tion of pregnancy might be expected to be known within more accurate limits. But the variations here, too, extend over almost as great a range of time as in the cases in which the duration of the pregnancy is measured from the menstrual flow. The number of cases in which a single act can be taken as the starting point of the gestation is much more limited than the series of the previous section, but the following series have been reported:17

The mean derived from these, where the number of cases is known, gives for the 1,547 cases 269.7 days as the time after a single coitus that delivery usually occurs. The variations from this mean are a minimum duration of pregnancy of 242 days, given by Auvard, and a maximum of 317 days, given by Rossie. Auvard in his "Travaux d'Obstétrique," t. III., has estimated averages for primipara and multipara separately, and finds that no constant difference can be counted upon.

17 Schlichting to Devilliers, inclusive, Trav. d'Obstét. III. Reid to Desormais, Winckel, Samml. Klin. Vort., 292-3. inclusive, Brouardel, Le Mariage. Walich to Auvard, inclusive, Auvard,

III. VARIATIONS IN PERIOD OF PREGNANCY.

53. In general.-The limits of variation from this usual duration of gestation are very important from a medico-legal standpoint. At the one end come the questions bearing upon the length of time husband and wife can be separated and still have the woman bear a legitimate heir to her husband; at the other end are the questions bearing on the point of how soon after marriage can a viable legitimate child be born. In France and in Austria the legal limits of pregnancy are fixed as from 180 to 300 days. In Prussia the limits are from 181 to 302 days. But that these limits are not satisfactory is brought out by an article written by Winckel in the Deutsche Klinik for 1901,18 on the duration of pregnancy. This article represents the report of a committee of physicians appointed to investigate the question in its legal aspect. At the outset of his paper he enumerates many of the obstetricians and the period of gestation that they consider as the limit of protraction. As satisfied with the limit of 302 days, he names three men; with a limit of 308 days, a half dozen; and all of them had done their writing before 1870; as assigning a limit of 320 or more days, Winckel cites Crédé, Spiegelberg, Scanzoni, Devielliers, Joulin, Ahlfeld, Lowenhardt, Braun, Wachs, Cohnstein, Zollner, Ohlshausen, Auvard, Wickel, Parvin, Spiegelberg, Wiener, Barker, Kaltenbach, Range, Dewees, McTavish, and many others from 1853 to 1898.

54. Variations in other physiological functions. That the period of pregnancy is not a fixed number of days might well be argued from the other physiological processes of the human body. Just as the matter of size, weight, coloring, appetite, frequence of micturition or defecation, or the length of the menstrual periods, varies in different individuals or in the same individual at different times, so the period of gestation may be expected to vary.

55. Variations in period of gestation in lower animals.-Again, the period of gestation in animals, where it can be noted without question, from a single impregnation, is well known to vary. In the mare the usual period of eleven months may be shortened to ten months, or prolonged to over fifteen months; in the cow, the nine and a half months may be shortened to eight or extended to eleven. In fact, Rainard 19 describes a case where the labor was retarded 125 days, and then the bull calf was of such size that it needed medical

18 Lief. 7-9 Bd. IX., p. 1.

Parturition des Femelles Domestique, t. p. 239.

Rainard, Traité Complet de la I.,

skill to extract the calf. In the goat and ewe a latitude of over three weeks must be allowed to the regular five months. In the sow a full quarter of its four months term; and in the bitch the same proportion of its nine weeks term must be reckoned on. In the cat not only the frequent two-week allowance must be made in the term of eight weeks, but in some cases there is a variation of fifty or even sixty-four days, and in the guinea-pig the usual term of thirty days may be longed to seventy-five. From these data, as given by Bouchacourt,20 we see that in the lower animals, at least, the period of pregnancy is not limited to any invariable number of days.

pro

56. Variations in period of gestation in woman, in general.-When we come to the question of protraction of pregnancy in women, we have again the difficulty of determining the date of conception. Dating from the menses is very uncertain. A single coitus is also uncertain, though within narrower limits.

57. Signs of protracted gestation. As in the case of estimating the age of the under-developed fetus, so in these protracted cases, the most satisfactory guide in general is the stage of development of the infant, as represented by the length, weight, and organic maturity. If we take as normal-term infants those of 50 cms. length and 3,000 gms. weight, we may compare with them Winckel's statistics based on the length of the child, which are as follows:21

And also his statement that of all the children born in the Munich clinic weighing over 4,000 gms., 11 per cent of the mothers considered the pregnancy to have lasted over 300 days after the last menses. These are suggestive, at least, of continued development in the protracted cases, and are interesting in comparison with the reports of the cases of protraction which follow. But, on the other hand it is not allowable from the size alone to make a diagnosis of protracted gesta

"Bouchacourt, La Grossesse, Etudes "Deutsche Klinik, 1901, Lief. 7-9, Bd. sur sa durée et ses variations, Paris, IX.

tion; for Winckel, in the same article, describes a case born 277 days after the last menses, and 263 days after conception, and 149 days after quickening, certainly a nearly normal duration,-in which the child was 56 cms. in length, and weighed 4,659 gms. at birth.

