Dropsical discharges from the uterus, uterine hæmorrhage, the expulsion of a mole, hydatid,[[400]] or polypus; or the removal of any of those diseases which constitute what has been termed a false conception, have been said to occasion effects which simulate the signs of parturition. It must be admitted that there are some signs which are common both to the diseases in question, and to the delivery, but there are at the same time others that exclusively indicate the occurrence of the latter; the irruption of fluids from the womb, menorrhagia, and leucorrhæa, may mimic the lochial discharge, but they will not remain, nor will they present that characteristic odour by which the latter is so preeminently distinguished; so again, the relaxation of the soft parts may be the consequence of disease as well as of delivery, while the paleness of the visage is the usual concomitant of profuse evacuation; but then the distention of the vagina, and the state of the neck of the uterus, and the absence of all contusions, lacerations, and discolourations will obviate the possibility of deducing any erroneous conclusion from these phenomena; the wrinkles and marks upon the abdomen may certainly follow any considerable change in the reduction of its bulk, whether it be the result of parturition, ascitic discharges, or the absorption of fat; but we may easily disarm such signs of their treachery by a previous inquiry into the state of the woman’s health, and into that of her robustness and general strength. Burns also remarks that other circumstances may concur in confirming the opinion of the practitioner, “as for instance, if the patient give an absurd account of the way in which her bulk suddenly left her, ascribing it to a perspiration, which never in a single night can carry off the size of the abdomen in the end of a supposed pregnancy.”[[401]]
Q. 6. Can we determine by any signs whether a woman has ever borne a child, although at a period remote from that of the examination?
The following are the principal indications of a woman having been delivered at a distant period, but in offering them to the attention of the practitioner, it is necessary to observe, that singly they can furnish but very slender evidence, and should they even all occur, they must be regarded as affording only a strong presumption of the fact.
1. The orifice of the womb has not its conic figure; its lips are unequal; and it is more open than in those who have never borne children.
2. There is a roughness of the abdomen, the parietes of which are also more expanded and pensile.
3. There are small white and shining lines running on the surface of the abdomen.
4. The breasts are more flaccid, and pendulous, and the lines on their surface are white and splendid.
5. The nipples are prominent, and the colour of their disks brown.
Q. 7. What are the earliest and latest periods of life, at which women are capable of child-bearing?
Zacchias and other authors have considered the commencement and cessation of menstruation as the two extreme points, beyond which the female is incapable of conception; they have very justly considered the menstrual flux as indispensably necessary for the healthy action of the uterine system. It must be also admitted that no female can conceive until her system has undergone that revolution which we have already described under the head of Puberty, although we then stated, that the period of life at which it takes place is liable to be controlled by several physical as well as moral circumstances, we have accordingly many instances upon record of very young females having borne children: during the year 1816 some girls were admitted into the Maternité at Paris as young as thirteen years; and during the revolution one or two instances occurred of females at eleven, and even below that age, being received in a pregnant state into that hospital. Schurigius[[402]] states the case of a Flemish girl, who was delivered of a son at the age of nine years; and in the notes to Metzger several instances are related where conception had occurred under the age of ten. It has been attempted to ascertain what age, and what season was most prolific: from an accurate register kept by Dr. Bland, it would appear, that more women, between the age of twenty-six and thirty years, bear children, than at any other period; of 2102 women, who bore children, 85 were from fifteen to twenty years of age, 578 from twenty-one to twenty-five, 699 from twenty-six to thirty, 407 from thirty-one to thirty-five, 291 from thirty-six to forty, 36 from forty-one to forty-five, and 6 from forty-six to forty-nine.