situation of the orifice of the urethra; sometimes it opens in the
perinæum, occasionally on the dorsum of the penis, and frequently
underneath. Mr. _John Hunter_ was consulted by a person, who expressed
great anxiety to have children, but whose urethra opened into the
perineum, he therefore recommended him to inject by means of a syringe,
previously warmed, the semen into the vagina, _post coitum_, and during
the existence of the orgasmus venereus; the wife, it is said, became
pregnant, and Sir E. _Home_ observes, that no doubt was entertained by
Mr. _Hunter_, or the husband, that the impregnation was entirely the
effect of the experiment. It would appear that _emissio seminis in
vaginam_ is in some cases all that is required for impregnation, and
therefore provided the orifice of the urethra be situated in a part of
the penis that enters the vagina, any unusual deviation in its direction
may not be material; nay farther, in some instances _emissio sine
penetratione_ has appeared sufficient;[303] many cases are recorded in
which the hymen was entire at the time of delivery;[304] and Dr.
_Huxham_[305] relates an instance of pregnancy, where from the
preternatural formation of the female genital organs, it was impossible
that the act of copulation should ever have been completed. A contracted
state of the Prepuce, or _Phymosis_, may so interfere with the discharge
of the seminal liquor, as to constitute a cause of impotence,
(_Dyspermatismus Præputialis_, Culleni) an operation, however, will
always in such cases remove the impediment.[306] By some authors the
undue dimensions of the penis have been classed under the causes of
impotence, but upon this point we would observe that the case already
cited from Mr. _Wilson_, p. 201, clearly shews that exception ought not
to be taken against mere diminutiveness[307] of structure; extraordinary
dimensions in length and thickness may certainly prove a cause of
_relative_ impotence; there are besides certain enlargements in the
neighbouring organs which may afford obstacles to the venereal congress,
as remarkable obesity,[308] scrotal hernia, and hydrocele.
It has been a question to what extent the penis might be mutilated,
without the extinction of virility: repeated instances have occurred
where the _glans_ has been lost, and yet the individual has retained his
faculty of procreation. _Piazzoni_[309] relates a case where both the
_corpora cavernosa_ were destroyed, but as the canal of the urethra was
preserved, the person could perform the act of coition without
difficulty. _Franck_[310] also states an instance in which so
considerable a portion of the penis had been carried away by a musket
shot, that when the wound healed, the organ remained curved, and yet it
proved adequate to the performance of its functions.
A Paralysis affecting the muscles of the penis is not a disease of very
rare occurrence; it may depend upon various injuries of the nervous
system, and while it remains, it is unnecessary to say that the penis is
incapable of performing those sexual functions for which it is
constructed, constituting the _Anaphrodisia Paralytica_ of Dr. _Cullen_.
The continued erection of the penis (_priapism_) is sometimes the result
of morbid irritation,[311] and occasions a temporary impotence, (the
_Dyspermatismus Hypertonicus_ of _Cullen_) in consequence of the urethra
being so closely shut up by the vigour of the erection, that the powers
which throw the semen from the _vesiculæ seminales_ are unable to
overcome it; gentle evacuations and a slender diet are the best remedies
in such a case. Strictures in the urethra, or morbid affections of the
prostate glands, may occasion a similar inconvenience, (_Dyspermatismus
Urethralis_) and we perhaps ought to enumerate extreme costiveness under
the same division of the subject.
IN FEMALES.
Adhesion of the Labia may take place in adult women from inflammation;
in consequence of which the due secretion of mucus with which these
parts are naturally clothed on their internal surface is prevented; or
it may arise from the neglect of accidental excoriation. In children the
labia frequently cohere in such a manner as to leave no vestige of a
passage into the vagina, except at the anterior part for the discharge
of urine; the disease, whenever it may occur, is easily and safely
removed by the knife.[312] In some cases hard labour has given rise to
preternatural union of the labia.[313]
In cases of ulceration, where due care has not been taken to prevent the
surfaces from remaining in contact with each other, the opposite sides
have adhered so as to obliterate the passage; Schirrous and steatomatous
tumours,[314] and polypi may also occupy the cavity of the vagina: in
certain cases these may be removed with safety,[315] in others some
hazard[316] will attend the operation. There is sometimes a faulty
organization of the vagina itself, it may be too short, and too
narrow,[317] (_Arctitudo_.) Inversion or Prolapsus is perhaps one of its
most common diseases;[318] in some rare instances the passage has been
obliterated by the _Clitoris_, elongated and enlarged in such a manner
as to equal the size of the penis, when it constitutes one of those many
peculiarities which have been mistaken for an Hermaphrodite.
The membrane called the _Hymen_ has been found of so strong and
ligamentous a texture, that it cannot be ruptured, and consequently
prevents venereal congress. Ambrose _Paré_ relates the case of a young
woman, whose hymen was as strong as parchment, which he was obliged to
cut with the scissars, before coition could be effected; a more recent
case is recorded in which the density of the membrane was so
considerable as to require the application of a trocar.[319]
With respect to the incompatible locality of the vagina, a malformation
which occasionally occurs, it is only necessary to allude;[320] the
medical judgment upon it must be directed by the circumstances of each
particular case.
Where irritability of the sexual organs exists to such a degree as to
occasion insufferable pain at the moment of coition, it must be regarded
as a source of impotence.[321] It may depend upon various causes; Dr.
_Cockburn_[322] relates a case of this kind which depended upon internal
piles, and which was cured by their removal. Mr. Anthony _White_[323]
has published three very interesting cases, in which the pain which
accompanied the attempt at coitus was so acute, that the women rarely
escaped fainting; upon examination he discovered in each of them a small
fistulous opening, leading into a sinus of at least two inches and a
half in length; the disease was attributed in each instance to a local
injury having some years previously occasioned an abscess in those
parts; the painful state of the vagina was entirely and permanently
cured by dividing the sinus.
2. _Functional Causes of Impotence._
Repeated intoxication, and vicious indulgences, may so debilitate the
constitution in general, and the organs of generation in particular, as
to render the debauchee wholly incapable of venereal congress; such
impotence however is not to be regarded as permanent; bark, steel, the
cold-bath, and above all, a change of habits may restore the patient to
the full possession of his powers. There is a peculiar species arising
from debility which deserves some notice in this place; it depends upon
a want of consent between the immediate and secondary organs of
generation; thus the penis acts without the testicles, and becomes
erected when there is no semen to be evacuated; while the testicles
secrete too quickly, and an evacuation takes place without any erection
of the penis. Under the consideration of constitutional causes, we must
not omit to enumerate the occurrence of Epilepsy: there can be little
doubt, but that in certain cases, the venereal orgasm has excited an
attack of this disease, and prevented the consummation of the act; we
are therefore bound to recognise it as an occasional cause of impotence,
and Dr. _Cullen_ has accordingly considered it as forming a distinct
species, under the title of DYSPERMATISMUS _Epilepticus_.
The operation of certain powerful narcotics may be likewise regarded as
capable of producing impotence, and cases are recorded where impotence,
so occasioned, has become permanent;[324] much credulity, however, has
existed upon this subject; the anaphrodisiac powers of Camphor were long
believed, and is one of the vulgar errors noticed by Sir Thomas
_Brown_;[325] and Amurath the IVth published an edict which made smoking
tobacco a capital offence: a measure which was founded on an opinion
that it rendered the people infertile;[326] equally gratuitous are the
different opinions which have been advanced respecting the aphrodisiac
virtues of particular substances; one of which, from the extent to which
it is believed, and the authority by which it is countenanced, deserves
to be noticed on this occasion; we allude to the popular notion that a
fish diet contributes to increase fecundity; and we are not a little
surprised to see it sanctioned by such a writer as _Montesquieu_, who
observes, that “the regimen of certain monks seems to be wholly
repugnant to the intention of their founders.” The same belief is very
generally entertained in fishing towns, in consequence of the great
population of such places, but surely the fact admits of easy
explanation upon that general principle in political economy, which no
one will attempt to deny, that the number of marriages will be in
proportion to the facility with which children can be supported.
A blow on the head may also deprive a man of his virility; a case of
this kind is related by _Hennen_, in his Military Surgery, where a
soldier became so affected in consequence of a fracture of the occipital
bone, by the fragment of a shell.
3. _Moral Causes of Impotence._
A temporary impotence from certain emotions of the mind is by no means
so rare an occurrence as may be supposed; and in times of superstition
was generally attributed to the influence of some magical incantation;
an opinion which was even maintained by _Zacchias_, _Teichmeyer_, and
_Schurigio_, but which it is hardly necessary to add, has been
reprobated by _Vogel_, _Cullen_, and all modern authorities. Where this
occurs it is often productive of the greatest distress of mind, and has
not unfrequently led the unfortunate sufferer to the commission of
suicide. Mr. _Hunter_[327] has treated this subject with his accustomed
sagacity, and relates a successful mode of treatment; he prevailed on a
person in this situation to promise on his honour to pass six nights in
bed with a young woman without attempting to have any connection with
her, whatever might be his power or inclination; he afterwards assured
_Mr. Hunter_ that his resolution had produced such a total alteration in
the state of his mind, that the power of connection soon recurred, for
instead of going to bed with the fear of inability, he went with fears
that he should be possessed with so much desire, and so much power, as
to become uneasy to him, which really happened; and having once broken
the spell, his mind and powers went on together, and they never relapsed
into their former state of imbecillity.
Disgust is also a frequent cause of temporary impotence “Morositas,
Contemptus, Iræ, Tristitia, Corporis immundities ac fætor, venerem
primario supprimunt.”[328] The imagination[329] is sometimes the cause
of temporary impotence, with regard to particular females, as
exemplified in the famous case of the _Earl of Essex_ and _Lady Frances
Howard_, in 1613, in which the marriage was declared void, because the
Earl, on his own confession, was impotent with regard to his lady,
(_erga hanc_) although he had no defect or impediment, and was able to
copulate with other women.
We have thus related the principal causes of Impotence in the sexes; it
would be as idle to dwell upon the absurdity of the opinions which
attach any weight to astral influence, as it would to refute the idea,
that suggested the custom so universally observed by the Scythians, and
which is even followed at this day by the natives of some of the South
sea islands, of cutting the veins behind the ears, in order to render
the males impotent, and the females sterile.
2. _STERILITY._
Sterility occurs more frequently in the female, than impotence does in
the male sex.
Its causes may be distinguished into those that arise from imperfect
structure, and into those that entirely depend upon a morbid performance
of certain functions.
