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THE present Treatise, although only another edition of a work already published, may be, I think, with truth regarded as almost a new book; every sentence of the former having been carefully revised, and the quantity of new matter now added being more than equal in amount to the whole contents of the former edition; in making which additions, I have been careful to use only such as either my own observation has furnished, or, if derived from other sources, appeared to my judgment consonant to truth, and likely to be useful in practice.
The Preliminary chapter, On the State of the Female System during Pregnancy, has, in the present instance, attained to very nearly double its former contents, numerous additions having been made to those parts of it which treat of the increased susceptibility of the nervous system and mind of the pregnant woman, especially as regards impressions made by external objects, and the influence thus exercised on the physical organization and mental constitution of the child, of which, some striking illustrations are adduced; the relations existing between pregnancy and disease have been also much more fully discussed than formerly.
The subject of obstetric auscultation, as a means of detecting pregnancy, which was but briefly treated, has received my best attention, and is here discussed at a length, and with a particularity more commensurate with its great and acknowledged importance.
That singular condition of the female system known as Spurious, or Simulated Pregnancy, which, in the former edition, was comprised within the limits of a short section, is now much more adequately considered, and occupies an entire separate chapter.
Being very anxious to obtain, if possible, accurate, and more numerous data in illustration of certain points connected with the period of human gestation, I addressed letters to several medical men, not only throughout Ireland, but also in England, Scotland, France, Germany, Norway, Denmark, Sweden, and America, requesting such information on the subject as they could afford of a perfectly exact kind. To these applications I received many replies, and accounts of not a few conclusive cases; and I wish now to express my thanks to those gentlemen who have thus enabled me to add so satisfactorily to the number of observations which I had myself already collected.
The state of the blood and urine in pregnancy having, of late years, attracted much notice, and occupied the attention of many of our most distinguished physiologists, and analytical chemists, I judged it expedient to give a full resumé of their researches, opinions, and conclusions on those subjects, adding thereto my own, especially as to the practical value of such conditions as means of deciding on the presence or absence of pregnancy.
In the former edition, the dusky hue of the vagina, as an evidence of pregnancy, was very briefly noticed, the subject being then new, and, consequently, but little investigated; since that time, however, ample opportunities of judging of its importance have been afforded me, and I have endeavored to assign its true practical value, as ascertained by my own observations, and the investigations of others.
The chapter on the Examination after Death, has been greatly enlarged by a much more extended account of the corpus luteum, and its value as an evidence of conception. Two specimens of
unusual interest are described and figured: one, where that body was found very perfectly developed in connection with uterine hydatids, without any foetus; and another in which there was only one corpus luteum, in a case of twins.
I have also, now, for the first time, inserted a table containing accurate measurements of fifty-three specimens, either examined by myself, or reported by others, at different intervals, from a few days, to eighteen months, after conception.
The Essay on the Spontaneous Amputation of the Foetal Limbs in Utero has been considerably enlarged by the addition of several new cases of that particular accident; and by making the paper embrace, also, the consideration of some other pathological lesions, to which the child is liable before birth, and, especially, some which appear to have a more than ordinary interest of a medico-legal kind, as being liable to be mistaken for injuries wilfully inflicted on the child, or the results of malpractice, either at the time of birth or afterwards; whereas, they are, in reality, the effects of accidental causes.
Under the head of Signs of Delivery, some precise measurements are added to those formerly given, of the size of the uterus at stated intervals after delivery, taking place at different periods of gestation; a kind of knowledge in which, although confessedly of the greatest value, there is an acknowledged deficiency in our medico-legal works. Under the same head, the fatty degeneration of the uterine substance after delivery, and its entire recon. struction, has now received a notice proportionate to its interest and importance: and I have given the particulars of a remarkable case, in which delivery took place, under my own observation, during natural sleep in a first labor.
When we consider the peculiar nature and immense importance of the subjects treated of in this volume, whether we regard them in a professional, social, or legal point of view, and the extreme difficulty not unfrequently to be encountered in coming to
a correct conclusion on such questions, on which, however, may depend, more than on the result of any other deliberation in medicine or surgery, for these can effect only life or health, but, in the questions to be considered in the following pages, are con cerned, in addition, virtue, honor, domestic peace, legitimacy, and the rights thence derivable; in short, the closest ties that bind together, and sanctify the most delicate and important of our social relations; while the difficulties that beset us in such investigations, are as intricate and embarrassing as they are numerous and deceptive, even to those who have long and carefully considered them, few, I apprehend, will be found to dissent from the opinion of Van Swieten, that "there is no circumstance, where a physician's reputation runs so great a risk, as when he is employed to determine concerning pregnancy: if he is not exceeding cautious, there are, everywhere, a number of frauds, a number of insidious cunning tricks, by which he may be easily imposed upon." Under such circumstances, then, I may hope that the present work will not be considered superfluous, especially as there is not, as far as I know, any other sufficiently comprehensive account of the subject, either in our own language or in any other, of which I am aware.
The Index subjoined to the present edition will, I hope, be found sufficiently copious to enable the reader to find, without difficulty, any passage to which he may wish to refer.
I should not do justice, either to my own feelings or to his claims, if I omitted to acknowledge here, with thanks, the many occasions on which, during the composition of this work, I have been indebted for important assistance to Dr. William Moore, of this city, whose correct knowledge of several foreign languages opens for him so many sources of valuable information accessible, in general, to but few, and which his most liberal and obliging disposition makes him take pleasure in imparting to others, in aid of the objects which they may have in view.
In conclusion, I beg to say, that, in the midst of many interruptions, from causes which will readily suggest themselves, I have endeavored, and with perhaps somewhat more than ordinary diligence, faithfully to embody in this book, the results of careful observation of facts, as they presented themselves before me in the contingencies of daily practice, or as collected and digested by others who appeared to be worthy of confidence: still, I am but too conscious that it may be, not unjustly, charged with many defects and imperfections, for the palliation of which I must trust to the kindness of the candid reader, and hope that he may be disposed to adopt the liberal and indulgent sentiment of the Roman critic, and say:
"Non ego paucis
Offendar maculis, quas aut incuria fudit,
Aut humana parùm cavit natura."