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.”
LETTER VIII.
DURATION OF PREGNANCY.
Difficulties of Ascertaining it—Rules by which it is to be Known—At what
Age can a Fetus Live?
The question relating to the duration of pregnancy is a difficult one.
The general belief is, that the term lasts about nine calendar months.
We hear spoken of “nine calendar months,” “ten lunar months,” “forty
weeks,” or “two hundred and eighty days,” as indicating the length of
this period.
It should be recollected, that there may be a material difference
between nine calendar months and ten lunar months, as also between nine
calendar months and forty weeks. Nine calendar months may fall short of
forty weeks by from four to seven days. Thus, it may be two hundred and
seventy-three days, two hundred and seventy-four, two hundred and
seventy-five, or two hundred and seventy-six days, instead of two
hundred and eighty days, or forty weeks.
What are the means by which the true duration of pregnancy, or an
approximation thereto, may be established?
1. _Cessation of the menses._ This is by no means an infallible sign, as
every one knows. The menstrual function, as we have already seen, often
becomes obstructed from other causes than pregnancy. Conception may take
place without the woman being regular. Thus, it may occur some months,
even, after the menses have ceased from other causes. If, then, the
reckoning should be made to commence at the time when cessation
occurred, it would be found very fallacious in many cases. On the other
hand, menstruation may occur one or more times after conception has
taken place. So, also, it appears to be well established, that pregnancy
may occur before menstruation ever appeared with the individual.
2. _The period of quickening._ This, too, is not a reliable source of
reckoning the period of gestation. Quickening sometimes takes place,
doubtless, before it is perceived. It takes place, also, at very
variable periods, as I have elsewhere remarked; sometimes as early as
the third month, sometimes not until the fifth, or, perhaps, the sixth.
The range of quickening may be said to extend over a period of at least
sixteen weeks. Thus it will appear that this mode of reckoning is by no
means to be depended upon, although it often has been.
3. _Peculiar sensations soon after conception._ Some persons experience
peculiar sensations within a day or two after conception. This is not
true of every case, nor does the same individual experience these
symptoms at each time of pregnancy. At one time she may have them, and
at another time not.
4. _Nausea and vomiting._ These symptoms are too indefinite to enable us
to form any just idea of the time when conception takes place. Some
individuals do not experience them at all; some experience them very
soon, almost immediately after conception; others not until the lapse of
weeks, in some cases, probably months.
5. _Coition._ In the generality of cases it is impossible to know at
what precise period pregnancy has commenced, because it is not known
when the effectual coition took place. Now and then, however, such cases
do occur; and in such instances, which are, on the whole, very rare, we
find that the period of pregnancy varies somewhat as to its length.
Another method of reckoning has been to count from the time of the last
menstrual discharge. Dr. Merriman, of London, has published a table of
the births of 144 mature children, calculated from the day after the
last menstruation was perceivable. According to this table
3 were born in the 37th week.
13 „ 38th „
14 „ 39th „
83 „ 40th „
22 „ 41st „
15 „ 42d „
10 „ 43d „
4 „ 44th „
Dr. Guy, of London, gives the following cases:
A case by Dr. Nixon 273 or 276 days
„ Dr. Montgomery 280 „
„ Dr. Forster, of New York 283 or 285 „
A case before Lancaster Assizes 284 „
A case by Dr. Dewees 286 or 288 „
„ Dr. Desormeaux 290 „
„ Dr. Reid 292 or 293 „
The results of these cases are as follows:
Average of the seven cases 284 or 285 days.
Minimum „ 273 or 276 „
Maximum „ 292 or 293 „
Range „ 16, 17, 19, or 20 „
Excess above 280 days, 12 or 13 days.
Excess above nine calendar months, 16 or 17 to 19 or 20 days.
Thus it is plain that the period of gestation is more variable than some
have supposed.
The same thing is also observed in animals, where, in general, a much
more true record can be kept, than is possible in regard to the human
species. M. Tessier, in France, caused a set of observations to be made
on the duration of pregnancy in 160 cows, which commonly go nine months
with young. His table is as follows:
3 brought forth on the 270th day.
50 „ 270th to the 280th day.
68 „ 280th to the 290th „
20 „ 300th day.
5 „ 308th „
14 „ 241st to the 260th „
There is, as will be seen in this table, a variation of sixty-seven days
in the time a cow may carry her young.
