Chapter XLIII: Introduction (18)

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[370] 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[371] 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 deliver”. He gives,[372] 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,[373] 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,[374] “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,

“Superat tener omnibus humor,
Et genitalia semina poscunt.”

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,[375] 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,[376] “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.

ON

THE UTERINE MEMBRANES AND HUMOURS.

OF THE

UTERINE MEMBRANES AND HUMOURS.

“Four kinds of bodies” are enumerated by Hieronymus Fabricius[377] “as existing externally to the fœtus; these are the umbilical vessels, the membranes, the humours, and a fleshy substance.” On these subjects, guided by my observations, I shall briefly state wherein I differ from him; first, however, giving his statement in his own words.

“There are,” he says, “three membranes, two of which envelope the whole fœtus, but the third does not do so. Of those which envelope the whole fœtus, the innermost, immediately investing one, is called ἃμνιον, i. e. the mantle. That which follows next is entitled by the Greeks χόριον; the Latins, however, have not given it a name, although some interpreters have thought proper erroneously to call it “secundæ” or “secundina,” the secundines; this also envelopes the entire fœtus. The third is called ἀλλαντοειδὴς, i. e. gut-like, from its resemblance to a stuffed intestine; it does not entirely encompass the fœtus, but is applied upon the thorax and part of the abdomen, and extends to either horn of the uterus.” He allows that this last membrane is only found in the fœtus of the sheep and cow; he asserts also that it is continuous with the urachus, and by means of this receives the urine from the bladder. Hence, he goes on, “horned animals, in whom this allantois is found, have the urachus so wide and straight, that it resembles a small intestine; it gradually decreases in size until it reaches the fundus of the bladder; whence it would appear to owe its origin rather to the intestine than to the bladder itself. But in man and other animals furnished with incisors in both jaws, and in whom the allantois is wanting, the size of the urachus is so diminished, that although it rises from the fundus of the bladder as a single tube, it afterwards splits into innumerable fibres, which pass beyond the umbilicus together with the vessels, and carry the urine into the chorion, although the exact mode in which it does so cannot be demonstrated.” On this ground he accuses Arantius of a double error--first, his denial of the existence of the urachus in man; and, secondly, his assertion that the fœtus passes its urine through the genital organs.

For my own part, I must confess I am a willing party to the errors of Arantius, if errors they are to be called. For I am quite sure, if pressure be made on the bladder of a full-grown fœtus, whether of man or of any other animal, that urine will flow by the genitals. But I have never seen an urachus, nor observed that the urine is propelled into the membranes by making pressure on the bladder. I have indeed seen in the sheep and deer what appeared to be a process of bladder between the umbilical arteries, and which contained urine; but it in no way resembled the urachus as described by Fabricius. Not that I would obstinately deny the existence of an allantois; for the minor membranes are so delicate and transparent (those, for example, which we have described as existing between the two “whites” of the egg) that they may easily escape observation. Moreover, in the hen’s egg a white excrementitious matter, and even fæces are found between the colliquament and albumen, i. e. between the amnion and chorion; this I have mentioned before, and Coiterus has also observed it. Added to which, the membrane of the colliquament itself, in which the fœtus swims, although it is so exceedingly transparent and delicate that Fabricius himself allows nothing can be imagined more so, nevertheless (for according to him all membranes, however thin, are double) may nature sometimes find herself compelled to deposit urine or some other matter between its duplicatures. An allantois of this kind I am ready to allow Fabricius; but that other intestine-like body produced into either horn of the uterus, I do not discover among the membranes in cloven-footed animals, nor aught else, in fact, except the conception itself. I can only find, as I before said, a process of the bladder, situated between the umbilical arteries, which contains an excrementitious matter, and varies in length in different animals. Wherefore, in my opinion, the tunic which Fabricius calls the allantois is, in fact, the chorion; and the ancients applied the name of allantois to it on account of its resemblance to a double intestine. For that external membrane, constricted in the middle, and resembling a saddle-bag in form, which is stretched upwards to each horn of the uterus, and in its passage is pinched in by that part of the uterus which connects the horns, is in truth the chorion; and in the sheep, goat, roe, fallow-deer, and other cloven-footed animals, it can be raised by the hand in the middle of its course, and easily extracted whole; this is the same as what is called the “conception” or ovum. Like an egg, it contains within itself two fluids, and the fœtus with its appendages; it is possessed besides of those characters which Aristotle attributes to the egg; these are, that out of part of it the embryo is originally formed, and that the remainder constitutes the sustenance of the new animal, as has been frequently explained. I believe, then, the tunic which Fabricius called the allantois to be either the chorion or else some unnatural structure formed out of the reduplication of the membranes. It is accordingly only found to exist in some animals, and not always in these; it cannot be traced from the commencement of conception, and in some animals it is more apparent than in others: whilst in others nothing can be seen except a mere process of the bladder. Besides, Fabricius himself allows that its purpose is not to envelope the fœtus, but to contain its urine. In truth, I must think that he has described it rather to defend the doctrine of the ancients, than because he really believed he had discovered such a membrane, or that it served any good purpose. For he allows, with the ancients, and every medical school, that the chorion contains urine, when he says[378] that there are two humours encircling the fœtus, one, viz. in the amnion, consisting of sweat; the other in the chorion, consisting of urine. It is, therefore, clear that the ancients under the two names understood one and the same membrane; and that in the cloven-footed animals they called it “allantois,” on account of its form; but in others “chorion,” because they thought its object was to receive the urine. Wherefore they allow that this tunic is neither found in man nor any of the other animals. For what need can there be of another tunic to retain the urine, when they themselves admit that the office of doing so belongs especially to the chorion? There can be no probable reason assigned why this tunic should exist in the sheep, goat, and the other cloven-footed animals, and not also in the dog, cat, mouse, and others. For in truth, if the object of this membrane were to contain the urine, the fœtus of the sheep and cow must secrete a much larger quantity than those of animals furnished with incisors in both jaws; there must then either be three different humours, or at least two receptacles for the urine. For myself, I am sure that the chorion from the first is full of water. I will not, however, enter into controversies; I would rather record what I have found by my own observations.