1. _Organic Causes._
_Absence of the uterus._ We have before alluded to this occasional
defect; it has sometimes occurred, where the vagina has been wholly
impervious.[330] _Columbus_ dissected a woman who had always complained
of great pain _in coitu_, in whom he found the vagina very short, and no
uterus at its termination. In _Hufeland’s_ German Journal[331] for May
1819, a case is related of a total deficiency of the uterus, which was
discovered by Professor _Stein_ during an operation undertaken to remedy
a supposed contraction; in this paper the author quotes several
analogous cases from the writings of _Engel_, _Schmuker_, and _Theden_.
_Imperforated uterus._ The os uteri, says Dr. Baillie, has been found to
be so contracted as to have its passage in a great measure obliterated;
and it has even been known to be closed up by the growth of an
adventitious membrane. The _os tincæ_ may be also shut up, either
originally, or by cicatrix, in consequence of suppuration, laceration,
ulceration, or the like, when the case may be considered as incurable,
unless the menstrual discharge force a passage by its pressure, or the
introduction of a trochar is able to afford an opening[332]. Original
conformations of this kind seldom admit of any cure, for besides the
impervious state of the _os tincæ_ it not unfrequently occurs that the
uterus itself appears as a solid body, without any cavity in its
centre.[333] _Morgagni_ states that he was consulted by a barren woman,
whose vagina was only a third part of the usual length, and that its
termination felt firm and fleshy, in which case he advised a dissolution
of the marriage. _Marchetti_, on the contrary, has given a case where
the vagina ran downwards beyond the internal orifice of the uterus, and
terminated in a kind of cul de sac.
_Polypus in utero._ This may be sometimes removed by exsection; a
valuable paper upon this subject by _M. Deguise_ is to be found in the
_Nouveau Journal de Medicine_, entitled “Observations des Polypes
Uterines,” in which the author relates many successful cases, and
controverts the common opinion, that after the operation for an uterine
polypus, the organ is incapable of being impregnated.
_Ovaria, absence of, or diseased condition of._ There is a specimen in
Dr. Hunter’s museum, in which one ovarium is wanting; other instances
have been recorded in which no vestige of an ovarium could be observed
on either side.[334]. The case of this kind published by Mr. _Pears_ in
the Philosophical Transactions for 1805, we have before described: to
this may be added another instance from the writings of _Morgagni_.
Instances of diseased ovaria are very common, and may arise from a
variety of causes: the _Fallopian tubes_ may also, in consequence of
peritoneal inflammation, become obliterated, and lose the power of
conveying the ovum from the ovarium to the uterus; they may besides be
originally defective in structure; Dr. _Baillie_ has seen them, without
any aperture, or _fimbriated_ extremity, terminate in a cul-de-sac.
_Morgagni_ noticed these tubes in some courtesans having been entirely
obliterated by the thickening of their parietes; an evident consequence
of the habitual orgasm in which they had been kept by too frequent
excitement. _Richerand_ on dissecting a subject at La Charité that had
been sterile, found the fringed margins, or expanded extremities of the
tubes, adhering to the lateral and superior parts of the pelvis, so that
it had been impossible for them to perform the motions necessary for
fecundation.
2. _Functional Causes._
These are constitutional debility, leucorrhœa, or an excess, or
deficiency of the menstrual discharge. Observation has fully established
the fact, that women who do not menstruate cannot conceive; this
discharge appears to be essentially necessary for the due and healthy
state of the uterus, and Dr. _Denman_[335] has also observed that in
cases of painful menstruation, a membranous substance is often
discharged, and that no woman, in the habit of forming such a membrane
has been known to conceive, although, he adds, that as it is not
uninterruptedly formed at each period of menstruation, the capability of
conceiving may exist at any interval of freedom from its formation.
Women who are very corpulent are often barren, for their corpulence
either exists as a mark of weakness of the system, or it depends upon a
want of activity in the ovaria; thus spayed, or castrated animals
generally become fat.
A state of exhaustion of the uterine system, occasioned by frequent and
promiscuous intercourse with the other sex, is also a very common cause
of barrenness in women, and hence few prostitutes conceive.
In some cases the uterine system is capable of being acted on by the
semen of one individual, but not by that of another, for many instances
are on record where persons have lived in wedlock without offspring, and
being, after divorce, re-married, have each had families.
3. OF THE LEGITIMACY OF CHILDREN.
The validity of Marriage considered on medical grounds being
established, the next point to be considered in the same light is the
legitimacy and illegitimacy of children, as it may legally affect their
rights to succession and property[336]. On this point the laws of
England are most indulgently favourable to the child, for provided “it
be born though not begotten in lawful wedlock,” (1 _Bl. Com._ 454.) the
law will presume its legitimacy, (5 _Rep._ 98.) (_præsumitur pro
legitimatione_). But this presumption may be rebutted by evidence. “As
if the husband be out of the kingdom of England (or as the law somewhat
loosely phrases it, _extra quatuor maria_[337]) for above _nine_ months,
so that no access to his wife can be presumed, her issue during that
period shall be bastards.” (1 _Bl. Com._ 454. 457. _Co. Litt._ 244.) but
it was held that if the husband was in England during any part of the
time between the conception and the birth (without any reference to the
physiological impossibility of the fact) the child would be deemed
legitimate (_Rex v. Alberton._ 1 _Raym._ 395.) If the husband be proved
castrate the issue are bastards (1 _Ba. Ab._ 310. _Rolle Ab. tit.
Bastard_, 356.) But though the husband were divorced from his first wife
_causa frigiditatis_, yet his issue by his second were adjudged
legitimate, (5 _Rep._ 98.) and this is reasonable, for there may be an
_impotentia erga hanc_, from various causes; (_vide post._) If a man
marries a woman who is pregnant, he is generally to be supposed
cognisant of the fact, and that he is the father of the child; and the
law which regards the time of birth, and not of conception, pronounces
it legitimate. But the husband may have been imposed upon, and utterly
ignorant[338] of his wife’s state. A man returning from abroad (to put
the case of non access more strongly) marries immediately on his
arrival; within four or five months his wife is delivered of a perfect
child which lives, shall such child inherit? on the one hand _Præsumitur
pro patre quem nuptiæ demonstrant_, on the other, the ordinary course of
nature prohibits the supposition that the child can be the offspring of
the husband. But see _Rolle Ab. tit. Bastard_, p. 358, where the woman
was _grossement enseint_ the issue was held _un mulier_, and contrary
decisions cited there: see also _Foxcroft’s Case, Rolle_, 359, & _sec._
45. So also a man may purposely marry a pregnant woman to disappoint his
supposed heir at law; on the other hand a woman may for some purpose of
malignity bastardize her offspring, as was the case of _Savage_ the
poet.[339]. But none can be legitimate who are born out of wedlock; in
which our law differs materially from the Roman or Canon law, and it is
somewhat singular that the celebrated[340] “_quod nolunt Leges Angliæ
mutare_” of the Barons, at the Parliament of Merton, in the 20th of
_Henry_ the 3d, should have been induced by an attempt on the part of
the bishops, (_omnes episcopi magnates_) to introduce this novelty,—that
children born before marriage should be legitimised by the subsequent
performance of the ceremony between their reputed parents. There may
indeed be a few instances where illegitimate children have been
legitimised by Act of Parliament[341], but though such legislative
interference might in some cases of extreme doubt and hardship be deemed
not only excusable, but desirable, the present feeling appears to be so
strong against such Acts, that the rule of Law may be considered as
among the most fixed; yet there are some points which may yet receive
considerable elucidation from the studies of the physiologist, and these
will resolve themselves into several questions, (_vide post._)
For the legal authorities on this subject we cannot do better than refer
the reader to the very learned note of Mr. _Hargrave_ in his valuable
edition of _Coke Littleton_, and to the same subject in his
_Jurisconsult Exercitations_, vol. 3. p. 411; but as these may not be of
easy access to our medical readers we have added a full extract of them
in the _Appendix_, p. 209.
SUPPOSITITIOUS CHILDREN.
But there is yet another question which may, and in truth frequently
does occur; where either a pretended pregnancy is followed by the
grosser fraud of imposing a strange child upon the husband, either for
the purpose of fixing his affection, or securing his estate; or where a
living and healthy child is substituted for one either dead, or too
sickly to give reasonable hope of prolonged existence. To this crime our
laws assign no specific punishment; the parties can only be indicted for
a conspiracy as they might have been for any ordinary misdemeanor; the
real punishment falls on the unconscious instrument of the wrong,[342]
the child, who having been educated in every indulgence that affection
and affluence could bestow, finds itself on the exposure of a vindictive
menial, without name, hope, or fortune; abandoned by its assumed, it may
be unable to trace its real parents, yet the authors of this irreparable
wrong have generally escaped even the inadequate punishment to which
their crime had subjected them. Those who are curious to inform
themselves of the doubts and difficulties with which such questions are
entangled, will do well to consult the proceedings in the celebrated
Douglas case,[343] than which few have ever excited so much difference
of opinion on the bench, or so much intensity of interest in the public
mind. The Anglesea case also, with the several trials connected with
it,[344] is well worthy of perusal by those whom interest or curiosity
may lead to this species of investigation.
We should not have alluded to personal resemblance[345] between parents
and children, as a mode of proof in these cases, first, as we have
doubted whether such proof can be satisfactory, and secondly, as it may
not be considered a point of medical evidence; but as to our first
doubt, we find that so high an authority as Lord _Mansfield_ thought
that a family likeness was a material proof that a child was the genuine
offspring of the parents through whom he claimed. His lordship in
delivering his judgment in the House of Lords on the Douglas cause, is
reported to have said, “I have always considered likeness as an argument
of a child’s being the son of a parent; and the rather, as the
distinction between individuals in the human species is more discernible
than other animals[346]: a man may survey ten thousand people before he
sees two faces perfectly alike; and in an army of a hundred thousand men
every one may be known from another. If there should be a likeness of
feature, there may be a discriminancy of voice, a difference in the
gesture, the smile, and various other characters; whereas a family
likeness runs generally through all these, for in every thing there is a
resemblance, as of features, size, attitude, and action. And here it is
a question, whether the appellant most resembled his father Sir _John_,
or the younger _Sholto_ resembled his mother Lady _Jane_? Many witnesses
have sworn to Mr. _Douglas_ being of the same form and make of body as
his father; he has been known to be the son of Colonel _Stewart_, by
persons who had never seen him before; and is so like his elder brother,
the present Sir _John Stewart_, that except by their age, it would be
hard to distinguish the one from the other.”
