On the comparative size of the hand of the accoucheur and of the female pelvis / by George King.

Date:
1851
    action of the hotly and immaterial principles on each other, that have had much more to do with these tragical scenes than the organ of destructiveness, or concealment. In most cases of in- fanticide, all our attention is directed to the child in order to dis- cover if there are any marks of violence, or any disorganization or injuries to account for its death. But the mother is considered a murderer and almost inhuman, and, shunned by her relations, is left only to the nurse, and often a policeman in the room or in at- tendance; little is thought of her condition or of any derangement or malformation of the pelvis through which the child has passed, or the altered condition of the parts engaged in the act of partu- ration. Women with a small pelvis, and a rigid, contracted vagina, and perhaps a large child, must naturally be a long while in labour, which will allow time for the disejuieted mind to compose itself, and an opportunity for reflection on their condition and the consequences connected with it; and I have no doubt that then the moral and finer feelings will overcome the brutal. These poor creatures, long before their trouble, must have been told that the pangs of childbirth were awful and terrible to bear, and also have learnt, or had been given to understand, that the process of labour must be long, as well as painful and difficult; they, therefore, could not ever expect or have the least idea that they should be able to give birth to a child without its being known, and charity would lead us to hope that no female would premeditate the death of her own offspring. I have long determined never to give such evidence, in any case of prosecution, as would be likely to convict a woman of inffinticide, unless it was very clearly proved to me that it had been premeditated, and that no preparations had been made for it before the birth of the child! I believe there is no rule of law that can prevent or restrain a pi'ofessional man, when in the witness-box on such momentous occasions, from taking into his consideration probabilities as well as facts, of which lie is, professionally, best able to judge. But the indecision of medical witnesses is so generally known by juries, that verdicts are frequently returned in direct opposition to their testimony. There is a case related in the Lancet some years back, of a medical man being requested by a magistrate to examine a young woman who had been suspected of giving birth to a child. She was examined by him six days after the child had been born. His evidence was, “ That he found her vagina rather relaxed, so as readily to admit the whole hand,” and this evidence was brought forward and intended to convict the woman instead of, .as I think, acquitting her. The vagina, if not immediately, very shortly after delivery contracts to its natural state .and calibre, and ifsi-x days after the giving birth to a child there was room to ad-
    init the whole hand, there must have been the usual capacity of the vagina, and no proof of recent delivery. This is a point of very great importance to those who may be called to give evi- dence in proof of recent delivery, and deserves their most serious consideration. Writers on Forensic Medicine tell us, that the external parts of generation exhibit signs of recent delivery for days after, and even in some instances a week. After a woman has given birth to a child, we may find the vagina relaxed and easily dilated, and its internal surface smooth from the oblitera- tion of the rugte, and that the labia would be also tixmcfied and inflamed; but all this could only occur after a long and very tedious labour, where the child’s head had been a long while in the passage pressing on the perineum. In sudden and rapid labours the child is, by the powerful actioir of the uterus, and in conse- quence of the capacity of the pelvis, and absence of the usual constricting powers of the outlet, shot through the vagina with that rapidity and almost painless velocity that, I believe, scarce!}’ any inconvenience or disorganisation can be or is produced in the child’s passage into the world, and that on examination of the vagina even two hours after delivery, we should find the rugaj, and the parts engaged in expelling the child, in their natural state; and there would be much difficulty in such cases in proving that a woman had recently given birth to a child, by the appear- ance of the external organs of generation. The following cases will tend to illustrate the latter part of this subject, and will show, as well as prove, how quickly and sud- ilcnly some women will give birth to a child. Those who liave been much engaged in obstetric practice, must have been called to many sudden and rapid labours, and have, no doubt, witnessed some curious and frightful scenes, and have been, like myself, surprised and astonished with what rapidity the parts which are engaged in expelling the child yield and dilate. As facts are genei’ally valued above hypotheses, I will just name two or three out of the several cases of easy parturition that have occurred in my own practice. In order that they may be understood I must also relate some of tbe circumstances connected with them. Some years since, a young man called on me to know at what hour in the evening a female fi-iend of his could see me. I fixed the time, and, at the appointed hour, a very respectable-looking young woman, about 20, called on me. She was living in a family as lady’s maid. She introduced herself by saying that she believed a friend of hers had called on me, and knowing the object of her visit, I put such questions to her as I then con- sidered necessary, in order to ascertain the situation she was in. She did not seem to be very well versed in such matters, and I had some difficulty in getting out of her what I wished to know;
    from what I did elicit, I thought her to he about eight months gone in the family way, and this I told her, which appeared to surprise her much, and she became much affected, sobbed out she had hoped it was not so, and left my surgery very mucli de- pressed, without telling me where she lived or who lier friend was. Early on the following morning her young man called on me to say that I was quite right, his friend was in tlic family way, and that she had had a child in the night, and he came to know what they were to do with it, as it was dead, without entering into any particulars as to what had happened in the night. I gave him directions as to how still-born children were usually buried. He was also to tell me that the young woman would call on me in the evening, which she did, and from her I got the following account out of her about her labour, whicb, from her manner and natural simplicity, I believe was the truth :—After she left me the preceding evening she went to bed at tlie usual time, had no pain except of mind from what I had told her; her bedfellow was the housemaid, and she slept with her that night. She thinks she had slept about three hours, when she awoke up with great pain in the lower part of her bowels, with an urgent desire to make water ; she got out to the po and could not get off again till the