To do as Fabricius has done, and give the structure of the full-grown and perfect embryo, is one thing, but it is another to enter fully on the subject of its generation and first formation: just as they are very different things to describe the ripe fruit of an apple or any other tree, and to explain the manner in which it is produced from the germ. I will, therefore, briefly go through the stages by which the “conception” is brought to maturity, in which way the true doctrines in the matter of the membranes and other fœtal appendages will be better ascertained.

In the production of all living creatures, as I have before said, this invariably holds, that they derive their origin from a certain primary something or primordium which contains within itself both the “matter” and the “efficient cause;” and so is, in fact, the matter out of which, and that by which, whatsoever is produced is made. Such a primary something in animals (whether they spring from parents, or arise spontaneously, or from putrefaction) is a moisture inclosed in some membrane or shell; a similar body, in fact, having life within itself either actually or potentially; and this, if it is generated within an animal and remain there, until it produce an “univocal” (not equivocal) animal, is commonly called a “conception;” but if it is exposed to the air by birth, or assumes its beginning under other circumstances, (than within an animal), it is then denominated an “egg,” or “worm.” I think, however, that in either case the word “primordium” should be used to express that from whence the animal is formed; just as plants owe their origin to seeds: all these “primordia” have one common property--that of vitality.

I find a “primordium” of this kind in the uterus of all viviparous animals before any trace of a fœtus appears: there is a clear, thick, white fluid (like the albumen of the egg) inclosed in a membrane, and this I call the ovum. In the roe, fallow-deer, sheep, and other cloven-footed animals, it fills the whole uterus and both its horns.

In process of time an extremely limpid and pure watery fluid (similar to that which in the hen’s egg I have called the colliquament) is secreted by this “primordium” or “ovum;” in clearness and brilliancy far exceeding the remaining fluid of the ovum in which it is contained. It is of a circular form, and inclosed in a very delicate and transparent membrane of its own called the “amnion.” The other fluid, of a denser and thicker character, is contained in the outer envelope, or chorion, which is in immediate contact with the concave surface of the uterus, and which also encompasses the entire ovum: the shape of this second membrane varies according to that of the uterus: in some animals it is oval, in others oblong, but in those with cloven feet it resembles a saddle-bag. After a short time a red pulsating point shows itself within the transparent substance, and from this point exceedingly fine twigs, or rather rays of vessels, start forth. By and by the first aggregated portion of the body makes its appearance, folded upon itself orbicularly, and somewhat resembling a grub: the remaining parts follow in the order described in our history. For I have ascertained that the production of the fœtus from their ova or “conceptions” in viviparous animals, takes place exactly in the same way as the growth of the chick within the egg.

