SIGNS AND SYMPTOMS OF PREGNANCY.

Pregnancy is the condition in which the female has within her an impregnated, fecundated germ, which gradually becomes developed in or out of the womb. In a perfectly normal state of things, the impregnated ovum becomes attached to the inner surface of the womb by virtue of a preordained vital force by which the ovum becomes animated at the moment of conception. It obtains its nutrition from a plexus of blood vessels, by means of which the ovum is attached to the inner side of the walls of the uterus, and this complex of vessels grows with the development of the fetus, and constitutes the placenta, which, together with the membranes and the umbilical cord, is called the afterbirth.

The growth of the embryo, which is the predestined child in the mother’s womb, occupies a period of ten lunar months, or two hundred and eighty days—this is the average term of pregnancy, although the duration of pregnancy is prolonged in a large proportion of cases to three hundred days, and even longer, while in a small proportion of pregnant women the period of gestation falls naturally shorter than two hundred and eighty days.

In a small number of pregnancies the impregnated ovum is arrested at the ovary, or on its passage from the latter through the Fallopian tubes; it then does not arrive in the cavity of the uterus. This state of things is unnatural, hence termed preternatural, because the growth of the fetus takes place out of the uterus, and this is also called extrauterine pregnancy, which may take place in the ovary, Fallopian tubes, or cavity of the abdomen. False pregnancy implies that there was no pregnancy at all, or in other words, that there was no fetus, and that the enlargement was due to something else.

In pregnancy the female experiences signs and symptoms resulting from changes in the condition of her organs and functions. The suppression of the courses or menstrual discharges is considered in the popular mind an unerring proof of pregnancy, yet, as a matter of fact, this is far from the truth. I have known of two women who menstruated regularly during the entire period of their pregnancies, and there are a number of reliable cases recorded of women who menstruated during pregnancy and at no other time.

It is a rule, that the menses cease during pregnancy, but it is equally certain that the menstrual function becomes suspended from other causes, and these are quite numerous, so that taken by itself, the sign is of little importance. Young married women not infrequently have a slight menstruation for two or three periods after their first conception, and on the other hand, newly married women will have their menses occasionally arrested, and this may continue for two or three months and indeed no pregnancy exist.

Nausea and vomiting is also presumptive evidence of gestation. Some women are affected with sick stomach almost from the moment of conception, and from actual experience they are so certain of their condition, that they can calculate with certainty the day of their confinement from the time when they had their first feeling of nausea. Experience seems to teach that a certain amount of nausea, the morning sickness, and the vomiting which accompanies or follows it, is to be met in women who go through a natural or healthy pregnancy, so that many eminent authorities have looked upon this symptom as a physiological accompaniment, and one of the most constant and reliable symptoms. The vomiting and nausea of pregnancy is different from that which is an indication of general ill health; in pregnancy the vomiting is followed with a sense of relief, and the patient is for the time being quite easy. The length of time that women feel this gastric irritability varies in different individuals; ordinarily it will cease about the fourth month, sometimes sooner, and it may return again during the last two or three months of gestation. It is supposed to be due to a reflex action of the spinal cord from the uterus to the stomach. It must be remembered, however, that a disease of the uterus, a fibroid or ovarian tumor, and a suppression of the menses from other causes than pregnancy will occasion nausea and vomiting.

A capricious appetite is another of the peculiarities of pregnancy, a longing for unnatural food, so that some women will enjoy eating such things as chalk, slate pencils, and similar indigestible stuff; this I have always considered a form of hysteria, that is, a functional derangement of the nervous system, for which I gave ten grains of bromide of sodium three times a day, with the best results; others again became passionately fond of sour salads, or strong condiments like mustard, Worcestershire sauce, and salt fish, while others again long for fruits.

Salivation of the mouth is another very unpleasant symptom which annoys some women when they are pregnant, for they will secrete such enormous quantities of saliva, that they cannot help drooling from the mouth when they speak. In salivation of pregnancy the gums do not become sore as in the salivation from mercury; in the former the irritation is confined to the salivary glands alone. The wonderful sympathy that exists between remotely situated organs of the body is here strikingly illustrated between the sexual organs and the salivary glands in both sexes. In mumps also, which is an inflammation of the salivary gland, it is not unusual for the testes in the male and the mammÆ in the female to become swollen and painful, and as soon as this swelling takes place, the inflammation of the salivary gland disappears.

The breasts become enlarged and otherwise altered in pregnancy, the enlargement is accompanied with more or less sharply shooting pain, they also become harder and are more movable than otherwise. The nipple becomes more prominent and painfully sensitive, the veins that run from the breast become distended so that they can be readily traced by the eye. The presence of milk in the mammÆ is another sign, but that, too, is only presumptive, because the secretion of milk takes place in other conditions than that of pregnancy; even the newly-born infant has sometimes milk in its breasts, and milk has been recognized in the breasts of some males and not infrequently in those of young virgins.

