CHAP. X. and the pulse is cæteris paribus more frequent in women than in men,(7) THE MALE and we have noticed some other differences.(m) ORGANS, &c. OF THE FEMALE The female organs of generation, with their collateral parts, are much more numerous, complicated, and elaborate than in the male. The part ORGANS OF Which the male bears in congress is quickly accomplished, and is confined GENERA to the mere act of penetration and impregnation, and there terminates; TION.(n) whilst the female, although when sensible of the proceeding (which is by no means universal) is simultaneous in the congress, yet in the completion of her part she has to undergo a series of operations and changes which occupy a great length of time, and comprehend conception, gestation, parturition, and afterwards lactation. (0) The female With respect to her organs of generation, they are surrounded and pelvis.(t) protected by the pelvis, of which a general description has already been given,(p) and the bones of which in front (or rather, the membranes between them, for the bones themselves are never actually joined, according to the opinion of many) have providentially a capacity to open or relax in their membranous connexion to a small extent, (perhaps, as some contend, two or three inches in width, in parturition,) and ordinarily the head and parts of the child are adapted to the dimensions and such capacity.(q) Thus the long measure of the child's head is, from the vertex, or crown, to the chin, 54 inches; the short measure, from the protuberance of one parietal bone to the other, is 3 inches; whilst directly across, it is 4 or 4 inches; so that, with reference to the beforementioned size of the pelvis, and the capacity of the sutures to overlap each other and compress, there is not usually any serious difficulty in the passage of the foetus.(r) The female organs of generation themselves may be treated as principally of five orders; first, the bony pelvis; secondly, the external fleshy parts bounded by the hymen; thirdly, the hymen, vagina, and other parts, which receive the male organ and semen, and convey the latter towards its destination; fourthly, the organ upon which the male semen is considered principally to act so as to perfect the inception of a foetus, and called ovarium; and, fifthly, the organ which is destined for the reception and nutrition of such foetus after it has been so perfectly originated, and which is called the uterus, or womb. (s) As an adequate knowledge of the correct anatomical and physiological view of all the parts of these organs is frequently of the utmost importance in judicial inquiry, we must here consider them in natural order. Breschet, vol. iii. 521; and see Denman's (n) See Anatomical description, 2 Hor- (0) 3 Bost. 14. (p) Ante, 74, (4) Dr. Denman's Prac. Mid. 7th ed. Blum. Lect. Mid. 18; 5 Good, 214. But (r) James' Burns, 26; ante, 385. 1. Last lumbar vertebra. 2. Sacrum. 3. Ilium. 4. Pubis. 5. Ischium. 6. Coccyx. 7. Cavity of Pelvis. 8. Crest of ilium. Explanation of Pelvis. 9. Anterior inferior spine of ilium. 1. Atlas. 10. Acetabulum or socket for the head of 11. Thyroid foramen, or foramen ovale. 13. Sacro ischiatic notch. 14. Symphysis pubis. 15. Arch of pubis. 16. Tuberosity of Ischium. Explanation of Spinal column and Pelvis. 2. Sixth cervical vertebræ. 3. Twelve dorsal vertebræ. 4. Fifth lumbar vertebra. 5. Crest of ilium. 6. Ilium. 7. Sacrum. 8. Coccyx. 9. Sacro ischiatic notch. 10. Acetabulum. 11. Os pubis. 12. Ischium. The above plate first describes a lateral view of all the vertebræ, Plate of cervical, dorsal, and lumbar, and of the sacrum, os coccygis, and lateral the pelvis. bones of the pelvis; and, secondly, is prefixed a front view of the pelvis, with all its component bones and parts, and their names, and the knowledge of which is indispensable, not only to those who immediately practise midwifery and surgery, but, in some cases, to lawyers.(t) The spinal column, with the pelvis at the base, in its perfect natural The female state, is bent as appears in the above plate.