits being opposite each other, which makes delivery much more easy with them. Even in the negroes, and other inferior races, the passage is much straighter than in the whites. The more perfect the organization therefore, the more difficult is parturition; and the more imperfect or simple the organization, the more easy is parturition. The dotted line in Plate XI. shows the direction of the passage of the Pelvis, in the human female, to be a curve, so that the child has to move, during its passage, in a circle.

PLATE XI.

The axis, or direction, of the upper strait is denoted by the line A, that of the lower strait by the line B, and that of the Vulva by the line C. The force of expulsion tending to push the child in each direction, it has to traverse a path intermediate with them all, or compounded of them all, not being able to move in either alone. This aggregate direction is denoted by the dotted curved line, which shows the direction in which the child passes, and in which the hand must be passed when introduced.

I is the Perineum.—The dotted line which crosses A denotes the upper strait, and the line I the lower strait.

CHAPTER III.

FUNCTIONS OF THE PRINCIPAL FEMALE ORGANS.

The great object for which the whole of the Female organs perform their several functions is, that of bringing into existence a new being! For this purpose they act both separately and conjointly, each one having its specific part to play in the grand phenomenon. As already remarked, it would not be in place here to give all the details of this wonderful event, but merely such a description of its principal stages, as will suffice for an understanding of the main subject of the present treatise. I shall therefore, first give the uses of the principal organs separately, and then explain the processes of conception, and fœtal development.

THE WOMB.

The Womb is nothing more than the receptacle in which the impregnated egg is placed, and in which it undergoes all the wonderful changes by which it eventually is developed into a perfect human being. The womb is not therefore absolutely needed in conception, and indeed several cases have been known where the new being was formed without the womb altogether, though not perfectly. Its principal use is in fœtal development, which cannot take place perfectly in any other part of the body.

THE OVARIES.

The Ovaries, as already remarked, are two oval-shaped bodies, placed one on each side of the womb, and connected with it, whose use is to form the germ or rudiment, called the ovum, or egg, from which the new being is developed. The structure of the Ovaries is very simple, and the manner in which they produce the ovum is not very well understood. It is certain however, that they are indispensable to conception, being in fact the most essential parts of the female generative system.

MENSTRUATION.

Menstruation appears to be a process resulting from the development and healthy action of the Female organs, and is essential to their well being. The following brief account of its nature and origin is extracted from my Diseases of Woman, page 152 to 155:

"Until very recently but little was known, with any certainty, respecting this remarkable and important phenomenon of the female system. The most crude and visionary theories have been advanced to explain it, and our works on medicine and physiology do nothing more than repeat them, one after the other. The investigations of several distinguished physiologists however, within the last few years, have thrown a new light on this hitherto obscure subject, and explained much that was previously unknown, or, at best, merely conjectured upon. A brief statement of the result of those investigations will not only be highly interesting in itself, but will materially assist in explaining what we shall afterwards speak upon.

"It is well known that the female organs are liable, at regular periods, to assume a peculiar action, which results in the discharge of a fluid termed the menses. The secretion and excretion of which are highly essential, both to the proper performance of many other functions, and to the maintenance of the general health. Whence comes this fluid, and what causes it to flow? These were questions unanswered, except by mere supposition, previous to the discoveries referred to, which we now proceed to make known.

"In the first chapter it was stated that the Ovæ, or eggs, contained the rudiments or germs, from which, when impregnated by the male principle, new human beings were developed. These ovæ, however, are not prepared to undergo this development before the age of puberty, nor after the change of life, nor are the whole of them fit for conception even during the prolific period. It appears that they become fit for fecundation in succession, during the menstrual period, one ovum, or more, being ripened every month! When fully perfected it separates from the ovary and is lost, unless conception occurs, in which case it passes along the fallopian tube into the Womb, and then develops into the fœtus. Here then we see the cause of the menses; the ripening of the ovum causes a local excitement, and congestion, in the ovary and womb, which increases till the period when it is thrown off, and then the accumulated fluid is discharged, the excitement subsides, and a new development commences.

"This curious process is termed by some physiologists the monthly ponte, or laying of eggs, and by others the Ovarian labor, or birth! A small scar is left on the ovary at the point where the ovum separates, which fades away after a time, but a number of them may always be observed on the ovaries of those who have long menstruated. In those who die during menstruation the ovaries are found very red, and full of blood, and sometimes one of the ovæ will be found swelled, and just ready to burst through, or the ruptured opening may be seen through which it has actually escaped.

"Precisely the same phenomenon occurs in the lower animals, excepting that their periods are more extended; some of them occurring annually, and others at still longer intervals. Some of the monkeys even have a species of real menstruation.