“If Sir _John Stewart_, the most artless of mankind, was actor in the
_enlevement_ of _Mignon_ and _Saury’s_ children, he did in a few days
what the acutest genius could not accomplish for years; he found two
children, the one the finished model of himself, and the other the exact
picture in miniature of Lady _Jane_[347]. It seems nature had implanted
in the children what is not in the parents; for it appears in proof that
in size, complexion, stature, attitude, colour of the hair, and eyes,
nay in every other thing, _Mignon_ and his wife, and _Saury_ and his
spouse were, _toto cœlo_, different from and unlike to Sir _John
Stewart_ and Lady _Jane Douglas_.” 2 _Collec. Jurid. p._ 402.
A painter or a sculptor would be more competent to decide a question of
this nature than a physician or surgeon, but in their absence there is
none on whose testimony we can more safely rely than on the medical
witness, whose habits of observing the formation, changes, and
peculiarities of the human body, naturally prepare him for such
examination.
It has been supposed that an experienced surgeon or midwife might be
able to determine whether a newly born infant was the child of a
particular woman, both being submitted to their examination; but this
mode of proof, fallacious as it must always be, can be of no possible
value, unless the investigation take place within a very few days of the
supposed delivery; and even then it goes no further than to determine
that the birth and delivery have been nearly cotemporaneous, a result
not inconsistent with the supposition that the infant is the child of
some other woman, and substituted for one dead, unhealthy, or of the sex
incapable of succession.
In ordinary cases this early inspection is not likely to take place, as
in the lifetime of both parents the heir presumptive seldom has a
summons to view proceedings; but in the case of a pregnant widow, and
especially where there has been a question _de ventre inspiciendo_, it
is otherwise, and it then becomes a point of duty in all parties, to
obtain the most satisfactory evidence.
A yet more important occasion occurs at the birth of princes; whose
entrances and exits are equally subject to question, whenever a disputed
succession or an impatient heir give rise to speculation. In England and
elsewhere precautions are taken which are as offensive to female
delicacy as they are ineffective to the demonstration of truth. The
chamber of a pregnant princess, at the moment when quiet is most
necessary, is crowded with officers of state and lords of the household;
yet we need not remind the reader of all the questions which have,
however foolishly, been raised on the supposititious births of princes;
for the evidence on the birth of Prince _Charles Edward_, see 12 _Howel.
St. Tri._ 123. We need only observe that imposition is best practised by
skilful jugglers in a crowd, and without disrespect to those learned and
reverend personages, we may doubt whether the Archbishop of Canterbury,
or the Lord High Chancellor, can be as effective at an _Accouchement_,
as the President of the College of Physicians, or the Master of the
College of Surgeons.
TENANT TO THE COURTESEY.
Whether a child, born under certain circumstances, was or was not born
alive, is a frequent and important question on the right of the father
to the tenant of the courtesey; and as it is naturally connected with
the doctrine of gestation, will be partly considered here, though the
external signs of incipient and independent vitality will be more fully
treated of under the head of Infanticide.
[348]“Tenant by the courtesie of England is where a man taketh a wife
seized in fee simple or in fee taile general, or seized as heir in taile
especial, and hath issue by the same wife, male or female, born alive
(_oyes ou vife_), albeit the issue after dieth or liveth, yet if the
wife dies the husband shall hold the land during his life by the law of
England, and he is called tenant by the courtesie of England, because is
this used in no other realme but in England onely.[349] And some have
said that he shall not be tenant to the courtesie unless the childe
which he hath by his wife be heard crie[350]; for by the crie it
proved[351] that the child was borne alive. Therefore Quære.”[352] _Co.
Litt._ 29. 30.—Here therefore is another occasion[353] where Medical
Evidence may be useful or necessary, and it cannot be too often forced
on the attention of practitioners, who at the expiration of many years
may be called upon to give testimony, very frequently affecting property
of considerable magnitude, that they should on all occasions make
sufficient notes of the births which they attend, the circumstances
which they have observed, and the number and descriptions of the persons
present, who may at a future period be called to corroborate their
testimony. We have known an instance where the books of a surgeon
attending a then obscure individual, became necessary evidence before
the highest tribunal of the land towards determining the right of
peerage.
Foreign jurists have doubted whether a child extricated by the Cæsarian
operation[354] is capable of succession. “Illud autem valde controversum
est inter jurisconsultos, an is qui editus est execto matris ventre
reputetur partus naturalis et legitimus et successionis capax.”
(_Caranza de partu naturali et legitimo._ _p._ 427). And though the
question is now decided in the affirmative, some nice points may yet
arise,[355] if not for the instruction of the jurist at least for the
amusement of the casuist.
OF MONSTERS AND HERMAPHRODITES, LEGALLY CONSIDERED.
It will be seen by the note from _Co Litt_, quoted under the preceding
head, that by the law of England a monster cannot inherit; but the
question as to what constitutes a monster is left vague and
undetermined. It can seldom have been necessary to agitate this point,
since few well attested instances are recorded of any monster, which has
materially deviated from the human form,[356] having long survived its
birth. Some curious instances, however, have occurred of twins who,
having become united in the womb by an obvious operation of nature,[357]
have lived for several years.[358] Whether each body should possess
separate legal rights would probably be determined by the question
whether each possessed the vital organs necessary for a separate
existence, if, bating the danger of the operation, they could be
corporeally severed. Is it necessary to inform the midwife that he is
not authorised to destroy any production however monstrous![359]
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.
At about the _Fourth_ month after conception, that stage of
utero-gestation arrives, which enables us, by means of an external
examination, to place the fact beyond the reach of conjecture; for at
this stage the uterus may be distinctly felt through the integuments of
the abdomen; nor are we able before this period to determine the
question by any examination _per vaginam_, for the _fundus_ uteri is the
portion first distended in consequence of conception; while the
_cervix_, the only part that we can feel, does not begin to shorten to
any appreciable extent, before the period just stated.[373]
The following method of examining the uterus, in order to ascertain
whether it be gravid, is proposed by _Tortosa_,[374] and is well
calculated to accomplish the object. The woman, being fasting, and her
bowels and bladder having been previously evacuated, should be directed
to lie down, with the loins low, and with the head and buttocks
elevated; the knees are then to be raised and bent, so as to bring the
thighs to the belly, and the heels to the buttocks, by which position
the abdominal integuments will be relaxed; the midwife is then to place
the hand upon the epigastric region in such a manner that the little
finger may rest on the pubes, and the thumb on the navel, and ordering
the woman to breathe hard, he must press the belly gently during the
expiration: if the uterus be gravid, and is more than three months
advanced, he will at this moment feel above the pubes an equal, hard,
globular body; and if the same examination be made after the fifth month
of gestation, he will probably feel at the same time the motions of the
fœtus; but, in cases where no tumour can be distinctly felt, the
operator must be very careful not to be deceived by motion, for the
action of flatus may mislead him, and even where an obvious enlargement
exists, the pulsations of the aorta may lend to it a deceptive motion;
this is particularly striking where the ovarium is extensively diseased,
or the uterus is distended with tumours, an occurrence which has not
unfrequently induced the patient to consider herself pregnant;[375] in
such a case the ovarium may be felt through the parietes of the abdomen,
sometimes pretty high, like the uterus, or like a prominent part of a
child, but the round and circumscribed nature of the tumour can never
deceive an experienced midwife. _Avenzoar_, however, has left a
confession that he was deceived about his own wife, whom he had treated
as dropsical, though she had passed her fourth month of pregnancy.[376]
We ought also to state that dropsy and utero-gestation may be
coexistent, and there are unfortunate cases on record where, on such
occasions, women have been sacrificed by the mistaken application of the
trocar.
In order to ascertain the exact state of the _os uteri_, an examination
must be made _per vaginam_, which may be conveniently effected while the
woman remains in the same position, by introducing the fore and middle
fingers of the right hand. For the first three months the _os tincæ_
feels smooth and even, and its orifice is nearly as small as in the
virgin state; when any difference can be perceived, it will consist in
the increased length of the projecting tubercle of the uterus, and the
shortening of the vagina from the descent of the fundus uteri through
the pelvis: this change in the position of the uterus, by which the
projecting tubercle appears to be lengthened, and the vagina
proportionally shortened, chiefly happens from the third to the fifth
month. The following is another mode of examination proposed by the
anatomist _Petit_,[377] and sanctioned by _Puzoff_,[378] and which, with
some slight and unimportant difference, coincides with that recommended
by _Morand_[379] and _Baudelocque_.[380] The woman having been placed in
the position above described, two fingers are to be introduced into the
vagina, so far as to touch the orifice of the uterus; and at the same
time, the other hand is to be applied to the abdomen; the operator is
then to press internally with his fingers, so as to raise the uterus,
and then lower it again by pressing on the abdomen with the other hand;
if by such alternate movements a solid resistance is felt, without
fluctuation, we may be assured that the uterus is gravid.
As utero-gestation advances, the question of pregnancy becomes, of
course, less equivocal; for the progressive increase of the abdominal
tumour, from the stretching of the fundus uteri, affords a mark too
decisive to be easily mistaken. About the _sixteenth_ or _eighteenth_
week after conception, the uterus suddenly ascends from the pelvis into
the abdomen, a change which is attended with a very peculiar sensation
to the woman, and is erroneously called _Quickening_,[381] from its
having been supposed to arise from the first motions of the fætus in
utero, which was imagined at this period to receive the essence of
vitality; the law of England still sanctions this hypothesis as a
principle by which the degree of criminality[382] in cases of _Abortus
procuratus_ is determined, and according to which the plea of pregnancy
in bar of punishment is either admitted or rejected.[383]
The physiologist is now satisfied that the sensation has no relation
either to the life, or to the motions of the fætus, but is solely
attributable to the _sudden_ change in the position of the uterus; nor
is there any difference between the aboriginal life of the child, and
that which it possesses at any period of pregnancy, though there may be
an alteration in the proofs of its existence by the enlargement of its
size, and the acquisition of greater strength. The feeling of
_Quickening_ is very different from any that is excited by the
subsequent motions of the child; it more nearly resembles that which is
occasioned by terror or agitation from any other cause, and is often
followed by Syncope, or Hysteria; we shall indeed cease to be surprised
at this effect when we consider that from the uterus thus changing its
situation, a very considerable pressure is suddenly removed from the
Iliac vessels, in consequence of which the blood rushes to the lower
extremities, and a temporary exhaustion of the vessels of the brain, and
a general loss of balance in the circulating system, are the results. In
some women the motion is so obscure as not to occasion any distress, and
where the ascent of the uterus is gradual, it is often not felt at all.
