In certain comatose states of the brain, as those produced by depression of bone, the operation of narcotic substances, or the violence of fever, we must admit the possibility of such an occurrence; Hippocrates[[384]] relates the case of a woman who was delivered during a state of insensibility, in the last stage of fever, from which she never recovered, and therefore died unconscious of the event. In the Causes Celèbres,[[385]] the case of the Comtesse de Saint Geran is recorded, who having been plunged into a profound sleep, by a medicated draught prepared for that purpose, brought forth a son without being in the least conscious of the act that gave it birth; and when she awoke, on the following day, bathed in her blood, and exhausted in strength, and demanded her infant, the artful attendants denied the fact of her delivery. Women have moreover given birth to an offspring in articulo mortis; and many instances have occurred where the infant has escaped from the womb during the exertions of the mother to evacuate the contents of the bowels.
Q. 2. How far the term of Utero-gestation can be shortened, to be compatible with the life (viabilité) of the offspring.
If this question could be decided by the number of recorded cases, we should be called upon to acknowledge the possibility of the fœtus surviving at extremely early periods; Capuron[[386]] relates the case of Fortunio Liceti, who, it is said, was born at the end of four months and a half, and that he lived to complete his twenty-fourth year! In the case of Marechal de Richelieu the parliament of Paris decreed that the infant at five months possessed that capability of living to the ordinary period of human existence,[[387]] (viabilité) which the law of France required for establishing its title of inheritance. The Roman law[[388]] “de suis et legitimis hœredibus” establishes, upon the authority of Hippocrates, that an infant may be born six months and two days after the term of conception; while a second law, sanctioned also by the same high authority, requires an interval of seven months between the conception and delivery; this discrepancy receives explanation from the fact that the ancients fell into many contradictions from indiscriminately using in their calculations lunar and solar months; thus, for instance, Hippocrates uses the former in his books “de Septimestri et Octomestri partu,” while in those de Alimento, de Carnibus, de Epidemicis, the latter uniformly constitute the basis of computation. Physiologists of the present day consider that a fœtus born before the completion of the seventh month has a very slender chance of surviving, although instances have occurred where the life has been preserved after a birth still more premature. Hippocrates and other ancient physicians entertained a conceit, which has even prevailed in the more modern schools of physic, that an infant could live at seven, but rarely or never at eight months; it is hardly necessary to observe with Haller, that the capability of living in an infant increases in the ratio of its maturity, or in proportion as it advances towards the natural period of delivery; the child, therefore, that is born at the expiration of eight months has of necessity a greater aptitude for living than the one which is produced at seven; and nothing could have suggested or upheld a contrary opinion but that overwhelming belief in the harmony and powers of certain numbers with which the philosophers of ancient days were infected, and of which the Pythagorean number SEVEN was deemed the most perfect and efficient,[[389]] as we have before had occasion to remark, while treating of the subject of Ages.
Q. 3. Whether to any, and to what probable extent, the natural term of Utero-gestation can be protracted?
Although the period of gestation is usually limited to nine calendar months, or forty weeks,[[390]] yet the term does not appear to be so arbitrarily established, but that Nature may occasionally transgress her usual law; and, as we have just stated that many circumstances may occur to anticipate delivery, so are we bound to admit that in some instances it may be retarded; in several tolerably well attested cases, the birth appears to have been protracted several weeks beyond the common time of delivery; and Dr. Hamilton remarks upon this occasion, that if the character of the woman be unexceptionable, a favourable report should be given for the mother, though the child should not be produced till nearly ten calendar months after the absence or sudden death of her husband. The question is one of the greatest importance in its moral and legal relations, for it may involve the honour and happiness of families, the legitimacy of offspring, and the succession of property.[[391]] We cannot, therefore, feel surprised that it should have occupied so great a portion of the attention of our most able physiologists, and have given origin to considerable controversy. Each side is supported by an equally respectable list of partisans, and we perceive that upon this occasion the two celebrated medico-jurisconsults of France are opposed to each other; Mahon having associated his name with those of Bohn, Hebenstreit, Astruc, Mauriceau, Da La Motte, Rœderer, and Baudelocque, who reject the belief in retarded delivery as impossible, and contrary to the immutable law of nature; while the name of Foderé ranges with those who support the contrary opinion, as Teichmeyer, Heister, Albert, Vallentini, Bartholin, Haller, Antoine Petit, Lietaud, Vicq d’Azyr, and Capuron, who may boast of the support of Hippocrates, Aristotle, and Pliny.
