CHAPTER VII. DELIVERY. PART I.-1. Signs of delivery-period within which the examination should be made. Concealed delivery. Pretended delivery—modes in which it may present itself—where there has been no pregnancy—when there has been previous delivery-where there has been an actual delivery, but a living child has been substituted for a dead one. Appearances on dissection, indicative of a recent delivery. Case of Mr. Angus. Corpora lutea —their value as a proof of impregnation. 2. Possibility of delivery without the female being conscious of it. Whether a female, if alone and unassisted, can prevent her child from perishing after delivery: Application of this in cases of infanticide: Instances in which this plea should be received. PART II.-1. Signs of the death of the child before and during delivery. 2. Signs of its maturity or immaturity—its appearance, size, length, and weight at various periods during pregnancy. Weight of infants born at the full time-length. Other characters which mark the maturity of the child. 3. The state necessary to enable the new-born infant to inheritits capability of living-the time when it is generally deemed viable. Laws of various countries as to what constitutes life in the infant, and thus enables it to inherit-Roman, French, English, and Scotch laws. Medico-legal cases, in Italy-State of New York. Unborn infants recognized. Infants extracted by the Cæsarean operation-their capability of inheriting Laws on this subject. First born of twins. How far deformity incapacitates from inheriting. Monsters: Laws on this subject. DELIVERY may be considered-1. As it respects the mother; and 2. As it respects the child. We shall accordingly divide the chapter into two parts; and with respect to the mother, we shall notice 1. Concealed and pretended delivery. 2. Some medico-legal questions connected with the subject. The second part will comprise a view of— 1. The signs of the death of the child before or during delivery. 2. The signs of maturity or immaturity. 3. The state necessary to enable the new-born infant to inherit. PART I. I. Concealed or pretended delivery. Delivery, whether concealed or pretended, can alone be elucidated by referring to its real signs; and it will therefore be proper to commence with a notice of them. If the female be examined within three or four days after the occurrence of the delivery, the following circumstances will generally be observed: greater or less weakness, a slight paleness of the face, the eye a little sunken, and surrounded by a purplish or dark-brown colored ring, and a whiteness of the skin, like a person convalescing from disease. The belly is soft, the skin of the abdomen lax, lies in folds, and is traversed in various directions by shining, whitish (sometimes pearly) lines, which especially extend from the groins and pubis to the navel. These lines, called linea albicantes, are owing to the giving way of the true skin under the distention caused by the gravid uterus.* [They are most numerous on the lower part of the abdomen, and are not unfrequently seen on the nates and upper part of the thighs. They give the skin a reticulated or roughened appearance.-C. R. G.] The breasts, particularly about the third or fourth day after delivery, are tumid and hard, and on pressure emit a fluid, which at first is serous and afterwards gradually becomes whiter; and the presence of this secretion is generally accompanied with a full pulse and soft skin, covered with a moisture of a peculiar and somewhat acid odor. The areola round the nipples are dark colored. The external genital organs and vagina are dilated and tumefied throughout the whole of their extent, from the pressure of the foetus. The uterus may be felt * Along with these, Dr. Montgomery (pp. 304, 307,) has sometimes noticed a brown line of about a quarter of an inch in breadth, extending from the umbilicus to the pubes, and especially in women of dark hair and stronglycolored skin. through the abdominal parietes, voluminous, firm, and globular, and rising nearly as high as the umbilicus. Its orifice is soft and tumid, and dilated so as to admit two or more fingers. The fourchette or anterior margin of the perinæum is sometimes torn, or it is lax, and appears to have suffered considerable distention. A discharge (termed the lochial) commences from the uterus, which is distinguished from the menses by its pale color, its peculiar and well-known smell, and its duration. The lochia are at first of a red color, and gradually becomes lighter until they cease.† These are the signs enumerated by the best writers on the subject, and where they are all present, no doubt can be entertained that delivery has taken place. Several of them, however, require further notice, for the purpose of indicating the mistakes which observers may experience concerning them. 1. The lochial discharge might be mistaken for menstruation or fluor albus, were it not for its peculiar smell, and this it has been found impossible, by any artifice, to destroy. It also is variable as to the time of its continuance. In some it does not remain red for more than a day or two. 2. The soft parts are relaxed from menstruation, though very rarely as much as from delivery; but in these cases the os uteri and vagina are not so much tumefied, nor is there that tenderness and swelling. Dr. Montgomery attaches great importance to a peculiar condition of the os uteri. Its labia, he says, in those who have borne children are jagged and notched. There is no