In the _fifth_ month, the abdomen swells like a ball with the skin
tense; the fundus uteri now extends about half way between the pubes and
umbilicus, and the cervix is sensibly shortened; in the _sixth_, the
upper edge of the fundus is a little below the umbilicus; and in the
_seventh_ the fundus, or superior part of the uterine tumour, advances
just above the umbilicus, and the cervix is then nearly three-fourths
distended; in the _eighth_ it reaches midway between the navel and
_scrobiculus cordis_ itself, the neck being then entirely distended:
thus at full time the uterus occupies all the umbilical and hypogastric
regions, although a short time before delivery it subsides to where it
was between the _seventh_ and _eighth_ month.
Of PARTURITION, or _Delivery_.
The term of utero-gestation is limited by nature to nine calendar
months, or _forty weeks_, at the expiration of which, the process of
labour usually commences; ingenious theorists have endeavoured to
discover the principle of the expulsatory action of the uterus, and to
assign the reason of its taking place at a stated period, but after all
the subtle ingenuity which has been displayed upon this occasion, it is
doubtful whether we are prepared with a better solution of the problem
than that furnished by the physiologist in the time of _Avicenna_, who
declared that labour came on at the appointed season, _by the command of
GOD_. We shall therefore pass over the question without farther
discussion, and proceed to the investigation of those practical parts of
the subject, which are highly interesting on account of their numerous
and important relations to medical jurisprudence; we propose, therefore,
to discuss the following questions in succession:
1. Whether a woman can be delivered during a state of insensibility, and
remain unconscious of the event?
2. How far the term of utero-gestation can be shortened, to be
compatible with the life of the offspring?
3. Whether to any, and to what probable or possible extent, the natural
term of utero-gestation can be protracted?
4. What is the value of those signs by which we seek to establish the
fact of a recent delivery?
5. Are there any, and what diseases, whose effects may be mistaken for
the traces of a recent delivery?
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?
7. What are the earliest and latest periods of life at which women are
capable of child-bearing?
8. What is the possible number of children that may be produced at one
birth?
9. Is _Superfœtation_ possible, and under what circumstances, and at
what period of gestation can a second conception take place?
10. What are the causes of _Abortion_?
11. Under what circumstances, and by what means, is it _morally_,
_legally_, and _medically_ proper, to induce premature _labour_?
12. What circumstances will justify the _Cæsarean operation_, and of
what value is the section of the Symphysis Pubis, or _Sigaultian_
operation?
Q. 1. _Whether a woman can be delivered during a state of insensibility,
and remain unconscious of the event?_
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.
2. The breasts are swelled, are harder than usual, and painful; and, in
some cases, lumpy to the touch, and emit, by pressure or suction, a
lactiform fluid; the nipples are thicker, and the areola, by which
they are surrounded, is widened in extent, and darkened in colour.
3. The abdomen is flaccid, and its skin lies in folds, and is traversed
in various directions with shining, reddish, and whitish lines, and
light-coloured broken streaks, which especially extend from the groins
and the pubes towards the navel.
4. There is an extraordinary swelling and tumefaction of the external
parts of generation; sometimes the anterior margin of the perineum is
lacerated, or it is very lax, from the distention which it has
undergone.
5. The vagina is preternaturally distended; the orifice of the uterus is
soft and open, and capable of admitting the point of the finger
without difficulty, as if a late discharge had been made from it; the
womb itself, not having properly collapsed, and resumed its natural
shape and dimensions, may be felt through the parietes of the abdomen,
voluminous, firm, and globular, contracting and expanding under the
hand, on pressure.
6. A discharge of serous fluid mingled with blood from the vagina,
called the _Lochia_, continues from five to thirty-five days after
delivery: it differs from the common menstrual flux in being paler,
but more particularly in its peculiar and characteristic sour odour;
at first this discharge is decidedly sanious, but in a few days it
becomes of a much paler and of a brownish, or a dirty green hue, so as
to acquire the common term of _green waters_.
In addition to these signs, _Michael Albertus_ mentions the hair falling
off from the pubes as a sign of delivery; it is hardly necessary to
caution the practitioner against relying upon any sign so extremely
uncertain and precarious.
Although the period during which the consecutive signs of delivery
remain evident, will vary in each case, yet as a general position we
must admit with _Zacchias_,[394] _Albert_, _Bohn_, _Foderé_, _Mahon_,
and _Belloc_, that after ten or twelve days, they may become too obscure
to afford unexceptionable evidence. This conclusion was sanctioned by
the _arrêt_ of the parliament of Paris, in the case of a woman of Mantes
accused of infanticide, who, in consequence of a conference with
_Antoine Petit_ and _Louis_[395] was pronounced innocent, upon the
ground of the woman not having been examined as to the fact of her
delivery, until after the expiration of a month. The criminal department
of the Seine acquitted a woman cook of the name of _Aimée Perdriat_,
charged with the perpetration of a similar crime, and of whose guilt no
reasonable doubt could be entertained, in consequence of the same defect
in the medical testimony.[396]
The relative value which each of the signs possesses, will be better
appreciated after we have considered the diseases whose effects may
resemble them; but as a general principle we are anxious to enforce the
necessity of always considering the consecutive signs of parturition
collectively, and not individually; under such circumstances the
practitioner can never be betrayed into an erroneous conclusion; for, as
_Professor Chaussier_ has remarked, “_no disease, or affection, besides
parturition, can possibly produce the whole series of signs above
described_.”
The secretion of milk, upon which such considerable stress has been laid
in ancient as well as in modern times, it is now admitted may take place
independently of pregnancy, and we are accordingly bound to reject the
aphorism of Aristotle, “_Lac habet, ergo peperit_.” In the _Causes
Celèbres_[397] there is an account of a girl, who, although a virgin,
suckled an infant; and in the _Sloane_ collection of manuscripts in the
British Museum, a case of a woman is related, who, although she had not
borne children for more than twenty years, actually suckled her
grand-children, one after the other, at the age of 68! but, what is
still more extraordinary, instances have occurred where men have been
able to perform this duty. The BISHOP OF CORK[398] has related a case in
which a man suckled his child after the loss of his wife; and in the
personal narrative of _Humboldt_ we have an analogous instance.[399]
Q. 5. _Are there any, and what Diseases, whose effects may be mistaken
for the traces of a recent delivery?_
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.
The time at which menstruation, and consequently child-bearing ceases,
will be materially influenced by that at which it commenced; with those
who commenced at ten or twelve, the discharge often ceases before the
age of forty; but where the first appearance has been protracted to
sixteen or eighteen, such women may continue to menstruate until they
have passed the fiftieth year; but in this climate the most usual period
of cessation is between the age of forty-four and fifty,[403] after
which women never bear children, although we have in ancient[404] as
well as in modern times, many extraordinary examples of protracted
fecundity, to which but little credit ought, in general, to be attached.
_Marsa_, a Venetian physician, relates a case of a woman who at the age
of sixty brought forth a daughter, and suckled her, and whom he had
previously treated for what he had considered to be ovarian dropsy; the
annals of our own country[405] would furnish some extraordinary
instances of a similar kind. _Dr. Gordon Smith_ illustrates the subject
by the case of the wife of a peruke-maker in Poland-street, in the year
1775, who at the age of fifty-four produced two sons and a daughter,
although she had been married for thirty years, and had never before
been pregnant.
It is probable that many of those “well authenticated instances” of old
women having menstruated, like those recorded of children, are merely
sanguineous discharges from the vagina, or from a diseased uterus; this
we have no doubt is the true explanation of the case related by
_Richerand_,[406] of a woman, who at the age of seventy had not ceased
to menstruate.
Q. 8. _What is the possible number of Children that can be produced at
one birth?_
According to the most accurate estimates, _Twin_ cases, on an average,
occur about once in ninety labours; _Triplets_ are considerably more
rare, they are stated not to take place more than once in three thousand
times; and the occurrence of four at a birth is so rare an event, that
no calculation has been formed upon the subject. The reader will find a
very interesting paper on the “_Plurality of Births_,” by _Dr.
Garthshore_, in the 77th volume of the Philosophical Transactions, to
which we beg to refer him. _Dr. Osborne_ states that he has distinctly
traced as many as six fœtuses in an abortion.
It is a curious fact that the relative number of males and females born
is nearly equal, there being only a small majority in favour of the
former, in the proportion of 21 to 20; in consequence of which both
sexes are equal at the age of 14, since more male children are
still-born, or die in infancy, than females, owing, as _Dr. Clarke_[407]
has supposed, to the relative size of the head, being greater in the
former. _Hufeland_[408] has collected the relative number of the two
sexes in all parts of the world, and has found them every where the
same. “It seems very singular,” says Sir _Gilbert Blane_,[409] “and at
the same time most admirable in the institution of Nature, that this
relative number of the sexes should be maintained, though the primordial
germs are mixed in different proportions in the ovaria of different
females; for it is well known that many women produce such a number of
children in succession, of the same sex, as is utterly irreconcileable
with the laws of blind chance, another word for mathematical necessity.”
The reader will also derive much pleasure by the perusal of a
memoir[410] upon this subject by _Dr. Arbuthnot_, entitled “_An Argument
for Divine Providence, taken from the constant regularity observed in
the birth of both Sexes_” from which the learned author deduces as a
scholium, that polygamy is contrary to the law of Nature and justice,
and to the propagation of the human species.
Q. 9. _Is Super-fœtation possible, and under what circumstances, and at
what period of Gestation can a second conception take place?_
The term _Super-fœtation_ implies that a second impregnation may take
place, whilst a child is in utero.
There are perhaps few questions relating to the subject of conception,
that have given origin to more rigorous controversy; and indeed its
important judicial bearings render it a subject of greater interest than
it could ever have become intrinsically as a mere object of abstract
speculation. Let us, for the sake of illustration, suppose the following
case:—A woman loses her husband suddenly, _tenant in tail male_, a month
after marriage, and at a little more than eight months after his decease
she is delivered of a perfect female child, and at nine months, she
declares that she is delivered of another infant, which is a male. The
heir at law, who has entered, contests the fact of this latter birth;
the question therefore to be determined is, whether such an event is
compatible with the known laws of utero-gestation.
The ancient physicians and philosophers undoubtedly believed in the
possibility of super-fœtation; and the Mythology contains a well
characterised example in the instance of Iphicles and Hercules, who were
begat upon Alcmæna, the former by Jupiter, and the latter by Amphitryon.
