Part 6

The case I refer to was that of a young lady, privately married, the gradual enlargement of whose abdomen was decided by her medical attendant to arise from dropsy; for, although she had most of the symptoms of pregnancy, and the medical man was aware she had been married eight months, still, as she continued to menstruate, he declared it impossible that she could be pregnant. Tapping was proposed; and, except that her general health suffered much at this time, the operation would have been performed. The delay saved the patient such unfortunate and mistaken treatment—it might have proved fatal in its results—and she shortly gave birth to a living and healthy male child.

Fourth exception.—That women late in life have conceived after menstruation had apparently ceased for ever, the following cases prove:—

In September, 1834, I was called to the assistance of a female in labour in her forty-ninth year. She had not been pregnant for twelve years, and supposed she had ceased to menstruate two years previous to that time. She did well, and never afterward saw anything.

Mrs. B——, ætat. 39. Has been married eighteen years, commenced to be unwell very early in life. Has had three children; the last pregnancy seven years since. Is now again pregnant, her menses having left her sixteen weeks prior to conception; before which, she had been very irregular, and supposed she had ceased to be unwell for ever.

Other cases of a similar nature are on record. There can be no doubt they are authentic; but at the same time it must be acknowledged that a female is not unlikely to be deceived, by the irregularity which attends the returns of this discharge, late in life. It so happens, too, that just before the change of life takes place, there appears in the constitution of some females a great disposition to pregnancy; so that many who have ceased to bear children for years, or have been hitherto barren through the whole of their married existence, at this time, to the surprise of their friends and themselves, become pregnant.

A knowledge of these facts must be useful, as they will tend to allay apprehension at what might be supposed disease, both by the mother and by the hitherto childless woman.

A female must not forget, however, that she may mistake her condition, and that such mistakes are not at all unlikely to arise from the circumstance that the symptoms which naturally accompany the cessation of menstruation, much resemble those of pregnancy. She passes over the menstrual period;—she is struck with this. Other symptoms are soon manifested; the size increases—the breasts even become swollen and painful—the stomach disordered, and the appetite capricious;—flatulence collects in the intestines; and while on this account the size still increases, the air moving about the bowels gives an inward sensation which is mistaken by the female for the plunging of the child. Time alone, or the investigation of the medical attendant, detects the mistake; and the symptoms are then to be easily removed by the exhibition of carminative and purgative medicines, the use of active exercise, and bandaging the distended abdomen.

It must be remembered, also, that suppression of the monthly return may arise from a variety of causes, altogether independent of conception. Every female is aware, that exposure to cold, just before the expected period, is a frequent cause. Different forms of disease, hardship, or mental emotions, may produce the same result. It does not follow, therefore, because a woman ceases to menstruate, she must be pregnant; which naturally presents this inquiry: what dependence, then, is to be placed upon the omission of menstruation as a symptom or sign of pregnancy?

When a female ceases to be unwell, and experiences other symptoms of pregnancy, she must consider her situation as yet uncertain, because these signs are common to disease as well as pregnancy. But if toward the third month, while the suppression continues, she recovers her health, and if her appetite and colour return, she needs no better proof of pregnancy; for under other circumstances her health would remain impaired, and even become worse.

Morning Sickness.

Soon after conception, the stomach often becomes affected with what is called “morning sickness.” On first awaking, the female feels as well as usual, but on rising from her bed qualmishness begins, and perhaps while in the act of dressing, retching takes place.

This symptom may occur almost immediately after conception; but it most frequently commences for the first time between two or three weeks after. Now and then it is experienced only the last six weeks or two months of pregnancy, when it is attended, generally, with much distress and discomfort. And lastly, it is not unfrequently absent altogether.

It continues, more or less, during the first half of pregnancy, and subsides about the time when the movements of the child begin to be felt.

Irritability of the stomach, however, may arise from a variety of causes totally independent of pregnancy, and connected with disease or disordered function. Of what avail, then, it will be asked, is this symptom as a sign of pregnancy? It is so far available:—

The nausea and vomiting of pregnancy are not accompanied by any other symptom of ill health; but, on the contrary, the patient feels as well as ever in other respects, and perchance takes her meals with as much relish as formerly; but while doing so, or immediately after, she feels suddenly sick, and has hardly time to retire, when she rejects the whole contents of her stomach, and very shortly after is quite well again. Not so with sickness arising from disease, or disordered condition of the stomach.

Shooting pains through—enlargement of—and other changes of the breast.