"These important facts, by enabling us to understand what causes menstruation, give us an insight also into the nature of its derangements, and the conditions required for their regulation. When we call to mind also the close sympathy between the uterine organs and every other part of the system, it shows us how important a proper menstruation is to the general health, because without it those organs must be diseased, and consequently every other part of the system liable to suffer with them.

"Formerly many absurd notions prevailed respecting menstruation, which in fact are not quite removed even now. Thus some authors asserted that a female, while unwell, could cause various diseases, by merely touching persons! Others supposed they would curdle milk, and nearly all believed that the menstrual fluid itself was highly poisonous, so that females, at those times, were compelled to live apart and approach no one. In the Old Testament there are many regulations given, for females while menstruating, which show the prevalence of such notions in olden times. It is scarcely necessary to say that there is no foundation whatever for all this, as the fluid itself differs but little from ordinary blood, and is equally innocuous.

"In like manner it was supposed, that menstruation was influenced by the Moon, and only occurred at a certain period of her age. We know, however, that females are unwell almost every hour of every day in the year.

"The due establishment of the menstrual function is absolutely necessary, to the perfection both of mind and body, and its regular performance is quite as essential to the continuance of health, for there is scarcely a single disease that its derangement will not either cause, or at least seriously aggravate.

"It is therefore vitally important to attend to this matter, particularly in young persons approaching puberty! A little care at that time, properly bestowed, may prevent years of disease and suffering, if not untimely death!"

CONCEPTION.

Conception is the union of the male principle with the female ovum, or egg, after that is perfected in the manner described in the article on Menstruation. The precise manner in which this union is effected is unknown, though our information in regard to it is much more extensive, and precise, than formerly. As nearly as can be stated it occurs in the following way:

At the time of a fruitful connection, which can only occur, it must be remembered, when the ovum is ripe, the male principle is carried into the Womb, (B, Plates I. and III.) and is then supposed, by some, to meet with the ovum which has descended down the Fallopian Tube (f, Plates I. and III.) from the Ovary, so that the union of the two takes place, according to this view, either in the Fallopian Tube or in the Womb. Others, however, suppose that the ovum does not leave the Ovary before conception, but that the male principle passes down the Fallopian Tube and meets it there, and that it is several days after before it reaches the Womb. There are many facts and arguments brought forward in support of each view, all of which will be set forth in my forthcoming work on the reproductive functions. All that is known for certain is, that the two principles must unite in one place or the other, and that the ovum must pass down the Tube into the Womb, either before impregnation, or after.

The union of the two principles in the Womb appears so likely an event that it is scarcely possible to avoid thinking that it really does then take place, but at the same time there are very strong reasons for adopting the opinion that it takes place in the Ovary. Among others may be mentioned the phenomenon of extra uterine conception, which will be more fully alluded to in another place. In these cases the fœtus is found outside of the Womb, in the Tube, or the Ovary, or even in the Abdomen, among the intestines. Such an occurrence seems to render it almost certain that the ovum must have been fecundated in the Ovary, because we cannot well conceive, if it were not so, how it could reach the outside of the Womb. This difficulty is not, however, regarded as insuperable, by the advocates of the opposite theory. Possibly conception may occur in both ways.

There are many causes which prevent conception, or, in other words, which produce barrenness and sterility. These various causes cannot be all explained, except in connection with a full explanation of the process of reproduction, and of the nature of many female diseases. In my work on "The Diseases of Woman," I have given a chapter on this subject, and have also referred to the present work as one in which it would be more fully treated. This reference, however, was made in mistake; the subject is not needed here, but will be in the other work, on the reproductive functions in which it will be discussed at length.

CHAPTER IV.

FŒTAL DEVELOPMENT.

The last Chapter brought us up to the point of conception, or the first commencement of the new being. The next step is to exhibit its various stages of development, and to show how it is nourished and maintained in its proper position. This is requisite in order to understand the origin of many diseases and accidents which occur during gestation, and also to explain the various signs by which it is determined whether a female is pregnant or not.

FŒTAL DEVELOPMENT.

The development of a perfectly formed human being from the egg in which it originates, is one of the most astonishing phenomena that can come under our observation, and is eminently deserving the study of every rational being. The present explanation of it must necessarily be brief, being merely intended to make the main subject more clear.

It has already been remarked that it is uncertain whether the ovum is impregnated before it is brought into the Uterus, or after it arrives there; but be that as it may, nothing has yet been discovered in the Womb till several days after conception. Some physiologists tell us that the rudiment of the new being may be found there about the sixth day; but others again assure us that it cannot be found before the twelfth, at which period our explanation of its development will commence.