(u) The pelvis itself may pelvis. be considered, first with reference to its bones, and, secondly, its central cavity. The principal of these, with their names, are shown in the above plate of the pelvis. In the adult state it is composed of four bones, namely, the sacrum, the os coccygis below it, and the two ossa innominata, one on The bones each side, and which together form (as may be collected from the name of the pelpelvis) the appearance of a basin with the centre or bottom removed, and vis. through which lower aperture the child escapes; but these four in infancy are composed of several more bones, which gradually become so united as scarcely to be distinguishable; but still the different parts retain several more names than those of the four principal enumerated bones. (x) The (t) See Dr. Wm. Hunter's Medical Observations and Inquiries relative to the Bones of the Pelvis; Dr. Denman's Prac. Mid. 1 to 27; 2 Horn, Anat. 104 to 106; Dewees, Midwif. 17 to 21; Dr. Ryan's (u) See ante, 70, 71. GANS, &c. CHAP. X. sacrum is a distinct bone, though in continuation of the lumbar vertebræ, THE FE- and usually contains six bones, called false vertebræ, and in the inner MALE OR- surface, of which there are five pairs of, or ten, holes, (or sometimes only four pairs, with eight holes,) through which nerves pass for the supply of the contents of the pelvis, and a continuation of the spine (which latter is termed the cauda equina) passes down the upper four of these false vertebræ, and sometimes, in the latter stage of gestation and during labour, the pressure of the child upon these nerves occasions cramps, not unfrequently complained of in that stage. The sacrum externally and posteriorly is rough, with numerous elevations and depressions for the insertion of muscles. The os coccygis is that bone which in the plate appears at the bottom of the os sacrum, and is usually composed of four bones, gradually diminishing nearly to a point, and the last of which is sometimes called the little angle of the sacrum; but the os coccygis, in its proper state, is composed of four distinct bones, not united to the sacrum, though articulated by intermediate cartilages, but which, in their proper state, are in a degree pliant, so as to be bent or forced by the pressure of the child, or artificial means, at least an inch backwards, and thereby to that extent enlarging the passage from front to back (usually from four inches to five inches.) Where there has been a complete anchylosis, or ossified junction, between the sacrum and the os coccygis, destroying the due pliancy of the latter, and diminishing the power of enlarging the dimensions of the passage of the child during parturition, then the use of the forceps may be required, especially when women begin to breed late in life, and other remedies may become advisable for the purpose of enlarging the cavity of the passage. There are two ossa innominata, namely, one on each side, and the description of one will suffice for both. This is a broad large bone, composed originally of three bones, and forms the fore part and one side of the pelvis. The three bones which are so united at maturity that no division is perceptible, still retain their original names, namely, the os ilium, os ischium, and os pubis. The ilium is the uppermost, and forms the principal part of the basin-like appearance of the pelvis, and has its various named parts, as, at the top, the crista, vulgarly called the hip; the linea ilio pectinea, extending round towards the sacrum. The ischium forms the lowest external part of the os innominatum; its parts are usually described under the names of body, tuberosity, or obtuse process and ramus; in its body, and nearly in the centre and strongest part of the entire os innominatum, and so placed as best to bear the weight of the superstructure and facilitate the motion of the thigh, is the acetabulum, being the socket of the thigh bone. The os pubis forms the lowest and inner part of the os innominatum, and is usually considered in three parts, namely, its body, its spine, and the ramus; the body extends from the central division towards, and contributes in the formation of the acetabulum; the anterior part of the os pubis is 'called the angle, or spine, and constitutes that surface which, being joined (or rather connected by membranes) to the opposite os pubis, forms the symphysis of the ossa pubis, (y) and is vulgarly called the share-bone, and will be presently noticed as regards parturition. The two ossa pubis 'connected together form on the external or inferior side an unequal concavity; but on the internal or superior surface they are pretty equally convex, and both the edges have a small degree of flexure outwards. The arch of the pubis is formed by its two descending processes, or rami, which diverge and meet the corresponding