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of insertion is at the middle of the body. The general development of the brain, the extent to which the cerebellum is covered by the cerebrum, the particular fissures that are present will also serve to determine the age of the fœtus. The importance of the presence or absence of an osseous deposit in the inferior epiphysis of the femur has already been referred to (p. 45). It should be mentioned, in connection with the subject of the length and weight of the foetus at full term, that these may vary considerably.' Thus, for example, it is well known that children have been born at full term who measured as much as twenty-four and even thirty-two inches, and who weighed as much as seventeen and three-quarter pounds,2 and eighteen pounds and two ounces,3 respectively. On the other hand, children at full term not unfrequently weigh only from four to six pounds. There is usually no difficulty experienced in recognizing an embryo in situ, or even amid the contents expelled from a uterus in cases of abortion, unless the latter be committed in the very early periods of gestation.
Moles.-Under certain circumstances the medical examiner may be called upon to determine whether peculiar growths, either formed in the uterus or expelled from it, are polypi or membranous in character, as due to dysmenorrhoea, or what are known as moles.* It is most important that the true nature of the latter, when present, should be recognized, as moles, being due to disease of the
1 As to variability in size and weight presented by the fœtus at different periods of intra-uterine life, compare Casper, vol. iii. pp. 15–17; Guy and Ferrier, p. 88; Tidy, part ii. p. 59; Wharton and Stillé, vol. iii. p. 75; Woodman and Tidy, pp. 647, 712.
2 Owens: Lancet, December, 1838, p. 477.
3 Meadows: Medical Times and Gazette, August 4, 1860, p. 105. Montgomery: op. cit., pp. 255, 269, 326, 353.
placenta or of the fœtal membranes, are as much proof of a pregnancy having existed as the presence of the embryo itself. Moles, when due to disease of the placenta, are either fleshy or fatty. A fleshy mole consists of layers of a fibrinous material inclosing a cavity in which the remains of the foetus are sometimes formed. While the cause of fleshy moles is obscure in some instances, they appear to be due to hemorrhage into the chorion. A fatty mole differs more particularly from a fleshy one, in that a fatty degeneration is an accompaniment of the early death of the foetus. The hydatiform, or vesicular mole, is due to the villous processes of the chorion becoming infiltrated with serum, and hanging in masses like bunches of grapes. A true hydatid—that is, a helminth of the uterus-is exceedingly rare; indeed, it is very doubtful if it has ever been found.
The proofs of an abortion having been committed, as derived from an examination of the mother, are not very positive, if the act has been performed at an early period of pregnancy. The hemorrhage and relaxed condition of the vagina, for example, and the somewhat dilated condition of the os uteri, might be attributed to menstruation. If the pregnancy was, however, far advanced at the time of the occurrence of the abortion, the proofs will usually be sufficiently strong to establish the fact. It is far more difficult, therefore, for a woman to conceal her pregnancy and the fact that an abortion had been committed to save her from exposure, at a late period of gestation than at an early one. If death follows within three days after abortion, the post-mortem examination will generally establish the fact that an abortion was committed. If several weeks, however, have elapsed, little or nothing will be learned by the autopsy, as the parts involved will
have usually reassumed by that time their usual condition.
Determination of Foeticide.-In every case of fœticide the vagina and uterus should most carefully be examined for metritis and marks of violence which might have been produced by the use of instruments. Wounds of the vagina would rather indicate that they had not been made by a professional abortionist, but by one who was inexperienced in such work and who had been rendered nervous in attempting to perform the operation. If the neck of the uterus or its fundus be found perforated, or the placenta wounded, the inference to be drawn would be that pointed instruments had been used, though not necessarily, since fatal wounds have been also inflicted by blunt instruments. The most common causes of death in cases of abortion as produced by instrumental violence are hemorrhage and peritonitis. The stomach and intestines should also be carefully examined in cases of fœticide, as they present, not unfrequently, evidence that irritant poisons have been taken. Remains of cantharides, tops of savin, ergot may be found; or the oils of savin, tansy, pennyroyal may be recognized by their odor or by appropriate chemical means, such as distillation, etc. The shape and size of the uterus should be carefully noted in cases of fœticide, as they enable the examiner to determine approximately at least the age of the fœtus.
The normal uterus in the unimpregnated condition measures about two and a half inches in length, one inch and threequarters in breadth, and one inch thick. As pregnancy advances, the uterus increases gradually in size-very little change being noticeable, however, during the first month. During the second month, the increase is considerable. By the end of the third month it has attained a length of
five inches, including one inch for the cervix. At the end of the fourth month, the uterus is five inches long from the fundus to the beginning of the cervix, and at the end of the fifth, sixth, and seventh month it is six, seven, and eight inches long, respectively. At eight months the uterus varies in length from nine to nine and a half inches, and at nine months from between ten and a half to twelve inches in its total length. While the thickness of the walls of the uterus at full term is about the same as that in the unimpregnated condition, or from one-third to
two-thirds of an inch within a few hours after delivery, they may become, through contraction, at least two inches thick.
The changes in the shape of the uterus presented at different periods of gestation are also very characteristic. From being flat and pyriform, the uterus, after impregnation, becomes globular; the cervix also, as already mentioned, gradually shortens towards the end of the fifth month, losing about a quarter of its length each succeed
ing month, until, at the end of the ninth month, it has disappeared entirely (Figs. 34, 35, 36), the form of the uterus being then ovoid. After delivery at full term the uterus begins usually to contract, its size being reduced within two days to six inches in length and four in breadth.
By the end of the first week it has so contracted as to measure usually from 5 to 6 inches in length. At the end of the second week the uterus is about four inches long and one and a half inches broad. By the end of the second month it has returned to its normal size. In those cases, however, in which death occurring at full term is due to hemorrhage, no contraction of the uterus will have taken place. If the woman, however, has survived for a few days, the uterus will be found more or less contracted. During pregnancy the round ligaments and Fallopian tubes increase in size and become more vascular; the broad ligaments are gradually effaced through the great develop
Means of Producing Foticide.-Among the means first tried by women to bring on a miscarriage may be mentioned the effects of violence, such as submitting to a severe beating, jumping from high places, as tops of fences, gates, etc., venesection, emetics, and drastic ca