other cause except childbirth that can leave this state. The converse is not true; the unfissured state of the os does not negative a previous pregnancy. [I have seen two cases where the os was smooth, regular, and "With the birth of the first child, the commissure is generally torn through and the fossa disappears with it, though not always: so that the existence of these parts is no disproof of previous childbirth, and I remember myself a case in which, though I had delivered the patient not without difficulty, with the forceps, the commissure and the fossa existed afterwards in all their perfection." (Blundell's Lectures, Lancet, N. S., vol. iv. p. 641.) Foderé, vol. ii. sec. 1; Mahon, vol. i. pp. 166 to 170; Capuron, p. 124; Hutchinson on Infanticide, p. 90; Burns, p. 326. even circular, in one of which parturition at term had taken place once, in the other three times.-C. R. G.] Again, when all signs of contusion disappear after delivery, the female parts are found pale and flabby. This does not follow menstruation. 3. The presence of milk. This must be an uncertain sign, for the reasons stated in the chapter on Pregnancy. "It is possible for this secretion to take place independently of pregnancy. The most unequivocal form in which it can appear, is when the breasts are tense and painful, and filled with the fluid of its usual nature-not serous or watery, as is observed in pretended cases. It is also to be remarked, that this secretion goes on during the presence of the lochia; while, on the contrary, the breasts become flaccid and almost empty, if the menses supervene, and fill again when they disappear.† Should, therefore, a case occur where doubt is entertained, it would be proper to notice the state of the breasts while the discharge (of whatever nature it may be) is present. [Mr. Mercer Adam reports a case in the Edin. Med. Journ., May, 1853, where, in a case of concealed delivery, the girl explained the fact that there was milk in the breasts, by alleging that she had nursed a previous child till within three months. The cheat was discovered by the microscopic examination of the milk. Numerous colostric globules were found, proving that delivery had very recently occurred.-C. R. G.] 4. The linea albicantes, being caused by a "giving way of the true skin under the distention caused by the enlarged uterus," may also be the consequence of dropsy, or of lankness following great obesity. Indeed, any cause producing * Burns, p. 326. The error in the third London edition, of substituting “impossible” for “possible" in this quotation, and which is noticed by Professor Montgomery, is not mine. It is correct in the edition published here. † Foderé, vol. ii. p. 15. The following is a very uncommon case. "There is now in this town, a lady sixty years of age, who bore and reared eight children, without her breasts discharging a drop of milk after the birth of any one of them. The glands, when she was confined with a part of them, became somewhat swollen, but no milk flowed out. She never, at any period of her life, had a nipple on either breast." (Dr. Sutton, of Georgetown, Kentucky, Western Journal of Medicine and Surgery, vol. iv. p. 317.) much distention may give rise to them. On the other hand, this state of the parts is occasionally not very striking after the birth of a first child, as they shortly resume their original state. 5. The lineæ albicantes are permanent, and hence should not be depended upon in cases where females have had several children.* It is hence the duty of the medical examiner to view all the signs enumerated in connection; and where all or most of them are present, it is his duty to declare that they are the consequence of SEXUAL CONNECTION.† So far he can pronounce with safety. But if the question has a bearing on the charge of infanticide, the existence of the child should be proved. I make this remark out of its place, but it cannot be too often repeated in a treatise on legal medicine. To prevent mistakes, inquiry should also be made, whether the individual has labored under dropsy, menorrhagia, or fluor albus; or whether any external violence has been applied to the genital organs. The next subject of inquiry is, within what time should this examination be made? An astonishing difference occurs among females in the period of recovering from the effects of delivery. Some have been known to proceed to their occupation on the day that They are sometimes wanting in females who have had several children; and Dr. Montgomery saw them very marked in a male laboring under general dropsy. (Cyclopedia of Practical Medicine.) A similar appearance (of white silvery lines) has been occasionally noticed by our author on the breasts of young females, particularly when those parts have been greatly and rapidly enlarged during pregnancy. (Signs of Pregnancy, p. 296.) "All the recent continental writers agree, that if the signs related be all, or nearly all, found in the person of the prisoner, the conclusion is infallible; and that whatever a few obstinate accoucheurs may have been urged by the spirit of contradiction to allege, they are never imitated conjointly by any disease whatever. At the same time, a just and necessary caution is added, against placing reliance on any one sign, or even on several of these together, since frequent experience has shown, that though never found conjointly but after delivery, they are often produced individually by other causes." (Edin. Med. and Surg. Journal, vol. xix. p. 454.) |