# The Works of William Harvey/Anatomical Exercises on the Generation of Animals/On Parturition

ON PARTURITION.
ON PARTURITION.
On generation follows parturition, that process, viz. by which the fœtus comes into the world and breathes the external air. I have, therefore, thought it well worth while, and within the scope of my design, to treat briefly of this subject. With Fabricius, then, I shall consider the causes, the manner, and the seasons of this process, as well as the circumstances which both precede and follow it. The circumstances which occur immediately previous to birth, and which, in women especially, indicate that the act of parturition is not far distant, are, on the one hand, such a preparation and arrangement on the part of the mother as may enable her to get rid of her offspring; and on the other, such a disposition of the foetus as may best facilitate its expulsion.
With respect to the latter, viz. the position of the fœtus, Fabricius says, "that it is disposed in a globular form and bent upon itself, in order that its extremities and prominent points generally may not injure the uterus and the containing membranes; another reason being that it may be packed in as small a space as possible." For my own part, I cannot think that these are the reasons why the limbs of the foetus are always kept in the same position. Swimming and moving about, as it does, in water, it extends itself in every direction, and so turns and twists itself that occasionally it becomes entangled in a marvellous manner in its own navel-string. The truth is, that all animals, whilst they are at rest or asleep, ​fold up their limbs in such a way as to form an oval or globular figure: so in like manner embryos, passing as they do the greater part of their time in sleep, dispose their limbs in the position in which they are formed, as being most natural and best adapted for their state of rest. So too the infant in utero is generally found disposed after this manner: the knees are drawn up towards the abdomen, the legs flexed, the feet crossed, and the hands directed to the head, one of them usually resting on the temples or ears, the other on the chin, in which situation white spots are discernible on the skin as the result of friction; the spine, moreover, is curved into a circle, and the neck being bowed, the head falls upon the knees. In such a position is the embryo usually found, as that which we naturally take in sleep; the head being situated superiorly, and the face usually turned towards the back of the mother. A short time, however, before birth the head is bent downwards towards the orifice of the uterus, and the fœtus, as it were, in search of an outlet, dives to the bottom. Thus Aristotle: "All animals naturally come forth with the head foremost; but cross and foot presentations are unnatural." This, however, does not hold universally; but as the position in utero varies, so too does the mode of exit; this may be observed in the case of dogs, swine, and other multiparous animals. The human fœtus even has not always the same position; and this is well known to pregnant women, who feel its movements in very different parts of the uterus, sometimes in the upper part, sometimes in the lower, or on either side.
In like manner the uterus, when the term of gestation is completed, descends lower (in the pelvis), the whole organ becomes softer, and its orifice patent. The "waters" also, as they are vulgarly called, "gather;" that is, a portion of the chorion, in which the watery matter is contained, gets in front of the fœtus, and falls from the uterus into the vagina; at the same time the neighbouring parts become relaxed and dilatable; in addition to which the cartilaginous attachments of the pelvic bones so lose their rigidity that the bones themselves yield readily to the passage of the fœtus, and thus greatly in​crease the area of the hypogastric region. When all these circumstances concur, it is quite clear that delivery is not far distant. Nature, in her provident care, contrives this dilatation of the parts in order that the fœtus may come into the world like the ripe fruit of a tree; just as she fills the breasts of the mother with milk that the being who is soon to enjoy an independent existence may have whereon to subsist. These, then, are the circumstances which immediately precede birth; and thus it happens that the presence of milk has especially been regarded as a sign of approaching delivery—milk, I mean, of a character suitable for the sustenance of the offspring; and this, according to Aristotle, is only visible at the period of birth; it is therefore never observed before the seventh month of pregnancy.
Fabricius maintains that on the subject of parturition there were two special heads of inquiry, viz. the time at which and the manner in which the process took place. Under the first of these heads he considers the term of utero-gestation; under the second, the way in which the fœtus comes into the world.
Aristotle thought that the term of utero-gestation varied much. "There is," he says, "a certain definite term to each animal, determined in the majority of cases by the animal's duration of life; for it follows of necessity that a longer period is required for the production of the longer-lived animals." He attributes, however, the chief cause to the size of the animal; "for it is scarcely possible," he continues, "that the vast frames of animals or of aught else can be brought to perfection in a short period of time. Hence it is that in the case of mares and animals of cognate species, though their duration of life is small, their term of utero-gestation is considerable; and thus the elephant carries its young for the space of two years, the reason being its enormous size, for each animal has a definite magnitude, beyond which it cannot pass." I would add, that the material of which each is formed has also its fixed limit in point of quantity. He says, moreover, "There is good reason why animals should have the periods of gestation, generation, and duration of life in certain cycles—I mean by cycle, a day, night, month, and year, and ​the time which is described by these; also the motions of the moon—for these are the common origin of generation to all. For it is in accordance with reason that the cycles of inferior things should follow those of the higher." Nature, then, has decreed that the birth and death of animals should have their period and limit after this manner.