_Hippocrates_,[411] _Aristotle_,[412] and _Pliny_,[413] entertained no
doubt respecting the fact, and in later times we find that the most
eminent physiologists have sanctioned the same belief, and have been
engaged in recording facts in its support. _Gasper Bauhuin_[414] relates
a case in which a woman at the end of nine months brought forth a dead
child, with a deformed head, and that six weeks afterwards she was
delivered of a well formed child which lived. _Buffon_[415] presents us
with a still more striking example; a woman of Charles-town, in South
Carolina, was delivered in 1714 of twins, which came into the world one
directly after the other, but to the great surprise of the midwife, one
was black and the other white; the woman herself, considering this proof
of her infidelity too obvious to be denied, admitted the truth without
hesitation,—that shortly after having enjoyed the embraces of her
husband, a black servant entered her room, and by threats accomplished
his purpose. _Aristotle_[416] speaks of an adultress who produced at the
same birth two sons, the one of which resembled the husband, and the
other the lover; _Pliny_[417] also relates several cases of
super-fœtation, some of which are certainly no other than twin cases,
and the others are merely copied from Aristotle. _Musa Brassavolus_[418]
has the following remarkable observation upon the subject. “_Nos vidimus
super-fœtationem quandoque fuisse epidemicam affectionem._”
_Zacchias_[419] also believes in the phenomenon; and in the case of one
_Laurette Polymnie_, his testimony secured for her child the rights of
inheritance; _Harvey_[420] likewise relates a case of super-fœtation, to
which we beg to refer the reader; _Haller_[421] expresses his opinion in
the following words: “_Os uteri nunquam clausum est; ideoque potest
super-fœtari non solum a die sexto ad trigessimum, aut primis duobus
mensibus, sed omni omnino tempore._” _Zacchias_[422] however, thinks
that it can only take place in the first two months of pregnancy, for
that after this period, the developement of the fœtus renders it
impossible. _Plouquet_ observes, that immediately after a first
conception, a second may easily take place, but that after a few months
it can only occur under the most extraordinary circumstances. If time
and space would allow we might adduce a considerable mass of similar
testimony, but we shall conclude this part of the subject with the
opinion of _Kannegeiser_, “_De super-fœtationis existentia rationis
quippe principiis, atque infinitis hominum et brutorum exemplis abunde
comprobatu, Medicis atque jurisconsultis mens vix amplius hæret in
ambiguo._”[423] The best authenticated case of super-fœtation that has
occurred in our own times is that communicated to the College of
Physicians by _Dr. Maton_:[424] Mrs. T—— an Italian lady, remarkable for
her fecundity, was delivered of a male child at Palermo, on the 12th of
November, 1807, under very distressing circumstances, having been dropt
on a bundle of straw in an uninhabited room at midnight, and although
the infant at the time of his birth had every appearance of health, he
lived only nine days; on February the 2d, 1808, (not quite three
calendar months from the preceding _accouchement_) Mrs. T—— was
delivered of another male infant, completely formed, and apparently in
perfect health; the child however fell a victim to the measles at the
age of three months. _Dr. Granville_, in a paper entitled “On the
Mal-formation of the Uterine System,”[425] takes occasion to observe
with respect to the above case, that “it merely goes to prove the
occasional co-existence of separate ova in utero, and proves nothing
farther; the lady, whose prolific disposition is much descanted upon in
that paper, and with whom twin cases were a common occurrence,”
continues Dr. Granville, “was delivered of a male child sometime in
November, 1807, ‘_under circumstances very distressing to the parents,
and on a bundle of straw_,’ and again in February, 1808, of another male
infant, ‘_completely formed_!’—mark the expression, for it was not made
use of in describing the first. The former died ‘_without any apparent
cause_’ when nine days old; the other lived longer. Now can we consider
this otherwise than as a common case of twins, in which one of the
fœtuses came into the world at the sixth, and the other at the ninth
month of pregnancy, owing to the ova being quite distinct and separate?
Had this not been the case, the _distressing circumstances_, which
brought on the premature contraction of the womb, so as to expel _part_
of its contents in November, as in the simplest cases of premature
labour, would have caused the expulsion of the whole, or in other words,
of both ova, in that same month; and we should not have heard of the
second _accouchement_ in the following February; which led the author of
the paper in question to bring the case forward as one of superfœtation,
in opposition to what he has called ‘the scepticism of modern
physiologists.’ Had it been proved that the child, of which the body in
question was delivered, had _reached its full term_ of utero-gestation
in November, and that she had brought forth another child one, two, or
three months afterwards, of equally full growth, then a case something
like superfœtation would have really occurred, and scepticism would have
been staggered.” In consequence of the doubts thus expressed by _Dr.
Granville_, the author of the present work, actuated only by a desire
after truth, applied to _Dr. Maton_ for a farther explanation of those
particular points upon which the merits of the case would seem to turn;
and he is thus enabled to clear up the doubts which might be supposed to
embarrass its history; the fact is, that _both the children were born
perfect_, the first therefore _could not_ have been a six month’s child;
and with respect to the _distressing circumstances_ which attended the
delivery, _Dr. Granville_ appears to have fallen into an important
error; he speaks of them as having “brought on the premature contraction
of the womb, so as to expel _part_ of its contents in November,” whereas
upon referring to the particular expressions used by _Dr. Maton_ in the
paper alluded to, we shall soon perceive that they by no means support
the assumption of the labour having been _premature_, nor that it was
_brought on_ by distressing circumstances; on the contrary, we find upon
farther inquiry that the distressing circumstances to which the author
alludes were the natural consequence, not the active cause of the
labour; indeed the fact, as we learn from _Dr. Maton_, stood thus,—the
lady could not obtain better accommodation at the time; that the labour,
although quick, was not sudden, for the accoucheur was already in
attendance; and that it was not premature, for the natural period of
utero-gestation was supposed to have been completed. We must not omit to
state that all the particular circumstances of the case were
communicated to _Dr. Maton_ by the husband of the lady, and as he could
not have had any particular theory to maintain, or any private interest
to serve, there cannot exist any good reason for questioning the
veracity of his testimony, or the justness of our conclusions.
Several physiologists who have attempted to explain the cause of
superfœtation have supposed that in such cases the uterus is virtually
_double_; _Morgagni_ informs us, that _Catti_, the Neapolitan anatomist,
was the first to observe this phenomenon, and that it is owing to a
strong membrane which so divides the uterus, that the mouth of a
fallopian tube corresponds with each of its cavities; and he farther
states, that this strange structure was found combined with a
corresponding division of the vagina; _Valisnieri_[426] also met with a
double uterus, and a double vulva; the same malformation has been
noticed by _Littre_,[427] _Bauhuin_,[428] _Eissenmann_,[429]
_Haller_,[430] and by _Rhoederer_; this latter physiologist in a letter,
from Strasburgh, preserved among the Sloane manuscripts, says, “We have
got here a great curiosity, viz. a woman body of eighteen years of age,
who has the natural parts externally well formed, but internally two
vaginæ, each with its _hymen_, to which responds also an uterus duplex
having two orificia, each of ’em hanging in its proper vagina, that in
such a manner there is quite a double system of generation, and if she
had been living a superfœtation could have been formed.” _Sabbatier_
says that he believes in the possibility of superfœtation, and that the
above formation will explain its occurrence; an opinion which is
sanctioned by _Gravel_[431] and _Teichmeyer_;[432] _Duffien_ also
observes, “_Cette double matrice sert très bien a expliquer la
superfœtation_.”[433] In quadrupeds superfœtation very commonly occurs,
and it has been explained by supposing that the uterus of these animals
is divided into different cells, and that their ova do not attach
themselves to the uterus so early as in the human subject, but are
supposed to receive their nourishment for some time by absorption; hence
the os uteri does not close immediately after conception; for a bitch
will admit a variety of dogs while she is in season, and will bring
forth puppies of these different species; thus, it is common for a
greyhound to have in the same litter, one of the greyhound kind, a
pointer, and a third or more, different from both.[434]
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.
Q. 11. _Under what circumstances, and by what means, is it morally,
legally, and medically proper, to induce premature labour?_
That premature labour may be induced by a mechanical operation, is too
well known to the practitioner in midwifery to require any explanation
in this place, while, in a work calculated for circulation beyond the
confines of the profession, it would be obviously imprudent to enter
into any minute details. It becomes our duty, however, to state, that in
those cases of distorted pelvis, through which a full grown fœtus cannot
pass without mutilation, the operation may be performed with perfect
safety, and with equal advantage both to the child and to the mother. We
are informed by _Dr. Denman_[445] that there was in 1756 a consultation
of the most eminent men in London at that time, to consider of the moral
rectitude of, and advantages which might be expected from, this
practice, which met with their general approbation; the morality of this
mode of practice, however, says _Dr. Merriman_,[446] has been doubted by
many other persons, but probably for want of considering the question in
a proper point of view; for the proposal was, that labour should be
prematurely induced, _in those cases only_, where it had been _decidedly
proved_ that the pelvis was so much contracted in its dimensions, as to
render it impossible for a full sized fœtus to pass undiminished; and it
is supposed, that this proceeding, while it affords a chance of
preserving the child, does not much implicate the life of the mother.
_Mr. J. Barlow_[447] has given us the result of an extensive practice in
inducing premature labour in cases of distorted pelvis, from which it
appears that he has had recourse to this method of delivery _eighteen_
times, in five women, all of whom had been previously delivered once, or
oftener, by the crotchet, and that premature labour occurred
spontaneously once in two of this number. All the women recovered, a
circumstance which adds a further confirmation to the opinion, that the
life of the parent is exposed to very little hazard in this way; of the
children thus brought into the world, _six_ were dead and _twelve_ were
born alive, of which some died soon after birth, _one_ lived ten months,
and _five_ were living at the time the account was published. _Mr.
Barlow’s_ method consists in exciting premature labour _early_ in the
_seventh_ month of pregnancy. _Dr. Hull_, well known for his
controversial zeal on these subjects, has offered some remarks so
judicious and important, that it would be an act of injustice to
withhold them from the reader. “The propriety of inducing premature
labour,” says he, “in any deformed woman, can rarely, if ever, be
determined upon before the crotchet has been found indispensably
necessary, and actually employed in a previous labour; indeed, unless
the contraction of the tube or canal of the pelvis be very considerable
and pretty accurately ascertained, it will scarcely be justifiable in
any case to have recourse to this practice in all the subsequent
pregnancies, until the woman has been delivered a second, or third time,
by the crotchet; for it has happened in a very great number of
instances, that a woman who has been delivered of her first child by the
perforator and crotchet, has been afterwards delivered of one or more
living children, at the full time; this observation is made not to
discountenance the inducing of premature labour, but to prevent the
abuse of it.” _Dr. Merriman_, whose extensive practice, and generally
acknowledged judgment, stamp a peculiar value upon his opinions, has
also pointed out the limitations and cautions which he deems necessary
to be observed, to render this operation safe and eligible,[448] and he
concludes by observing that “_a regard to his own character should
determine the accoucheur, not to perform this operation, unless some
other respectable practitioner has seen the patient, and has
acknowledged that the operation is advisable_.”
