MIDWIFERY. 



261 



Or tb* The uterus is felt to be enlarged, and has neither the 

 Puerperal ghape of the gravid nor of the unimpregnated womb. 

 State. j t g enera lly lies obliquely to one side. The os uteri 

 ""V*"* is nearly circular, is soft, somewhat rugged, and will 

 admit the point of one or more fingers, according to 

 the time which has elapsed fcince delivery. The belly 

 is prominent, and the integuments lax, wrinkled, and 

 covered with light-coloured broken streaks. The 

 breasts are enlarged, and contain milk, and have a very 

 distinct and dark areola. Many writers on medical 

 jurisprudence, however, consider these signs as falla- 

 cious. This, however, is one of the questions, it would 

 appear, which can be more accurately determined by a 

 man of plain sense than by a speculative philosopher. 

 There have been instances where milk has been dis- 

 covered in the breasts in the virgin state, at least so 

 we are told by authors ; but it would certainly be con- 

 sidered as no great proof of virginity, were a female to 

 be found with abundance of milk suckling a child. 



One thing is certain, that the whole of the signs or 

 appearances enumerated cannot exist without a pre- 

 vious pregnancy. A question naturally arises here, 

 May they not be met ith when the female has ex- 

 pelled a mass of hydatid*, or a mole, as it has been 

 called This may be decidedly answered in the negsv. 

 live. Most of such substances are produced by con- 

 ception, but after a time the ovum becomes blighted, 

 and changed into hydatid, or a more i. I di-organ- 

 ized mass. As pregnancy therefore has existed, it is 

 evident that the secretion of milk and distention of the 

 brtsnH nay take place, and the uterus will be found 

 enlarged. But it is very rare for these maises to ac- 

 quire such a size as shall enlarge the uterur, or distend 

 the belly, so as to produce such appearances as follow 

 the delivery of a child. And as they are soft, we do 

 not find the same injury sustained by the perineum, 

 or external parts. 



-tain cases of suppression of the menses are ac- 

 companied with swelling of the belly, and sometimes 

 secretion of a milky or serous fluid in the breasts. But 

 the abdominal tumour arises from inflation nf the bow- 

 el*, and when removed, leaves no mark on the skin, 

 and cannot have any effect on the state of the vagina, 

 labia, or uterus. Ignorant people suppose that in such 

 cases of suppression the menses are really retained and 

 accumulated in the uterus, and therefore may enlarge 

 it This can only happen when the vagina is dosed, 



and in that case relief must be obtained by an opera- 

 tion, the performer of which can bear testimony to the 

 nature of the case. 



If in any one instance it could be established that a 

 female had !en large, as in pregnancy, and all the 

 signs above enumerated were met with, and particu- 

 larly when combined with laceration of the perineum, 

 there cannot be a doubt. Granting that hydatids and 

 blighted ova, or moles, could pnxhice the other symp- 

 . they could not tear the perineum. If such sub- 

 stances really were expelled, they would be shewn by 

 the patient, or described by her, so as to satisfy a me- 

 dical practitioner. Far less can mechanic;:! obstruc- 

 tion of the menses occasion deception, for this cannot 

 possibly injure the perineum, and indeed can only be 

 removed by a surgical operation. Last of all, the ab- 

 surd account often given by the patient herself niu-,t 

 convince every intelligent practitioner of her guilt. 



In cases where the mother is dead, and it is neces- 

 sary to ascertain whether or not she has been delivered 

 of a child, we have, in addition to those marks already 

 described, an opportunity of examining the uterus and 

 its appendage* by dissection. The womb is found en- 

 larged, its substance thickened, its cavity filled with 

 coagulated blood, or, if empty, the interim) surface is 

 covered with a black coating of blood. The vessels 

 are large, and as they are largest where the placenta 

 was attached, marks corresponding to this attachment 

 may for a time be observed. The extremities of the 

 tube*, but particularly the ovaria, are highly vascu- 

 lar, and these latter contain, on different parts of their 

 surface, resides filled with bloody fluid. Can it be 

 determined by dissection, whether a female has had a 

 premature labour, or ha\e discharged a false concep- 

 tion, as it has been called ? This is chiefly to \>c done 

 by the -tale of the surface of the uterine cavity, and 

 the size of the vessels. After abortion, or premature. 

 labour, there is usually some portion of decidua left, 

 and the uterine vessels are large in proportion as the 

 period has lieen advanced. In blighted ova, or false 

 conception, on the other hand, there can be no portion 

 left of healthy decidua ; but, particularly, there can- 

 not \>f expected the same enlargement of uterine ves- 

 sels to support a fading or impcrfectlv organized mass, 

 which would be requisite for a perfect and vigorous 

 OMIIII. (j. B.) 



Of the 



Puerperal 



State. 



MIGRATION. 



BKRNATION. 



MI a 



See BIRDS Migratory, and Hv- 



M 1 1 A V . n city of Italy, and the capital of that portion 

 which was lately formed into the kingdom of Lorobardy 

 h, but which formerly constituted the 

 iy of Milan. It is situated in a plain, between 

 th rivers Adda and Ticino, from which it is watered 

 by canals drawn from each. One of these canals was 

 commenced in the year 1 1 79, and rendered navigable 

 in I-J71 : and the navigation is now advancing towards 

 Pavia by a third. '1 his city is about eight miles in 

 circuit. Some of the streets are spacious, and built in 

 straight lines ; but many art- narrow, crooked, and in- 

 convenient. For the most part they are paved with 



M I L 



small marble, or granite pebbles, from the bed of the 

 neighbouring rivers and torrents. 



Public buildings are numerous in Milan. The ca- 

 thedral, standing nearly in its centre, for size and 

 beauty is considered the finest in Italy, next to St. 

 Peter's at Rome.* It is an edifice in the genuine gothic 

 style, of the largest dimensions, and consists entirely 

 of pure white marble. It extends 4^0 feet in length, 

 in breadth, it is divided into live naves by , r >J2 

 enormous marble gothic columns, and is lighted by five 

 cupolas. The height within undir the principal dome 

 is 258 feet ; the arches, corresponding to " Mt- are 

 48 feet wide, supported by columns 8 feet nrTliame- 

 ter. The pillars supporting the roof are above 90 feet 



Ss Cnru ABCSITICTVBI, Vol. VI. p. 653, and PUTS CLXV. 