A similar variation has been found in mares as cows, respecting the time
of gestation. The same author—M. Tessier—made observations which were
extended to 102 mares. The shortest period at which they brought forth
was two hundred and forty-one days, the longest at three hundred and
eight days.
Where there is no knowledge as to the precise time when an impregnation
took place—and such is the fact in almost all cases with the human
subject—a very good mode of reckoning is this: first ascertain the
precise time when the menses last appeared, then reckon two weeks; at
which time consider pregnancy as beginning. Nine calendar months, or
forty weeks, which may vary somewhat from that period, will be about the
time at which labor will ordinarily come on.
Another method is as follows: Quickening takes place at about the
twentieth week; add twenty weeks more to the previous time, and we have
an approximation to the truth. But, as I have elsewhere shown, the time
of quickening is subject to a good deal of variation, namely, from the
twelfth to perhaps the thirtieth week.
I think it will seldom be found to happen that labor occurs short of
forty weeks, or 280 days, after the last appearance of the menses. But
it is not out of place for me to inform you that medical men have varied
considerably in regard to the duration of pregnancy. Thus, Dr. Guy has
quoted five authorities, of greater or less eminence, to wit:
Sir Charles Clarke; 40 weeks—280 days.
Dr. Blegborough; 39, usually 40 weeks—273–280 days.
Mr. Pennington; 37 weeks; some, 40 weeks—259–280 days.
Dr. Gooch; a day or two before or after nine calendar months—271, 274,
275, or 278 days.
Dr. D. Davis; a day or two under nine calendar months.
The question as to the length of time it is necessary for a child to
remain in the mother’s womb, in order to enable it to live, or to render
it _viable_, as the term is, has been a very puzzling one to writers on
medical jurisprudence. On this subject, I do not know that I can
interest you in any better way than to give you some of the remarkable
examples on record which go to establish the point.
“I have seen,” says Belloc, “a girl who, at birth, was only twelve and
three quarters inches in length, whose skin was of a marbled redness,
whose head was covered with down, whose nails were imperfectly formed,
and who altogether bore a close resemblance to a young flayed rabbit.
She was fed with the spoon for eight days, because she was unable to
suck. Nevertheless, she is not only at the present moment alive, in her
seventeenth year, but is likewise an extremely clever, amiable girl,
above the middle stature, graceful in figure, and gay in her
disposition. The mother could not fix with precision the date of her
conception, but was convinced she was not at the term even of seven
months. I considered her at six months, at the utmost.”
Dr. Guy, of London, mentions a case given by Dr. Rodman, in which he
describes the mother as “more cautious in her decisions, accurate in her
observations, and steady in her deportment than what is usually met with
in society.” She had borne five children previously, and in this
instance “was confident that the period of her gestation was less than
nineteen weeks.” Premature labor came on in consequence of fatiguing
exertions, and she was delivered of a living male infant.
“Not daring to allow the washing of the infant’s body, he was speedily
wiped, and wrapped in flannel, with only an opening in the dress around
his mouth for the admission of air; and by the time the dressing was
over, the mother was ready to take him into the warm bed with herself.
It is common, if there be much apparent weakness, to feed a child the
first twelve hours after birth very frequently, yet, in this instance,
although the child was weak, no feeding was attempted until beyond that
time; the nourishing heat with the mother in bed was relied on. On the
following day, the head, body, and extremities of the child were
surrounded with fine cotton wool, pressed to appear like cloth, to the
thickness of two or three folds, and over that the flannel, as before;
and again the child was given to the mother in bed. His vital energy was
so deficient, that even with this dress, of himself, he was unable to
support the degree of warmth which was necessary to his existence. The
heat of a fire was evidently injurious, as he soon became weaker when
exposed to it; while the warmth of the mother in bed enlivened and
strengthened him. Too much heat induced a sickly paleness of his face,
with an obvious expression of uneasiness in his countenance; and the
abstraction of heat, even by tardily undressing his head, brought on a
nervous affection, or starting of the muscles all over his body. From
seeing how these morbid affections were induced, the child was kept
regularly and comfortably warm, by the mother and two other females
alternately lying in bed with him, for more than two months. After this,
he could be left alone from time to time, but was still undressed very
cautiously, and only partially at any one time. It was not till the
child was three weeks old that the length or weight of the body could be
ascertained. The length was found to be thirteen inches, and the weight
1 lb. 13 oz. avoirdupois. It was extremely difficult to get the child to
swallow nourishment the first week; the yellow gum soon came on, and the
thrush seized him severely on the eighth day, and was not cured till the
end of the third week. During the first week, he was fed with toasted
loaf bread, boiled with water, sweetened, and strained through fine
linen; in the second week, twenty drops of beef tea were added to the
two or three tea-spoonsful of his mother’s milk, and in two days
afterward he made exertions to suck. His mother’s milk was gradually
substituted, at least in part, for the panada, though this was still
continued occasionally, with a few drops of port wine. Under this
careful management he attained the age of four months, at which time his
health and excretory functions were peculiarly regular.”