When two months of pregnancy have been completed, an uneasy sensation of throbbing and stretching fulness is experienced, accompanied with tingling about the middle of the breasts, centring in the nipple. A sensible alteration in their appearance soon follows: they grow larger and more firm. The nipple becomes more prominent, and the circle around its base altered in color and structure, constituting what is called “the areola.” And, as pregnancy advances, milk is secreted.

The period of gestation at which these changes may occur, as well as the degree in which they become manifested, varies very much. Sometimes, with the exception of the secretion of the milk, they are recognised very soon after conception;—in other instances, particularly in females of a weakly and delicate constitution, they are hardly perceptible until pregnancy is far advanced, or even drawing towards its termination.

Enlargement of the Breast.—The changes in the form and size of the breast may be the result of causes unconnected with pregnancy. They may enlarge in consequence of marriage, from the individual becoming stout and fat, or from accidental suppression of the monthly return. There are, however, these differences: enlargement from pregnancy may in general be distinguished from that produced merely from fat, by the greater firmness of the breast, and its knotty uneven feeling—it is heavier; and the tension and enlargement from suppressed menstruation, by its subsiding in two or three days, whereas that caused by pregnancy continues to increase. Nevertheless, the dependence which may be placed upon the enlargement of the breast only, as an evidence of pregnancy, is not very great, and considered alone, but a doubtful sign.

The Nipple.—Not so the changes which take place in the nipple, and around its base. These alterations, if present, are of the utmost value, as an evidence of pregnancy. The changes referred to are these:—

About the sixth or seventh week after conception has taken place, if the nipple be examined, it will be found becoming turgid and prominent, and a circle forming around its base, of a colour deeper in its shade than rose or flesh-colour, slightly tinged with a yellowish or brownish hue, and here and there upon its surface will be seen little prominent points, from about ten to twenty in number. In the progress of the next six or seven weeks, these changes are fully developed; the nipple becoming more prominent and turgid than ever: the circle around it of larger dimensions, of an extent of about an inch or an inch and a half; the skin being soft, bedewed with a slight degree of moisture, frequently staining the linen in contact with it; the little prominences of larger size, from the sixteenth to the twelfth of an inch perhaps; and the colour of the whole very much deepened, but always modified by the complexion of the individual, being darker in persons with dark hair, dark eyes, and sallow skins, than in those of fair hair, light-coloured eyes, and delicate complexions.

Such are the essential characteristics of the true areola, the result of pregnancy, and, I believe, of that condition only.

This, then, is a most valuable sign; but, unfortunately, it is frequently absent; and how often it is present, although I have examined many hundred cases for it, I cannot determine, as unfortunately no note was made upon this point. It should also be observed, that both in dark and fair women, the change of colour, without the other appearances, may be present, and yet pregnancy exist; and I have also seen frequently the dark circle alone, where pregnancy did not exist; but I never saw an instance where these prominences were truly developed, without the presence of pregnancy.

This fact has been more particularly noticed of late years by an eminent physician-accoucheur, and the attention of the author has, in consequence, been much directed to it; and, as a striking illustration of its truth, he may mention, that, called upon very recently to visit one of the Institution patients, the third day after her delivery, and having occasion to examine the breast, I pointed out to the gentleman in attendance the presence of these little prominences around the base of the nipple; upon which the patient, to my great surprise, immediately observed, “Ah, sir, I always know when I am pregnant by them, for they appear about ten days or a fortnight after its occurrence, and subsequent to delivery diminish gradually, as my milk leaves me.”

It has occurred to me during the past year to be consulted in five cases of doubtful pregnancy. In two of them, circumstances forbade the probability of its occurrence; but in both the true areola was distinctly and fully developed. It decided my opinion; and the result proved its correctness: both became mothers. Two others had made themselves patients of the Lying-in-Institution, having obtained letters for attendance from governors of the charity, and upon which was marked, by their own calculation, the month of their expected confinement. But I was led to believe, from observing two or three symptoms, that pregnancy did not exist.

Their cases were examined, and at last the breast; in both the true areola was wanting: the review of symptoms decided all doubts. Had, however, the true areola been present in either, it would at once have reversed, instead of confirming my first suspicions.

The fifth was pregnant, but the true areola was wanting; and I was obliged to refer to those signs which can alone be recognised by a medical man.

The absence, then, of this sign, except in combination with other circumstances, proves nothing, but, if present, I believe it conclusive.