PLATE XVIII.neck of the WombFirst child.Woman who has borne children.The neck of the Womb in a first pregnancy, and in a female who has borne children before, at the end of the seventh month.
PLATE XVIII.
PLATE XVIII.
neck of the Womb
First child.Woman who has borne children.
First child.
Woman who has borne children.
The neck of the Womb in a first pregnancy, and in a female who has borne children before, at the end of the seventh month.
The neck of the Womb in a first pregnancy, and in a female who has borne children before, at the end of the seventh month.
The part below the lower line here, shows that part of the neck which is contained in the Vagina. It will easily be seen how much shorter this part is, and how much more open the passage is, in the female who has borne children, than in a first pregnancy.
Ballotment and Auscultation both, now afford unmistakeable evidences as to the condition of the patient.
End of the eighth month.—By referring to the precedingPlates, it will be seen that the part of the neck of the Wombabovethe Vagina, which is placed between the two dotted cross lines, remains almost unchanged, while the partwithinthe Vagina, or that below the lowest line, becomes less and less, till at this time, in those who have borne children, it can scarcely be felt at all; and even in a primipara it is merely like a small tubercle. About this time however, the upper part of the neck begins to shorten also, though that is not so obvious, and therefore not so useful for our present purpose.
On making an examination, the mouth of the Womb itself may now be felt, at the upper part of the Vagina, and far back. It is however, very difficult to reach, on account of its position. The finger will now pass, in those who have previously borne children, into the cavity of the Womb itself, but in others it will scarcely reach so far.
The linea alba becomes darker at this period, and so does the areola around the nipple. Certain peculiar marks also appear on the Abdomen, and upper part of the thighs, almost like thepitsfrom small pox. They are usually diamond shaped, slightly depressed, and dark in color. They appear to be owing to the over stretching of some of the parts under the cuticle, and which give way in consequence. In first pregnancies, and in those who enlarge very much, these marks are sometimes very numerous, and remain for a long time after delivery, sometimes even they never disappear. As signs of pregnancy however, they are but of little value, because they are often produced by other causes that distend the Womb. None of these presumptive signs are now needed, and therefore they are of little consequence, because there are others more certain.
The motions of the child itself can now be generally both felt and seen, and an experienced observer may even predicate from them, with tolerable certainty, the position in which it lies. Ballotment, by one hand on the Abdomen, may still be practised with success; but in the Vagina it is difficult, because the Fœtus is both more fixed and heavier.
Auscultation is now the surest dependence however, and may be advantageously resorted to also as a means of determining beforehand the position of the child. This may be done even a month earlier, but not so certainly as now.
To understand how this important point is determined, it is only necessary to recollect, as will be very evident, that the pulsation will be heard the loudest immediately over the heart; and as we know the form and general size of the Fœtus, and the manner in which it usually lies, it becomes possible, when the position of its heart is discovered, to trace out, from that, the position of every other part. This will be evident by referring to Plates XIX, XX, and XXI. It will then be seen that, if a line be drawn across the middle of the Abdomen, the heart will beabovethat line when the breech presents, andbelowit when the head presents, and on the right or left side, as the case may be, in each position.
In case of twins there will be two pulsations, and they so much interfere with each other that it is difficult to distinguish either. The two children being generally disposed with the head of one to the heels of the other, one heart will beabovethe line, and the otherbelow, on opposite sides, as shown in Plate XXII.
PLATE XIX.This Plate represents the Fœtus in the most usual position, the head downwards, and the back of it presenting to theleftside.The black spota, shows the situation of the heart; usually immediately under that part where the sound is heard the strongest.—It is below the line.
PLATE XIX.
This Plate represents the Fœtus in the most usual position, the head downwards, and the back of it presenting to theleftside.
The black spota, shows the situation of the heart; usually immediately under that part where the sound is heard the strongest.—It is below the line.
Fœtus in the most usual positionPlate XIX.This Plate represents the Fœtus in the most usual position, the head downwards, and the back of it presenting to theleftside.
Fœtus in the most usual position
Plate XIX.This Plate represents the Fœtus in the most usual position, the head downwards, and the back of it presenting to theleftside.
Plate XIX.
This Plate represents the Fœtus in the most usual position, the head downwards, and the back of it presenting to theleftside.
PLATE XX.This Plate represents the Fœtus in the next most frequent position, the head downwards, but the back of it presenting to therightside.The black spota, shows the situation of the heart as in the previous Plate. It is now below the line, as before, but on the opposite side.
PLATE XX.
This Plate represents the Fœtus in the next most frequent position, the head downwards, but the back of it presenting to therightside.
The black spota, shows the situation of the heart as in the previous Plate. It is now below the line, as before, but on the opposite side.
Fœtus in the next most frequent positionPlate XX.This Plate represents the Fœtus in the next most frequent position, the head downwards, but the back of it presenting to therightside.