Pigmentation or the deposit of coloring matter in pregnancy has long been observed as a prominent symptom and when taken together with other signs it is worthy of careful consideration, but here, too, we encounter the obstacle to anything of a positive nature, for discoloration is also met with in females who are suffering from pelvic diseases and who are not pregnant. Areola is the technical name of that peculiar circle which immediately surrounds the nipple. In a healthy virgin this circle is characterized by a beautiful rose-tinted blush, but under the influence of disease, even in the virgin the circle becomes more or less discolored. When pregnancy has occurred the areola around the nipple becomes darker and darker; other parts of the body become similarly discolored, this occurs on the abdomen and perineum.

The womb descends during the first two months of pregnancy, this constitutes a kind of physiological falling of the womb and indeed the accompanying symptoms of a pregnant woman are often similar or identical to that diseased and permanent condition of physical suffering, namely, falling of the womb. Perhaps the most common symptoms of the descent of the uterus will be more or less frequent desire to pass water, because of the dragging of the womb on the neck of the bladder; sometimes there is also a straining or inclination to go to stool, owing to pressure on the rectum from the same cause.

The umbilicus or navel becomes painful and even depressed from traction of the superior ligament of the bladder, which is attached to the umbilicus, thus illustrating the operation of cause and effect, namely, as the bladder is depressed by the descended uterus, the bladder in turn pulls on the umbilicus to which its ligament is attached. The pregnant uterus remains only the first few months in this depressed state; at the third month, as a result of its continual growth and that of the fetus, the uterus ascends out of the pelvis and as a natural consequence the symptoms of the bladder and rectum subside. Towards the end of the ninth month the womb again descends into the pelvis and with this there may be a return of the irritation of the bladder and a feeling of bearing down or tenesmus of the rectum. The descent of the uterus toward the close of pregnancy diminishes the prominence of the abdomen, and as the diaphragm has freer play, the respiration becomes easier; if there was any cough that, too, disappears, and on the whole the woman feels herself more comfortable and in happy spirits. This may even arouse suspicion in her own mind as to her condition, because she does not know the cause of the change; it may portend to her that something is not right, that she is not pregnant or that her child may be dead. In women who have borne one or more children in a natural manner, the descent of the womb is of no particular moment in the last months of gestation, because the abdominal walls having been stretched by previous pregnancies the body or fundus of the womb may fall forward and give the lungs and other organs relief from pressure, but in the first pregnancy this is never the case, because the abdominal walls are too tense to allow this normal anteversion.

The German school of midwifery has laid down an important rule as a consequence of this observation, and I have never known an exception to occur in my experience. The rule is that when the uterus does not descend into the pelvis toward the close of the first pregnancy, it is because there is a disproportion between the child’s head and the maternal pelvis, or in other words that either the child’s head is too large for a natural or unaided delivery to take place, or that the pelvis of the mother is too small for a natural delivery to take place, and this is true, and knowing this to be true at the outset or commencement of a confinement it would be only torture and a valuable loss of time to wait at the bedside of a woman suffering with the pangs of childbirth in the vain hope that she might deliver herself—when in truth and as a fact that cannot be done without the aid of scientific assistance.

The vagina and external organs are more or less modified in pregnancy. The vagina becomes wider and shorter and as there is an increase of spongy tissue, it presents a swollen appearance. The mucous glands become larger and secrete a greater abundance of mucus. The internal surface of the vagina becomes discolored in consequence of pregnancy and I believe that it is one of the most reliable presumptive signs; the mucous membrane presents a sort of bluish tint, a French authority calls it a violet hue, not unlike the lees of wine.

Quickening is a term that is employed to designate the particular length of time that pregnancy has existed, and at the same time to furnish evidence to the mother through the movements of the fetus that she carries within her womb a living being. In a former chapter I have already detailed the theory of the ancients upon this subject, which was as absurd as it was fanciful. The late Professor Bedford defines “quickening as nothing more than the ordinary result of progressive increase when the physical organization of the fetus has reached a state of development which imbues it with the power of movement—a movement dependent upon muscular contraction.” The period of quickening is usually about the fourth and a half month or the middle term of pregnancy.

Pulsation of the fetal heart, when heard, is no longer presumptive but absolutely positive evidence that pregnancy exists. That the heart of the child can be distinctly heard to beat in its mother’s womb was one of the greatest discoveries in midwifery. The pulsations of the fetal heart are much faster than those of the mother’s heart, hence there is no danger of getting them mixed; while the child’s heart averages from one hundred and ten to one hundred and sixty per minute, the heart of the mother averages from seventy-five to eighty beats. There are cases where the mystery of a pregnancy can be solved beyond a possibility of a doubt, through the recognition of the pulsations of the fetal heart, and yet a woman may be pregnant in whom it will be impossible to distinguish the action of the child’s heart, at the termination of her period of gestation she will bring forth a healthy child.