processes of the two ischia, which ascend to join them. Thus, the inferior aperture of the pelvis is formed (y) Symphysis, from our and que, adhæresco, and the term in its original signification denoted a cohesion or growing to gether, and in one sense means a growing together in adults of bones which in infancy were distinct. by the diverging rami of the pubis and ischia, the tuberosity of each ischium, the point of the os coccygis, and two oblique ligaments, extending forwards from the os coccygis to each tuber ischii. CHAP. X. THE FE MALE ORGANS, &C. These bones are respectively linked or connected by intervening cartilages, and the two ossa innominata are joined together in the front Ligaments wherever they meet by a cartilage, which covers the scabrous end of each between, bone, and the space between them (usually about four lines, or the third of an inch,) is filled with a ligamentous substance, and which connexion symphysis is called the symphysis of the ossa pubis. constitu ting the of the ossa It has long been the subject of controversy whether in pregnancy or at pubis. the time of labour there is uniformly a considerable temporary separation between these ossa pubis, and to what extent. The best authorities consider it unquestionable that such expansion sometimes, if not generally, takes place when requisite, but that it is not universally so. (z) Even in man a separation has occurred to the extent of some inches, occasioned by a sudden blow. (z) With respect to the general form and capacity of the upper and lower Dimenparts of the pelvis, which vary considerably in every individual, some sions of ca authorities state that the superior aperture, which lies horizontally ra- vity of pel ther below the lowest lumbar vertebræ, is triangular, whilst others state vis. it to be oval, with the widest part from one side to the other. But that the inferior aperture, independently of the ligaments and soft parts, cannot be said to resemble any known or general form, on account of its irregularity, though the widest part is, from the inferior edge of the symphysis in front to the point of the os coccygis behind, allowing for the progressive motion of that bone, about five inches.(a) With respect to the general dimensions of the upper and lower apertures and cavity, providentially it will be found that in general nature has proportioned the parts to the size of the child to be born, (b) so that in ordinary circumstances the delivery is an operation of nature, and on that account females in this and every country (in France termed Sages femmes) have been allowed, as it has been termed to "assist nature," although wholly unscientific; (c) but modern refinements, not allowing adequate healthy exercise during the progress of growth, and still worse, compressing dresses and bad habits, have occasioned such numerous deformities and deviations, especially in the higher classes, that no branch of medical science is now of more practical importance than the obstetric art.(d) In a healthy, well exercised, and consequently in general well-grown woman, subject to very few deviations, the dimensions and the capacity of the bone of the female pelvis is upon the average at the upper aperture, i. e. from the upper part of the sacrum to the upper edge of the symphysis, about four inches, and between the two sides, it is about five inches and five inches and a quarter; at the inferior aperture the dimensions are in a degree reversed, the narrowest part being between the sides. The perpendicular depth of the pelvis, from the upper part of the sacrum to the point of the os coccygis, is about five inches; but this will be increased, when the latter bone is pressed backwards. From the margin of the pelvis to the inferior part of the obtuse processes of the ischia, the depth is about three inches, and at the symphysis about one inch and a half. Moreover, the depth of the pelvis at the posterior part is rather more than three times the depth at the anterior; and there is a (z) Denman's Prac. Mid. 7th ed. 8 to 13; ante, 383; see Dewees, Midwif. 21 to 28. (a) Id. 19; Dewees, Midwif. 28, 29. Med. Jur. 89. (d) As to the parts distorted and degree of defect, and the proper proceedings, see Denman's Pr. Mid. 245, 246; and post, 2d part; also Dewees, Midwif. 