Those physiologists who deny the possibility of superfœtation, among whom we find some of the most celebrated names, assert that one conception can never supervene another in the same woman, because the os uteri is closed by coaguable lymph, and the entrance to the fallopian tubes is obstructed by the Decidua Uteri, soon after conception, and therefore that the semen can never find its way to the internal organs of generation, so as to impregnate a second ovum; this opinion is fortified by the well known aphorism of Hippocrates,[[435]] “οκοσαὶ εν γαστρὶ εχουσὶ; τουτεων δε στομα των υστερων ξυμμεμυκεν.” Galen[[436]] also quoting Herophilus says, “Ne specilli quidem mucronem admittere uteros antequam mulier pariat; prœterea ne vel minimum quidem hiscere ubi conceperint.” Neither Galen, however, nor Ætius, nor Paulus Ægineta, make any mention of superfœtation, a circumstance upon which the opponents of the doctrine lay considerable stress. Avicenna alludes to it, but for the purpose of expressing his disbelief in its possibility. Hebenstreit[[437]] and Ludwig,[[438]] have also expressed very strong opinions upon the subject; the former of whom observes, “Nullæ fere observationes extra omnem dubitationem positæ superfœtationem confirmant.” Baudelocque[[439]] is equally hostile to such a belief. But it may be said that the argument founded on the entire closure of the uterus is quite gratuitous, many authorities might be cited who disavow the fact, we have already adduced the opinion of Haller upon this point; besides, are we sufficiently acquainted with the manner in which impregnation is effected to authorise any deductions from our hypothesis? We are completely ignorant in what way the male semen arrives at the internal organs,[[440]] nay, we are not even convinced that its direct transmission to the ovaria is essential to fecundation; it is possible that these organs may be stimulated by sympathy with the vagina. Parsons opposes another argument to the doctrine of superfœtation; it is, says he, impossible, because the fallopian tubes become after conception too short to embrace the ovaria, but this opinion is successfully combated by Haller. The cases which have been cited to illustrate the phenomenon of superfœtation, are regarded by those who oppose the doctrine as instances in which a plurality of children has existed, and in which one of the following circumstances have occurred, viz.
1. The fœtus has prematurely died, but has remained in utero with the living child, to the full period of utero-gestation.
2. The descent of the ova into the uterus from the ovarium, has not observed the same order of time, one being more slowly evolved than another, although both might have been fecundated by the same coitus.
This latter was the favourite idea of Celoni:[[441]] “I am therefore decidedly of opinion,” says he, “that this superfœtation is no other than a later developement of a fœtus contemporaneously generated.”
We have thus presented the reader with a review of the different arguments which have been adopted by the partisans and opponents of this celebrated doctrine, and we have cited copious authorities with a view to enable the student to pursue the investigation to any extent which may be commensurate with his notions of its importance. We shall now conclude by observing that the following occurrences are essential to constitute a case of superfœtation.[[442]]
1. The pregnant woman must bear two children, each of a distinct age.
2. The delivery of these children must take place at different times, with a considerable interval between each.
3. The woman must be pregnant and a nurse at the same time.
Q. 10. What are the causes of Abortion?
A gratuitous assumption on the part of some writers respecting the viability of the fœtus, has led them to adopt a division into abortion and premature labour, according as the exclusion from the uterus takes place before, or after, the sixth month of conception; and the distinction is now generally adopted. Natural abortion may be considered as arising either from accidental or constitutional causes; we shall hereafter consider the different modes by which the premature ejectment of a fœtus may be occasioned by art. The exciting causes of accidental abortion may, in general, be easily detected[[443]]; those giving rise to the constitutional kind are often more obscure, and without great attention, the woman will go on to miscarry until either sterility or some fatal disease be induced. In many cases there can be no peculiar pre-disposing cause; as, for instance, when it is produced by blows, rupture of the membranes, or accidental separation of the decidua; but where it occurs without any very perceptible exciting cause, it is allowable to infer that some pre-disposing state exists, and this frequently consists in an imperfect mode of uterine action, induced by age, former miscarriages, and other causes. It is well known that women can only bear children until a certain age, after which the uterus is no longer capable of performing the action of gestation, or of performing it properly; now it is observable, that this incapability or imperfection takes place sooner in those who are advanced in life before they marry, than in those who have married and begun to bear children earlier; thus we find, that a woman who marries at forty shall be very apt to miscarry; whereas, had she married at thirty, she might have borne children when older than forty, from which it may be inferred, that the organs of generation lose their power of acting properly sooner, if not employed, than in the connubial state.[[444]] We also find that one miscarriage renders the woman liable to the accident at the same period of utero-gestation in subsequent labours, and to such an extent is this susceptibility carried, that it is often difficult with every precaution, for a woman to go to the full time, after she has miscarried frequently. These are circumstances which the juridical physician is, for obvious reasons, to keep in mind; females of disreputable character have been frequently known to miscarry repeatedly in succession; and in such cases we ought not, without very cogent reasons, to draw an inference that may subject them to accusation. We do not consider that any farther observations are required upon this subject, as the numerous works upon midwifery are ready to supply the practitioner with a solution of any problem which may present itself.