THE determination of pregnancy at the earliest possible period forms one of the most frequent, difficult and important problems in the practice of medicine. The physician will often be called upon to decide this question where strong feeling are awakened and great interests at stake, of the most opposite character. The honor, and therefore the happiness, of female, may depend upon his decision; the peace of families may rest upon it; and the inheritance of property be controlled by it. For some to be enceinte is the gratification of their highest hopes and most ardent desires; by other it is regarded as a most serious inconvenience, as something to be dreaded on account of health; or, in the unmarried, as threatening a disgraceful exposure of their want of chastity. All these different states of mind and various social relations must always be considered in estimating the value of evidence for or against a supposed pregnancy; since those earnestly desirous of children will naturally magnify every new sensation; while in some other cases there may be a disposition to suppress or overlook the signs of an actual pregnancy. In all such cases the physician must remember that the he may not merely be requested to investigate a case of doubtful pregnancy where no shame is involved, but that he may be consulted in cases where pregnancy is concealed by unmarried women, or by married women under certain circumstance, to avoid disgrace; and on the other hand, where it is pretended, in order to secure an inheritance, to extort money, or to delay punishment. And the very circumstances which tend to render the question more difficult to decide, at the same time seriously increase the responsibility attached to such decision. Hence, the physician can never be too discreet in these matter; especially where the question relates to the unmarried; his acknowledging himself to have been mistaken will afford but a reparation for shocking the feeling and insulting the virtue of the pure minded and the innocent. Such a blunder were worse than a crime; and its consequences might be irreparable, as well for the physician himself as for his patient.
The sings of pregnancy may be divided into classes; those earliest observed, which are called rational or presumptive signs; and those subsequently making their appearance, which are termed sensible or positive signs. From one or more of the first class a presumption of pregnancy may arise; and from that the case affords in its early stages, a rational conclusion may be drawn; but this is not positive knowledge. This can be derived form the positive or sensible sings alone; even of all these there is but a single one that is entirely incapable of being mistaken, and that is the beating of the foetal heart. The signs of pregnancy increase in number and become accumulative in value as the case advances. Thus the diagnosis which in the first instance had been possible pregnancy, becomes presumptive, probable, and finally, certain or demonstrable pregnancy. We will study, therefore, these signs as they arise, in order of succession, proceeding form the rational to the sensible.
RATIONAL SIGNS are derived form the circumstantial history of the case, from the related experience and sensations of the female, and from our own observations of such changes as may appear. Among these may be classed the general effects observed in the female economy, such as greater rapidity of pulse and of respiration; greater activity of the circulation and secretions, especially those of the genital organs; greater sensibility of the nervous system; but from indications so general as these, no rational inference can be drawn; they are only important when taken in connection with other more particular signs.
The first sign of pregnancy, strictly speaking of conception, is individual rather than general; and consists in a certain peculiar thrill or voluptuous sensation, which is felt by some women during a prolific coition, who by experience learn to regard this unusually profound erethism as a certain evidence of conception in their own case. Nearly connected with this is a certain sense of chilliness subsequent to coition, which is found, by those who experience it, to be invariably followed by pregnancy. These sensations, which experience has taught some individuals to regard as decisive in their own case, may therefore be considered as possessing some value when reported by primiparae.
I. Suspension of the catamenia is however most generally the first indication which leads the female, in whom impregnation has been possible, to consider herself enceinte. But the importance of this symptom will very greatly depend upon the attendant circumstances; if the female have been regular, and if the cessation of the menses promptly occur after particular sexual intercourse, the presumption of pregnancy will be very strong indeed. But if she has always been very irregular, the mere fact of the menses failing to make their appearance at a particular monthly period, will carry with it but little weight. Where the entire absence of the menses for two or three months occurs from no other assignable causes, and where this suspension is attended with good health and appetite, and some perceptible increase in the size of the abdomen, the rational conclusion of pregnancy may be considered to be well founded. And yet even these circumstances are far from affording infallible evidences of pregnancy; since they have been known to arise in this combination from other causes. In newly-married females the catamenia are sometimes lost from irritation of the sexual organs, where no conception has taken place; and at the same time may be an increase in the size of the abdomen and in the sensibility of the breasts; so that even this very strong combination of symptoms cannot be positively relied upon.
The attendant circumstances must be borne in mind in other respects; for while conception may take place in females who have never apparently menstruated; so the catamenia may still continue even after conception and through all the months of utero- gestation: cases have been recorded in which menstruation appeared only during pregnancy; but such cases are anomalous. Thus while the cessation of the menses, under favorable circumstances, becomes the first and one of the most important signs of pregnancy, it is by no means decisive; since on the one hand the catamenia may be suspended without pregnancy, and on the other pregnancy may occur without the suspension of the menses. The general rule will be all the more valuable, if we constantly bear in mind the possibility of the exceptions which, though far from being common, may occur in any given case.
II. Morning sickness forms in may women the next sign of pregnancy; as its name indicates, it is a morbid symptom, but on that account none the less valuable as a diagnostic sign. It arises from sympathy of the coeliac or solar plexus with the organic nervous system of the uterus; and indicates the existence of some hereditary psoric miasm in the system. This morbid irritability may commence immediately after conception; but it generally sets in about the fifth or sixth week, and ceases soon after the third month. Like some of the voluptuous sensations already mentioned, this affection may be come in individual a positive indication of their being pregnant; since these persons learn by experience that these symptoms occur with certainty and regularity at a particular time after conception. Thus in different persons the presence or absence of morning sickness will have a very different diagnostic value. In those who have had it, in former pregnancies, unless the disposition to it has been removed by Homoeopathic medication, its non- appearance will be tolerably conclusive evidence against the existence of pregnancy; while in primiparae it non-appearance would scarcely be considered worth noticing as an evidence that they were not enceinte. Still, where morning sickness makes its appearance persistently, attended by suppression of the catamenia, and in circumstances liable to impregnation, it can scarcely be attributed to any other more probable cause than pregnancy. And this indication will be strengthened by the character of the sickness itself. The appetite improve and is good through the day, in spite of the nausea, vomiting of a peculiar watery fluid and sinking at the pit of the stomach occur and continue for a short time only on first rising in the morning. The sickness and the fluids vomited up are different from those accompanying any other disorder, such as gastric or bilious fevers for example. While morning sickness, from its peculiar character, brief daily appearance, usual temporary continuance, and final sudden and perhaps unexpected disappearance, becomes, where it occurs, a valuable indication of pregnancy; its absence is hardly to be regarded as a negative sign.
Certain other derangements of the digestive organs, such such eructations heartburn, remarkable longings for some particular article of food or other substances not used as food, and corresponding aversion to some one or more of the common varieties of food, which occur separately or in connection with morning sickness, or even subsequently to it, may also be regarded as among the rational signs of pregnancy.