Just as the birth of animals depends on the course of the sun and moon, so have they various seasons for copulation and different terms of utero-gestation, these last being longer or shorter according to circumstances. "In the human species alone," says the philosopher in the same part of his works, "is the period of utero-gestation subject to great irregularity. In other animals there is one fixed time, but in man several; for the human fœtus is expelled both in the seventh and tenth months, and at any period of pregnancy between these; moreover, when the birth takes place in the eighth month, it is possible for the infant to live." In the majority of animals there is a distinct season for bringing forth their young; this is generally found to be in the spring, when the sun returns, but in many species it is in the summer, and in some in the autumn, as is the case with the cartilaginous fishes. Hence it is that animals, as the time of labour approaches, seek their accustomed haunts, and provide a safe and comfortable shelter where they may bring forth and rear their young. Hence, too, the title "bird-winds," applied to those gales which prevail toward the beginning of spring, the word owing its origin to the fact of certain birds at that period of the year availing themselves of these winds to accomplish their migrations. In like manner stated seasons are observed by those fishes which congregate in myriads in certain places for the purpose of rearing their young. Moreover, in the spring, as soon as caterpillars fall under our notice (their ova, as may be observed by the way, like to invisible atoms, being for the most part carried by the winds, and not owing their origin, as commonly supposed, to spontaneous generation, or to be looked upon as the result of putrefaction), straightway the trees put forth their buds, soon to be devoured by these creatures; and these in their turn fall victims to birds innumerable, and are carried to the nest as food for the young brood. So constantly does this hold, that whenever strange species of caterpillars fall under ​notice, at the same time we are sure to see some rare and foreign birds, as if the latter had chased the former from some remote corner of the earth. Now in both of these classes of creatures the time for bringing forth their young is the same. Physicians, too, when these phenomena occur, are enabled to predict the approach of sundry strange diseases. Bees bring forth in the month of May, when honey abounds; wasps in the summer, when the fruit is ripe; and this is analogous to what takes place in viviparous animals, who produce their young at the period when their milk is best adapted for their offspring. But other animals of the non-migratory classes, in the same way, at stated seasons seek a place to deposit their young as they do a store of food. And thus it results that the countryman is able to decide what are the proper seasons for ploughing, sowing, and getting in his harvest, forming his opinion chiefly from the approach of flocks of birds, and especially of the seminivora. There are, however, some animals in whom there is no fixed time for production, and this is chiefly the case with those which are called domestic, and live with the human species. These both copulate and produce their young at uncertain seasons, and the reason probably is to be sought for in the larger quantity of food they consume, and the consequent inordinate salacity. But in these, as in the human species, the process of parturition is often difficult and dangerous.
There are other animals also on whom the course of the moon has influence, and which consequently copulate and bring forth their young at certain periods of the year—rabbits, mice, and the human female may be instanced. "For the moon," observes Plutarch, "when half full, is represented as greatly efficacious in shortening the pains of labour, and this she effects by moderating and relaxing the humours—hence, I think, those surnames of Diana are derived, Locheia, i.e. the tutelar deity of childbirth, and Eilytheia, otherwise Lucina; for Diana and the moon are synonymous."
"In all other animals," says Pliny, "there are stated seasons and periods for production and utero-gestation; in man alone are they undetermined." And this is, to a great extent, true; ​for in his case, although nature has laid down for the most part certain boundaries, yet there is sometimes a vast difference in individuals, and instances are recorded of women bringing forth viable children, some in the seventh, and others in the fourteenth month. Further, although Aristotle asserts "that the majority of eight months' children in Greece die," he still admits "that they survive in Egypt and in some other countries, where the women have easy labours;" and although he says "that children born before the seventh month can under no circumstances survive, and that the seventh month is the first in which anything like maturity exists, and that the feebleness of children born even then is such as to make it necessary to wrap them in wool," he still allows "that these are viable." Franciscus Valesius tells us of a girl in his time, who, although a five months' child, had arrived at the age of twelve years. Adrianus Spigelius also records the case of a certain courier, "who proved to the satisfaction of all, on the public testimony of the city of Middleburgh, that he was born at the commencement of the sixth month, and that his frame was so slight and fragile that his mother found it necessary to wrap him up in cotton until such times as he was able to bear the ordinary dress of infants." Avicenna also states that a sixth months' child is very capable of surviving. In like manner it is proved, both by ancient and modern authorities, that children may live who are born after the completion of the eleventh month. "We are told," says Pliny, "by Massurius, that when his inheritance was claimed by the next heir, Lucius Papyrius the prætor gave the decision against the claimant," although, by his mother's account, Massurius was a thirteen months' child—the ground of the judgment being that the term of utero-gestation had not been as yet accurately determined. There was indeed, not so long since, a woman in our own country who carried her child more than sixteen months, during ten of which she distinctly felt the movements of the fœtus, as indeed did others, and at last brought forth a living infant. These are rare contingencies, I will allow; and therefore it is hardly fair of Spigelius to blame Ulpianus the lawyer because he regarded as legitimate no child born after the completion of the ​tenth month. Both laws and precepts of art, we must remember, have reference to the general rules of vital processes. Besides, it is impossible to deny that many women, either for purposes of gain or from fear of punishment, have simulated pregnancy, and not hesitated to swear to the truth of their assertion:—others again have frequently been deceived, and fancied themselves pregnant, whilst the uterus has contained no product of conception. On this point Aristotle's words may be quoted: "The exact period at which conception takes place in the case of those born after the eleventh month can scarcely be ascertained. Women themselves do not know the time at which they conceive; for the uterus is often affected by flatulent disorders, and if under these circumstances conception takes place, women imagine this flatulency to mark the period of conception, because they have recognized certain symptoms which accompany actual conception."
In the case of other women in whom the fœtus has died in the third or fourth month, then putrefied, and come away in the form of fetid lochial discharges, we have known superfœtation to take place; and yet these same women have persisted that they have brought forth their children after the completion of the fourteenth month. "It happens sometimes," says Aristotle, "that an abortion takes place, and ten or twelve products of superfœtation come away. But if the (second) conception takes place soon after (the first), the woman goes to the full time with the second, and brings forth both as twins. This was said to have been the case in the fable of Iphicles and Hercules. And it is a subject which admits of proof; for it is known of a woman that she brought forth one child resembling her husband, and another like a man with whom she had had adulterous intercourse. Another woman became pregnant of twins, and conceived another by superfœtation. Her labour came on, and she brought forth the twins well formed and at their proper time, whilst the third child was at the fifth month, and so died immediately."
A certain maid-servant being gotten with child by her master, to conceal her disgrace, fled to London in the month of September; here she was delivered, and returned home with her ​health restored. In December, however, the birth of another child, conceived by superfœtation, proclaimed to the world the fault she had committed. "It happened to another woman," adds the philosopher, "to be delivered of a seven months' child, and afterwards of twins at the full term, the single child dying, the twins surviving. Other women also, having become pregnant of twins, have miscarried of one, and borne the other to the full term." It is very easy to understand how, if the earlier or later product of superfœtation come away after three or four months have elapsed, that mistakes may be made in calculating the subsequent months, especially by credulous and ignorant women. We have sometimes observed, both in women and other animals, the product of conception perish, and come away gradually in the form of a thin fluid, somewhat resembling fluor albus. Not long since a woman in London, after an abortion of this kind, conceived anew, and brought forth a child at the proper period. Subsequently, however, after a lapse of some months, as she was engaged in her ordinary duties, without any pain or uneasiness, there came away piecemeal some dark bones belonging to the fœtus of which she had formerly miscarried. I was able to recognize in some of the fragments portions of the spine, femur, and other bones.
