The Matron's Manual of Midwifery, and the Diseases of Women During Pregnancy and in Childbed / Being a Familiar and Practical Treatise, More Especially Intended for the Instruction of Females Themselves, but Adapted Also for Popular Use among Students and Practitioners of Medicine

by Frederick Hollick

Neck of the Womb in a first Pregnancy, very slightly opened.

Neck of the Womb in a female who has borne children before, showing how it admits of the introduction of the finger.

This is at the end of the Fifth Month, and the drawings are about one-third of the natural size.

Ballotment is now much more easily practised, and is more conclusive. A new sign is also to be distinguished, by which we are furnished with another valuable means of detecting pregnancy. The child's heart begins to beat so strongly, and its circulation is so vigorous, that the sound of it can be heard externally. The same means are taken to ascertain this that are used in sounding the chest of an adult. If the ear be placed on the Abdomen, over the womb, the beating of the fœtal heart may be heard quite plainly; and if the stethoscope be used it will be still more distinct. This practice is called Auscultation. The signs furnished by it are certainly of the greatest value, and frequently enable us to detect pregnancy with unerring certainty. Indeed, not only can we tell by them that a child is in the womb, but often even the very position in which it lies, and whether there be twins, or more. This is done by noting where the heart is situated, by the sound, and whether the beating is single or double.

The nature of these sounds, and the manner of detecting them, require to be carefully explained.

If the person wishing to notice this sign is not already familiar with the beating of the adult heart, he had better become so first. The ear should be placed on the left side of a grown up person, on the skin, just beneath the breast, and held very still. The heart will then be heard to beat very distinctly, there being two sounds, a long one and a short one, alternating with each other. When this has been listened to for some time, the ear will be able to catch any similar sound, and the auscultation may then be practised to detect pregnancy.

The ear must be placed on the Abdomen, about midway between the Pubes and the umbilicus, and towards the left side. No weight should be borne on the body, but the ear must be laid sufficiently close to exclude all external sounds, and no motion should take place, particularly with the clothes. If the sound be not heard in the position first assumed, move a little, in different directions, till that point is attained where it is most distinct. It can scarcely fail to be heard, with ordinary care. A practised ear will sometimes distinguish the sound as early as the fourth month, but generally it cannot be heard before the end of the fifth, or even till the sixth month. There are several sounds that may either be mistaken for it, or that may confuse the ear. The beating of the mother's heart will sometimes be very distinct, as far as the lower part of the Abdomen, but it is much slower; the child's heart throbbing nearly twice as fast. The movements of the Fœtus, and the rumbling of the intestines, will also interfere; but when once the proper sound has been caught it may be kept independently of all these.

The manner in which the child lies in the womb will determine where the heart shall be opposite, and as its position frequently varies, both in different individuals, and at different periods, in the same person, the sound must be sought for at several points, till the right one is found. The most usual position will be seen in several of our plates, and they will give sufficient indication to enable almost any one to practise this mode of detection with success. During the early months the child moves about a good deal, so that the sound may be heard one day in one place, and the next in another. About the seventh month however, it becomes more fixed, so that the place of the heart can be pretty certainly ascertained, and thus the position of the whole body is made out, whether the head is downwards or upward, and a tolerable idea can be formed even as to the direction of each part.

Many persons have failed in their attempts to hear the Fœtal pulsation, but I cannot but think it must have been either from inattention, or from not being acquainted with the sound of the heart at all. I never recollect an instance when I could not do so, at the proper time. M. Chailly says he does not hesitate to affirm that in every instance they can be detected; and M. P. Dubois distinctly heard them in one hundred and eighty-five females, out of one hundred and ninety-five, in the other ten the child being probably dead. Indeed, the absence of this sound is the most certain sign of the death of the Fœtus, as its existence is of its being alive; and medical men now tell whether the child is dead or not by these very means.