The case of Hermaphrodites, or rather of those who may have been deemed such, stands on different grounds; in the physiological illustrations of this subject, the circumstances will be investigated which have led to erroneous conclusions upon this point. In a legal view, it is only necessary to caution the medical attendants to be more careful in the investigation of such cases of doubt, especially where succession to property may depend on the sex of the child. The case of the celebrated Chevalier D’Eon, may long serve as a warning to those who would judge of the doubtful sex of a party by any ordinary and external distinctions;[[360]] while that related in the causes celèbres of a female[[361]] who, on account of a prolapsus uteri, was pronounced by the sagacious physician at the Hotel Dieu to be an hermaphrodite, is sufficient to shew the futility of any personal examination, unless conducted by a skilful anatomist.
PHYSIOLOGICAL ILLUSTRATIONS CONNECTED WITH THE FOREGOING SUBJECTS.
The investigation of the preceding subjects necessarily comprehends within its range a series of physiological questions of great importance, the solution of which is essential to the establishment of just and satisfactory conclusions; we therefore now proceed to the consideration of Conception: a subject which in relation to Legitimacy, and the various legal questions dependant on it, may be considered as the basis upon which the superstructure rests, or the trunk from which the various ramifications of inquiry must proceed.
Of Conception and Utero-Gestation.
The different theories which the ingenuity of the physiologist has invented for the elucidation of this mysterious and wonderful process, have been supported with so much zeal and argument by the disciples of one school, and disputed with so much warmth and plausibility by those of another,[[362]] that to recite the merits and defects of each system would be a task as laborious in its execution, as it must be unsatisfactory and unprofitable in its results; we shall therefore not attempt to ascend into the scale of causes, but rest on the phenomenon of conception, as an ultimate fact, and confine our researches to the history of its œconomy. The series of changes which constitute the phenomena of conception and gestation are clearly proved by the experiments of De Graaf to originate in the ovaries, and not in the uterus, as former physiologists had supposed. One or more of the vesicles, or ova, contained in the former of these organs, no sooner receive the vivifying impression communicated by the coitus than they are loosened from their connection, and grasped by the fimbriæ of the Fallopian tube, by whose peristaltic contractions they are, in due time, conveyed into the uterus; the spot in the ovarium from which the ovum has been thus separated, when examined after death, exhibits a slightly lacerated appearance, as if the germ had been detached from a vesicle at the moment of conception, by the rupture of its parietes; to this structure, which from the colour that it assumes has been called by physiologists corpus luteum, we shall have frequent occasion to allude during the course of the present inquiry. While these actions are proceeding, the uterus passes through several contemporary changes, in order to prepare it for the reception of the ovum; its blood-vessels are increased in size, as seen in slight cases of inflammation; the texture of its internal surface becomes softer, and more spongy, and a white mucus is secreted, which, from the extreme delicacy of its arrangement, has been compared by Harvey[[363]] to the web of the spider; it soon, however, assumes a more solid form, becomes vascular, and adheres so as to form a lining to the whole cavity of the uterus, except at the orifices which lead to the Fallopian tubes, and the os uteri. Dr. William Hunter considered it as the inner lamina of the uterus cast off, like the exuviæ of some animals, after every conception, and he accordingly called it the Decidua, and from the manner of its passing over the ovum, the Decidua Reflexa.[[364]] It is not known what exact interval is required for the fœtal primordia to pass through the Fallopian tube, and descend into the cavity of the uterus. Valisnieri and Haller have never been able to find it distinctly in the latter viscus before the seventeenth day. As the mouth of the pregnant uterus is sealed up with gelatinous matter from the moment of conception, it is, under ordinary circumstances, incapable of allowing any passage for the Catamenia, although exceptions to this law are frequently mentioned by men of science,[[365]] which have probably arisen from the observation of an occasional sanguineous discharge from the vessels of the vagina; and which, says Burns,[[366]] are neither regular as to the monthly period, nor of the same quality as that of the menses, and he concludes by remarking, that he has never known any instance where menstruation was perfect and regular during the whole of pregnancy. Dr. Denman[[367]], whose authority upon such a question must carry with it very considerable weight, says, “a suppression of the Menses is one of the never-failing consequences of conception, at least I have not met with a single instance to the contrary.”
