delivered at term the cervix uteri is irregular, the os is puckered and fissured, and is more open than in nulliparous women, generally admitting the tip of the finger. If the hymen be present, it is proof that no mature infant can have been born per vias naturales, and if the posterior commissure be intact, it indicates that the woman has not given birth to a mature infant per vias naturales. The only additional evidence of remote delivery to be obtained at a post-mortem examination is derived from inspection of the walls and cavity of the uterus. The uterus of a woman who has been delivered of a child remains somewhat larger and heavier than the virgin uterus; the walls are thicker, and the cavity is less triangular in outline, the angles where the Fallopian tubes enter being rounded off. Cicatrices around the external os may indicate the seat of past rents. In some cases, however, it is impossible to definitely say whether a given uterus is parous or nulliparous. UNCONSCIOUS DELIVERY The question as to whether a woman can be delivered of a child unconsciously at once admits of an affirmative answer. The contractile power of the uterus is independent of volition, and the results of deliveries under the influence of anæsthetics demonstrate that the expulsive power of the uterus may be as energetic in the unconscious as in the conscious state. Delivery may take place when a woman is unconscious from any of the following conditions the use of narcotic poisons or vapours, coma, profound sleep, asphyxia, syncope, or the use of intoxicating liquors. It is highly improbable that a primiparous woman should be delivered during ordinary sleep without being roused to a sense of her condition. Instances, however, of unusually rapid first labour have been recorded, of which the two following may be taken as examples : 1 Wharrie relates the case of a primiparous woman, aged 1 Cormack's Jour., 184€. twenty-one, who was in labour for six hours, without complaining of any pain. The child was born without effort or consciousness; it was small, weighing rather more than four pounds. A case has been recently recorded' of a strong, healthy, primiparous young woman who, at full term, was taken suddenly in the night with rapid labour pains. She immediately sent her husband for the midwife; but during his absence she experienced a desire to defæcate, went to the night-stool, had a strong pain, and felt something pass away, after which she became unconscious. On the arrival of the midwife in a few minutes it was found that the woman had given birth to a full-time infant, which was head downwards in the excreta in the pan, and was dead. The plea of unconscious delivery is a common defence put forward by women charged with infanticide. A woman accused of this crime will not uncommonly state that, while suffering from labour pains, she felt a strong desire to evacuate the bowels (a very common symptom during, or just previous to, labour), and that while so engaged the child was suddenly born without her knowledge, and so fell into the privy or watercloset in which it was found. This subject will be referred to again in connection with the article on infanticide, but the following case illustrates the fact that a child may be expelled during defæcation, without the mother being aware that she was in labour till the expulsion of the child had taken place. Laugier 2 relates the case of a woman, who had previously borne a child, who was admitted into a hospital on January 9th when about eight months pregnant. On February 18th she had colicky pains, which she attributed to five days' constipation. An enema was given, and directly afterwards she sprang out of bed. The enema with fæces was at once expelled, and at the same time the child was delivered, being shot into the chamber-vessel, falling more than a foot downwards, as the 1 Brit. Med. Jour., 1834. 2 Jour. des Sages-Femmes, and Brit. Med. Jour., 1894. mother had not time to sit fairly on the vessel. The child was saved, and the placenta was expelled a quarter of an hour later without difficulty. The mother had not the slightest idea that labour was coming on, though she knew that term was at hand, and remembered that her first child had been delivered just as rapidly and as painlessly three years previously. TIME REQUIRED TO ELAPSE AFTER DELIVERY BEFORE It is generally supposed that about one month must elapse before the generative organs of the female can revert to the condition necessary for the exercise of their procreative functions. This is probably correct as a general rule, but from a number of statistics it appears that conception may occur within this period, and that the fourteenth day after delivery is the earliest at which a fresh impregnation can take place. CHAPTER XXXV Abortion-Natural abortion--Artificial abortion-Criminal abortion- Noxious substances-Methods used to procure criminal abortion-Emmenagogues and ecbolics-Signs of abortion in the living and dead. In medical language the term abortion is generally understood to refer to the expulsion of the contents of the uterus before the sixth month of gestation-i.e. before the fœtus is considered viable. If delivery occur between the sixth and ninth months, but before full term, it is called a premature labour. By criminal abortion is meant unlawfully producing the expulsion of the contents of the gravid uterus at any period of gestation. short of full term. The popular term miscarriage is applied especially to an abortion occurring before the sixth month of gestation, but is also sometimes loosely applied to a premature labour. The law makes no distinction between an abortion, a miscarriage, and a premature labour; in the legal sense the term abortion is applied to the expulsion of the contents of the gravid uterus at any period of gestation short of full term. For convenience of description abortion may be divided into three classes:—(1) Natural abortion; (2) Artificial abortion, and (3) Criminal abortion or fœticide. NATURAL ABORTION A natural abortion is, in medical language, termed a miscarriage if it consist of the expulsion of an ovum or of a nonviable foetus before the sixth month of gestation, and a premature labour if it consist of the expulsion of a viable child between the sixth and ninth months. There are many causes of natural abortion, for a detailed description of which obstetric works should be consulted. Briefly they may be divided into the maternal and foetal causes of abortion. The maternal causes are --poisons in the mother's blood (syphilis, the poisons of the specific fevers, uræmia, &c.), impoverishment of the mother's blood (anæmia, over-lactation, &c.), mechanical disturbances of the circulation (heart, lung, and liver diseases), nervous causes (chorea, fear, anxiety, &c.), uterine diseases or affections (inflammation, tumour, displacements, &c.), and over-excitement of the sexual organs by excessive sexual intercourse (it is probable that the apparent sterility of prostitutes is not due to actual non-conception, but to their frequently aborting at very early periods of gestation). The foetal causes of abortion are either diseases of the membranes of the ovum or foetus, or diseases of the embryo itself. It should be borne in mind, since it is contrary to the popular idea, that the earlier the period at which abortion occurs, the greater is the danger to the woman. At early periods of gestation the contractile powers of the uterine walls are limited, so that hæmorrhage is very likely to result from non-occlusion of the bleeding vessels; in addition, if the uterus has not contracted thoroughly, the open sinuses are liable to absorb septic matter, so that septic infection is of much more frequent occurrence if abortion occur at early periods than after delivery at full term. At or near the completion of term the uterus has become a collection of powerful muscles, which, after delivery, are able to contract firmly, and so occlude the bleeding vessels. ARTIFICIAL ABORTION This refers to the induction of premature labour which has been resorted to for the purpose of saving the life of the mother, and, if possible, that of the child. There is no formal recognition by the law of the induction of premature labour by medical practitioners, but judges have always upheld the moral justification of the act, when the object has been to save the |