View of the Breast about the Fourth Month.—a. a. The Breast.—b. The Nipple.—c. The Areola, or part which becomes brown; it is elevated above the rest of the Breast, as may be seen.—d. d. The little Tubercles.
Most frequently the breasts do not swell, nor the areola change color, nor the tubercles appear, till about the fourth month, and frequently much later.
All these changes in the breast are also liable to become more or less permanent, after the first pregnancy, so that they are of much less service, and less to be depended upon, in all succeeding ones. They also remain, with most females, during nursing, and are therefore not available in those who conceive while they are nursing. On the whole however, these signs, especially in those not previously pregnant, may be pretty confidently relied upon, and will seldom deceive an experienced observer.
The secretion of milk is, by most persons, considered a positive sign of pregnancy, but it is not so, for it sometimes takes place in young girls merely from the establishment of puberty, and in some females it always occurs at each monthly period, though they have never been pregnant. Instances have been known of women nursing other people's children though they had never conceived themselves.
Miscellaneous signs.—There are a few other presumptive signs, not easily classified, some of which are of value, while others are so uncertain, or so little available, as to be almost worthless. All these however, it is necessary to point out, because some of them may be made use of in cases where the more ordinary signs are absent.
In the unimpregnated state the mucus membrane, which lines the Vagina, is of a bright rose color, but in nearly every case of pregnancy it changes to a bluish, or purplish hue. I do not recollect a single instance, in the course of my own observation, in which this change has not occurred, and the same statement is made by several eminent authors. It is true that in some young females the mucus lining is naturally darker than it is in others, but, like the areola round the nipple, this natural tinge is not like that produced by pregnancy. It is of course impossible to say whether this blue tinge is always produced, though I am inclined to think it is, and I should certainly consider it an almost infallible sign when present. Parent Duchatelet states that he was present when M. Jacquemin proved this, without a single failure, in four thousand five hundred cases.
Many females are also warned of their condition by pains in various parts of their bodies, the most frequent of which is one felt at the top of the head. Some always have palpitation at the heart, and others experience a singular kind of fluttering in the womb.
Many medical men rely altogether on certain peculiarities in the urine, and as this sign is really a valuable one, in some cases, I will describe the mode of examination fully. The urine is put in a clean vessel, and allowed to stand perfectly still. In a short time, varying from two to six days, a number of little opaque bodies begin to rise from the bottom, like flocks of cotton, which unite together at the top into a thin but firm layer, or pellicle, like cream on the top of milk. This layer is frequently so consistent that it can almost be raised out of the vessel, by taking hold of one edge, and may be easily drawn out by passing the finger under it. This substance is called kyestein. It is of a whitish color, semi-transparent, and looks as if it were partly crystalized. After a few days, if left undisturbed, the urine becomes thick and muddy, and the pellicle of kyestein breaks up and falls to the bottom. According to the experience of many medical men, and so far as I have seen myself, this peculiar substance is always to be found in the urine of pregnant females, after the first month, and frequently even earlier. Sometimes a substance similar to it is observed in the urine of those not pregnant, but there is, in most of these cases, sufficient difference between them to enable any one, who has seen both, to distinguish one from the other. The only time, except during gestation, when real kyestein appears to be formed, is while the milk is being secreted and not freely discharged. Thus it may often be found when the female is weaning, and, some writers assure us, in some cases during the whole period of nursing. On the whole this sign is a very valuable one, and may be much relied upon.
The changes in the pulse, on which some persons rely, are of no value whatever as a sign of pregnancy, since they are no more frequent, and not at all different, so far as I have seen, from what ordinarily occur from other causes.