Dr. Guy has arranged a table showing the lengths and weights of children
reported to be born during the fifth and sixth months of gestation, with
the assumed age and the probable age, according to estimates and
observations which he had made and collected from various authors on the
subject. It is as follows:
┌───────────┬───────────────┬───────┬────────┬──────────┬─────────────┐
│ Author. │ Length. │Weight.│Survived│ Asserted │Age according│
│ │ │ │ its │ Age. │to Estimates │
│ │ │ │ Birth. │ │ and │
│ │ │ │ │ │Observations.│
├───────────┼───────────────┼───────┼────────┼──────────┼─────────────┤
│ │ Inches. │lb. oz.│ │ Days │ │
│Rodman │ 11–13 at 3 │1 13 │1 yr. 9 │133 │ 5 months│
│ │ w’ks. │ │ m. │ │ possibly.│
│Outrepont │ 13½ │1½ 0 │8 years │175 or 189│ 6 months.│
│Belloc │ 12¾ │— — │17 years│6 months │ possibly 5│
│ │ │ │ │ │ months.│
│Bucholtz │ 14 │1½ 0 │ 2 days │189 days │ 6 months.│
│Kopp │ 12¼ │2 0 │4½ days │182 │ 6 months.│
│Fleischmann│ 11½ │1 5 │ 8 days │168 │ possibly 5│
│ │ │ │ │ │ months.│
│Christison │ 13 │1 7 │8½ hours│167 │ possibly 5│
│ │ │ │ │ │ months.│
│Mr. Thomson│ 12½ │1 8¾ │3½ hours│5 months │ 5 months.│
└───────────┴───────────────┴───────┴────────┴──────────┴─────────────┘
Thus, it would appear, that it is possible for a child to live when born
at about the end of the sixth month of fetal life, and, perhaps,
somewhat earlier. But these cases must, I think, be rare, and not
according to the general rule.
When a child is born, some idea may be formed respecting its age by the
appearance it presents. A description of the signs of maturity and
immaturity, founded upon that of two French authors, Foderé and Capuron,
will serve to contrast the one with the other.
The signs of maturity are the following:
The ability to cry as soon as the child reaches the atmospheric air, or
shortly thereafter, and also to move its limbs with facility, and more
or less strength; the body being of a clear red color; the mouth,
nostrils, eyelids, and ears perfectly open; the bones of the cranium
possessing some solidity, and the fontanelles not far apart; the hair,
eyebrows, and nails perfectly developed; the free discharge of the urine
and meconium in a few hours after birth; and finally, the power of
swallowing and digesting, indicated by its seizing the nipple, or a
finger placed in its mouth.
The signs of immaturity, on the other hand, are the following:
The length and volume of the infant—much less than those of an infant in
full term; it does not move its members, and makes only feeble motions;
it seems unable to suck, and has to be fed artificially; its skin is of
an intense red color, and traversed by numerous bluish vessels; the head
is covered with a down, and the nails are not formed; the bones of the
head are soft, and the fontanelles are widely separated; the eyelids,
mouth, and nostrils closed; it sleeps continually, and must be preserved
by artificial heat; and, lastly, it discharges its urine and meconium
imperfectly, and often after a long interval.
You will, of course, readily comprehend that the appearances of children
at birth, even of the same age of fetal life, must be subject to a good
deal of variation. Some are much stronger than others, and the size and
weight also varies a good deal. At one time a mother may have a very
large, strong, and well-formed child, and at another a small and weak
one. The size, however, does not determine the healthfulness of a child.
LETTER IX.
MANAGEMENT IN PREGNANCY.
Importance of Attention to the Health at this Period—Clothing, and its
Effects—How to Regulate it.