Conception is succeeded by many important changes in the constitution, that are indicated by affections of various parts, and which, therefore, to a certain degree, afford signs of a woman having conceived; and indeed in the earlier periods of pregnancy, they afford us the only means of judging of the fact; and although they are necessarily ambiguous and uncertain, yet Dr. Denman observes, that from the common occurrence of the case, and the particular attention which is paid to it, a faculty of discrimination is acquired which generally prevents error. The medical jurist, however, can never receive such testimony as satisfactory, and it is fortunate that the law rarely requires elucidation upon this point, for in those cases of violent death in which it may be important to ascertain the fact, the light of dissection will assist our decision; and in cases where the plea of pregnancy has been set up, in bar of punishment, it will not avail, unless it be so far advanced as to render our investigation easy and satisfactory. The following symptoms may be said to afford the earliest indications of pregnancy: the disappearance of the catamenia; nauseating sickness, or vomiting, chiefly occurring in the morning, and after meals, and which in some cases is almost coeval with conception, and often resembles sea-sickness, both in the violence of its symptoms, and the obstinacy with which it resists every measure of relief; vertigo and drowsiness; heart-burn and diarrhæa, frequently supervene; the appetite becomes depraved; there is a feverish diathesis; the breasts swell, and the nipples are surrounded by an areola, or brown circle, which is more or less dark according to the complexion of the woman; the countenance becomes altered, the eyes appearing larger, and the mouth wider; and a peculiar sharpness is given to every feature; the temper also becomes unnaturally peevish, and the sleep is broken and disturbed. Subsidence, or falling in of the abdomen is recorded by the old French proverb as another sign of pregnancy,
“Dans une ventre plat
Un enfant il y a.”
In some instances, particular sympathies occur, and hence tooth-ache has been considered as affording some evidence upon such an occasion. Some midwives have supposed that the appearance of blood drawn from the veins would indicate the state of pregnancy; the blood undoubtedly becomes sizy very shortly after conception, and it differs from that of a person affected with inflammation; “in the latter case,” says Burns,[[368]] “the surface of the crassamentum is dense, firm, and of a buff colour, and more or less depressed in the centre; but in pregnancy, the surface is not depressed, the coagulum is of a softer texture, of a yellow and more oily appearance.”
It is not, however, possible to determine positively, from the inspection of the blood; for a pregnant woman may labour under some local disease, which will impart to it a truly inflammatory character, while, on the other hand, it is possible for the suppression of the menses, if accompanied with a febrile diathesis, to give the crassamentum the same appearance which it would present during pregnancy; and, in truth, the same remark will apply to all those signs to which we have before alluded; and even the swelling of the breasts, upon which so much stress has been laid, as a presumptive sign of pregnancy, cannot be considered unexceptionable, for so great a sympathy subsists between the mammæ and the uterine system, that any disturbance of the latter is not unfrequently attended with an enlargement of the former: such an occurrence is by no means uncommon in Amenorrhæa. Belloc,[[369]] however, has made an observation respecting them which merits our regard; he says, that when a woman has a suppression of the menstrual flux, with the other concomitant signs of pregnancy, we may consider her situation as yet doubtful, because these signs are common both to pregnancy and amenorrhæa; but if about the third month, while the suppression still continues, she suddenly recovers her health, and the incidental circumstances disappear, her appetite, plumpness, and colour returning, nothing can better prove the existence of pregnancy; for had the impaired health, and the accompanying symptoms been the simple effect of suppression, the derangement would have continued, and even increased during the continuance of the cause; to this observation, however, of Belloc, we have one important objection to offer: in every case of clandestine pregnancy, (and it is on such occasions that our diagnosis is principally useful) the anxiety and distress of the woman’s mind, and her desire to appear as if labouring under some serious complaint, will render her returning health at the period mentioned by Belloc as unlikely, or very equivocal; in short, we do but adopt the sentiments of the most experienced midwives,[[370]] when we assert, that it is impossible to arrive at any conclusion beyond that of suspicion; and in delivering a confident opinion upon it, the practitioner must take care that he does not compromise his character for skill and knowledge. “Notandum est magna hic prudentia opus esse medico ne facile graviditatem vel affirmet, vel neget; peritissimi enim decepti fuerunt toties; nunquam magis periclitatur fama medici, quam ubi agitur de graviditate determinanda.”[[371]] History informs us, says Capuron,[[372]] and it is attested by Ambrose Paré, Moriceau, Riolan, Devaux, and others, that pregnant women have been brought to the scaffold, after an examination by medical men and matrons, who have declared the absence of pregnancy.