58. Cases dating from menses.-If we date the pregnancy from the last appearance of the menses there are quite number of cases reported as extending over 300 days, and all on good authority. Winckel, in the article referred to above, gives references to twenty cases of pregnancy reported since 1867, where the period of pregnancy has exceeded the limit of 302 days. Of these cases he gives the histories; and then, for various reasons, eliminates nine of them as being unsatisfactory. In the remaining eleven cases he finds six that give every method of determining the duration in harmony: the cessation of the menses, the time of quickening, the size and appearance of the child at the time of birth, and all the measurements of the child. Hence, he considers them unquestionable cases of protracted pregnancy. These eleven cases are as follows:

1. Amer. Jour. Obst. Vol. XXXI., 1895, p. 842 (Stahl). Child born 302 days after the last appearance of the menses, 56 cm. long, weight, 5,600 gms.

2. Monatsschr. f. Geburtskh. XXXI., 1867, p. 321 (Credé and Martin). Birth 308 or 312 days after the last menses, 50 cm. long, weight, 5,125 gms.

3. Centralblatt f. Gyn. 1900, Nr. 29 (Riedinger). Child born 310 days after last menses, 64 cm. long, weight, 5,750 gms.

4. Wiener Med. Presse, 1885, p. 1094 (Rosenfeld). Child born 311 days after last menses, length, 59 cm., weight, 5,730 gms.

5. Zeitschr. f. Geburtsh. u. Gynäk. 1877, I., p. 44 (Martin). Birth 311 days after the last menses, craniotomy done, weight without brain, 7,470 gms.

6. Amer. Jour. Obstet. 1896, Vol. XXXIV., p. 846 (Sprengel). Child born 312 days after the last menses, 56 cm. long, weight, 5,542 gms.

7. Freidreich's Blatter, 1890, p. 91 (Pürkhauer). Child born 320 days after last menses, 53 cm. long, weight, 4,000 gms.

8. Amer. Jour. Obstet. 1896, Vol. XXXIV., p. 846 (Sprengel). Birth 320 days after menses, length 55 cms. weight, 5,280 gms.

9. Zeitschr. f. Geburtsh. u. Frauenkh., 1888, XV., p. 285 (Brosin). Child born 324 days after last menses, length, 60 cms. weight, 5,770 gms.

10. Lancet, July 30, 1892, Vol. II., p. 256 (Harris). Child born 326 days after menses, length, 67 cms., weight, 6,355 gms.

11. Centralbl. f. Gynäk. 1893, Vol. XVII., p. 816 (Bensinger). Child born 336 days after menses, diagnosis confirmed at end of first month of pregnancy, length, 58 cms., weight, 6,000 gms.

In addition to these eleven cases, Winckel in a later article in the Samml. Klin. Vorträge for 1901 cites from Schlichting's Thesis six other cases of protracted gestation, three of which exceed the period of 300 days, being 316, 318, and 344 days after the last menses.

59. Cases dating from coition. If we estimate the duration of the gestation from the last coition we find six cases referred to in the last-named article by Winckel, where the pregnancy lasted more than 300 days after coition. The cases are cited from Schlichting 22 as follows:

In addition to these six cases from Schlichting, there are several others on record:

Auvard, in his Travaux d'Obstétrique, 1889, Vol. III., p. 443, cites a case protracted to 305 days after coitus.

Rossié, in the Amer. Jour. Obstet. 1886, Vol. XIX., p. 19, describes a case of pregnancy subsequent to a single violation, where the child was born 319 days after the rape.

60. Limit of protraction.- That these cases reported represent the limit to which pregnancy may be protracted is improbable. There seems to be no evident reason why pregnancy should last 334 days after coitus, and not be protracted another day. Nor does the limit of protraction after the cessation of the menses seem to be any more strictly limited; this same case of Schlichting's exceeding the next longest quoted above by six days. A number of other cases of protraction of pregnancy have been reported, some of them lasting over still longer periods of time; but there seems to be reason for ques

Statistisches über den Eintritt des

erstens Menstruations, und über Schwangerschaftsdauer, Thesis, Munich, 1880. VOL. III. MEd. Jur.—3.