As I before observed, “conceptions” in viviparous animals vary in form, number, and in their modes of attachment to the uterus. At first, especially in the cloven-footed animals, the “conception” does not adhere to the uterus, but is only in contact with, and fills and distends the organ, and can be easily extracted entire. In cloven-footed animals, which conceive within the horns of the uterus, and also in the solidungula, one ovum only of this kind is found, and that stretching up into either horn of the uterus: and although these animals sometimes produce one, sometimes two young at a birth, and so sometimes one, sometimes two colliquaments are found, one in the right, the other in the left horn of the uterus, yet the two are always contained in one and the same ovum.

In other animals, however, the number of ova answers to the number of fœtuses, and within them are as many colliquaments: this is the case in the dog, cat, mouse, and other animals of this kind with teeth in either jaw. In cloven-footed animals the ovum is shaped like a saddle-bag: the form, in fact, under which Fabricius represented the allantois. In the mare, the figure of the uterus internally resembles an oblong bag; in the woman it is of a globular form.

In animals in whom the “conception” adheres to the uterus, (and in very many it does not do so until the fœtus is fully formed), this takes place in various modes. In some it is adherent in one place by the intervention of a fleshy substance, which in the woman is called the “placenta,” from its resemblance to a round cake (placenta): in others it is attached at many points by certain fleshy bodies, or “carunculæ:” these are five in number in the hind and doe; more numerous, but of smaller size, in the cow; and in the sheep they are in great numbers and of various sizes. In dogs and cats these fleshy bodies entirely surround each ovum like a girdle. A similar substance, in the hare and mole, grows to the side of the uterus: like the human placenta, which embraces about half the “conception,” (just as the cup does the acorn at the commencement of its growth), it is attached by its convex aspect to the uterus, and by its concave surface to the chorion.

With these observations premised, I shall now state my opinions on the humours, membranes, fleshy substance of the uterus, and the distribution of the umbilical vessels, in the order described by Fabricius.

The words δεύτερα and ὔστερα are correctly understood by Fabricius[379] to answer to “secundæ” and “secundina” (the secundines): and by these are implied not only the membranes, but everything which comes away from the uterus at the last stage of parturition, or at least not long after it, viz. the humours, membranes, fleshy substance, and umbilical vessels.

_Of the Humours._

The doctrines inculcated on the subject of the humours, and which, as being entertained by the ancients, Fabricius regards as certain truths requiring no farther proof, are altogether inconsistent and false; the doctrines, I mean, that the fluid within the amnion, wherein the fœtus swims, consists of sweat; and that within the chorion of urine. For both these humours are found in the “conception” before any trace of the fœtus is visible; added to which, the fluid they call urine can be seen before that which they regard as sweat. In truth, these humours, especially the outer one, may be observed in unfruitful conceptions where nothing like a fœtus is discoverable.

Women sometimes expel conceptions of this kind, analogous to the subventaneous or wind egg. Aristotle[380] says they are called “fluxes;” among ourselves they are termed “false conceptions,” or “slips.” An ovum of this kind was aborted in the case of Hippocrates’s pipe-player. “In all creatures,” we are informed on the authority of Aristotle,[381] “which breed another within themselves, immediately on conception an egg-like body is formed; that is to say, a body in which a fluid is contained within a delicate membrane just like an egg with the shell removed.” The humour in the chorion, which Fabricius and other physicians consider to be urine, Aristotle seems to have regarded as the seminal fluid (spermatis sive genituræ liquor). He says,[382] “when the semen is received into the uterus, after a certain time it becomes surrounded by a membrane, and if expulsion takes place before the fœtus is formed, it has the appearance of an egg with the shell removed and covered by its membrane: this membrane, moreover, is loaded with vessels.” It is, in fact, the chorion; so called from the conflux or multitude of veins. I have often observed ova of this kind escape in the second and third month; they are frequently decomposed internally, and come away gradually in the form of a leucorrhœal discharge, and thus the hopes of the parent are lost.

Another reason why these humours cannot be sweat and urine, is, that they exist in such abundance at the very beginning;--for the purpose, no doubt, of preventing the body of the fœtus from coming in contact with the adjacent parts when the mother runs, jumps, or uses violent exertion of any kind.

