Niiiien it is dependent on ovarian disease, the at tentiun must be directed to the removal of that, which is a matter of great difficulty. The present excellent and zealous Professor of .Nlidtlifery in the University of Edinburgh, Dr. Hamilton, has informed the author, that he has, in some cases, been successful, by employing patting or frit tion externally, and prescribing the solution of muriate of lime.
This chronic swelling is not to be confounded with a tuniefacticat of a more acute nature, which sometimes occurs in the puerperal state, without pain, or indica tion of infl.mitm,,tion. The same experienced practi tioner compares this swelling to a pillow of down, for, by pressing with the hand, a similar soft sensation is perceived : the hand sinks, but the swelling immediately rises on removing the pressure. It is considered as a fatal symptom.
Of the Signs that a Woman has been recently livered.
It is sometimes an object of great importance in medical jurisprudence, to determine whether a woman have lately been delivered of a child. This can be done by examination of the breasts, the external ap pearance of the abdomen, and the condition of the ute rus and vagina. We find the labia and vagina relax ed, somewhat tumid, and of a deeper red than usual. The perineum is generally injured, or the fourchette at least is torn. There is a sanguineous discharge. The uterus is felt to be enlarged, and has neither the shape of the gravid nor of the unimpregnated womb. It generally lies obliquely to one side. The os uteri is nearly circular, is soft, somewhat rugged, and will admit the point of one or more fingers, according to the time which has elapsed since 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 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 considered as Ito 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 with when the female has ex pelled a mass of hydatids. or a mole, as it has been called ? This may be decidedly answered in the nega tive. M,,st of such substances are produced by con ception. but after a dine the ovum becomes blighted, changed into hydatid, or a more solid disnrgan izcd mass. As pregnancy, therefore, has existed, it is evident that the secretion of milk and distention of the breasts may take place, and the uterus will be found enlarged. But it is very rare for these masses to ac quire such a size as shall enlarge the uterus, 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.
Certain 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 !rum inflation of the bow els, 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 closed, 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 been 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 produce the other symp toms, they could not tear the perineum. If such sub stances really were expelled, they would be shown by the patient, or described by her, so as to satisfy a me dical practitioner. Far less can mechanical 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 must 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 appendages by dissection. The womb is found en larged, its substance thickened, its cavity filled with coagulated blood, or, if empty, the internal 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 tubes, but particularly the ovaria, are highly vascu lar, and these latter contain, on different parts of their surface, vesicles filled with bloody fluid. Can it be determined by dissection, whether a female has had a premature labour, or have discharged a false concep tion, as it has been called ? This is chiefly to be done by the state 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 been 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 he expected the same enlargement of uterine ves sels to support a fading or imperfectly organized mass, which would be requisite for a perfect and vigorous ovum. cr