Q. 12. _What circumstances will justify the Cesarean Operation, and of
what value is the section of the Symphysis Pubis, or Sigaultian
operation?_
Where the size of the pelvis[449] will not admit the passage of the
child, surgical aid is indispensably necessary; but, says _Dr.
Merriman_,[450] it becomes every man to set out with a determination
that he will not hastily, nor without due cause, have recourse to
instrumental assistance;[451] for he may assure himself that if he were
easily to yield to his own apprehensions, or to the expressions of alarm
by the attendants in the lying-in chamber, and in consequence were to
try to expedite the delivery by his instruments, he would, on very many
occasions, do irreparable injury to the parent or her child.
Instrumental delivery resolves itself into three classes,—
1. _Where neither the mother nor the child is of necessity injured_, as
by the use of the FORCEPS[452] and LEVER.[453]
2. _Where the mutilation of the child is the principal object_, as by
the PERFORATOR and CROTCHET.
3. _Where the mother is wounded_, as in the CÆSAREAN and SIGAULTIAN
operations.
It is of the latter class we have now to speak.
_Of the Cæsarean Operation_:
By which a fœtus is extracted from the uterus of the mother through a
wound, made for that purpose, in the abdomen. The term _Cæsarean_,
according to some authors, is derived from the operation “_cæso matris
utero_,” while others have supposed that it owes its origin to the fact,
recorded by _Suidas_, of Julius Cæsar having been cut from the womb of
his dead mother in the ninth month. Although _Hippocrates_, _Celsus_,
_Paulus_, _Ægineta_, and _Albucasis_, all treat upon the subject of
instrumental labours, not the slightest allusion is made to the
_cæsarean_ section. The _Chirurgia Guidonis Cauliaci_ is the first work
in which any mention is made of the operation; and this was published
about the middle of the fourteenth century, but the author only
describes it as a resource to save the child after the death of the
mother, as, says he, happened at the birth of _Julius Cæsar_. _Parè_
also considered the operation as one that ought never to be attempted on
the living subject; _Rousset_, however, his cotemporary, published a
work[454] in its favour, which becoming popular, was, through the medium
of a latin translation by _Caspar Bauhine_ in 1601, quickly circulated
throughout Europe; from this period, the cæsarean section acquired a
certain degree of vogue, and began to be performed in cases of extreme
difficulty, particularly on the continent, where it has not unfrequently
proved successful. In this country the operation has been generally
fatal: a very extraordinary case[455] is, however, stated to have
occurred in Ireland, and however incredible the story may appear, says
_Dr. Merriman_,[456] there seems no reason to doubt its truth; it is
related by _Mr. Duncan Stewart_, surgeon, in Dungannon, who saw the
patient some days after the operation; and the account is confirmed by
_Dr. Gabriel King_ of Armagh, who says, that he drew out the needles,
which the midwife had left to keep the lips of the wound together. The
patient’s name was _Alice O’Neil_, and the operator was an illiterate
midwife, one _Mary Dunally_; the instrument used was a razor, with which
she first cut through the containing parts of the abdomen, and then the
uterus. “She held the lips of the wound together with her hand, till
some one went a mile and returned with silk and the common needles which
tailors use; with these she joined the lips in the manner of the stitch
employed ordinarily for the hare-lip, and dressed the wound with whites
of eggs.” The woman recovered in twenty-seven days. It has often been an
object of inquiry, why this operation[457] should have been more
successful upon the continent than in this country? the answer to this
question is obvious and satisfactory. In this country we have only had
recourse to it as an operation of necessity, where we can neither
accomplish the delivery by diminishing the bulk of the child, nor by any
of the other resources already explained; whereas the practitioners of
France, and the other states on the continent of Europe, perform it not
only as an operation of necessity, but as one of election, in cases
where the mother may confessedly be delivered with safety, by
sacrificing the life of the fœtus; it would also appear that in general
they have recourse to the operation, before the patient has suffered
very much from the continuance of labour. How greatly this circumstance
is capable of influencing the success of a surgical operation, we have a
satisfactory demonstration in the history of that for _Hernia_, and in
which _Mr. Bell_[458] informs us, the French were formerly more
fortunate, because they proceeded more early to the operation than the
surgeons of almost any other nation. It deserves notice that the
religious tenets of different countries appear to have influenced the
popularity of the cæsarean section; it is easy to suppose that in those
catholic nations where, a belief exists of the necessity of baptism to
secure the eternal happiness of the infant, the mother would become a
willing sacrifice to make her offspring a christian.[459].
In delivering our opinion upon the propriety of performing the cæsarean
section in this kingdom, we should say that there are cases in which it
is the bounden duty of the accoucheur to proceed without delay, and such
appears to have been that described by _Dr. Merriman_, of which the
pelvis in the museum of _Mr. Charles Bell_ is a sufficient proof; for so
extreme is the distortion, that a marble measuring less than one inch in
diameter, cannot be made to pass through it in any direction; in this
case, and some others of a similar nature, the _Cæsarean_ section was
the only means of preserving the child. We are of opinion, however, that
the operation ought never to be performed where by _Embryulcia_ the
child can be extricated; and although circumstances of inheritance
should induce the husband to entertain a feeling like that which
animated Henry VIII, the practitioner has but one broad line of duty to
observe, to save if possible the mother and child, but where this is
impossible, to feel no hesitation in sacrificing the life of the latter.
In the event of a woman, near the full time of pregnancy, dying
undelivered, the _Cæsarean_ operation ought always to be performed with
as little loss of time as possible; since by this measure a chance of
preserving the child will be afforded, and _Dr. Merriman_ states that
several cases of such an operation, after the death of the mother, have
been recorded, with the desired effect of saving the infant.[460] _Numa
Pompilius_ prohibited the burial of a pregnant woman until the fœtus
shall have been extracted.[461] We have already stated, upon the
authority of _Suidas_, that to such an interposition Rome owed the life
of _Julius Cæsar_; and it has been maintained that _Edward_ VI was thus
taken from his mother after death, while others have endeavoured to
render it probable, that the cæsarean operation was performed while she
was yet living. How long after the death of the mother the child may
survive _in utero_, is a question which cannot be readily answered; some
authors[462] mention twenty-four or even forty-eight hours; and in
relating this fact, _Dr. Merriman_ adds an accompaniment which we also
feel a great inclination to adopt—_a note of admiration_! In the late
_Dr. S. H. Jackson’s Cautions to Women_ (1798) mention is made of a
child extracted by the _forceps_, which was restored to life, though the
mother had been dead full half an hour before it was taken from the
womb.
It must be admitted, that a child taken from the womb of its mother by
the cæsarean section, cannot in philological strictness be said to have
been _born_. The ingenious purpose to which _Shakspeare_ has applied
this quibble has no doubt suggested itself to the reader.
_App._ Macbeth! Macbeth! Macbeth!
* * * * * * *
Be bloody, bold, and resolute: laugh to scorn
The power of man; for _none of woman born_
Shall harm Macbeth.
_Act_ iv, _sc._ 1
_Macd._ * * Despair thy charm;
And let the angel, whom thou still has serv’d,
Tell thee, _Macduff was from his mother’s womb
Untimely ripp’d_.
_Act_ v, _sc._ viii.
The circumstance merits our observation, in as much as it has furnished
a subtlety for disputation, as we have already noticed at page 225.
OF EXTRA-UTERINE CONCEPTION.
It sometimes happens, that instead of the impregnated ovum passing into
the womb, it is either retained in the ovarium,[463] or it stops in the
fallopian tube, or it misses the tube and falls amongst the bowels. Of
these, the _tubal_ is by far more frequent than the _ventral_
conception. We learn from the numerous cases which are recorded of
extra-uterine pregnancy, that it may terminate in several different
ways; in some cases sudden death occurs from hemorrhage;[464] in others,
the unfortunate woman survives for a long period; and it has occurred
that the fœtus has been converted into a substance somewhat analogous to
the _gras de cimetières_,[465] in which case very little inconvenience
is felt beyond that which must attend the tumour of the belly for so
many years. Nature, however, more generally institutes a process to get
rid of the extraneous body; the sac adheres to the peritoneum or
intestines, and, after an uncertain period, varying from a few weeks to
several years, it either opens externally, or communicates with the
abdominal viscera, and highly offensive matter, together with putrid
flesh, bones, and coaguli, are discharged through the abdominal
integuments, or by the rectum,[466] vagina, or bladder.[467]
The most extraordinary circumstance in the history of these conceptions
is the sympathetic enlargement of the uterus, and even in some cases,
the formation of the _Membrana Decidua_.[468] _Riolanus_[469] was the
first person who noticed these conceptions. _Vesalius_ observed a
_tubal_ conception at Paris in 1669; the fœtus was four months old, and
the tube was so enlarged, that he mistook it for a second uterus, and
actually published an account of it, under the title of “_Demonstration
d’une double Matrice_.” _De Graaf_, and afterwards a learned German by
the name of _Elshotius_ commented upon this case in a tract entitled
“_De Conceptione Tubaria, qua humani fœtus extra uteri cavitatem in
tubis quandoque concipiuntur_,” in which is given the figure of the two
supposed _uteri_, and the fœtus in the distended tube. In the _Journal
des Sçavans_, A. D. 1678, a case is recorded of a woman at Paris who
carried an _extra-uterine_ fœtus in the omentum for twenty years; and in
the _Philosophical Transactions_ there is an account of a fœtus of this
description, by _Dr. Steigerthal_, that remained in the body of the
mother for upwards of _forty_ years. In the present state of our
physiological knowledge it is impossible to offer any explanation of the
cause of these anomalies in the law of Nature, but we recommend to the
attention of the student a paper by _Dr. Blundell_, on the Physiology of
Generation, to which we have before taken occasion to allude[470] in
terms of high commendation.
OF HERMAPHRODITES.
The term _Hermaphrodite_[471] signifies an animal in which there exists
a mixture of the male and female organs, and which is therefore capable
of begetting or conceiving. There can be no doubt but that some of the
lower orders of animals[472] are, in the strict sense of the term,
Hermaphrodites; but it is now universally admitted that, in the human
species, no such phenomenon ever existed; indeed, if we only consider
the osteology of the pelvis, to the bones of which the organs of
generation are connected, it is impossible to imagine how the complete
parts of the male and female could be placed distinct from each other;
nor is there upon record a single case which can be considered
authentic;[473] numerous are the instances of preternatural structure,
which gives the appearance of a double sex, and it is on the nature of
such monstrous productions, that the medical man is frequently called
upon to decide. _Baron Haller_ has industriously collected in one point
of view, the histories of reputed hermaphrodites, from almost every
author that has preceded him; and from this memoir,[474] and the
interesting paper by _Sir E. Home_, entitled “An account of the
Dissection of an Hermaphrodite Dog, to which are prefixed some
observations on Hermaphrodites in general,”[475] we acknowledge
ourselves principally indebted for the following remarks.