I am acquainted with a young woman, the daughter of a physician with whom I am very intimate, who experienced in her own person all the usual symptoms of pregnancy; after the fourteenth week, being healthy and sprightly, she felt the movements of the child within the uterus, calculated the time at which she expected her delivery, and when she thought, from further indications, that this was at hand, prepared the bed, cradle, and all other matters ready for the event. But all was in vain. Lucina refused to answer her prayers; the motions of the fœtus ceased; and by degrees, without inconvenience, as the abdomen had increased so it diminished; she remained, however, barren ever after. I am acquainted also with a noble lady who had borne more than ten children, and in whom the catamenia never disappeared except as the result of impregnation. Afterwards, however, being married to a second husband, she considered herself pregnant, forming her judgment not only from the symptoms on which she usually relied, but also from the movements of the child, which were frequently ​felt both by herself and her sister, who occupied the same bed with her. No arguments of mine could divest her of this belief. The symptoms depended on flatulence and fat. Hence the best ascertained signs of pregnancy have sometimes deceived not only ignorant women, but experienced midwives, and even skilful and accurate physicians—so that as mistakes are liable to arise, not only from deception on the part of the women themselves, but also from the erroneous tokens of pregnancy, I should say that no rule is to be rashly laid down with respect to births taking place before the seventh or after the fourteenth month.
Unquestionably the ordinary term of utero-gestation is that which we believe was kept in the womb of his mother by our Saviour Christ, of men the most perfect; counting, viz. from the festival of the Annunciation, in the month of March, to the day of the blessed Nativity, which we celebrate in December. Prudent matrons, calculating after this rule, as long as they note the day of the month in which the catamenia usually appear, are rarely out of their reckoning; but after ten lunar months have elapsed, fall in labour, and reap the fruit of their womb the very day on which the catamenia would have appeared, had impregnation not taken place.
As regards the causes of labour, Fabricius, besides that of Galen (who held "that the fœtus was retained in utero until it was sufficiently grown and nourished to take food by the mouth," according to which theory weakly children ought to remain in utero longer than others, which they do not), gives another and a better reason, viz. "the necessity the fœtus feels for more perfectly cooling itself by respiration, since the child breathes immediately on birth, but does not take food by the mouth. This is not only the case," he continues, "in man and quadrupeds, but has been particularly observed in birds: these, small as they are, and furnished as yet with but tender bills, peck through the egg-shell at the point where they have need of respiration; and they do this rather through want of breath than of food, since the instant they quit the shell the function of respiration begins, whilst they remain without eating for two days, or longer." This point, however, whether ​the object of respiration be really to "cool" the animal, shall be discussed elsewhere at greater length.
In the mean time I would propose this question to the learned—How does it happen that the fœtus continues in its mother's womb after the seventh month? seeing that when expelled after this epoch, not only does it breathe, but without respiration cannot survive one little hour; whilst, as I before stated, if it remain in utero, it lives in health and vigour more than two months longer without the aid of respiration at all. To state my meaning more plainly—how is it that if the fœtus is expelled with the membranes unbroken, it can survive some hours without risk of suffocation; whilst the same fœtus, removed from its membranes, if air has once entered the lungs, cannot afterwards live a moment without it, but dies instantly? Surely this cannot be from want of "cooling," for in difficult labours it often happens that the fœtus is retained in the passages many hours without the possibility of breathing, yet is found to be alive; when, however, it is once born and has breathed, if you deprive it of air it dies at once. In like manner children have been removed alive from the uterus by the Cæsarean section many hours after the death of the mother; buried as they are within the membranes, they have no need of air; but as soon as they have once breathed, although they be returned immediately within the membranes, they perish if deprived of it. If any one will carefully attend to these circumstances, and consider a little more closely the nature of air, he will, I think, allow that air is given neither for the "cooling" nor the nutrition of animals; for it is an established fact, that if the fœtus has once respired, it may be more quickly suffocated than if it had been entirely excluded from the air: it is as if heat were rather enkindled within the fœtus than repressed by the influence of the air.
Thus much, by the way, on the subject of respiration; hereafter, perhaps, I may treat of it at greater length. As the arguments on either side are very equally balanced, it is a question of the greatest difficulty.
To return to parturition. Besides the reasons alluded to above, viz. "the necessity for respiration and the want of nourishment," Fabricius gives another; he says, "that the weight of the fœtus becomes so great as to exert considerable pressure, ​and the bulk such that the uterus is unable to retain it, added to which the quantity of excrementitious matter is so much increased that it cannot be contained by the membranes."
Now it has been shown above that the uterine humours are not excrementitious. Nor do the weight and bulk of the fœtus help us to a more probable explanation; for the fœtus suspended in water weighs but slightly on the placenta or uterus; besides which some nine months' children are very small, much less in fact than many fœtuses of eight months, nevertheless they do not abide longer in the womb. And as to weight, any twins of eight months are far heavier than a single nine months' child; yet they are not expelled before nine months are completed. Nor do we find a better reason in "want of nutriment;" twins, and even more children, are abundantly supplied with support up to the full term; and the milk which after delivery is sufficient for the nourishment of the child, could equally well, if transferred to the uterus, nourish the fœtus there.
I should rather attribute the birth of the child to the following reason—that the juices within the amnion, hitherto admirably adapted for nutriment, at that particular period either fail or become contaminated by excrementitious matter. I have touched on this subject before. The variation in the term of utero-gestation, occurring as it does chiefly in the human species, I believe to depend on the habits of life, feebleness of body, and on the various affections of the mind. And thus in the case of domesticated animals, owing to their indolence and overfeeding, the seasons both of copulation and production are less fixed and certain than in the wilder tribes. So women in robust health usually experience easy and rapid labours; the contrary holding good in those whose constitutions are shattered by disease. For the same thing befalls them that happens to plants, the seeds and fruits of which come later and less frequently to perfection in cold climates than in those where the soil is good and the sun powerful. Thus oranges in this country usually remain on the tree two years before they arrive at maturity; and figs, which in Italy ripen two or three times annually, scarcely come to perfection in our climate:—the ​same thing happens to the fruit of the womb; it depends on the abundance or deficiency of nutriment, on the strength or weakness of body, and on the right or wrong ordering of life with reference to what physicians call the "non-naturals," whether the child arrives sooner or later at maturity, i.e. is born.