Added to which, many animals never sweat at all, (and we must remember what is said by Aristotle,[383] “that all creatures which swim, walk, or fly,” I will add serpents and insects, whether viviparous or oviparous, or generated spontaneously, “are produced after the same manner,”) as is the case with birds, serpents, and fishes, which neither sweat nor pass urine. The dog and cat also never sweat; neither in fact does any animal in which the urinary secretion is very abundant. Besides, it is impossible that urine can be passed before the kidneys and bladder are formed.

Moreover, and this is the strongest argument that can be brought forward, those humours can never be excrementitious into which so many branches of the umbilical vessels are distributed by means of the chorion; these vessels, in fact, in this manner taking up nourishment, (as it were from a large reservoir,) and then conducting it to the fœtus.

Besides what need is there of an allantois, if the fluid within the chorion is urine? And if that in the amnion is sweat, why does Nature, who contrives all things well, ordain that the fœtus should float about in its own excrement? And why, too, should the mother (as is the case with some animals) immediately after birth, so greedily devour the excretions of its own offspring, together with the containing membranes? Some have even observed that if the animal fails to eat up these matters it does not give its milk freely.

Notwithstanding these arguments, it may possibly be imagined by some that the humours which I believe serve for the nutrition of the fœtus are excrementitious, led chiefly by the fact that they increase as the fœtus grows larger, and in some animals are observed to exist in immense quantities at the period of birth (at which time it might be supposed that all alimentary matters would have been absorbed), and serve besides other uses hardly compatible with their supposed function of nutrition. I nevertheless most confidently assert my belief that these humours are at the commencement destined for the nourishment of the fœtus, just as the colliquament and albumen are in the case of the chick; but that, in course of time, when the thinner and purer portions are absorbed, the remainder takes on the character of excrementitious matter, but still has its uses, and in some animals especially conduces to the safety of the fœtus, and also greatly facilitates birth. For just as wine becomes poor and tasteless when the spirit has evaporated; and as all excreted matters owe their origin for the most part to what has been previously food; so, after all the nutrient portions of the fluid contained in the chorion have been taken up by the fœtus, the remainder become excrementitious, and is applied to the above-mentioned uses. But all the fluid of the amnion is usually consumed by the time of birth; so that it is probable the fœtus seeks its exit on account of deficiency of nutriment.

Lastly, if any other fluid is ever contained within the allantois, and this is sometimes the case, I believe it to be unnatural. For sometimes we see women at their delivery have an enormous flow of water, sometimes a distinctly double flow; and this the midwives call the “by-waters.” And so some women are seen with the abdomen immensely distended, and yet they bring forth a little shrivelled fœtus accompanied by a vast flow of water. Some imagine that a larger quantity of water is found with weakly and female children, whilst stronger and male fœtuses have a smaller share. I have often seen the waters come away in the middle of pregnancy, and abortion not take place, the child remaining strong and vigorous until birth. Since, then, there are naturally two collections of fluid, one in the chorion, the other in the amnion, so it sometimes happens that unnatural accumulations take place either in membranes of their own, or between the duplicatures of the chorion.

_Of the Membranes._

With respect to the membranes or tunics of the uterus; as their special office is to contain the “waters,” and as these waters are two only, it is pretty certain that the membranes themselves do not necessarily or usually exceed that number.

Those who enumerate three tunics are, I believe, in error, owing to the ancients having described the same membrane at one time under the title of “chorion,” from the concourse of veins, at another under the name of “allantois” from its form.

Unquestionably, every “conception” is inclosed in two envelopes, just as the brain is surrounded by its two membranes; every tree and fruit, moreover, has its double bark; and lastly, seeds and fruits are protected by a double covering, the outermost of which is harder and stronger than the inner one.

Of the above-mentioned membranes, the innermost (that which contains the colliquament or purer fluid,) is exceedingly delicate; it is called the “amnion,” i.e. the mantle, from the way in which it is disposed round the fœtus. The outer tunic, however, is much thicker and stronger, and has received the name of “chorion,” “because,” says Fabricius, “a multitude of arteries and veins are aggregated together and arranged in it, as it were, after the manner of a chorus. Hence one of the tunics of the eye has been denominated χοροειδὴς (choroid) from its vessels having a similar arrangement to those in the chorion; the plexus of arteries and veins in the ventricles of the brain has also gained its name from the same circumstance.”