At the twelfth day the ovum is about the size of a large pea, it is composed of a vesicle containing a thick fluid, called the germ, which corresponds to the opaque substance seen in the white of a fecundated bird's egg, and of a yellowish substance, in which it floats, called the vitellus, which answers to the yelk. The whole being surrounded by two membranous coverings, the outer one called the chorion, and the inner one the amnion. Between these is a gelatinous substance, and within the amnion is a fluid, called the liquor amnii. The two membranes, the liquor amnii, and the inclosed ovum, are called the ovulum! Immediately after conception the uterus begins to secrete, from its inner walls, another membrane, very delicate, called the decidua. This lines the whole cavity, so that when the ovulum passes out of the tube it is met by this lining which seems to prevent its entrance into the womb. The ovulum, however, presses upon it and so makes a depression, like a nest, in which it lies. This prevents its moving about, or falling to the bottom of the womb.

The weight of the entire ovulum is about one grain. The embryo commences in the germ, and may now be seen about the size of a pin's point. The vitellus removes away from it, but remains connected by a small pedicel or thread-like tube, down which it is gradually absorbed as nutriment. A small white thread, scarcely perceptible, may be seen sometimes as early as this period, being the commencement of the brain and spinal marrow. The mouth is visible also from the twelfth to the twentieth day, and frequently the eyes. These are placed at first on the side of the head, like those of quadrupeds, and move round to the front afterwards.

At twenty-five days, the embryo is about the size of a large ant, which it also resembles in form. It begins to have a little more consistence, and the future bones begin to resemble cartilage, or gristle. A small groove may be seen denoting the neck, which thus indicates the separation of the head from the trunk. The weight is three or four grains.

The first month, it is about the size of a Bee, and is somewhat like a small worm bent together. The arms may be seen like two little warts. They are first formed under the skin, and shoot out like buds, growing straight from the body; afterwards they become folded together, in a curious manner, upon the breast. The head is as large as the rest of the body, and upon it we can now see distinctly the eyes, like two black dots, the mouth, like a line, and also the nose. The lower extremity is lengthened out like a tail. Weight about ten grains.

The second month. Every part has now become much more developed, and the general form is that of a human being. The superior members are much more elongated, and the inferior ones begin to be distinguished, forming in the same manner as the others. The fingers are united together by a membrane, like the web on a Frog's foot. In the ribs, clavicles, and jaw bones, a few points can be seen ossified, the cartilage beginning; to harden into bone. The rudiments of the first teeth are also visible. The weight is about one drachm, and the length one inch.

At about seventy days the eyelids are visible, the nose becomes prominent, the mouth enlarges, and the external ear may be seen. The neck is well defined. The brain is soft and pulpy, and the heart is perfectly developed.

Every organ is originally formed without either blood or blood vessels. The circulation which afterwards takes place in them is merely for their subsequent development. The heart is perfect in all its parts, and even has a slight motion, before the blood is found in it.

Three months. All the essential parts are well defined. The eyelids distinct, but firmly closed. The lips perfect, but drawn tightly together. The heart beats forcibly, and in the larger vessels red blood is seen. The fingers and toes are defined, and the muscles begin to be apparent. The organs of generation are remarkably prominent, but still it is somewhat difficult, at first, to distinguish the sex by these organs, notwithstanding their development, as the principal parts in both are nearly identical in form. It can, however, be ascertained by other circumstances, as the form of the head, dorsal spine, thorax, and abdomen. It now weighs about two ounces and a half, and measures four or five inches in length.

Four months. The development is remarkably increased. The brain and spinal marrow becomes firmer, the muscles distinct, and a little cellular tissue is formed. The abdomen is fully covered in and the intestines are no longer visible. A little of the substance called meconium even collects in the intestines, the same as is found in at birth. It now weighs seven or eight ounces, and measures six or seven inches. The bones are ossified in a great part of their extent, and the rudiments of the second set of teeth are visible, under the first.

The uterus now is so large that it can no longer remain in the lower part of the pelvis, but is compelled to rise up into the abdomen for more room. This change of position is improperly called quickening! Sometimes it takes place very gradually, so that it is scarcely noticed, but more frequently it rises suddenly, disturbing all the internal organs, and causing in them considerable derangement till they accommodate themselves to the change. This occurrence often causes unnecessary alarm, though the sickness, and other unpleasant sensations, are always sufficiently annoying.

This stage corresponds with that in which the young of oviparous animals breaks the shell and escapes. The human being however, undergoes a remarkable change, and remains in the womb for a period longer than that already past, in order to become more perfected.