Pliny tells us that the Prætor L. Papirius was declared entitled to succeed an infant born after thirteen months, but he adds, this was because no time appeared by law “quoniam nullum certum tempus pariendi statum videretur.” We read in Aulus Gellius of an edict by the Emperor Adrian in favour of a woman of irreproachable character, who was delivered eleven months after the decease of her husband; and the parliament of Paris, in the case of a widow, decided in favour of the legitimacy of an infant born in the fourteenth month of pregnancy. Bartholin relates the case of a young woman at Leipsic who was delivered in the sixteenth month; and, if we may credit it, the account would appear to have been as unexceptionable as any case on record, for during her pregnancy she was in custody by order of the magistrates. The civil code of France has placed a limit to our credulity respecting retarded births, and decrees three hundred days, or ten months, to be the most distant period at which the legitimacy of a birth shall be allowed.[[392]] Were we called upon to deliver an opinion upon this momentous question, we should certainly consider such a law as rather inclining on the side of mercy, than on that of stern justice. For any farther information upon this question, we must refer the reader to the learned notes of Mr. Hargrave, printed in our Appendix, page 209; but before we quit the subject, we shall notice the opinion of Joubert, if it be only for the purpose of animadverting upon its absurdity; he supposes that the duration of gravidity may be influenced by sexual indulgence; supposing that excessive venery will accelerate, while abstinence may so far retard the time of delivery, that it shall not take place until after the expiration of eleven months.
Q. 4. What is the value of those Signs by which we seek to establish the fact of a recent delivery?
There are circumstances which may induce a woman to conceal the event of parturition, or to simulate a delivery which had never taken place; in either of such cases the importance of medical testimony is sufficiently obvious. In cases of alleged Infanticide the practitioner is always required to examine the supposed mother, and to give his opinion as to the fact of her having been recently delivered: and his report has not only very frequently acquitted the prisoner, but in some cases has rescued the innocent but unfortunate female from the horror and disgrace of a public trial. Capuron cites a curious case which we shall relate in this place as well adapted to exemplify the serious importance of medical evidence on such occasions:—A young woman having granted her favours to a lover who had seduced her, under the promise of wedlock, feigned pregnancy in the hope of hastening the celebration of her marriage, but the lover refused to ratify the solemn engagement into which he had entered, and she therefore determined to carry on the imposition, with a view to conciliate his affections, and to secure his future protection and support; for this purpose, after a proper interval had elapsed, she confined herself for several days to her bed-chamber, and having stained her linen and bed with bullock’s blood, she openly declared that she had been delivered, and that the infant had been committed to the care of a nurse; the young man, however, notwithstanding this supposed new pledge of affection, remained obdurate, and persisted in his refusal to complete his engagement; in consequence of which all intercourse between the parties ceased, until after the lapse of two years, when the alleged father claimed his child; in answer to this application the young woman confessed the deception which she had been induced to practise; but the criminal department of the Seine, before whom she was summoned, hesitated in giving credence to her tale; upon which a personal inspection was instituted by Capuron, Maigrier, and Louyer Villermay, in order to decide whether the woman in question had ever been delivered; and as the result of this inspection enabled the professors to decide in the negative, the prisoner was immediately discharged. A similar instance of pretended delivery has recently appeared in a Berlin Journal, as having occurred at Sirakovo in the circle of Posen, where a young woman, anxious to fulfil the ardent desire of her husband to have an heir, pretended to have been suddenly and unexpectedly delivered, and stole an infant in order to support the fiction; the case was rendered more atrocious from the real mother having, in consequence of the theft, been subjected to the accusation of infanticide; the fact was, however, happily discovered, and the culprit has been delivered to the punishment due to her crime. Such cases of pretended delivery are by no means so rare as the reader may at first be led to imagine; and the medical practitioner should be on his guard lest he become the dupe of such an imposition. Dr. Male[[393]] relates a case which occurred not long since in his own town; a surgeon was called to a pretended labour, when a dead child was presented to him, but there was no placenta; he therefore proceeded immediately to examine the woman, when he found the os tincæ in its natural state, nearly closed, and the vagina so much contracted as not to admit the hand; astonished at this circumstance he went to consult a medical friend; but before any farther steps were taken, it was discovered that he had been imposed upon; the woman, in fact, had never been pregnant, and the dead child was the borrowed offspring of another; it appears that she was induced to practise the artifice to appease the wrath of her husband, who frequently reproached her for her sterility.
The signs from which the judgment of the midwife is to be deduced may be comprised under the following general and particular heads, to each of which we shall successively direct our attention, and endeavour to establish the degree of validity to which they are singly or jointly entitled.
1. The face is pale, the eye sunken, and surrounded by a purplish or dark brown coloured ring; the pulse is full and undulating; the skin soft, supple, rather warmer than ordinary, and covered with a moisture which has a peculiar and somewhat acid odour.