scribe; in reference to which two points it may be suggested, 1st, that in such cases, the greater number of the rational signs must be held as entitled to little or no consideration, if not altogether disregarded; and our reliance should be placed on careful manual examination, by which the abdomen, however enlarged, is found soft, puffy, and compressible, the umbilicus sunk, no abdominal tumor, and the uterus, examined per vaginam, unaltered; for although, as formerly stated (p. 319), the organ does occasionally under these circumstances enlarge somewhat, the increase of size, and condition otherwise, are not such as would be likely to lead us astray in forming our opinion: 2dly, whenever the circumstances are such as, while they apparently favor strongly the notion of pregnancy in the apprehension of the woman herself, or of others, leave room for doubt in our mind as to the fact, its existence, though doubted, should not be too positively denied; and the woman should be treated for a time as if she were pregnant, and such remedies ordered as would be compatible with that state, and at the same time calculated to improve the state of the system generally; an object which we shall in the great majority of instances, best accomplish by a suitable course of aperients, conjoined with tonics, and the use of the tepid, or cold bath.

The necessity for such caution will appear from the following case: Several years ago, after seeing within a short time some cases of spurious pregnancy, I was consulted by a lady whom I knew to be past forty, and whose youngest child was then between seven and eight years old. She stated that the catamenia, which had been for some time gradually diminishing, had disappeared altogether for the preceding three months, that in every other respect her health was as good as usual, but that some of her friends had been joking her about being in the family-way: this idea I discouraged as improbable, and suggested as delicately as I could, that her age would account sufficiently for the circumstance which had attracted her attention, and I ordered merely some gentle aperients which she required. Two months afterwards she sent for me, and to my surprise and consternation, informed me that she had quickened and would require my attendance at such a time; adding, that she hoped I was now satisfied, that she was not quite too old to add to her family. It

was all true; in due time, she gave birth to a son, whom she frequently afterwards presented to me, with some playful observation calculated to recall my former error to my recollection.1

CHAPTER XIII.

INVESTIGATION AFTER DEATH.-EXAMINATION OF THE UTERUS AND ITS APPENDAGES.-THE OVARIES, CORPORA LUTEA, FALLOPIAN TUBES.

It is unnecessary to repeat here, what has been already particularly set forth, with regard to the state of enlargement in which the uterus must be, when containing the product of conception. In relation to our present subject, the first and most obvious fact to be noticed is that, when an examination is made after death, and the uterus found of its ordinary diminutive size, it is proof positive against the present existence of natural pregnancy. If, on the other hand, we find the organ enlarged, and its condition apparently corresponding to the period of pregnancy supposed to exist, nothing but a careful examination of its contents, or other cause of enlargement, can determine the question at issue. I will here only observe, that nothing less than the distinct and unequivocal detection within it of the ovum, or of some of its component structures, ought to satisfy our minds, or justify us in giving an opinion in the affirmative.2

We must here remember that we may meet with such cases as those already related, p. 286, et seq., or those still more remarkable ones referred to at p. 301, which show us that it is quite

1 On this important subject of Spurious Pregnancy, and for cases illustrative of it, see Ramsbotham, Practical Observations, part ii. p. 387. Gooch on Diseases of Females, p. 225. Perfect's Cases in Midwifery, vol. i. p. *293. Alexander Hamilton on Female Complaints, p. 125. Blundell, Principles of Obstetricy, p. 160. Schmitt, 7th, 8th, 13th, and 19th cases, 1st division; and Critical Introduction, p. 44. Gardien, Traité des Accouchemens, tom. i. p. 542. La Motte, ch. viii. de la Fausse Grossesse, p. 47. Fothergill's Works by Elliot, 1781, p. 464. Mauriceau, obs. 275 and 566.

See Observations on the Examination of the early Ovum, p. 251.

possible for a woman to have a child in the abdomen without being pregnant, in the ordinary meaning of that condition; but this consideration may have no small influence and importance in preventing undeserved deterioration of character; because, let us suppose a woman so circumstanced to become a widow, and so remain for a year or two; and then dying, an examination is made by some one not familiar with such exceptional cases, and a child is found in her abdomen, would not a conclusion be but too probably adopted which would cast an unmerited stain on her memory?

Another condition which may present itself is that in which the uterus is found enlarged but empty, exhibiting, however, several of the changes which accompany gestation; but these, upon examination, only afford evidence sufficient to convince us that the organ has recently contained something which had been attached to its internal surface by a vascular connection; the substance expelled may, or may not, have been the product of conception; and the most careful examination of the appearances remaining, or of the structural changes effected, may not enable us to pronounce safely on the precise nature of the cause which had produced them. Thus, for instance, in a case where hydatids have been expelled, we could not determine, by examination of the uterus alone, especially at early periods, whether the conditions there observable were the result of true pregnancy, and the expulsion of a foetus or ovum; or whether they might not have been produced by some other cause, unconnected with conception; we may not, in fact, be able to tell, without further investigation, whether the woman have recently conceived or not, a question which it may be, occasionally, of paramount importance to be able to answer; we must, therefore, turn our attention in another direction, and seek for proof of impregnation in the appendages, particularly in that part of them which is more especially the seat of conception.

