The Works of William Harvey M.D. / Translated from the Latin with a life of the author

by William Harvey

I am further acquainted with a woman who had the whole length of the vagina so torn and injured in a difficult labour, that subsequently, after she had again become pregnant, not only did the parts in the neighbourhood of the nymphæ, but the whole cavity of the vagina as far as the orifice of the uterus, become adherent; this went to such an extent that coition became impossible, nor could a probe be passed up, nor was there any passage left for the ordinary discharges. When her labour came on her sufferings were so dreadful that all hope of delivery was abandoned. She therefore gave up the keys to her husband, arranged her affairs, and took leave of her friends who were present. On a sudden, however, by the violent efforts of the fœtus the whole space was burst through, and a vigorous infant born; thus was the fœtus the salvation both of itself and its mother, besides opening the way for subsequent children. By the exhibition of proper remedies the mother recovered her former good state of health.

The following instance is even more remarkable. A white mare of great beauty had been presented to her Serene Highness the Queen, and in order that its symmetry and usefulness might not be impaired by foal-bearing, the grooms, as is the custom, had infibulated the animal with iron rings. This mare (by what chance I know not, nor could the grooms inform me) was got with foal; and at length, when no one suspected anything of the kind, she foaled in the night, and a living foal was found the next morning by the mother’s side. When I heard of the circumstance I went immediately to the place, and found the sides of the vulva still fastened together by the rings, but the whole pudendum on the left side so thrust and torn away from the pelvis by the almost incredible efforts of the fœtus, that a gap sufficiently wide was made to admit of its escape. Such is the force and vigour of a full-grown and healthy fœtus.

But, on the contrary, if the fœtus is diseased or feeble, or is bom before the full term, it must be considered more an abortion than a regular birth, the fœtus being expelled rather than born; and thus for some days after birth it neither properly takes the breast nor gets rid of its excretions.

And yet the following example will show that the uterus also contributes towards delivery. A poor washerwoman had long suffered from procidentia uteri to such an extent that a tumour hung between the thighs as large as the fist. As no remedies had been applied, the prolapsed part became so rough and wrinkled as to take on the appearance of the scrotum, and in this state she suffered less than at the commencement of her illness. When consulted on her case, I ordered her to keep her bed for several days, to employ fomentations and ointments, and after the uterus was returned, to keep it in its place by means of pessaries and bandages, until by the use of strengthening applications it should be fixed firmly in its place. This plan was followed by some success; but she soon suffered a relapse, when compelled by her circumstances to follow her usual occupations, and continue long in the erect position. She bore, however, her inconvenience with patience, the uterus at times protruding, at others not doing so. At night she could usually reduce it, and it remained for some time in its proper place. After the lapse of a few days she returned, and complained that the uterus was so swelled from the use, as she thought, of the remedies, and especially of the fomentations, that it could not any longer be retained. By using some applications she was enabled to accomplish the reduction; but the cure was only temporary, for as soon as she stood up, and followed her ordinary occupations, the uterus immediately gave her much inconvenience by its weight, and at length entirely prolapsed. And now it hung down to the middle of the thigh, like the scrotum of a bull, to such an extent that I suspected not only the vagina but also the uterus to be inverted, or that there was some kind of uterine hernia. At length the tumour exceeded in magnitude a man’s head, acquired a resisting character, and hung down as low as the knees; it also gave her much pain, and prevented her walking except in the prone position; added to which it discharged a sanious fluid from its inferior part, as if some portion had ulcerated. On ocular inspection (for I did not employ the touch) I feared that cancer or carcinoma might result, and so thought of the ligature or excision; in the mean time I advised the employment of soothing fomentations to ease the pain. The following night, however, a fœtus of a span long, perfectly formed, but dead, was expelled from the tumour, and was brought to me the next day. I took out the intestines, and kept it in cold water without decomposition for many months, showing it to my friends as an extraordinary object of curiosity. The proper skin in this fœtus was not yet formed, but in its place there was a pellicle, which could be stripped off entire, like that on a baked apple; underneath all the muscles of the body could be distinctly seen, the fœtus being very lean. I shall describe at another opportunity what I discovered in this fœtus on dissection. I have mentioned the case on this occasion to show that it was the uterus alone which excited the abortion, and expelled the fœtus by its own efforts.

Fabricius[370] suggests two circumstances as especially worthy of admiration in and after birth: first, the dilatation of the uterus at the time of birth; secondly, the way in which after birth it is restored to its usual small size. He wonders how the uterus can be so distended as to allow the fœtus to escape, and afterwards in so short a period return to its pristine state.