child was born ; she thought that she was on it about ten minutes. I asked her if the chihl cried ; she replied no, but it had a good deal of hair on its head. Not being a coroner or a judge I did not consider that I had a right to ask any more questions. I gave her an anodyne mixture, and advised her to take very great care of herself. She had that day waited on her mistress at dinner; she did very well, and got through it without being detected, in a house where there were several other female seiwants. Her milk was very trouble- some for some weeks. Siie had been seen almost daily by her lady’s medical man, and he had frequently prescribed for her, without discovering wliat was the matter with her. The most astounding part of this affair is, tiiat the birth of a child sliould have taken place by the side of tlic bed without rousing her fellow servant, no means having been used to prevent her knowing what was going on ; mesmerism and chloroform were not so much in vogue then as they arc in the present day. This woman is now married, and I have attended her witli six children since, and out of the six I was only in time to bo at the birth of one, although I was alwavs sent for directly she was t.akcn in labour, the distance not being far, and the messenger generally found me at home. With the first after her marriage she was taken in the kitchen, and had but one pain, and the child was born before she could be got up stairs. The second case, a young girl about 18, called on me late on a
    Saturday evening, to tell me that she thought that she was taken unwell. I had not seen her before for several months. She had then consulted me on the subject of the suspension of the menses. While talking to me she complained of a sliarp pain at the lower part of her stomach, with rather a queer look, whicli plainly pour- trayed what was going on; and although I am not a physiognomist, I think I have practice enough in midwifery to understand the physiognomical signs of the face during labour-pains, so as not to be mistaken; I therefore gave her to understand that site was in labour, and soon packed her off home, as I clearly saw that there was a chance of my having an increase in my family, and a pos- sibility of both doctor and patient being suspected of having con- templated the concealment of the birth of a child, not having made any preparation for such an event. About an Iiour after site left my house, I was sent for in great haste. Her young man let me in, and then set off for a friend. I found her alone, sitting up in bed, hushing a baby, which she had laid across her abdomen; it was crying lustily, with the jilacenta still in the vagina, and the umbilical cord not divided. I separated the child, and removed the placenta. While I was dividing the umbilical cord, she said, “ I didn’t have much pain when the child came into the world.” I remained with her till a neighbour came in. This young woman was living with her uncle; the poor old man could think of no- thing but the cholera, and was below puffing away with the bellows to get some water hot. The old man’s auditory nerve was not so sensitive as it had been fifty years before, therefore he did not hear the crying of the little brat. It was removed in the morning, and he knew nothing of what had taken phice in the night. The girl did very well, and got married directly she was able to go out. The first child after the marriage also came into the world in a hurry. I was not in time. With the third, she had been out for a walk, and on her return went up stairs to the po, and the child popped into it ; the po being half full of water, the child was suffocated. Although there were two or three females in the room with her, they were too terrified to lift her off and remove the child, but kept her in that situation till 1 came to her assistance. The third case. One night last winter I was called, unex- pectedly, to a married woman in an adjoining street, who had had two or three children. I found her sitting on the edge of the bed, very faint, and a child and the placenta attached, lying on the floor, and a large pool of blood across the room. The women who came in to her assistance were so aghast at the sight, that they became powerless, and could do nothing, as they said, till the doctor came. I did what was neeessary. The account this woman gave me Avas, that she was aroused up from her first nap with a pain and an inclination to make water, and she was stoop-
    ing down to get at the po, when the waters broke, and the child and the after-birth came away together, with one sliglit pain. Her husband was in b^d •, he immediately got up and I'an for me, and left his wife by herself. Such instances as these are numerous, and they most clearly show that women who have such rpiick and easy labours must have a large and well-formed pelvis, and the vagina and external parts must also be very relaxed, and easily dilated, which is a most satisfactory and convincing proof that during the act of par- turition such women can have but little or no contracting power over the outlet, and this is, I believe, the cause of so many children suddenly passing through life into a fcecal repository, whci'e they may be axphyxiated and die. Whctlicr this axphyxia is the re- sult of the rapid labour, or caused by the foul air of the receptacle, is not easy to determine; but death is not necessarily the conse- quence. If assistance was athand, the child might be resuscitated; therefore, the cause of death is the absence of this assistance, and is, I think, called in Medical Jurisprudence, “Infanticide by omis- sion.” I fear that many a poor creature, to our shame, has suf- fered the exti-eme penalty of the law, or is now pining in a dun- geon for this unintentional negligence, which, at the time, she must have been unconscious of. There was a remarkable instance of easy delivery published a few years since by a French physician, that occurred at Arras, in France. A woman, 22 years of age, in the last month of her pregnancy, was suddenly affected in the night with acute pains in the abdomen, and considering it was what is called a bowel complaint, she immediately proceeded to the garde-robe. She had scarcely taken her seat, when the child was expelled without any pain, and she declared .sAe was totally unaware of what had happened till she heard the child cry. This is the only case that I have met with recorded of a woman having a child without pain. Children that come into the world so rapidly do not generally cry. There is a case in a late number of the Provincial Medical and Surgical Journal, related by John Gregson Harrison, Esq., M.D., of Manchester: he states that he was engaged to attend a lady, aged 34, in her first labour, and “was hastily summoned to her house early in the morning; but on arriving there I was informed that the child was born a few minutes previously to the messenger leaving her, and that the infant was dead. On making inquiries 1 found that my patient, thinking she had a de- sire to use the night chair, attempted to make use of it. and then voided what she supposed to be the liquor amnii, and sat there some time afterwards, feeling much indisposed; but, on getting into bed, she saw, to her great astonishment, the child lying in