There is, perhaps, no period of life in which the management of the
health becomes a matter of more importance than in pregnancy. A little
mismanagement here is not unfrequently sufficient to cause the
individual life-long suffering and disease. I have known a woman, in the
fifth or sixth month of pregnancy, to go to an evening party, become
excited and mirthful, remain late at night, eating and drinking, as is
customary on such occasions, and perhaps, worst of all for a person in
such a condition, engage freely in the dance. Immediately, thereupon,
that woman has been taken with uterine hemorrhage, that ended
necessarily in abortion, a circumstance always more unfavorable to the
constitution than labor itself. I have known such a woman to be not only
in a very precarious and dangerous situation at the time, but to
experience for many months afterward an extreme prostration of the
general health, and an amount of suffering from depression of spirits
and nervousness, with all its multitudinous train of ills, which cannot
be conceived of only by those who have suffered them. I have known a
woman commit imprudences, such as doing a great deal of work at one
time, when she was generally indolent in her habits; and thus, by the
indolence and overworking alternately, abortion, hemorrhage, attended
with fainting—and which has brought her to the very verge of death—has
been caused. I have known, too, imprudent women, who, dissatisfied with
themselves and their condition, have taken powerful medicines, with the
idea of removing their unwelcome obstructions, and thus to bring upon
themselves a train of evils and sufferings which have ended only in the
sleep of death. I have known, too, women to be exceedingly injured by
the gross habits of their prurient husbands during this period. The
abominable and disgusting practice to which I here allude is, I fear,
exceedingly common. It cannot be too much reprobated or spoken against.
He that uses his wife like a brute during this time, is, to say the
least, little better than those who go away from home in quest of
illicit intercourse.
Women, too, are liable to accidents during this period. I lately had a
case in this city (New York), of a strong, healthy woman, who had borne
a number of children, and, at about the end of the seventh month, an
unfortunate circumstance occurred, in which no person was to blame, and
by which she became so much and so suddenly frightened as to be
prostrated on her bed for nearly a week. She did not recover the general
tone of the system during the remainder of the period; and the day after
the birth of the child, it was seized with fits resembling those arising
from fright. The child, as well as the mother, was very feeble. By very
prudent management, however, both finally recovered.
All great and powerful excitements, whether of mind or body—every thing,
in short, that is not consistent with a uniform, even tenor of both
mental, moral, or physical life, should, as far as possible, be avoided.
If ever woman’s life is to run like the smooth and placid stream, let it
be at this time, on which so much, not only of her own health, but that
of her offspring, depends.
CLOTHING.
The great advantages to be derived from a proper regard to the wearing
apparel in pregnancy, leads me to make in this place some general
remarks on the subject, which I shall follow with more special advice in
regard to this particular period.
It is an old maxim, that those who accustom themselves to go habitually
clad in thin garments are the most hardy, vigorous, and free from
disease.
The question then arises, how far is it safe, in each individual case,
to diminish the amount of clothing worn?
It is very evident that no _great_ change should be made _suddenly_.
By practicing the various natural means of hardening the system and
invigorating the general health, such as daily bathing, going often into
the open air, and avoiding overheated and illy-ventilated rooms, and, in
short, pursuing such a course of daily regimen as sound physiology
dictates, almost all individuals may very soon bring themselves to need
a much less amount of clothing than is usually worn.
At the far-famed hamlet Graefenberg, in Germany, many persons wear very
thin clothing, even when the weather is frosty, and the snow deep upon
the ground. According to the rules of fashion there, no cravat of any
kind need be worn upon the neck. Even the breast may be left exposed, to
receive the invigorating effect of the cool, fresh air. It is amusing
even, to see there, as I have often done, old men who have become so
hardy and vigorous that they could brace themselves up against the
snow-storm with bare and uncovered breasts, with a thin coat, and
perhaps no vest; and all this with apparent luxury and comfort. It is
indeed surprising to witness what habit is sufficient, in a short time,
to accomplish in these matters.
LACING.
Some persons seem to suppose, that if they dispense with the words
fashion, corsets, stays, and the like, they have nothing more to do in
the matter of tight clothing; but it should be remembered, there may be
_lacing_, that is, _compression_ of the body, by other means than mere
corsets, corset-strings, and stays. A dress may be so tight—and such
there often are—as to _lace_ the body as effectually as if the strings
were actually used.
It is to be hoped that the times will, ere long, change; that it will
become as fashionable for females to vie with each other as much in
possessing a full, plump waist, as it has hitherto been to possess a
small one. Why may it not be, and may we not imagine that cotton
wadding, etc., may be yet brought into requisition to remedy the forms
of nature about the waist, as now in other parts of the body? At any
rate, fashion can do any thing; and since it is the order of fashion to
change, we may, in time, expect a different state of things.