He says, “that with Galen[371] we can only wonder, but not understand,” how the neck of the uterus, a part so thick, hard, and closely sealed, as not to admit a probe, can suffer such distension at the time of deliver”. He gives,[372] however, the following reason: “that the unimpregnated uterus is of a thick and hard consistence, and so is its orifice, but when impregnated is yielding and soft, and in proportion as the term of delivery approaches, both the body of the uterus and its orifice become more and more yielding.” He believes this to arise “from the distension which the uterus undergoes, and that when this distension takes place, the compact and plaited, so to speak, body of the uterus is expanded and unfolded; thus what was before thick and hard becomes soft and yielding, and ready to admit of the passage of the fœtus.” He adds subsequently, “Some one may ask—if all this is correct, how is it that in pregnant animals the uterine aperture is so closed that it will not admit a probe? I answer, that this is so because the uterus, whilst it is being distended and undone, like a closely-folded piece of linen, begins to undergo these changes at its superior part; the lower portions then gradually widen, until the power of distension arrives at the aperture; this generally takes place at the period of birth. With reason then is the uterine orifice closely shut in the first months of pregnancy, whilst it is still hard and thick, but inclined to dilate in the latter ones. Thus much may be said about the unknown cause of Galen. Other circumstances may be mentioned as conducing to the dilatation of the orifice; for instance, the excretions of the fœtus, such as the sweat and urine; for although these are contained in their proper receptacles and membranes, yet some degree of moisture may be communicated to the uterine aperture, especially as it lies low, and always in the immediate neighbourhood of these humours; added to which, mucous and slimy matters are always found about the orifice.” But in my opinion this great man is wrong; for the neck of the uterus is not hard from being folded on itself, but in consequence of its own proper substance and cartilaginous nature; and the accidental causes which he gives can have but little weight towards furthering the dilatation. This, doubtless, like every other contrivance in the human body, is owing to the divine providence of Nature, which directs her workmanship to certain ends, actions, and uses. The structure, then, of the uterus is such, that immediately on conception it shuts up closely its cartilaginous aperture, for the purpose of retaining the seed; this part subsequently, at birth, and that the fœtus may escape, like fruit on the tree, comes to maturity and softens, and this not by any unfolding of its tissue, but by a change in its natural character. For a loosening and softening takes place even in the commissural attachments of bones, as in those between the haunches and the sacrum, the pubes, and the pieces of the coccyx. It is a truly wonderful thing that the little point of a sprouting germ, say of the almond or another fruit, should break the shell which a hammer can scarcely crush; or that the tender fibres of the ivy-root should penetrate the narrow chinks of the stone, and at length cause rents in mighty walls. But it does not appear so marvellous that the parts of the woman, when distended by labour, should recover their natural firmness, if we consider the state of the male organ in coition, and how soon it subsequently becomes soft and flaccid. A greater matter for wonder is it, and surpassing all these “foldings,” that the substance of the uterus, as the fœtus increases, not only is day by day enlarged and distended or unfolded, as it were, to take Fabricius’s notion, but that it should become more thick, fleshy, and strong. We may even, with Fabricius, marvel still more at the means by which the mass of the uterus, by the intervention of the ordinary lochial discharges, returns to its original size in so few days; for this is not the case with other tumours or abscesses; these require a longer period for dispersion, being made up of unnatural matters, and such as require digestion, a process opposed to the power of expulsion. Yet this is not more worthy of admiration than the other works of nature, for “all things are full of God,” and the Deity of nature is ever visibly present.

In the last place, it is object of great wonder to Fabricius how those vessels of the fœtus (meaning the oval opening out of the vena cava into the pulmonary vein, and the duct from the pulmonary artery into the aorta, on which subjects I have entered fully in my Essay on the Circulation of the Blood) immediately after birth begin to shrivel up and become obliterated. He is driven to that reason given by Aristotle,[373] and already cited by me, which is, that all parts are made for a certain function, and if the function ceases to be required that they themselves disappear. The eye sees, the ear hears, the brain perceives, the stomach digests, not because such characters and structures (naturally) belong to these organs; but they are endowed with such characters and structures to accomplish the functions appointed them by nature.

On grounds like these it would appear that the uterus holds the first place among the organs destined for generation; for the testicles are made to produce semen, the semen is for the purposes of intercourse, and coition itself, or the emission of the semen, is instituted by nature that the uterus may be fecundated and generation result.

I have said before that an egg is, as it were, the fruit of an animal, and a kind of external uterus. Now, on the other hand, we may regard the uterus as an egg remaining within. For as trees are gay with leaves, flowers, and fruit at stated periods, and oviparous animals at one time conceive and produce eggs, at another become effete, so that neither the “place” or the part that contained them can be found, so have viviparous animals their spring and autumn allotted them. At the season of fecundation the genital organs, especially in the female, undergo great changes, so much so that in birds, the ovary, which at other times is scarcely visible, now becomes turgid; and the belly of the fish, near about the time of spawning, far exceeds in bulk the rest of the body, owing to the enormous number of ova and the quantity of semen contained within it. In very many viviparous animals the genital organs, that is, the uterus and spermatic vessels, are not always found presenting the same mode and course of action and structure; but as they are capable or not of conception, so changes take place, and to such an extent that the organs can hardly be recognized as the same. In nature, just as there is nothing lacking, so is there nothing superfluous; and thus it happens that the organs of generation wither away and are lost when there is no longer any use for them.

At the period of coitus in the hare and mole, the testicles of the male become visible, and in the female the horns of the uterus appear. In truth, it is most marvellous to see what an enormous quantity of semen is contained in full-grown moles and mice at those times, whilst at others no semen can be seen, and the testicles are shrunk and retracted. So also when the reproductive faculty ceases in the female, the uterus is found with difficulty, and it is scarcely possible to distinguish the sexes.