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.”