Mother, Nurse and Infant / A Manual Especially Adapted for the Guidance of Mothers and Monthly Nurses, Comprising Full Instruction in Regard To Pregnancy, Preparation for Child-birth, and the Care of Mother and Child, and Designed to Impart so Much Knowledge of Anatomy, Physiology, Midwifery, and the Proper Use of Medicines as Will Serve Intelligently to Direct the Wife, Mother and Nurse in All Emergencies.

by S. P. Sackett

These marks are quite plain at the fifth month, and at six months a number of silvery streaks may be observed.

Quickening is one of the most important signs of pregnancy, and occurs about the fourth or fifth month; not because the child is then first alive, but because the womb then rises higher in the abdomen, and because the child has reached a further state of development. Quickening is a proof that the woman is near half her time gone; though it may happen that the sensation is observed as early as the third or fourth month, instead of at four and a half months. In some cases women do not know the time when they quicken, as only a slight sensation is felt; this some compare to the fluttering of a bird. But a lady may at that time be faint, or giddy, or sick, though there seemed to be nothing more than a mere pulsation. Subsequently, however, the movements become stronger and more frequent. The motions of the child may be felt by a third person on placing the hand on the woman’s abdomen, especially if the person’s hand be cold. I have known one case in which, by placing my hand on the woman’s abdomen, I caused motions which simulated active movements of the child, although there was no fœtus present.

Increased size and hardness of the abdomen is characteristic of pregnancy. Enlargement of the abdomen may be from flatulence, but such enlargement is not persistent; the belly is large one hour and small the next, and on pressing the bowels firmly, a rumbling of wind may be heard, which perhaps may move about, and on percussing (tapping) the part, a hollow sound may be elicited, as from a drum. A large abdomen may be due to fat, but there is a soft and doughy feeling that is characteristic of fat. On the contrary, in pregnancy, hardness, solidity and resistance to pressure characterize the gravid uterus, and the enlargement is not only persistent, but gradually increasing. It is true that when a very fat woman is pregnant, percussion or palpation of the abdomen may be fruitless, and any certain diagnosis cannot be made, but in most cases, if we are careful to observe these conditions, and also whether there is a distended bladder and rectum, the diagnosis can be made after the fourth or fifth month.

To make an examination by percussion and palpation, let the female lie down, with the head raised and the thighs flexed on the abdomen; then examine with both hands, especially near the pubis. Pressure with the ends of all the fingers, gradually moving them upward, will enable us to detect the womb, if it rise above the symphasis, and also the size and height of the fundus.

Ballottement, or repercussion, is used as a means of deciding upon the presence of a fœtus; a means that is most available about the fifth and sixth month. The female examined should be in an upright position, or if she be in bed, her shoulders should be raised. We are directed to introduce the forefinger into the vagina and touch the cervix uteri, or, rather, in front of the neck upon the walls of the uterus; then slightly jerking upward by slightly flexing the first joint of the finger; observe if something recede from it and fall again in a moment. The ballottement is said to be a sensation “analagous to that produced by placing a ball of marble in a bladder full of water and then striking the bladder with the finger just under where the ball rests, when the latter is thrown up and falls from its own weight upon the finger that displaced it.”

When the vaginal touch is practiced, while one finger remains in the vagina, palpation of the uterus with the other hand may assist in the diagnosis by depressing the uterus, or by holding it firmly in place. Then the jerk of the finger upon the head of the fœtus causes it to float upwards a little in the liquor amnii and descend.

Auscultation is used to decide many cases of doubtful pregnancy. The pulsations of the fœtal heart are generally perceptible by the fifth month. The examination may be made by applying the naked ear to the abdomen of the mother, she being placed on her back in the bed with her head raised.

The fœtal pulsations are frequent, generally from 120 to 140 a minute. The uterine souffle or bellows murmur may often be heard as early as the fourth month; it is synchronous with the mother’s pulse; its seat is said to be the uterus, and some believe that it indicates the position of the placenta. This sound and the pulsation of the umbilical cord are not very important diagnostic signs, and the same may be said of the presence of kiestiene in the urine, which may, however, be detected as early as the third month.

Some of the ailments that attend pregnancy I will now merely mention: There may be irritability and a disposition to inflammation; violent and obstinate vomiting; indigestion and depraved appetite, heartburn, costiveness, hemorrhoids, liver spots or blotches, especially about the face; diarrhœa or dysentery; strangury, with a frequent inclination to void the urine; leucorrhœa; varicose veins in the legs, thigh and abdomen; inquietude, and sleeplessness; dropsy, or an œdematous condition of the lower extremities; prurigo vulva; either of these may be more or less troublesome, but can hardly be regarded as diagnostic signs. Some remedies for these will be mentioned hereafter. (F. 69, 72, 75, 81, 131, 173, 206, 220).

The abdominal walls are often distended beyond what the woman is able to bear without inconvenience, as the skin may become inflamed and crack. It is much more common that the true skin beneath the epidermis cracks, and, although the outside is not altered, there often remains upon the abdomen of women who have had children a number of small marks, or little whitish streaks.