Fabricius describes the manner of parturition as follows: "The uterus having been so enlarged by the bulk of the fœtus that it will admit of no further distension without risk, and thus excited to expulsion, is drawn into itself by the action of the transverse fibres, and diminishes its cavity. Thus whilst previously neither the excrementitious matters from their quantity, nor the fœtus from its bulk, could be contained within it, the uterus, contracted and compressed as it is now, becomes still less able to retain them. Wherefore, first of all, the membranes, as being the weaker parts, and suffering most pressure, are ruptured, and give exit to the waters, which are of a very fluid consistence, for the purpose of lubricating the passages. Then follows the fœtus, which tends towards, and, as it were, assaults the uterine aperture, not only by the force of its own gravity as no longer floating in water, but compressed and propelled by the action of the uterus: the abdominal muscles and the diaphragm also assist mightily in the entire process."
Now in these words Fabricius rather describes the process of defæcation or an abortion than a genuine and natural birth. For although in women, as a general rule, the membranes are ruptured before the escape of the fœtus, it is not universally so; nor does it hold in the case of other animals which bring forth their young enveloped in their membranes. This can be observed in the bitch, ewe, mare, and others, and more particularly in the viper, which conceives an ovum of an uniform colour and soft shell (resembling in fact the product of conception in the woman); this is retained until the fœtus is completely formed; it is then expelled entire, and, according to Aristotle, is broken through by the young animal on the third day. It sometimes happens, however, that kittens, whilst yet in utero, gnaw through the membranes, and so come into the world uninvolved.
​And so also, according to the observation of experienced midwives, women have occasionally expelled the child with the membranes unbroken. And this kind of birth, in which the fœtus is born enveloped in its coverings, appears to me by far the most natural; it is like the ripe fruit which drops from the tree without scattering its seed before the appointed time. But where it is otherwise, and the placenta, subsequently to birth, adheres to the uterus, there is great difficulty in detaching it, grave symptoms arise, fetid discharges, and sometimes gangrene occur, and the mother is brought into imminent peril.
Since then the process of parturition, as described by Fabricius, does not apply to all animals, but to women alone, and this not universally, but only where the labour is premature, and, as it were, forced, we must regard it not so much as a description of a natural as of a preternatural and hurried delivery, in fact, of an abortion.
In natural and genuine labour two things are required, which mutually bear upon and assist each other: these are, the mother which produces, and the child to be produced; and unless both are ready to play their part, the labour will hardly terminate favorably, requiring as it does the proper maturity of both. For if, on the one hand, the fœtus, from restlessness and over-desire to make its way out, does violence to the uterus, and thus anticipates the mother; or if, on the contrary, the mother, owing to feebleness of the uterus, or any other circumstance necessitating expulsion, is beforehand with the fœtus, this is to be looked upon rather as the result of disease than as a natural and critical birth. The same may be said of those cases where parts only of the product of conception escape, whilst others remain; for instance, if the fœtus itself is disposed to come away when the placenta is not yet separated from the uterus, or, on the other hand, if the placenta is separated when the fœtus is not rightly placed, or the uterus is not sufficiently relaxed to allow of its passage. Hence it is that midwives are so much to blame, especially the younger and more meddlesome ones, who make a marvellous pother when they hear the woman cry out with her pains and implore assistance, daubing their hands with oil, and distending the passages, so as not to appear ignorant in their art—giving besides medicines to excite the expulsive powers, and when they would hurry the labour, re​tarding it and making it unnatural, by leaving behind portions of the membranes, or even of the placenta itself, besides exposing the wretched woman to the air, wearying her out on the labour-stool, and making her, in fact, run great risks of her life. In truth, it is far better with the poor, and those who become pregnant by mischance, and are secretly delivered without the aid of a midwife; for the longer the birth is retarded the more safely and easily is the process completed.
Of unnatural labours, therefore, there are chiefly two kinds: either the fœtus is born before the proper time (and this constitutes an abortion), or else subsequently to it, when a difficult or tedious labour is the result, either from the due time and order not being preserved, or from the presence of dangerous symptoms; these arise either from failure of the expelling powers on the part of the mother, or from sluggishness on the part of the fœtus in making its way out; it is when both perform their proper parts that a safe and genuine labour results.
Fabricius ascribes the business of expelling the offspring to the uterus; and he adds, "the abdominal muscles and the diaphragm assist in the business." It seems to me, however, on deep investigation, that the throes of childbirth, just as sneezing, proceed from the motion and agitation of the whole body. I am acquainted with a young woman who during labour fell into so profound a state of coma that no remedies had power to rouse her, nor was she in fact able to swallow. When called to her, finding that injections and other ordinary remedies had been employed in vain, I dipped a feather in a powerful sternutatory, and passed it up the nostrils. Although the stupor was so profound that she could not sneeze, or be roused in any way, the effect was to excite convulsions throughout the body, beginning at the shoulders, and gradually descending to the lower extremities. As often as I employed the stimulus the labour advanced, until at last a strong and healthy child was born, without the consciousness of the mother, who still remained in a state of coma.
We can observe the manner of labour-pains in other animals, as the bitch, sheep, and larger cattle, and ascertain that they do not depend on the action of the uterus and abdomen only, but on the efforts of the whole body.