Fœtus in the next most frequent position
Plate XX.This Plate represents the Fœtus in the next most frequent position, the head downwards, but the back of it presenting to therightside.
Plate XX.
This Plate represents the Fœtus in the next most frequent position, the head downwards, but the back of it presenting to therightside.
PLATE XXI.This Plate shows the position of the Fœtus in a presentation of the Pelvis, or breech, which happens, comparatively, but seldom.The black spota, denotes the situation of the heart, which is hereabovethe line, instead of below.In this case, as in the others, the heart may be on either side of the body, according as the child faces, but always above the line.
PLATE XXI.
This Plate shows the position of the Fœtus in a presentation of the Pelvis, or breech, which happens, comparatively, but seldom.
The black spota, denotes the situation of the heart, which is hereabovethe line, instead of below.
In this case, as in the others, the heart may be on either side of the body, according as the child faces, but always above the line.
Fœtus in a presentation of the PelvisPlate XXI.This Plate shows the position of the Fœtus in a presentation of the Pelvis, or breech, which happens, comparatively, but seldom.
Fœtus in a presentation of the Pelvis
Plate XXI.This Plate shows the position of the Fœtus in a presentation of the Pelvis, or breech, which happens, comparatively, but seldom.
Plate XXI.
This Plate shows the position of the Fœtus in a presentation of the Pelvis, or breech, which happens, comparatively, but seldom.
PLATE XXII.This represents the position of Twins, as most usually observed, one having a head presentation, and the other a breech.The black spota, on both, denotes the position of the heart, which in one case is above the line, and in the other below.The head however, may be on the right side instead of the left, and so reverse the position of the two hearts, but this is very seldom the case.When there are more than two, the confusion and uncertainty becomes still greater.
PLATE XXII.
This represents the position of Twins, as most usually observed, one having a head presentation, and the other a breech.
The black spota, on both, denotes the position of the heart, which in one case is above the line, and in the other below.
The head however, may be on the right side instead of the left, and so reverse the position of the two hearts, but this is very seldom the case.
When there are more than two, the confusion and uncertainty becomes still greater.
position of TwinsPlate XXII.This represents the position of Twins, as most usually observed, one having a head presentation, and the other a breech.
position of Twins
Plate XXII.This represents the position of Twins, as most usually observed, one having a head presentation, and the other a breech.
Plate XXII.
This represents the position of Twins, as most usually observed, one having a head presentation, and the other a breech.
At this period the signs previously observed become more distinct, but there are few new ones. The external lips sometimes swell, and the breathing becomes more difficult, owing to pressure on the diaphragm. The trouble with the urine is also apt to increase, and little mucus tubercles, like pimples, occasionally form around the Os Tincæ, and on the upper part of the Vagina.
End of the ninth month.—There is but little difference between this and the previous period. The mouth of the Uterus is more open, and, in those who have had children, the finger will pass directly into the Womb, and feel the child, but in primipara there is still a small portion of the neck left.
PLATE XXIII.Fig. 1.Fig. 2.neck of the Womb, at near the end of nine monthsThe neck of the Womb, at near the end of nine months in a primipara.The neck of the Womb, at near the end of nine months, in a woman who has previously borne children.
PLATE XXIII.
PLATE XXIII.
Fig. 1.Fig. 2.
Fig. 1.
Fig. 2.
neck of the Womb, at near the end of nine months
The neck of the Womb, at near the end of nine months in a primipara.The neck of the Womb, at near the end of nine months, in a woman who has previously borne children.
The neck of the Womb, at near the end of nine months in a primipara.
The neck of the Womb, at near the end of nine months, in a woman who has previously borne children.
Ballotment is now more obscure than before, as the Fœtus is very heavy, and quite low down, and pretty firmly fixed. Auscultation is distinct enough, but not more so than at the previous period. The swelling of the lips, and of the veins of the legs, may increase, and so may the difficulty with the urine; but the breathing generally becomes easier, owing to the Womb having descended a little, and so pressing the diaphragm less.
These comprise all the signs and indications of pregnancy that possess any real value. Some of them, at certain times, and under particular circumstances, may be calledpositive; such as those discovered by Ballotment and Auscultation, and also the presence of Kyestein in the urine. Most of the others merely make itprobablethat pregnancy exists, or warrant us in presuming as much. They are not to be depended on implicitly alone, but when many of them are observed together, and no other cause can be assigned for their production, the presumption becomes so well supported as almost to be called a moral certainty. A person of experience, who is familiar with all these signs, and with the others produced by disease which resemble them, will seldom find it difficult to decide; but still there are cases in which pregnancy proceeds, even to its termination, with but few unusual symptoms, so that both patient and attendant are completely at fault. This however is very rare, and many eminent authors contend that it isalwayspossible to detect pregnancy,after the sixth month, and I think so myself, unless the child be dead, in which case it will soon be evident in another way.