The question whether a female is pregnant will, from the very nature of the symptoms always remain debatable in a certain proportion of cases, or, in other words, there is no sign or symptom that is reliable and if reliable it is not uniformly present. From a medico-legal standpoint the question will always be of great importance, as it frequently involves the guilt or innocence of the accused; the social standing of one, or the merited punishment of the other, and it does seem like a travesty on both science and justice that at certain stages and in certain conditions no signs or symptoms are absolutely reliable. The unfortunate creatures whose illness may imitate or simulate the symptoms of pregnancy must always receive the benefit of the doubt, this would avoid the possibility of wrecking innocent lives. Professor Bedford reports a case in his work on obstetrics which is as sad as it is instructive, he says: “I was requested to visit a lady who was residing in the State of New Jersey, about thirty miles distant from New York. On my arrival I was received by her father, a venerable and accomplished gentleman. He seemed broken in spirit, and it was evident that grief had taken a deep hold of his frame. On being introduced into his daughter’s room, my sympathies were at once awakened in beholding the wreck of beauty which was presented to my view. My presence did not seem to occasion the slightest disturbance; she greeted me with these words: ‘Well, doctor, I am glad to see you on my beloved father’s account, for he will not believe that I cannot yet be restored to health. Life, however, has lost all its charms for me, and I impatiently long for the repose of the grave.’ These words were spoken with extraordinary gentleness, but yet with an emphasis which at once gave me an insight into the character of this lovely woman.

“Her father was a clergyman of high standing in the English Church, and had a pastoral charge in England, in which he continued until circumstances rendered it necessary for him to leave that country, and seek a residence in America. At a very early age, this young lady had lost her mother, and had almost been entirely educated by her father, whose talents, attainments, and moral excellence admirably fitted him for this important duty. When she had attained her eighteenth year, an attachment was formed between her and a young barrister of great promise and respectability. This attachment soon resulted in a matrimonial engagement. Shortly after the engagement she began unaccountably to decline in health; there was a manifest change in her habits; she was no longer fond of society; its pleasures ceased to allure and prove attractive; the friends whom she had caressed with all the warmth of a sister’s love, now became objects of indifference; in a word she was a changed being—her personal appearance exhibited alterations evident to the most superficial observer; her abdomen enlarged, the breasts fuller than usual, the face pale and careworn, and the appetite capricious, with much gastric derangement. Many were the efforts made to account for this change in the conduct and appearance of the young lady in question. Speculation was at work, and numerous were the surmises of her friends. The rumor soon spread that she was the victim of seduction, and her altered appearance the result of pregnancy.

“The barrister to whom she was affianced heard of these reports, and instead of being the first to stand forth as her protector, and draw nearer to his heart this lovely and injured girl thus measurably assuaging the intensity of grief with which she was overwhelmed, addressed a letter to her father requesting to be released from his engagement. This was, of course, assented to without hesitation. The daughter, conscious of her own innocence, knowing better than anyone else, her own immaculate character, and relying on heaven to guide her in this her hour of tribulation, requested that a physician should be sent for, in order that the nature of her case might be clearly ascertained. A medical man visited her, and after an investigation of her symptoms, informed the father that she was undoubtedly pregnant, and suggested that means should be taken to keep the unpleasant matter secret. The father, indignant at this cruel imputation against the honor of his child, requested an additional consultation. This resulted (as usual) in a confirmation of the opinion previously expressed, and the feelings of that parent can be better appreciated than portrayed.

“That good man resigned his pastoral living to proceed with his daughter to America. On her passage to this country, the daughter became extremely ill, and the advice of the physician on board the vessel was requested; he too told the father that there was danger of premature delivery, for he simply took appearances as his guide, and at once concluded that she was pregnant.

“This is about the substance of what I learned of this interesting and extraordinary woman. I proceeded with great caution in the investigation of her case, and after a faithful and critical survey, most minutely made in reference to every point, I stated in broad and unequivocal language that she was not pregnant. The only reply the gentle creature made on hearing my opinion, was—‘Doctor, you are right.’ The father was soon made acquainted with the result of my examination, but he indicated not the slightest emotion. He asked me whether something could not be done to restore her to health, and I thought that the old man’s heart would break when I told him that his daughter was in the last stages of consumption.

“It was the misfortune of this young lady to labor under an affection of the womb, which simulated, in several important particulars, the condition of pregnancy, and which the world in its ignorance and undying thirst for scandal, might have readily supposed did in fact exist; yet, there was no excuse for the physician, guided as he should have been by the lights of science, and governed by the principles of sound morality. The result of my investigation impressed me with the conviction beyond any shade of doubt, that the entire train of symptoms indicating pregnancy was due to the presence of a large fibrous tumor occupying the cavity of the uterus. About four weeks from this time I received a note announcing her death and asking that I would hasten to the house for the purpose of an examination. Dr. Ostrom, now practicing in Goshen, assisted me in the autopsy. As the father stood before me he was not unlike the stricken oak in the forest, which, though stripped of its branches, was yet upright and majestic. The moment I removed the tumor from the womb he seized it convulsively, and exclaimed, ‘This is my trophy; I will return with it to England, and it shall confound the traducers of my child!’

“Here, you perceive, both character and life were sacrificed by error of judgment on the part of those whose counsel had been invoked. Without a due responsibility, heedless of the distressing consequences, the medical gentlemen rashly pronounced an opinion which consigned to an early grave a pure and lovely being, and broke the very heart strings of a devoted and confiding parent.”