_Sir E. Home_ considers that all the monstrous productions, hitherto
noticed and described as Hermaphrodites, may be reduced to one of the
_four_ following classes, viz:
1. _Malformations of the Male._ 2. _Malformations of the Female._ 3.
_Males with such a deficiency in their organs, that they have not the
character and general properties of the male, and may be called_
NEUTERS. 4. _Where there exists a real mixture of the organs of both
sexes, although not sufficiently complete to constitute double
organs._
To illustrate the first case, we may refer to that of a negro described
by _Cheselden_,[476] who would appear to have possessed the organs of
the male exclusively, only in a state of great distortion, owing to the
imperfection of the _scrotum_, which was divided into two separate bags
with a deep slit between them, resembling very much the _labia pudendi_,
and the opening into the vagina; over these hung down the penis; the
imperfection of the septum of the _scrotum_ extended to the canal of the
_urethra_; this is not unlike the fissure of the hare-lip being
continued through the bony palate, a circumstance often met with. The
under surface of the _penis_ was attached, through its whole length, to
the two bags containing the testicles, looking like a preternatural
_clitoris_; to which it bore a more perfect resemblance from the absence
of the _urethra_. The urine passed through a preternatural termination
of the _urethra_ in the _perineum_, and came out externally in the space
between the testicles, which formed an enlarged aperture that had been
mistaken for a narrow vagina, in consequence of its allowing an
instrument to pass to some distance, by conducting it to the bladder.
Such mal-formation of the male organs[477] is particularly worthy
attention, for it is that, more than any other, which has given
origin[478] to mistakes respecting the mixture of the sexes. The _lusus_
often occurs in different degrees of imperfection, and may in some
instances be materially diminished by art. In the _second_ case, it may
be observed that there are two mal-formations of the female organs of
generation, which may give to the external parts a doubtful character;
one is an enlargement of the _clitoris_; the other, a protrusion of the
internal parts. It has been already stated that enlargements of the
_clitoris_ are not of rare occurrence, especially in hot climates; and
that at birth it is often larger than the penis, and has frequently
given rise to mistakes; so that females have been baptised as
males.[479] The following remarks may serve to lead to a correct
decision upon these occasions:—If the subject be a female, the labia are
well formed, and when handled no round bodies are felt in them like
testicles; the fissure at the extremity of the glans does not
communicate with any canal of the urethra; but under the glans, and at
the posterior extremity of the fissure, there is an opening which leads
immediately to the bladder.[480]
The other mal-formation of the female genital organs consists in a
protrusion of the internal parts, of which we have already given an
example (_see page_ 28); the womb when thus displaced, has assumed so
close a resemblance to the penis, that it has been actually mistaken for
one by medical men of the highest character, as in the instance related
by _Sir. E. Home_ in his paper upon Hermaphrodites; another case is also
published in the _fifteenth_ volume of the _Philosophical Transactions_,
in which the menses periodically flowed through the orifice of the
supposed penis. With respect to the third order of imagined
hermaphrodites, which _Sir E. Home_ has called _neuters_, and where the
subject, although a male, has not, in consequence of organic defects,
the characters of his sex, has been said to be more common than is
generally supposed, especially in early life, and that by farther
developement the anomalies have sometimes disappeared; it is, probably,
as _Sir E. Home_ very justly observes, only those whose form is very
like females, that have attracted the notice of common observers, so as
to have their defects discovered. _Ambrose Paré_ mentions a case, where
by violent exertion, the male organs of generation became suddenly
developed, and the person who had before been considered as a female,
was admitted to the rights of manhood; and a similar case is recorded by
_M. Veay_, as having happened at Thoulouse, (_see also Montaigne’s
Essay, chap._ xx.) The examples which fall under the fourth order are
very uncommon in occurrence,—where there is a real mixture of the organs
of both sexes, although not sufficiently complete to constitute double
organs; indeed we are very much inclined to question whether a real
participation of the nature of both sexes ever takes place; in almost
every case where due examination has been made, such persons have been
found to belong decidedly to the one sex or to the other. _Petit_[481]
has reported the dissection of a soldier, aged twenty-two, who had not
only the testes in the abdomen, but also a womb, and nearly the whole
apparatus of the female genitals; in this, as well as similar stories,
we are disposed to think with _Dr. Gordon Smith_,[482] that things have
been called by wrong names.[483]
OF IDIOTS AND LUNATICS.
ALTHOUGH the right of a child to succession and property be established
by proving its legitimacy, such right may be suspended or controlled by
various incapacities. Idiotism and Lunacy alone require our immediate
notice; for though non-age be another impediment to the exercise of a
child’s rights, and the fact may sometimes admit of medical elucidation,
yet the instances must be rare, and the question will more properly
belong to the head of Criminal responsibility; “Idiocy or not is a
question triable by jury”[484]; “and sometimes by inspection;” it is
distinguished in law from madness[485] & lunacy, being _dementia
naturalis vel a nativitate_[486], depending generally on a defective
organization, whereas madness and lunacy are _dementia accidentalis_,
the former continual, the latter intermittent,[487] both varying in
degree, danger, and resistance to cure, yet both capable of cure or
palliation by medical treatment, and pre-eminently subjects of medical
jurisprudence.[488].
An idiot[489] or natural fool is one that hath had no understanding from
his nativity, and is therefore by law, presumed never likely to attain
any;[490] 1st. _Blackstone’s Commentaries, c._ 1, _p._ 302. It has been
held that an inquisition finding that a person has not had any lucid
intervals _per spatium octo annorum_, was a good finding of idiocy;
_Prodgers and Phrazier_, 3 _Mod. Rep._ 43, _Skinner’s Reports_, p. 177,
and Lord _Donegall’s Case_, 2 _Vesey’s Reports_, p. 408,[491] _contra
Prodgers and Phrazier_, 1st _Vernon’s Reports_, p. 12. _see_ 1st
_Fonblanque’s Treatise of Equity_, p. 63; but as a person may not have
been mentally incapable _a nativitate_, and therefore not an idiot, and
yet be affected with madness without lucid intervals, and therefore not
legally or logically a lunatic; the better general distinction appears
to be, whether the party is _compos_ or _non compos mentis_,[492] but
see 1st _Blackstone’s Commentaries_, p. 304, 1st _Fonblanque’s Treatise
of Equity_, p. 63, and cases cited there; Lord _Hardwick’s_ Judgment in
_Ex parte Barnsley_, 3d _Atkyn’s Reports_, 168,[493] Lord _Eldon’s
Judgment in Rigeway and Darwin_, 8th _Vesey’s Reports_, 65; Lord
_Erskine’s Judgment in Ex parte Cranmer_; 12th, _Vesey’s Reports_ 445;
and _Collinson on Lunatics_. By which authorities it will appear that
the jurisdiction of the Court of Chancery[494] over the persons and
estates of lunatics extends to those who, being of infirm mind by reason
of grief, accident, old age, disease or other cause, are incapable of
managing their own affairs.[495]
A person born deaf and dumb is not of necessity an idiot, for he may
have received instruction by signs, _Dickenson and Blissett_, 1st
_Dicken’s Reports_, 268, but if he be also blind, the presumption is
that he is an idiot; Lord _Coke_ indeed says that those who become so,
being also deaf and dumb, are idiots, _Coke’s Littleton_, 42; 1st
_Blackstone’s Commentaries_, 304, and they are, so far as the
jurisdiction of the Court of Chancery extends; for though they may have
some mental faculty it is impossible that they can exercise it for the
management and protection of their property.
Habitual drunkenness[496] will not alone support a commission of lunacy,
_Cory and Cory_, 1st _Vesey_, _Senr._ 19, but in _Ridgeway and Darwin_,
8th _Vesey_ 66, Lord _Eldon_ stated that a commission had been supported
on this ground.
Among the legal disabilities under which persons, non compos, labour,
one of the most material to the medical adviser is connected with the
disposal of property by will,[497] and it is most peculiarly his duty to
observe, as in most cases his situation will enable him to do, whether
the testator was or was not of sound mind, memory, and understanding, at
the time of making his will; for it can scarcely be necessary to
observe, that many, who during the greater part of their lives have been
of sound mind, gradually lose their faculties towards its close, and
become liable to the impositions, restraints, and in some cases even to
duress, accompanied with cruelty of those about them, to the disgrace of
humanity, and the injury of their lawful kindred; in such cases the
medical attendant alone obtains access, it is to him therefore that the
law will look for the detection, exposure, and defeat of frauds. An
idiot cannot make a will, but a lunatic may, during a lucid interval;
and subsequent lunacy does not operate as a revocation of a will. _Forse
and Hembling’s_ case, 4 _Co._
If a person be improperly confined under pretence that he is a lunatic,
the remedy is by habeas corpus, directing the keeper to bring the party
into court; but if it appears on affidavit of some competent person that
the party is actually lunatic, and in such a state of mind that he is
not fit to be brought into court[498], and more especially if a
commission of lunacy is about to be issued, the court will enlarge the
time for the return of the writ according to the nature of the case,
(_Rex v. Clarke_, 3 _Burr R._ 1363.) And if liberty to have access and
inspection of such lunatic be applied for, it must be on behalf of some
person who has pretension to demand it, or the Court will reject the
request (ibid.)[499].
But though no commission has issued, the Court of Chancery will
interpose, as where the Lord Chancellor stopped a lunatic from being
carried out of the jurisdiction of the Court (into Scotland), Lady
_Marr’s case_, cited in Lady _Annadale’s case_. _Amb._ 82. The Court
also retains some jurisdiction after the death of the lunatic, _Ex parte
Grimstone, Ambler._ 706; _Ex parte Armstrong_, 3 _Bro. Ch. Ca._ 238;
_Fitz-gerald’s Case_, 2 _Sch. and Lef._ 439.[500].
