The development of the abdomen, though an invariable accompaniment of pregnancy, is by no means a certain sign of it, since it may be produced by other causes; and besides, it is sometimes but little to be observed till a late period. The peculiar manner of the development however, is usually somewhat different from that produced by tumors, and other diseases. Very often the abdomen will be tolerably large by the second month, and then again become so much smaller that the female will think she is certainly not pregnant. This is owing chiefly to flatulence, produced by digestive disturbance during the early periods, but which afterwards subsides. In a short time however, the uterus not only enlarges more, but rises, and the development becomes permanent. This circumstance of there being often two developments has deceived many, and I have known females declared to be not pregnant, simply because the development of the abdomen went down, who, in a short time after, exhibited unequivocal evidences of being in that condition. The first development, or swelling, is merely similar to what often arises from indigestion, and other causes, and is therefore no sign of pregnancy; but the second development is accompanied by other changes, besides being more permanent.
The linea alba, or white line, which may be seen extending from the navel to the pubis, in the ordinary state, becomes much darker, the skin of the abdomen wrinkles, and the umbilicus, or navel, becomes prominent.
Swelling of the eyelids, and puffing of the face, are experienced by some females, but are not very general, and so frequently result from other causes that they are of little value as evidences in this case.
This, I believe, comprises all the presumptive signs of Pregnancy that are worthy of notice. Some of them are valuable and may be depended upon, particularly the presence of kyestein in the urine, which may almost be called a certain sign. Others of them are of little value alone, but are useful in the way of corroboration. The more there are of them observed together, in any case, of course the more grounds there are for the presumption that pregnancy exists, and the reverse.
It must be carefully remembered however, that these presumptive signs are precisely those most likely to be produced by other causes, particularly by marriage only; they must therefore be well weighed, and unless very numerous, or very distinctly marked, must not be regarded as conclusive. As already remarked, it is only during the first three months that most of these presumptive signs are taken much notice of; after that we have others that can be more depended upon, and which will be described in the succeeding articles.
PROBABLE SIGNS.
End of the third month.—The probable signs now to be described are seldom recognized before this time, and not generally with distinctness till a still later period. They chiefly consist of certain changes in the form, development, and position of different parts of the uterus, to ascertain which requires an internal examination. These changes are not observable till the end of the third month, previous to which time we cannot be certain that the womb has really increased beyond its normal size. And even then, when the increase is obvious, we cannot tell how it has been produced; it is not till a much later period, till five or six, or even seven months are elapsed, that pregnancy can be ascertained with anything like certainty.
The changes to be noticed are in the form, and size, of the neck and body of the womb, and in its mouth, and also in the weight of the whole organ. No one, of course, can expect to recognize these changes who is not acquainted with the parts in the unimpregnated state, both in the virgin and in those who have borne children.
The mode of conducting the requisite examination is, by introducing the index finger of the right hand, covered with oil or mucilage, into the Vagina, and then carrying it upwards till it reaches the Os Tincæ. By means of this finger the position and length of the neck of the womb are ascertained, and also the state of its mouth, whether it is opened or closed, and to what extent. If it be then placed at the top of the neck, on the under side, and the other hand upon the fundus of the womb externally, and pressing firmly upon it, the organ is enclosed as it were between the two hands, so that its size and form may be pretty accurately ascertained, and also its degree of firmness, by which a judgment may be formed as to whether it is occupied by any solid body, or fluid, or whether it is empty. In addition to this a pretty accurate estimate may be made of its comparative weight, by balancing, and raising it up on the finger. This is called by the French Ballotment, and, as will be shown further on, is a valuable means, at certain stages, of ascertaining pregnancy.—(See Plate [XVI.])
The female may be examined either standing or lying down, though the recumbent position is best, except in certain displacements of the womb, when it is most likely to be thrown into a position in which the neck can easily be reached by the female standing. The position of the neck is very different in many of these displacements, and during pregnancy, to what it is in the ordinary state, and a person not acquainted with these changes might frequently be much puzzled to find it. As we have already remarked, also, there are certain differences between those who have had children and those who have not. The following three diagrams represent the changes just spoken of at three different periods:—