LETTER VII.. Signs of Pregnancy.

SIGNS OF PREGNANCY.

Importance of the Subject—Difficulties of ascertaining Pregnancy in some Cases—Means by which it is to be Known.

There are some circumstances in which a knowledge of the signs of pregnancy is of very great importance. Dr. Rigby informs us that “there are numerous cases on record where a false diagnosis in women convicted of capital offenses, has led to the most lamentable results, and where dissection of the body after death has shown that she was pregnant.”

Baudelocque, a French writer on the subject, relates the case of a French countess, who was imprisoned during the Revolution, in consequence of being accused of carrying on a treasonable correspondence with her husband, an emigrant. She was ordered to be examined by two of the best midwives in Paris, and they declared her not pregnant. She was accordingly beheaded upon the guillotine, and her body taken to the School of Anatomy, where it was opened by Baudelocque, who found twins in the fifth month of pregnancy.

A great many mistakes of this kind have been made, first and last, in the medical world. Not many months ago, in this city, two eminent practitioners—one of them in particular being one of the most celebrated in the world—had a patient whom it was declared had an internal tumor, from which it would not be possible for her to recover. The physician who attended principally in the case, went often to visit the lady, to crowd up the tumor, as it was called. After a time the physician was sent for early in the morning, to visit the case, as the lady was suffering a good deal of pain. He said he would make it his first visit to see her. On arriving, what must have been his surprise to find his patient already delivered of a fine boy!

The signs of pregnancy, that are very difficult to understand; or, in other words, to ascertain whether a woman is really pregnant in a given case, may be a very difficult matter, if not absolutely an impossible one.

You will agree with me, I am confident, that the old custom of impanneling a jury of twelve matrons, where a court of justice wished to ascertain whether a woman was quick with child or not, was not a good one. If the most experienced physicians and midwives are liable to great mistakes in these matters, how much more so those who have paid little attention to the subject.

But it is my purpose in the present letter to speak of the ordinary signs, changes, and appearances which will usually be found to be accompaniments of this state; and that you will feel a deep interest in the subject, I am already fully aware.

Suppression of the menses, as you well know, is not necessarily a sign of pregnancy. As a rule to which there can be but few exceptions, menstruation and pregnancy do not go on together. Indeed, many writers contend that there can never be menstruation in connection with fecundity. Others assert the contrary. But the rule is, pregnancy and menstruation cannot be present at the same time. But, as we have seen elsewhere, there is often suppression of the menses from various other causes than the one we are now considering.

Nausea, and vomiting in the morning, constitute one of the most common signs of pregnancy; but it is to be remembered also, that, in a considerable proportion of cases, no stomach-sickness, whatever, is experienced. On the other hand, likewise, many persons have nausea and vomiting arising from other causes than pregnancy.

If the child dies in the mother’s womb, it is believed that nausea and vomiting, for the most part, cease immediately.

An irritable state of the stomach is one of the most common symptoms in the early part of this period. The breasts often, at first, grow smaller; after two or three months, they enlarge, and sometimes become painful. A fluid, somewhat resembling milk, only more watery, is not unfrequently observed to ooze from these parts during the early months of gestation. The nipple is seen to be surrounded by a brownish circle; this is at least true in many cases. In the beginning of pregnancy, the abdomen does not necessarily grow larger, as might at first be supposed. Indeed, good authorities assert, that in the commencement of the period, it becomes rather flatter than formerly; and that when it does first increase in size, it is rather from inflation of the bowels, particularly the colon, than from expansion of the uterus. An enlargement of the abdomen may arise from such a variety of causes as the obstruction of the menses, dropsy, diseases of the ovaries, or of the womb. This sign must necessarily always be looked upon with caution, especially in those cases where there is a strong desire for progeny.

I remarked that a fluid resembling milk, is sometimes one of the signs of pregnancy. When this secretion takes place, it is looked upon by many of those who are not well-informed on the subject, as being a certain sign of this state. But it should be remembered, that not unfrequently when the menses cease from some other cause than that of pregnancy, a milky fluid is secreted in the breast. This has been known, likewise, to take place in women who had passed the child-bearing period, in young girls and infants, and even in men. Dr. Dewees gives us a case which is well calculated to impress upon us how careful we should be in forming our judgment in cases of this kind. It is as follows:

“I once knew a considerable quantity of milk form in the breasts of a lady, who, though she had been married a number of years, had never been pregnant, but who, at this time, had been two years separated from her husband. She mentioned the fact of having milk to a female friend, who, from an impression that it augured pregnancy, told it to another friend, as a great secret, who, in her turn, mentioned it to another friend; and thus, after having enlisted fifteen or twenty to help them keep the secret, it got to the ears of the lady’s brother. His surprise was only equalled by his rage; and in a paroxysm he accused his sister, in the most violent and indelicate terms, of incontinency, and menaced her with the most direful vengeance.