This leads us at once to investigate the value of that peculiar change in the ovary, by which, after fruitful intercourse, there is produced a new structure, to which has been applied the name of corpus glandulosum, or more generally, corpus luteum, the presence of which is, by some, considered incontrovertible evidence of impregnation. Others, however, with equal confidence, discredit

its value, asserting that its existence may be owing to causes altogether accidental, and independent of sexual intercourse, and that, consequently, it cannot be taken as evidence of conception. It becomes, therefore, a matter of great moment, to examine the truth of such assertions, and to determine, if we can, how far they coincide with, or depart from, absolute matter of fact, which alone can be the measure of their correctness, and consequently of their value. In order to do this, the first thing which appears essentially necessary is that we should have a clear idea of what a true and perfect corpus luteum is, and also of what is not such a corpus luteum.

If this inquiry should appear to any one to be, at the present day, superfluous, it certainly was not so when I first undertook to give a full account of the matter; when it was only necessary to compare the descriptions and delineations to be found in the generality of books, in which the corpus luteum was spoken of, with the object itself, as it exists in nature, to be convinced how faint was the resemblance between the portrait and the original.' I think that the naming of this substance gave rise to much of the error which existed and was propagated on the subject; the color being assumed as the only characteristic necessary to constitute the corpus luteum. Whenever, therefore, small spots, or even points, of a yellow hue were met with in the ovaries, they were supposed to be true corpora lutea. I recollect distinctly the first time my attention was drawn to the subject was at a demonstration of the structure of the ovaries by a distinguished anatomist; when two spots, each not larger than a grain of mustard-seed, and of a yellow color, were exhibited as specimens of corpora lutea, and as proving that the woman had borne two children; and even now there still exists great discrepancy of opinion as to the distinctive characters of the corpus luteum which attends upon conception, and of those which are produced independently thereof, and consequently as to the absolute value of this new structure as a proof of pregnancy.

1 Mason Good, for instance, says: "As soon as the ovulum has thus escaped, the lips of the wound hereby made in the side of the ovary are closed by an external cicatrix, and indented with a small cavity, which forms what is meant by a corpus luteum."-Study of Medicine, vol. v. p. 22, 3d ed., 1829. See also Veolsk's Tabulæ ad illustrandam Embryogenesin, &c., 1854, tab. 1, fig. 8.

A trial took place, some years ago, in Edinburgh, which, while it evinced the necessity for a correct knowledge of this subject which might occasionally arise, even under circumstances not apparently connected with its existence, proved, but too plainly, how little was known about it. A prosecution was instituted against four medical students, for exhuming the body of a lady in Glasgow. The body was so disfigured that it could not be identified; the ovaries were, however, examined, and it was reported that there was, in one of them, a perfect corpus luteum, which would be sufficient to prove that the remains were not those of the lady in question, who was a virgin, and advanced in life. On the trial there was a complete contradiction between the medical witnesses, some of whom affirmed the appearance in the ovary to be a true corpus luteum, while the others maintained. that it was not; so that no satisfactory inference could be drawn from the fact. The body was afterwards identified by a dentist, who produced a cast which he had taken of the gums.

They were then divided in

When Mr. Angus was tried in Liverpool, in 1808, for the supposed murder of Miss Burns, great doubt arose as to whether the condition of the uterus or its appendages was such as to prove a pregnancy recently existing. "It was not until after the trial, that the ovaria were examined. the presence of a number of physicians, and a corpus luteum distinctly discovered in one of them. Mr. Hay took the uterus and its appendages to London, and showed it to the most eminent practitioners there. He received certificates from Drs. Denman and Haighton, Messrs. Henry Cline, Charles M. Clarke, Astley Cooper, and Abernethy, all stating that it exhibited appearances that could alone be explained on the idea of an advanced state of pregnancy. And it appears to have been universally allowed, that the discovery of the corpus luteum proved the fact, beyond a doubt."

In order to understand this matter satisfactorily, it will be necessary to consider, briefly, the situation in which the ovum is placed in the ovary, its coverings, and some other circumstances connected with its expulsion thence.

The ovum is contained within the Graafian vesicle, which consists of two distinct membranous envelops; and besides these

See Report of the Trial; and Edinb. Med. and Surg. Journal, vol. v. p. 220.