28 to 30; 1 James' Burns, 29 to 35. CHAP. X. gradual change between the two extremes, when the ligaments are conTHE FE sidered as parts of the outline of the inferior aperture. (e) The knowMALE OR- ledge of these capacities assists the medical practitioner in judging how GANS, &C. far the head of the child has proceeded through the pelvis, and prevents any error that might proceed from the feel of the head at the anterior part.(e) It, however, has been cautiously observed, that no surgeon should proceed alone upon mechanical principles in assisting birth.(ƒ) We have secondly to consider what are termed the external parts of genal female neration, and which are, the mons veneris, with the anciently termed tresparts of ge- soria or hair thereon, the labia pudendi, the perinæum, (extending from neration. the uppermost part of and between the labia and the anus,) and the an The exter The pu ris and tres terior part of which perinæum is called the commissure. On separating the labia pudendi, the more internal parts are brought into view, consisting of the clitoris, (in ancient law termed superlabia,) the nymphæ, triangular space between the nymphæ, the meatus urinarius, the orifice of the vagina, the hymen lying in the vaginal orifice, and the carunculæ myrtiformes, which may co-exist with the hymen, (g) which might conclude the enumeration of these external parts, as being the barrier between the external and internal parts; but as the principal parts of the hymen are connected with the internal parts, it will be more properly examined with them. The Pudendum (including the Mons Veneris and the Tressoria) is dendum or placed above the upper part of the great orifice called the Fossa Magna, and pubes, or this is usually in adult women covered with hair, called in ancient law mons vene- proceedings tressoria,(h) and which extends towards the edge of the labia soria. (h) pudendi on each side, and extends perpendicularly from the mons veneris towards the lower part of the aperture, and within about an inch of the anus, and which intervening part is called the anterior perinæum. The absence of this tressoria has amongst the vulgar been considered matter of reproach; and we have on record, evidence of the barbarous state of the law, that when a female has been detected a third time in incontinent practice in the vicinity of the superior courts at Westminster, this tressoria was in punishment of the offence cut off in open court. (i) Some (e) Denman's Pr. Midwifery, 7th ed. 20, Dewees, Midwif. 28 to 38; and as to the usual and appropriate size of the child's head, Dewees, Midwif. 41 to 44. The pelvis may be divided into two parts, the true and the false, by the linea ilio pectinea; the upper or false requires little attention from the accoucheur. The true or lower part may be divided into three portions, the brim, the cavity, and the outlet. The shape of the pelvis is oval, its long measure from side to side, its short measure from before to behind; it is five or five and one quarter inches from side to side, four inches from behind to before, and five and one-eighth inches obliquely; but the regularity of the oval is broken in upon by the promontory of the sacrum. (f) Denman's Pr. Mid. 22, 23; Dewees, Midwif. Introd. xiii. (g) 2 Horner, Anat. 100 to 104; 2 Dungl. Phy. 268 to 370. (h) Perhaps the following description, may be preferable. The term pudendum is applied to the external parts of the female, consisting of two elliptical folds, called the external labia, and the nymphæ or internal labia. They are surmounted by a slight prominence of fat placed on the ossa pubis, and covered with hair, called the tressoria. Within the labia externa, at the upper part, is the superlabia or clitoris, corresponding in structure and appearance to the male member (or penis.) (i) The Marshalsea case, 10 Coke's Rep. 77. In this case the counsel in the course of argument thus observed: "And as to the said case of 7 Edw. 3, c. 23, b. 24 a, by the common law it belongs to the office of the marshal to protect the court from whores, as appears in Fleta, lib. 2, c. 5, (3 Inst. 205.) Mareschalli interest virgatam a meretricibus omnibus protegere et deliberare et habet Mareschal' ex consueti dine pro qualibet meretrice communi infra metas hospitii inventa 4d primo die; quæ si iterum in ballivà suâ inveniat', capiatur et cor' seneschal' inhibeant' ei hospitia legis reg',et liberor' suor', ne îterum ingrediatur et nomina car'im brevient'; quæ si iterum inventæ fuerunt hospit' secutrices, tunc aut remaneant in prisonâ in vinculis,aut sponte præd' hospit' abjurent, quæ si autem tertio |