Formerly the inquiry respecting idiots and lunatics was made by Writs to
the Escheator or Sheriff as an officer to enquire of the revenues of the
Crown, (_F. N. B._ p. 531: 1 _Collinson_, 117: _Ex parte Southcote_, 2
_Ves._ 401:) but these being very strict as to the wording, and as no
person could be found idiot or lunatic under them, except those who came
under the strict definition of either denomination, the Writs have been
superseded by Commissions[501] of a more comprehensive character under
the great seal[502]. These Commissions are directed to five
Commissioners,[503] who, or any three or more of them, are openly to
enquire on the oaths of twelve or more good and lawful men, whether the
person be or not an idiot, lunatic, or _non compos_: 1 _Collinson_, 120.
And they have power to issue their warrant to any person to produce the
_non compos_[504], _ib._ 143; which, if not obeyed, will be enforced by
the Lord Chancellor, and costs decreed, if required against the persons
having the custody of the party. _Ex parte Southcote_, 2 _Ves._ 401.
405: see also Lord _Wenman’s_ case[505] _ubi supra_. The Commissioners
have also power to summon witnesses as incident to their office. _Ex
parte Lund_, 6 _Ves._ 784.[506]
Where there is any misbehaviour in the execution of a Commission,
whether by the Commissioners, or Jury, (_Ex parte Roberts_, 3 _Atk._ 6.)
the Chancellor will quash it, and direct a new Commission.
If there has been a finding against the king, there may be _a melius
inquirendum_, but this is for the Crown only (3 _Atk._ 6.), which cannot
traverse as the subject can.
The remedy of the subject is by traversing the inquisition, or by
bringing the question to an issue at law. The right of traverse has been
disputed; Sir _John Cutt’s_ case, _Ley._ 26. 3 _Atk._ 6.; and it was
held that permission to traverse was a favour granted by the Court, and
not a right; _ibid._ but it is now established to be _de jure_ under the
2 _Ed._ 6. c. 8. § 6. _Ex parte Wragg_, and _ex parte Ferne_, 5 _Ves._
450. 832. But the petition of a stranger for this purpose will be
dismissed with costs: _Ex parte Ward._ 6 _Ves._ 579.
The manner of pleading a traverse is very short, (5 _Ves._ 452). An
idiot must traverse in person. _Smithson’s_ case was on motion to be
permitted to traverse by attorney, which was opposed; it was agreed that
a traverse was given by 2 _Ed._ 6, but it must be _in propriâ personâ_:
precedents were shown, but there was no case where an idiot had
traversed by attorney, though many where a lunatic had: 3 _Atk._ 7. Vide
_Stone’s_ case in _Tremaine’s Pleas of the Crown_, 653, a precedent of a
traverse, and for the doctrine of traversing an inquisition, vide 4
_Co._ 54. _b_; (the case of the Commonalty of the Sadlers), and 8 _Co._
168. _Xaris Storeghtors’_ case. Sir _T. Jones_, 198. _Show._ 199.
_Skinner_, 45. _Moseley_, 71. 1 _Collinson_, 171. But though a lunatic
may by permission of the Lord Chancellor traverse by attorney, the
better rule is that he attend in person. _Amb._ 112.
The appeal in lunacy is to the King in Council, and not to the House of
Lords. _Ex parte Pitt_, 3 _P. Wms._ 108: _Rochfort and Ely_, 6. _Bro.
Par. Ca._ 329; _Sheldon v. Aland_, 3 _P. Wms._ 107.
If the party be found lunatic the next consideration is as to the
disposal of his person and estate. “To prevent sinister practices, the
next heir is seldom permitted to be this committee of the person;
because it is his interest that the party should die. But it hath been
said there lies not the same objection against his next of kin, provided
he be not his heir; for it is his interest to preserve the lunatic’s
life, in order to increase the personal estate by savings, which he or
his family may hereafter be entitled to enjoy. The heir is generally
made the manager or committee of the estate, it being clearly his
interest by good management to keep it in condition; accountable however
to the Court of Chancery, and to the _Non compos_ himself if he
recovers; or otherwise to his administrators, 1 _Bl. Comm._ 305. But
this rule is not in all cases adhered to, _Ex parte Cockayne_, 7 _Ves._
591: _Neal’s case_, 2 _P. Wms._ 544, and _ex parte Ludlow_, _ibid._
635.” The Court will not give the custody of a lunatic to one who may
make a gain of it, Lady _Cope’s_ case, _Cha. Ca._ 239, or allow the
committee any thing for his trouble, whether as to the person (_In re
Annesley. Amb._ 78) or as to the estate, 10 _Ves._ 103.
A stranger may have the custody of a lunatic, _Ch. Ca._ 239. And where
no one could be procured to act as committee of a lunatic, a receiver
was appointed with a salary, but nevertheless to be considered and give
security as a committee. _Ex parte Warren_, 10 _Ves._ 622.
A committee may be removed on sufficient cause, as bankruptcy, but the
Court will not change the custody, if the Master finds it proper with
regard to the comfort of the lunatic. _Ex parte Mildmay_, 3 _Ves._ 2.
Where there are sufficient funds, a liberal application of the property
of a lunatic ought to be made, in order to afford him every comfort his
situation will admit, _Ex parte Baker_, 6 _Ves._ 8. _ex parte Chumley_,
1 _Ves. jun._ 296. _Dormer’s Case_, 2 _P. Wms._ 265. 3 _P. Wms._ 104.
His comfort, where no creditor complains, is the first object, not the
heaping up of riches for his next of kin, _ib._ The Chancellor will not
make an order, even for creditors, the effect of which would be to put
the lunatic in a state of absolute want, _Ex parte Dikes_, 8 _Ves._ 79;
nor unless it is clear that he will have a sufficient maintenance, _Ex
parte Hastings_, 14 _Ves._ 182.
We are next to consider how a party once found lunatic, can, upon
recovery, resume his natural and civil rights;[507] for this purpose the
strongest medical as well as general evidence will be necessary, not
only as to absolute recovery, but temporary remissions or lucid
intervals, for if a party be once found non compos, the finding is
conclusive, till evidence be shown to the contrary, see _Hall_ v.
_Warren_, 9 _Ves._ 605: _Attorn. Gen._ v. _Parnther_, 3 _Bro. Ch. Ca._
441: and if as to a lucid interval there must be this severity of proof,
much more must the onus of proving an absolute recovery rest with the
party seeking to set aside the former finding of a competent tribunal,
or even to negative an established presumption;—“When the party has ever
been subject to a commission, or to any restraint permitted by law, even
a domestic restraint, clearly and plainly upon him in consequence of
undisputed insanity, the proof shewing sanity is thrown upon him; on the
other hand, where insanity has not been imputed by relations or friends,
or even by common law, the proof of insanity, (which does not appear
ever to have existed) is thrown upon the other side; which is not to be
made out by rambling through the whole life of the party; but must be
applied to the particular date of the transaction. A deviation from that
rule will produce great uncertainty.” Lord _Eldon_ in _White and
Wilson_, 13 _Ves._ 88; see also 3 _Bro. Ch. Ca._ 241. On motion that a
recovered lunatic might settle his estate, Lord Keeper _North_ refused
the motion, but directed an issue in the Common Pleas to try the fact of
the recovery, 1 _Vern._ 155. so also Lord _Eldon_ in _ex parte
Holylands_, 11 _Ves._ 10; but the commission may sometimes be superceded
on inspection, when it is usual for the physician to attend. 1 _Fonb.
Tr. Eq._ 65. or to make affidavit; but the former mode is the best.
It has been said that there are no degrees of defect of understanding
save idiotcy and lunacy, _Hume_ v. _Burton, Ridgw. Par. Ca._ 211; this
may be true as relates to commissions of idiotcy or lunacy, and their
consequences, but it is neither legally or medically correct in any more
extended sense.
Delirium,[508] in the ordinary acceptation of the word, is the temporary
derangement of intellect consequent on acute disease; it may be
distinguished from lunacy or madness by the invariable presence of
fever, and it ceases as its exciting causes subside; this therefore
operates no permanent incapacity; for though the patient cannot be
permitted to do any act, or execute any instrument to bind his property
or estate, and would not be held responsible for any crime committed
during such temporary alienation of intellect, yet he becomes competent
to act, and responsible for his actions as soon as the paroxysm and its
consequences are clearly over.
But there is yet another species of mental disorder which, since it does
not incapacitate the patient from performing the ordinary duties and
offices of life, does not subject him to the inconveniences of
commission of lunacy, or exempt him from criminal responsibility; we
mean those partial insanities which are marked by peculiar and
unaccountable dislikes, fancies, and apprehensions, a mental
idiocyncrasy on some one particular subject.[509]
* * * Fuit haud ignobilis Argus
Qui se credebat miros audire tragædos,[510]
In vacuo lætus sessor plausorque theatro;
Cætera qui vitæ servaret munia recto
More; * * * * *
* * * * * *
Hic ubi cognatorum opibus curisque refectus
Expulit elleboro morbum bilemque meraco,
Et redit ad sese: Pol me occidistis, amici,
Non servastis, ait; cui sic extorta voluptas,
Et demptus per vim mentis gratissimus error.
_Hor. Epis._ 2, _L. ii. v._ 128.
To take out a commission of lunacy against such a man would be a greater
cruelty than to cure him, and yet occasionally some legal interference
may be necessary.
When a man suffers under a partial derangement of intellect, and on one
point only, it would be unjust to invalidate acts which were totally
distinct from, and uninfluenced by, this limited insanity; but if the
act done bears a strict and evident reference to the existing mental
delusion, we cannot see why the law should not also interpose a limited
protection, and still less why Courts of Equity, which, in their
ordinary jurisdiction relieve against mistake, should deny their aid in
such cases.
Mr. _Greenwood_ was bred to the bar and acted as “Chairman at the
Quarter Sessions, but, becoming diseased, and receiving in a fever a
draught from the hand of his brother, the delirium taking its ground
then, connected itself with that idea; and he considered his brother as
having given him a potion, with a view to destroy him[511]. He recovered
in all other respects, but that morbid image never departed; and that
idea appeared connected with the will, by which he disinherited his
brother. Nevertheless it was considered so necessary to have some
precise rule, that, though a verdict had been obtained in the Common
Pleas against the will, the judge strongly advised the jury to find the
other way, and they did accordingly find in favour of the will. Farther
proceedings took place afterwards, and concluded in a compromise.” Lord
_Eldon ubi supra_.
The records of Bedlam and Saint Lukes are full of similar instances of
persons insane on only one point; where that point may lead to mischief,
it is proper that the party should be placed under restraint; where the
aberration is harmless, it would be cruel to add imprisonment to the
evil of the disorder, running also the risk of producing an augmentation
of the disease; for it may safely be taken as a rule, that persons
labouring under limited, will be predisposed to general insanity, and
therefore it is at least necessary to watch them minutely, lest some
less harmless derangement should seize them at the moment when it is
least expected.