corresponding degree, friable, and continues so till it has completely returned to its usual condition; it loses its reddish color, becomes of a dirty yellow, and from these two circumstances (viz., its friability and color), it is possible, by a mere inspection with the naked eye, to perceive the termination of these changes, or even to know the size and weight of the organ at different periods of the process. In the fourth week, there usually ap-. pears, when the uterus has almost resumed its normal volume, but is still yellow and friable, the first commencement of a new formation of uterine substance in the body of the organ, whilst (fig. 25) in the outer layer, nuclei cells, and finally, cells drawn out into fibres (which assume completely the form of the subsequent muscular fibres), make their appearance, and become evident as young uterine substance. This formation is rarely to be Fig. 25. The development of the new uterus fibres about the fourth week. met with at an earlier period, and then only scattered here and there. Whilst the last portions of the muscular structure decay, and are absorbed, the new substance is developed at many points, so that in the majority of cases the reconstruction of the uterus is complete at the end of the second month. Puerperal diseases do not, in general, check, in any appreciable degree, this chain of changes, even though the uterus be itself diseased, &c. &c."-pp. 8, 9, 10.1 The occurrence of posthumous parturition has been already noticed (p. 492), as showing that the uterus retains its contractile power after death: it may be well to notice here another illustration of this fact, which may be brought before us, in the case of a woman dying during, or immediately after parturition; and the examination of the uterus not being made for a day or two afterwards; under which circumstances, we need not be surprised to find the organ considerably contracted, perhaps almost as much so as if the woman had survived her delivery. I have seen several examples of this, and it has occurred to others also. In a case recorded by Dr. C. M. Clarke,' in which the woman died undelivered, from a singular form of peritoneal rupture, delivery was accomplished by turning, after her death, and on examining the body next day, the uterus was found "in some measure contracted, its cavity not being capable of holding more than a quart." Leroux relates,3 that being called to a woman in labor, and being delayed, he found her dead when he arrived; he, however, turned the child, and delivered her, but on attempting to deliver the placenta, he was surprised to find that the cervix had contracted so much as to oppose the passage of his hand, to such a degree as to make him doubt that she was really dead. Baudelocque mentions, that on opening the body of a woman whom he had delivered under similar circumstances, he found the uterus firmly contracted on the placenta. 4 After the third week, very little information is likely to be obtained from an examination of the uterus merely; for although it probably is not reduced to its original unimpregnated condition before the end of the fourth, fifth, or sixth week, the altera It is only justice to Professor M. Retzius to mention here, that, in 1851, he published some very interesting observations on the process by which nature effects the reduction of the puerperal uterus, the process of absorption being preceded by fatty transformation of its component fibres; and he showed, also, that the blood, during puerperal convalescence, exhibits, under the microscope, a corresponding superabundance of globules, or granules of fat. Trans. for the Improvement of Med. and Chir. Knowledge, vol. iii. p. 290. 3 Traité des Pertes, obs. xiii. p. 25. 4 Tom. i. p. 123, note. tions which can be appreciated towards the conclusion of that period, are too liable to have been induced by contingent causes, to allow of our attaching value to them as proofs of delivery. Under such circumstances, our attention would be more profitably directed to an examination of the ovaries, and the existence of the corpus luteum; the value of which has been already so fully considered in Chap. XIII., that it appears now only necessary to remark, that although its existence, with all its characters in perfection, as already described, is, in the writer's opinion, proof positive of previous conception, it can be received as evidence of recent delivery of a child only when it is found in connection with other circumstances indicative of the occurrence of that event; in which case it ought to be considered as a very powerfully corroborative proof. At the same time, it must be borne in mind, that after the expulsion of a large mass of hydatids, as in case related p. 220, a perfect corpus luteum may be found accompanied by other conditions of the uterus so closely resembling those observable after childbirth, as to be with great difficulty distinguishable therefrom. To what has been stated already (p. 377), concerning the cicatrices on the surface of the ovaries, I shall only add here, in reference to their not being permanent, the opinion of Murat, whose observations confirm my statement in a very satisfactory manner: his words are: "Placé dans un hospice de femmes, j'ai souvent fait des recherches à ce sujet; et je me suis assuré, qu'il n'était pas possible de déterminer le nombre des grossesses par celui des cicatricules; car la plupart s'effacent avec l'âge." The substance of the preceding observations may be summed up in the following general corollaries : 1. The signs of delivery are most distinct after the birth of a full-grown child; and least so, when the uterine contents have been expelled at an early period of pregnancy. 2. The proofs are more distinct in proportion to the recency of the delivery; and any examination made after the lapse of ten days from the time of the delivery, is not likely to afford 'See Report of the Trial of Charles Angus for the Murder of Miss Burns, Liverpool, 1808. 2 Dict. des Sci. Méd., tom. vi. p. 204. satisfactory information; the most decisive signs, in general, disappearing within a week. 3. The third or fourth day, generally, presents the results of delivery very distinctly; the condition of the breasts being then most remarkable, from the active secretion of milk. 4. A first delivery is more easily detected than subsequent ones. 5. We cannot safely rely on any of the signs of delivery viewed separately, but must consider them collectively, their mutual relation and correspondence with each other, and with the other collateral circumstances of the woman's case and history. 6. The chief points of attention ought to be the state of the uterus, the external parts, and of the breasts. 7. Taken by itself, a fresh laceration of the perineum ought to be considered as a proof of great value. 8. There are certain physical signs which, when present, are sufficient to establish a negative decision; such are, for instance, a perfect hymen, or an imperforate state of the parts. 9. But, on the other hand, a woman may have borne children, and no one mark remain by which the fact of delivery could be proved, after the lapse of even a few weeks. 10. A woman may be delivered while in a state of insensibility, or even during deep natural sleep; so that her child may perish merely from want of attention, and without any moral delinquency on her part. 11. A woman may be naturally pregnant, and the life of her child ascertained, and yet childbirth may not occur; the child perishing and being decomposed before the time of delivery, as in the cases related, p. 589, et seq. |