From four to nine months the development is proportionally much more rapid than during the first four months, owing to the circulation of perfect red blood, which is now found the same as in the adult, and is probably derived from the mother's blood vessels.

Five months. Every part is considerably increased in size, and become more perfect. The lungs enlarge, and are even capable of being, to a certain extent, dilated. The skin becomes much stronger. The situation of the nails can be discerned. The meconium is more abundant, and lower down in the intestines. The length is now eight or ten inches, and the weight fifteen or sixteen ounces.

Six months. The nails are marked. The head becomes downy, from the first development of the hair. A little fat is formed. Length twelve inches, weight from one and a half to two pounds. No indications of intellectual faculties.

Seven months. The whole being has rapidly progressed. The nails are formed, the hair is perfect, in the male the testicles descend to the scrotum, and in the female the ovaries reach the brim of the pelvis. The bones are tolerably firm, and the meconium collects in the large intestines. Length fourteen inches, weight about three pounds. Intellectual functions not yet exercised.

The two remaining months are merely devoted to further increase in size and weight. No new phenomena present themselves.

Nine months. Every function has become active. The skin becomes colored, and perspiration occurs. There are no indications of the intellectual functions, but the animal functions are remarkably active, particularly that of taste, which no doubt leads to the act of sucking, from the natural desire for its gratification. The child can now experience all the ordinary sensations of pain, hunger, heat, and cold, and is capable of preserving an independent existence if brought into the world.

Plate XII. represents a section of the Uterus at about one month of gestation, so as to show all the parts in their proper situation.

PLATE XII.

Section of the Uterus, with the Ovum and appendages, at about one month of gestation.—a. a. a. The substance of the walls of the Womb.—b. b. The Embryo.—c. The different vessels by which it is connected with the Placenta.—d. d. The Placenta.—e. The Vitellus.—f. f. f. The Membrane lining the Uterus, called the Decidua; it is seen to be bent double, or reflected, the Embryo being on the outside of it.—g. g. The Chorion, or Middle Membrane, which is studded over with villosities, or small blood vessels.—h. h. The Amnion, or inner membrane, which contains the fluid called the liquor amnii, in which the Embryo floats.—i. i. The blood vessels which connect the Placenta with the Womb.—j. Is a plug of Mucus, by which the mouth of the Womb is now blocked up.—k. k. The ends of the Fallopian Tubes, which are cut off; these are also blocked up with mucus, the same as the Os Tincæ.—l. The Os Tincæ, or mouth of the Womb.—m. The Vagina.

Plate XII.

Section of the Uterus, with the Ovum and appendages, at about one month of gestation.

FŒTAL NUTRITION.

The manner in which the new being derives its nutriment, or the material by which it grows, is, in a great measure, unknown to us, though we certainly obtain some little information about it by a study of the apparatus employed in the process.

For the first fifteen or twenty days the substance called the Vitellus, (e. Plate XII.) which is analagous to the yelk of the ordinary egg, appears to supply most, if not all of the material that is required in the formation of the new being; and indeed this substance does not totally disappear till after the third month, though we cannot suppose it to be the sole source of nutriment then. It is also supposed, by some, that the amniotic liquor, in which the fœtus floats, may afford some nutriment, either by being swallowed, or by being absorbed through the skin. It is certain that this fluid is nutritive, and there is nothing impossible in its absorption, though it is not very likely to occur to a sufficient extent. The idea that it can be swallowed however, is erroneous, because the mouth of the Fœtus is firmly closed while in the Womb; and besides, children have been born alive without mouths, and even without heads, and of course they could not have swallowed anything. It is now generally conceded by physiologists that the material required by the Fœtus, for its nutrition, is obtained from the blood of the mother, through the medium of the Placenta, and the vessels in the Umbilical cord. It is, however, a matter of dispute whether the maternal blood is sent directly, in its ordinary state, into the body of the child, or whether it first undergoes a preparatory process, which most modern authors suppose it does.

From the earliest period of gestation, the middle membrane, called the chorion, (g. g. P. XII.) is covered, on its outer surface, with a number of small protuberances called villosities, which subsequently become true blood vessels. About the fourth month these have increased very much in size and number, and have all become conglomerated into one mass, in form like a mushroom. This is called the Placenta. It is almost entirely formed of blood vessels, which seem to attach themselves at one end, by open mouths, to the open mouths of other blood vessels on the inner walls of the uterus (i. i. Plate XII.) At the other end these vessels are drawn together and lengthened out into a long tube, called the umbilical cord, or navel string, which finally enters the body of the child at the navel and so establishes the connexion between it and the mother.—(c. Plate XII.)

