210 



MIDWIFERY. 



State. 



Of the has greatly arisen from the arguments and statements 

 Pregnant o f the late Dr. Osborn, who maintained that no case of 

 deformity so great could occur as would prevent the 

 extraction of the child by the crotchet. In proof of 

 this, he published a case where the operation proved 

 successful in extreme contraction. The fallacy of his 

 reasoning was very ably shewn by the late Dr. Hamil- 

 ton, whilst Dr. Johnston experimentally proved that 

 it was impossible to bring a mutilated child through 

 an aperture cut in a piece of wood exactly of the di 

 mension of the pelvis described by Dr. Osborn, who 

 consequently must have been deceived. It is of great 

 importance to humanity to have this point ascertained; 

 for, although every British practitioner prefers the crot- 

 chet to the Cffisarean operation, yet, if it be conceded 

 that in some cases the former cannot be employed, it 

 follows that in such cases the sooner we resort to the 



operation, the more likely it is to be successful. It 

 has almost uniformly been fatal in this country, but 

 often successful on the Continent. This must arise 

 either from it being performed earlier there, or on 

 more favourable subjects. If in this country we per- 

 form it only on the most deformed and unhealthy, it 

 is our duty to these sufferers not to increase their dan- 

 ger by delay, hi the senseless expectation of being able 

 to accomplish a physical impossibility. 



To carry this sketch of the progress of midwifery 

 farther, or extend it to the diseases of women and chil- 

 dren, would exceed the limits proper to a work of this 

 kind. To notice all the eminent writers and teachers 

 of the present day would be impossible, and to make 

 a selection where so many are to be found, would be 

 both difficult and invidious. 



PART I. OF THE PREGNANT STATE. 



CHAP. I. 

 Of the Gravid Uterus. 



Of the gra- THE first visible change produced on the uterus and 

 irid uterus. ovar ; a by conception, is increased vascularity. Simul- 

 taneous with this is an augmentation of the bulk of 

 the womb, or enlargement of its cavity, and a secre- 

 tion within that cavity. The cervix uteri is filled 

 with inorganic jelly, whilst the fundus and body are 

 lined with a coating consisting partly of lymph, and 

 partly of vessels. This has been called the membrana 

 decidua, and is formed before the ovum can be de. 

 tected in the uterus. Whilst a receptacle is thus pre- 

 paring for the child, changes are going on in the ova- 

 rium, where the ovum first appears. This becomes 

 more vascular, and at one part a small vesicle becomes 

 prominent. The exterior covering of the ovarium 

 seems at this part to be absorbed, whilst the fimbriat- 

 ed extremity of the tube adheres firmly over it, and 

 receives the vesicle or ovum, as it is extricated from 

 the ovarian surface, conveying it down into the ute- 

 rus itself, where it is to be developed. That part of 

 the ovarium whence the embryo has issued, undergoes 

 certain changes in appearance, forming a distinct sub- 

 stance, known under the name of corpus luteum, the 

 presence of which is considered as an indication of 

 conception having at one period or other taken place. 

 At a very early stage, several vesicles may be disco- 

 vered under the covering of the ovarium, at least the 

 writer has observed this in two or three instances, but 

 whether these be ova which fade, is not determined. 

 The ovum, from the earliest time when it can be ex- 

 amined, consists of two vesicles, one within the other. 

 The innermost is much smaller than the outermost, 

 but is connected with it at one spot. The internal 

 contains a little transparent fluid, and the minute em- 

 bryo. The space between the two vesicles is filled 

 with clear jelly, like the vitreous humour of the eye, 

 and the outer surface of the external vesicle is covered 

 with small vessels, which in a short time increase so 

 much, that they form a distinct vascular covering, 

 known under the name of the spongy chorion, whilst 

 the vesicle they cover is called the membranous cho- 

 rion : the vesicle within both is called the amnion, and 

 the fluid it contains, and which is in immediate con- 

 tact with the embryo, is named the liquor amnii. For 

 a considerable time after the ovum enters the uterus, 

 the chorion and amnion, except at one point, are far 

 distant from each other, but presently the amnion en-. 



larges more rapidly, so as to fill the space enclosed by 

 the chorion, and the intervening jelly is absorbed in 

 the same proportion. In common language, the em- 

 bryo is said to be within these membranes, but anato- 

 mists know well that it is exterior, as the bowels lie 

 without the peritoneum. For it is next to be noticed, 

 that at one part, namely, where the embryo is situ. 

 ated, a small prolongation of both membranes is turn- 

 ed inward, so as to form a short tube, along which 

 vessels run from the spongy chorion to the embryo, 

 and from the embryo to the chorion. This prolonga- 

 tion is afterwards called the umbilical cord, and the 

 passing vessels the umbilical vessels. When the ovum 

 enters the uterus, it does not pass down unconnected 

 through the tube, nor fall loosely into the uterine ca- 

 vity, but, arrived at the end of the tube, and entering 

 the womb, it meets with the decidua vera, as it has 

 been called, and an intermixture of vessels takes place 

 between the chorion and decidua, and in proportion a 

 the ovum expands and fills the cavity, the decidua ex- 

 pands or grows with it ; affording a covering, until it 

 grows so large as to fill the cavity. This expansion of 

 the decidua has received the name of decidua reflexa, 

 and it becomes thinner and more gelatinous as preg- 

 nancy advances. It has been already stated, that the 

 embryo sends vessels which ramify over the chorion, 

 and part of which there unite to the decidua reflexa ; 

 but at that part where they pass out from the embryo, 

 they are more numerous than elsewhere, and unite 

 with the decidua vera, and form a thick vascular cake 

 called placenta, which consists thus of two portions, 

 one formed by the womb, and one by the foetus, and 

 it serves as the intermedium between them, and the 

 source whence nourishment is derived, and a substi- 

 tute for the lungs in the foetal circulation. To be 

 more minute on this subject is not consistent with the 

 plan of this work. 



It is uncertain at what time the ovum enters the 

 uterus. Dr. Haighton could not detect it in the ute- 

 rus of the rabbit earlier than from the fourth to the 

 sixth day. Now, in that animal the period of utero. 

 gestation is only 30 days ; from analogy, which doubt- 

 less is not to be held as proof, one would not expect to 

 find it early in women, who go so much longer. Some 

 microscopic observers have supposed that they saw the 

 embryo eight days after conception ; but, be this as ft 

 may, it cannot be detected with the naked eye for 

 much longer. It is not probable that the ovum can 

 be seen in the uterus until nearly three weeks after 