The degree in which the offspring contributes to accelerate and ​facilitate birth is made clear from observations on oviparous animals; in these it is ascertained that the shell is broken through by the fœtus and not by the mother. Hence it is probable that in viviparous animals also the greater part of delivery is due to the fœtus—to its efforts, I mean, not to its gravity, as Fabricius would have it. For what can gravity do in the case of quadrupeds standing or sitting, or in the woman when lying down? Nor are the efforts of the fœtus to get out, the result, as he believes, of its own bulk or of that of the waters; the waters, it is true, when the fœtus is dead and decomposed, by their putrid and acrimonious nature, stimulate the uterus to expel its contents; but it is the fœtus itself which, with its head downwards, attacks the portals of the womb, opens them by its own energies, and thus struggles into day. Wherefore a birth of this kind is held the more speedy and fortunate; "it is contrary to nature," says Pliny, "for a child to be born with the feet foremost; hence those so born were called Agrippæ, i.e. born with difficulty"—(ægre parti), for in such the labour is tedious and painful. Notwithstanding this, in cases of abortion, or where the fœtus is dead, or, in fact, when any difficulty arises in the delivery so as to require manual aid, it is better that the feet should come first; they act as a wedge on the narrow uterine passages. Hence, when we chiefly depend upon the fœtus, as being lively and active, to accomplish delivery, we must do our best that the head escape first; but if the business is to be done by the uterus, it is advisable that the feet come foremost.
We are able to observe in how great a degree the fœtus contributes to delivery, not only in birds, which, as I have said above, break through the shell by their own powers, but also in many other animals. All kinds of flies and butterflies pierce the little membrane in which they lie concealed as "aureliæ;" the silkworm also, at its appointed time, softens by moistening, and then eats through the silken bag which it had spun round itself for protection, and makes its way out without any foreign aid. In the same manner wasps, hornets, all insects in fact, and fishes of every kind, are born by their own will and powers. This can be best seen in the skate, fork-fish, lamprey, and the ​cartilaginous fishes generally. These conceive a perfect two-coloured egg, made up, that is, of albumen and yelk, and contained in a strong quadrangular shell; from this, still retained within the uterus, the young fish is formed: it then breaks through the shell, and makes its way out. In an exactly similar manner the young viper eats through the egg-shell, sometimes whilst it remains in utero, sometimes when within the passages, at others two or three days after birth. Hence arose the fable of the young viper eating through the womb of its mother, and so avenging its father's death; it does, in fact, nothing but what the young of every animal does, breaking though the membranes which envelope it, either in the delivery itself, or a short time subsequently to that event.
We learn moreover from positive observations how much the fœtus contributes to its own birth. A woman in my own neighbourhood, and I speak as having knowledge of the circumstance, died one evening, and the body was left by itself in a room; the next morning an infant was found between the thighs of the mother, having evidently forced its way out by its own efforts. Gregorius Nymmanus has collected several instances of a similar kind from trustworthy authors.
I am further acquainted with a woman who had the whole length of the vagina so torn and injured in a difficult labour, that subsequently, after she had again become pregnant, not only did the parts in the neighbourhood of the nymphæ, but the whole cavity of the vagina as far as the orifice of the uterus, become adherent; this went to such an extent that coition became impossible, nor could a probe be passed up, nor was there any passage left for the ordinary discharges. When her labour came on her sufferings were so dreadful that all hope of delivery was abandoned. She therefore gave up the keys to her husband, arranged her affairs, and took leave of her friends who were present. On a sudden, however, by the violent efforts of the fœtus the whole space was burst through, and a vigorous infant born; thus was the fœtus the salvation both of itself and its mother, besides opening the way for subsequent children. By the exhibition of proper remedies the mother recovered her former good state of health.
The following instance is even more remarkable. A white mare of great beauty had been presented to her Serene High​ness the Queen, and in order that its symmetry and usefulness might not be impaired by foal-bearing, the grooms, as is the custom, had infibulated the animal with iron rings. This mare (by what chance I know not, nor could the grooms inform me) was got with foal; and at length, when no one suspected anything of the kind, she foaled in the night, and a living foal was found the next morning by the mother's side. When I heard of the circumstance I went immediately to the place, and found the sides of the vulva still fastened together by the rings, but the whole pudendum on the left side so thrust and torn away from the pelvis by the almost incredible efforts of the fœtus, that a gap sufficiently wide was made to admit of its escape. Such is the force and vigour of a full-grown and healthy fœtus.
But, on the contrary, if the fœtus is diseased or feeble, or is born before the full term, it must be considered more an abortion than a regular birth, the fœtus being expelled rather than born; and thus for some days after birth it neither properly takes the breast nor gets rid of its excretions.
And yet the following example will show that the uterus also contributes towards delivery. A poor washerwoman had long suffered from procidentia uteri to such an extent that a tumour hung between the thighs as large as the fist. As no remedies had been applied, the prolapsed part became so rough and wrinkled as to take on the appearance of the scrotum, and in this state she suffered less than at the commencement of her illness. When consulted on her case, I ordered her to keep her bed for several days, to employ fomentations and ointments, and after the uterus was returned, to keep it in its place by means of pessaries and bandages, until by the use of strengthening applications it should be fixed firmly in its place. This plan was followed by some success; but she soon suffered a relapse, when compelled by her circumstances to follow her usual occupations, and continue long in the erect position. She bore, however, her inconvenience with patience, the uterus at times protruding, at others not doing so. At night she could usually reduce it, and it remained for some time in its proper place. After the lapse of a few days she returned, and complained that the uterus was so swelled from the use, as she thought, of the remedies, and especially of the fomentations, that ​it could not any longer be retained. By using some applications she was enabled to accomplish the reduction; but the cure was only temporary, for as soon as she stood up, and followed her ordinary occupations, the uterus immediately gave her much inconvenience by its weight, and at length entirely prolapsed. And now it hung down to the middle of the thigh, like the scrotum of a bull, to such an extent that I suspected not only the vagina but also the uterus to be inverted, or that there was some kind of uterine hernia. At length the tumour exceeded in magnitude a man's head, acquired a resisting character, and hung down as low as the knees; it also gave her much pain, and prevented her walking except in the prone position; added to which it discharged a sanious fluid from its inferior part, as if some portion had ulcerated. On ocular inspection (for I did not employ the touch) I feared that cancer or carcinoma might result, and so thought of the ligature or excision; in the mean time I advised the employment of soothing fomentations to ease the pain. The following night, however, a fœtus of a span long, perfectly formed, but dead, was expelled from the tumour, and was brought to me the next day. I took out the intestines, and kept it in cold water without decomposition for many months, showing it to my friends as an extraordinary object of curiosity. The proper skin in this fœtus was not yet formed, but in its place there was a pellicle, which could be stripped off entire, like that on a baked apple; underneath all the muscles of the body could be distinctly seen, the fœtus being very lean. I shall describe at another opportunity what I discovered in this fœtus on dissection. I have mentioned the case on this occasion to show that it was the uterus alone which excited the abortion, and expelled the fœtus by its own efforts.