“The lady, conscious of her innocence, desired that I should be sent for forthwith, and insisted her brother should not leave the room until I arrived. Some time elapsed before this could be accomplished, as we were several miles from each other, during the yellow fever of 1798. During the whole of this time she bore his threats and revilings with almost exemplary patience and silence. I at length arrived; and, in the presence of the brother and a female friend, she informed me of what I have just stated, and said, her object in sending for me was, to submit to such an examination as I might judge proper to determine whether she were pregnant or not. She would not permit her brother to leave the chamber, and I conducted the examination without his withdrawing. This thing turned out as I had anticipated, from the history given at the moment, of her previous health. I pronounced her not pregnant; and she died in about eight months after of pulmonary consumption, in which disease obstruction of the catamenia is not an unfrequent occurrence.”

Quickening is one of the most unequivocal of the signs of pregnancy. This usually happens about the middle of the period. It may occur, however, as early as three months; not unfrequently, probably, at the end of four months; and sometimes considerably later than the middle of the period, or four and a half months. In quickening, “the motion is first felt in the hypogastrium, and is languid and indistinct, but by degrees it becomes stronger. It is possible for women to mistake the effects of wind for the motions of a child, especially if they have never borne children, and are anxious for a family.” But the sensation produced by wind in the bowels is not confined to one spot, and is very often referred to a part of the abdomen where the motion of a child could not possibly be felt. It must, however, be acknowledged that sometimes a sensation seems to be produced, distant from the uterus, and higher than the child can actually lie. This may be from motion communicated through the folds of the intestines, and the result shows that the woman was not mistaken in her sensation. It is not to be supposed that the child is not alive previous to the period of quickening, though the code of criminal law is absurdly founded on that idea. The child is alive from the first moment that it becomes visible, but the phenomena of life must vary much at different periods. It is seldom felt to move until after the ascent of the uterus out of the pelvis. Does the motion of the child arise from any change of the phenomena of life at that time in the child itself, or from the muscular power becoming stronger, or from the uterus now being in a situation where, there being more sensibility, the motion is better felt? All of these circumstances probably contribute to the sensation, which becomes stronger as the child acquires more vigor, and as the relative proportion of liquor amnii decreases. This fetal motion, however, is not to be confounded with the sensation sometimes felt by the mother, from the uterus rising out of the pelvis, and which precedes the feeling of fluttering.

If this elevation of the fetus takes place suddenly, the sensation accompanying it is pretty strong, and the woman, at the time, often feels sick or faint; and in irritable habits, even an hysterical fit may attend it. From the time when this is felt, women are said to have quickened, and they afterward expect to be conscious of the motion of the child.

The motion of the child, in many, soon increases, and becomes very vigorous; in others, it is languid during the whole of pregnancy; and in a few cases scarcely any motion has been felt, although the child at birth be large and lively. The morning-sickness, and many of the sympathetic effects of pregnancy generally abate after this, and the health improves during the last two quarters.

There is also liability to mistake in regard to quickening, as well as in the other signs of pregnancy. Thus, hysterical persons in particular may feel motions in the bowels, or imagine that they feel them, which they suppose to be the motions of a living child. This is much more apt to occur with those who are very desirous to be pregnant. Other persons also, doubtless, who are not hysterical, may, from flatulency in the bowels, be led into errors in this matter.

In some cases it is probably impossible for the female actually to determine whether pregnancy exists. These cases, however, are exceptions to the rule. As a general thing, there is no difficulty in determining by, or after, the middle of the period, whether a woman is with child.

A manual examination, by a competent physician or midwife, is the most certain test. In ascertaining pregnancy after the middle of the period, there is some liability to error. Practitioners of great experience, as I have before remarked, have made errors in regard to this matter.

Seeing, then, how difficult it is to determine positively beforehand in any case whether pregnancy really exists, you will, I am confident, look charitably upon those who are suspected of this state, without a full and sufficient cause. “It is better that ninety-nine wicked persons should escape, than that one righteous one should be punished.”