The blood vessels in the placenta, umbilicus, and fœtus, like those in the maternal body, are of two kinds, Arteries and veins. The arteries, which come from the left side of the heart, carry the pure blood, which contains all the materials for forming and nourishing every part of the system. The veins contain the blood in its impure state, and take it to the right side of the heart, from whence it is forced into the lungs to be purified by the act of breathing. The blood is made impure by some of its constituents being absorbed, to form the different parts of the body, and by having thrown into it a quantity of waste and poisonous matter no longer needed.

The course of the blood, therefore, is from the left side of the mother's heart along her arteries till it reaches the arteries of the uterus, from them it passes into those of the placenta, and thence into those of the umbilicus which convey it into the body of the child. When there it circulates in its arteries, supplies the material for its further increase and development, becomes in consequence impure, and passes into its veins, the same as in the maternal body. From these veins it passes into those of the umbilicus and placenta, and, apparently, into those of the mother, by which it is conveyed to the right side of her heart, and by its action to her lungs, to be again purified when she breathes. This explains what was previously stated, that the child uses the mother's heart, lungs, and stomach, while in the womb, and has, therefore, no occasion to use its own.

The diameter of the placenta is about six inches, and its thickness about one inch and a half. The length of the umbilical cord is from eighteen to twenty-four inches, its diameter about half an inch. These dimensions are, however, subject to great variation. Instances are mentioned of the cord being five feet long, and as thick as the child's arm. I have seen one myself four feet long. Sometimes it will be very short, not more than eight or ten inches. It is composed of one artery and two veins, twisted together like the strands of a cable, and of a sheath surrounding them composed of the chorion and amnion. Between the sheath and the vessels is a thick gelatinous fluid called the Gelatine of Wharton.

This explanation, it must be remembered, is in fact merely hypothetical. The direct passage of the blood through the Placenta, from the mother's vessels into those of the cord, is denied by many physiologists, who contend that there is an intermediate set of vessels in the Placenta, in which it first undergoes important changes. They also contend that the impure blood does not pass through into the mother's veins at all, but is purified in the Placenta, and immediately returned. Some have even averred that the Placenta is not required at all, to supply nourishment, but is merely a purifying organ. It is now known, however, that it is not absolutely essential to either process, for children have been born alive, and perfectly formed, which merely floated loosely in the amniotic liquor, having neither Placenta nor cord, nor any other connection with the mother. How they were nourished we cannot tell. These, however, must be regarded merely as curious exceptions, there being little doubt but that fœtal nutrition is ordinarily effected through the Placenta and cord, by means of the mother's blood, somewhat in the manner we have described.

PECULIARITIES OF THE FŒTAL CIRCULATION.

From the circumstance of the fœtus not using its heart and lungs, like the adult, its circulation has several modifications.

The engine by which the blood is forced along its vessels is the heart! This is divided into two distinct parts, each of which has two cavities, the upper one called the auricle, and the lower one the ventricle, which communicate with each other by curious valves. In the adult the whole of the impure blood is poured into the right auricle, that from the lower part of the body by the inferior vena cava, and that from the upper part by the superior vena cava. From the right auricle it passes into the right ventricle, which pumps it into the lungs, by way of the pulmonary artery; here it is purified by the act of respiration, and then brought, when pure, by the pulmonary veins, into the left auricle, and passes from thence into the left ventricle, which pumps it into the great aorta, and from thence into the smaller arteries all over the body. The two sides of the heart, therefore, do not communicate directly with each other, but there is a strong partition between them. In the fœtus the arterial blood from the mother, when it leaves the umbilical artery, enters first the liver, runs through its vessels, gives off the bile found in it, and then joins the vena cava inferior. By this passage it is taken into the right auricle, along with the impure blood of the vena cava. From the right auricle it passes through a hole in the partition directly into the left auricle, instead of taking the indirect route by the lungs as in the adult. From the left auricle it passes into the left ventricle, and is from thence distributed by the arteries all over the body. This opening in the partition is called the foramen ovale!

After birth, when the blood begins to pass through the lungs, this passage closes up. By the eighth day it is generally obliterated, often much sooner, though occasionally it has remained open longer without inconvenience. In some cases the foramen ovale does not close at all. The child then has what is called the blue disease! The whole body is of a uniform leaden, or blue color, and the whole system is generally languid and sluggish. The blue color is caused by the dark blood of the veins mixing with that of the arteries. These children mostly die early, but some live to be five or six years old, and one I saw twelve, but this is rare. No remedy can be had for this affliction, and I have never known it to cure spontaneously. Some children are so very dark for a few days after birth as to cause great alarm. This is owing to the foramen ovale being very open and closing slowly. No apprehension need be experienced in such cases, as it soon subsides.