Fabricius suggests two circumstances as especially worthy of admiration in and after birth: first, the dilatation of the uterus at the time of birth; secondly, the way in which after birth it is restored to its usual small size. He wonders how the uterus can be so distended as to allow the fœtus to escape, and afterwards in so short a period return to its pristine state.
He says, "that with Galen we can only wonder, but not understand," how the neck of the uterus, a part so thick, hard, ​and closely sealed, as not to admit a probe, can suffer such distension at the time of delivery. He gives, however, the following reason:
"that the unimpregnated uterus is of a thick and hard consistence, and so is its orifice, but when impregnated is yielding and soft, and in proportion as the term of delivery approaches, both the body of the uterus and its orifice become more and more yielding." He believes this to arise "from the distension which the uterus undergoes, and that when this distension takes place, the compact and plaited, so to speak, body of the uterus is expanded and unfolded; thus what was before thick and hard becomes soft and yielding, and ready to admit of the passage of the fœtus." He adds subsequently, "Some one may ask—if all this is correct, how is it that in pregnant animals the uterine aperture is so closed that it will not admit a probe? I answer, that this is so because the uterus, whilst it is being distended and undone, like a closely-folded piece of linen, begins to undergo these changes at its superior part; the lower portions then gradually widen, until the power of distension arrives at the aperture; this generally takes place at the period of birth. With reason then is the uterine orifice closely shut in the first months of pregnancy, whilst it is still hard and thick, but inclined to dilate in the latter ones. Thus much may be said about the unknown cause of Galen. Other circumstances may be mentioned as conducing to the dilatation of the orifice; for instance, the excretions of the fœtus, such as the sweat and urine; for although these are contained in their proper receptacles and membranes, yet some degree of moisture may be communicated to the uterine aperture, especially as it lies low, and always in the immediate neighbourhood of these humours; added to which, mucous and slimy matters are always found about the orifice." But in my opinion this great man is wrong; for the neck of the uterus is not hard from being folded on itself, but in consequence of its own proper substance and cartilaginous nature; and the accidental causes which he gives can have but little weight towards furthering the dilatation. This, doubtless, like every other contrivance in the human body, is owing to the divine providence of Nature, which directs her workmanship to ​certain ends, actions, and uses. The structure, then, of the uterus is such, that immediately on conception it shuts up closely its cartilaginous aperture, for the purpose of retaining the seed; this part subsequently, at birth, and that the fœtus may escape, like fruit on the tree, comes to maturity and softens, and this not by any unfolding of its tissue, but by a change in its natural character. For a loosening and softening takes place even in the commissural attachments of bones, as in those between the haunches and the sacrum, the pubes, and the pieces of the coccyx. It is a truly wonderful thing that the little point of a sprouting germ, say of the almond or another fruit, should break the shell which a hammer can scarcely crush; or that the tender fibres of the ivy-root should penetrate the narrow chinks of the stone, and at length cause rents in mighty walls. But it does not appear so marvellous that the parts of the woman, when distended by labour, should recover their natural firmness, if we consider the state of the male organ in coition, and how soon it subsequently becomes soft and flaccid. A greater matter for wonder is it, and surpassing all these "foldings," that the substance of the uterus, as the fœtus increases, not only is day by day enlarged and distended or unfolded, as it were, to take Fabricius's notion, but that it should become more thick, fleshy, and strong. We may even, with Fabricius, marvel still more at the means by which the mass of the uterus, by the intervention of the ordinary lochial discharges, returns to its original size in so few days; for this is not the case with other tumours or abscesses; these require a longer period for dispersion, being made up of unnatural matters, and such as require digestion, a process opposed to the power of expulsion. Yet this is not more worthy of admiration than the other works of nature, for "all things are full of God," and the Deity of nature is ever visibly present.
In the last place, it is object of great wonder to Fabricius how those vessels of the fœtus (meaning the oval opening out of the vena cava into the pulmonary vein, and the duct from the pulmonary artery into the aorta, on which subjects I have entered fully in my Essay on the Circulation of the Blood) immediately after birth begin to shrivel up and become obliterated. He is driven to that reason given by ​Aristotle, and already cited by me, which is, that all parts are made for a certain function, and if the function ceases to be required that they themselves disappear. The eye sees, the ear hears, the brain perceives, the stomach digests, not because such characters and structures (naturally) belong to these organs; but they are endowed with such characters and structures to accomplish the functions appointed them by nature.
On grounds like these it would appear that the uterus holds the first place among the organs destined for generation; for the testicles are made to produce semen, the semen is for the purposes of intercourse, and coition itself, or the emission of the semen, is instituted by nature that the uterus may be fecundated and generation result.
I have said before that an egg is, as it were, the fruit of an animal, and a kind of external uterus. Now, on the other hand, we may regard the uterus as an egg remaining within. For as trees are gay with leaves, flowers, and fruit at stated periods, and oviparous animals at one time conceive and produce eggs, at another become effete, so that neither the "place" or the part that contained them can be found, so have viviparous animals their spring and autumn allotted them. At the season of fecundation the genital organs, especially in the female, undergo great changes, so much so that in birds, the ovary, which at other times is scarcely visible, now becomes turgid; and the belly of the fish, near about the time of spawning, far exceeds in bulk the rest of the body, owing to the enormous number of ova and the quantity of semen contained within it. In very many viviparous animals the genital organs, that is, the uterus and spermatic vessels, are not always found presenting the same mode and course of action and structure; but as they are capable or not of conception, so changes take place, and to such an extent that the organs can hardly be recognized as the same. In nature, just as there is nothing lacking, so is there nothing superfluous; and thus it happens that the organs of generation wither away and are lost when there is no longer any use for them.
At the period of coitus in the hare and mole, the testicles ​of the male become visible, and in the female the horns of the uterus appear. In truth, it is most marvellous to see what an enormous quantity of semen is contained in full-grown moles and mice at those times, whilst at others no semen can be seen, and the testicles are shrunk and retracted. So also when the reproductive faculty ceases in the female, the uterus is found with difficulty, and it is scarcely possible to distinguish the sexes.