The chorion fills the whole uterus, and contains a viscid and rather turbid fluid; whilst the placenta, or carunculæ, adhere to its outer surface, and thus attach the “conception” to the uterus.

In the woman it is usually adherent to the amnion at its lower portion; nor can it be separated there without difficulty. In cloven-footed animals the chorion is of very large size, and contains a hundred times more fluid than the amnion: this last membrane at first is scarcely as large as a nutmeg, or broad bean, and is generally found in one or other horn of the uterus; that, namely, in which the embryo lies.

In the woman, more particularly, the chorion is externally rough and viscous, but internally it is smooth, slippery, and interwoven with abundance of vessels. In the woman, also, the upper part is thick and soft, but the lower is thinner and more membranous in character.

The placenta in the woman grows to the upper part of this membrane. In the sheep, numerous carunculæ adhere to it at various points. In the fallow and red deer the ovum is united to the uterus in five places only; whilst in the mare it is in contact with the inner surface of the uterus by an almost infinite number of points of attachment. Hence Fabricius[384] states that in almost all viviparous animals there is a soft, loose, porous, and thick fleshy body of a dark colour, in intimate union with the terminations of the umbilical vessels; he compares it to a sponge, or to the loose parenchyma of the liver or spleen; hence, too, it was called by Galen[385] “glandular flesh;” and it is now commonly known by the name of the uterine liver, in which the extremities of the umbilical vessels ramify to bring nutriment from the uterus to the fœtus.

But this fleshy substance is not found in all animals, nor at all periods of utero-gestation; but in those alone in which the conception adheres to the uterus; and then only when it becomes attached for the purpose of taking up nutriment. At the commencement the “conception” (like an egg placed within the uterus) is found in contact with every part of the uterus, yet at no point is it adherent; but produces and nourishes the embryo out of the humours contained within it, as I have explained in the instance of the hen’s egg. This adhesion, or growing together, first takes place, and the fleshy mass (constituting the bond of union between the “conception” and the uterus) is first produced, when the fœtus becomes perfectly formed, and, through want either of different or more abundant nourishment, dispatches the extremities of the umbilical vessels to the uterus, that from hence, (as plants do from the earth by their radicles) it may absorb the nutrient juices. For in the beginning, as I have said, when the “punctum saliens” and the blood can alone be seen, the ramifications of the umbilical vessels are only visible in the colliquament and amnion. When, however, the fabric of the body is completely formed, the ramifications extend further, and are distributed in vast numbers throughout the chorion, that from the albuminous fluid which there exists, they may obtain nourishment for the fœtus.

Hence it is manifest that the young of viviparous animals are at the beginning nourished in exactly the same manner as the chick in the egg; and that they are detained within the uterus in order that (when they can no longer supply themselves with nutriment from their own stores) they may form adhesions to it by means of this fleshy substance, and receiving more abundant supplies of food from the mother, may be nourished and made to grow.

Wherefore Fabricius has rightly observed, that in some animals the “conception” is scarcely attached to the uterus at all. Thus the sow and the mare have no such fleshy mode of union,--but in them the ovum or “conception,” as in the beginning it is formed out of the humours of the uterus, so it is nourished subsequently by the same means; just as the ovum of the hen is supplied with aliment at the expense of the albuminous matter without any connexion whatever with the uterus: and thus the fœtus is furnished with aliment by the “conception” in which it is contained, and is nourished as the chick is from the fluids of the egg. This is a strong argument that the fœtus of viviparous animals is no more nourished by the blood of the mother than the chick in the egg; and moreover, that the fluid within the chorion is neither urine nor any other excrementitious matter; but serves for the support of the fœtus. Although, as I have before remarked, it is possible when all the nutrient portions have been taken up, the remainder may degenerate into excrementitious matter resembling urine. This is also clear from what I formerly observed of the cotyledons in the deer, viz., that in these animals the fleshy mass was of a spongy character, and constituted, like a honeycomb, of innumerable shallow pits filled with a muco-albuminous fluid, (a circumstance already observed by Galen[386]); and that from this source the ramifications of the umbilical vessels absorbed the nutriment and carried it to the fœtus: just as, in animals after their birth, the extremities of the mesenteric vessels are spread over the coats of the intestines and thence take up chyle.

_Of the Placenta._