The uterus, especially in the woman, varies extraordinarily as it is fecundated or not, both in constitution and in the results of that constitution—I mean in position, size, form, colour, thickness, hardness, and density. In the girl, before the age of puberty, the breasts are no larger than those of the boy, and the uterus is a small, white, membranous organ, destitute of vessels, and not larger than the top of the thumb, or a large bean. In like manner in old women, as the breasts are collapsed, so is the uterus shrunken, flaccid, withered, pale, and void of vessels and blood. I attribute the suppression of the catamenia in elderly women to this cause; in them the menstruous fluid either escapes as hemorrhoidal flux, or is prematurely stopped, to the injury of the health. For when the uterus becomes cold and almost lifeless, and all its vessels are obliterated, the superfluous blood boils up, and either falls back and stagnates, or else is diverted into the neighbouring veins. On the contrary, in those pale virgins who labour under chronic maladies, and in whom the uterus is small and the catamenia stagnate, "by coition," says Aristotle, "the excrementitious menstrual fluid is drawn downwards, for the heated uterus attracts the humours, and the passages are opened." In this way their maladies are greatly lessened, seeing that want of action on the part of the uterus exposes the body to various ills. For the uterus is a most important organ, and brings the whole body to sympathize with it. No one of the least experience can be ignorant what grievous symptoms arise when the uterus either rises up or falls down, or is in any way put out of place, or is seized with spasm—how dreadful, then, are the mental aberrations, the delirium, the melancholy, the paroxysms of frenzy, as if the affected person were under the dominion of spells, and all arising from unnatural states of the uterus. How ​many incurable diseases also are brought on by unhealthy menstrual discharges, or from over-abstinence from sexual intercourse where the passions are strong!
Nor are the changes which take place in the virgin less observable when the uterus first begins to enlarge and receive warmth; the complexion is improved, the breasts enlarge, the countenance glows with beauty, the eyes lighten, the voice becomes harmonious; the gait, gestures, discourse, all are graceful. Serious maladies, too, are cured either at this period or never.
I am acquainted with a noble lady who for more than ten years laboured under furor uterinus and melancholy. After all remedies had been employed without success, she became affected with prolapsus uteri. Contrary to the opinion of others, I predicted that this last accident would prove salutary, and I recommended her not to replace the uterus until its over-heat had been moderated by the contact of the external air. Circumstances turned out as I anticipated, and in a short time she became quite well; the uterus was returned to its proper situation, and she lives in good health to the present day.
I also saw another woman who suffered long with hysterical symptoms, which would yield to no remedies. After many years her health was restored on the uterus becoming prolapsed. In both cases, when the violence of the symptoms was abated, I returned the uterus, and the event proved favorable. For the uterus, when stimulated by any acrid matter, not only falls down, but like the rectum irritated by a tenesmus, thrusts itself outwards.
Various, then, is the constitution of the uterus, and not only in its diseased, but also in its natural state, that is, at the periods of fecundity and barrenness. In young girls, as I said, and in women past childbearing, it is without blood, and about the size of a bean. In the marriageable virgin it has the magnitude and form of a pear. In women who have borne children, and are still fruitful, it equals in bulk a small gourd or a goose's egg; at the same time, together with the breasts, it swells and softens, becomes more fleshy, and its heat is increased; whilst, to use Virgil's expression with reference to the fields,
​Wherefore women are most prone to conceive either just before or just subsequent to the menstrual flux, for at these periods there is a greater degree of heat and moisture, two conditions necessary to generation. In the same manner when other animals are in heat, the genital organs are moist and turgid.
Such is the state of the uterus as I have found it before birth. In pregnant women, as I have before stated, the uterus increases in proportion to the fœtus, and attains a great size. Immediately after birth, I have seen it as large as a man's head, more than a thumb's breadth in thickness, and loaded with vessels full of blood. It is, indeed, most wonderful, and, as Fabricius remarks, quite beyond human reason, how such a mass can diminish to so vast an extent in the space of fifteen or twenty days. It happens as follows: immediately on the expulsion of the fœtus and its membranes, the uterus gradually contracts, narrows its neck, and shrinks inwardly into itself; partly by a process of diaphoresis, partly by means of the lochia, its bulk insensibly lessens; and the neighbouring parts, bones, abdomen, and all the hypogastric region, at the same time diminish and recover their firmness. The lochial discharge at first resembles pure blood; it then becomes of a sanious character, like the washings of flesh, and is otherwise pale and serous. At this last stage, when no longer tinged with blood, the women call it "the coming of the milk," for the reason probably that at that time the breasts are loaded with milk, and the lochia sensibly diminish; as if the nutritive matter was then transferred to the breasts from the uterus.
In other animals the process is shorter and simpler; in them the parts concerned recover their ordinary bulk and consistence in one or two days. In fact, some, as the hare and rabbit, admit the buck, and again become fecundated, an hour after kindling. In like manner, I have stated that the hen admits the cock immediately on laying. Women, as they alone have a menstruous, so have they alone a lochial discharge; added to which they are exposed to disorders and perils immediately after birth, either from the uterus, through feebleness, contracting too soon, or from the lochia becoming vitiated or suppressed. For it often happens, especially in delicate women, that foul and putrid lochia set up fevers and other violent ​symptoms. Because the uterus, torn and injured by the separation of the placenta, especially if any violence has been used, resembles a vast internal ulcer, and is cleansed and purified by the free discharge of the lochia. Therefore do we conclude as to the favorable or unfavorable state of the puerperal woman from the character of these excretions. For if any part of the placenta adhere to the uterus, the lochial discharges become fetid, green, and putrid; and sometimes the powers of the uterus are so reduced that gangrene is the result, and the woman is destroyed.
If clots of blood, or any other foreign matter, remain in the uterine cavity after delivery, the uterus does not retract nor close its orifice; but the cervix is found soft and open. This I ascertained in a woman, who, when laboring under a malignant fever, with great prostration of strength, miscarried of a fœtus exhibiting no marks of decomposition, and who afterwards lay in an apparently dying state, with a pulse scarcely to be counted, and cold sweats. Finding the uterine orifice soft and open, and the lochia very offensive, I suspected that something was undergoing decomposition within; whereupon I introduced the fingers and brought away a "mole" of the size of a goose's egg, of a hard, fleshy, and almost cartilaginous consistence, and pierced with holes, which discharged a thick and fetid matter. The woman was immediately freed from her symptoms, and in a short time recovered.
When the neck of the uterus contracts in a moderate degree after birth, and certain pains, called by the midwives "after pains," ensue, in consequence of the difficulty with which the clots are expelled, the case is considered a favorable one, and is so in fact; for it indicates vigour on the part of the uterus, and that it is inclined readily to contract to its usual bulk; the result of which is that the lochia are duly expelled, and health restored to the woman.
But I have observed in some women the uterine orifice so closed immediately after parturition, that the blood has been retained in the uterus, and then, becoming putrid, has induced the most dangerous symptoms; and when art did not avail to promote its exit, the woman has presently died.
A noble lady in childbed being attacked with fever for want of the ordinary lochial discharge, had the pudenda swollen and ​hot; finding the uterine orifice hard and firmly closed, I forcibly dilated the part by means of an iron instrument sufficiently to admit of my introducing a syringe and throwing up an injection; the effect of which was that grumous and fetid blood, to the amount of several pounds, flowed away, with present relief of the symptoms.
The wife of a doctor of divinity was brought to me; a lady of a very tolerable constitution, but who was barren, and having an extreme desire for progeny, had tried all kinds of prescriptions in vain. In her the catamenia appeared at their proper period; but at times, especially after horse exercise, a bloody and purulent discharge came from the uterus, and then, in a short time, ceased suddenly. Some considered the case as one of leucorrhœa; others, led chiefly by the fact that the discharge was not continually present, and in small quantities, but appeared by intervals and in abundance, suspected a fistulous ulcer; whereupon they examined the whole vagina by means of a speculum uteri, and applied various remedies, but in vain; when I was at length called to her. I opened the uterine orifice, and immediately two spoonfuls of pus came away of a sanious character and tinged with streaks of blood. On seeing this I said that there was a hidden ulcer in the uterine cavity, and by applying suitable remedies I restored her to her former state of health. But during the time when I was engaged in her cure, when the ordinary remedies did not appear to be doing much good, I applied stronger ones, suspecting as I did that the ulcer was of long standing, and perhaps covered by exuberant granulations. I therefore added a little Roman vitriol to the injection employed previously, the effect of which was to make the uterus contract suddenly and become as hard as a stone; at the same time various hysterical symptoms showed themselves, such, I mean, as are generally supposed by physicians to arise from constriction of the uterus, and the rising of "foul vapours" therefrom. The symptoms continued some time, until by the application of soothing and anodyne remedies the uterus relaxed its orifice; upon which the acrid injection, together with a putrid sanies, was expelled, and in a short time the patient recovered.
I have introduced this account from my "medical observations" for the purpose of showing how acutely sensible the ​uterus is, and how readily it closes on the approach of danger, especially when urgent symptoms accompany the puerperal state. Women are peculiarly subject to these accidents, especially those among them who lead a luxurious life, or whose health is naturally weak, and who easily fall into disorders. Country women, and those accustomed to a life of labour, do not become dangerously ill on such small grounds. Some of them may be found pregnant a month after delivery; whilst two months frequently elapse before others are able to set about the ordinary occupations of life.
It is laid down by Hippocrates, that as many days are required for the "after-purgings" as there are for the formation of the fœtus; therefore there are more for a female than a male child. "But this," says Scaliger, "is false; for in none of our women do "the cleansings" last more than a month; in very many they cease on the fifteenth day; in some even on the seventh day: and I have seen a case where they lasted only until the third day, although the woman had borne twins." Galen has many observations on this subject in his work περὶ κυουμένων, (On the Formation of the Fœtus.) In the New World, it is said that the woman keeps apart the day only on which she is delivered, and then returns to her ordinary occupations.
I will add, in conclusion, an extraordinary instance told me by the noble Lord George Carew, Earl of Totness, and long Lord-Lieutenant of Munster in Ireland—he who wrote the history of these times. A woman, great with child, was following her husband, who served as a soldier, and it happened that the army, when on the march, was compelled to halt for the space of an hour near a small river which impeded their passage; whereupon the woman, who felt her labour at hand, retired to a neighbouring thicket, and there, without the aid of a midwife or any other preparation, gave birth to twins; after she had washed both herself and them in the running stream, she wrapped the infants in a coarse covering, tied them on her back, and the same day marched barefoot twelve miles with the army, without the slightest harm ensuing. The following day the Viceroy, Earl Mountjoy, who at that time was leading an ​army against Kinsale, then occupied by the Spaniards, and the Earl of Totness, were so affected by the strange incident, that they appeared at the font, and had the infants called by their own names.
* ↑ De Form. Fœt. cap. ix, p. 40.
* ↑ Hist. Anim. lib. vii, cap. 7.
* ↑ De Gen. Anim. lib. iv, cap. 8, et lib. vii, cap. 5.
* ↑ Page 141.
* ↑ De Gen. Anim. lib. iv, cap. 4 et ult.
* ↑ Sympos. lib. iii. qu. 10.
* ↑ Lib. vii, cap. 5.
* ↑ Hist. Anim. lib. vii. cap. 4.
* ↑ In Epist. de incerto tempore partus.
* ↑ Lib. ix, De Nat. Anim. c. ult.
* ↑ Loco procitato.
* ↑ Hist. Anim. lib. vii, cap. 4.
* ↑ Ibid.
* ↑ De Non Part. lib. xv, cap. 7.
* ↑ P. 142.
* ↑ Hist. Anim. lib. v, cap. 34.
* ↑ Lib. vii, cap. 8.
* ↑ De Form. Fœt. p. 142.
* ↑ De Usu Part. lib. xv, cap. 7.
* ↑ P. 143.
* ↑ De Gen. Anim. lib. i, cap. 5.
* ↑ De Gen. Anim. lib. iii, cap. 1.
* ↑ Lib. de Fœtu.
* ↑ Com. in Arist. Hist. Anim. lib. vii, cap. 3.