The same may be said of salivation, which occurs in some women about the fourth or sixth week; in such cases the frequent spitting will be equally diagnostic whether the quantity be large or small. This salivation, differing from that which results form mercurial influences by the absence of the fetid breath, sore gums, and great prostration, becomes truly characteristic of pregnancy, just as the morning sickness above described does, by reason of its being a sympathetic rather than a primary and idiopathic affection.
III. The abdomen, by its changes in size and form, affords some rational signs of pregnancy even in the early stages. The enlargement of the abdomen may indeed occur from many other causes; but no other cause can simulate the shape and manner of development of the enlargements of pregnancy. A careful study of all the successive appearances of the abdomen in pregnancy, will therefore enable the practitioner to estimate at their proper value the changes which may present in any given case. Sometimes even in the first month the abdomen will seem than it does in the second; this arises from the co-operation of two distinct causes. First the abdomen seems larger because it is rendered tympanitic by the reflect influence of the newly-begun pregnancy itself. After three or four weeks this tympanitis passes off; and the abdomen loses its apparent increase in size. In cases in which this tympanitic condition has disappeared, as well as in those in which it had not occurred, the abdomen becomes flattened. This flattening of the abdomen is usually attended with a drawing inwards and downwards of the umbilicus. These appearances, the very opposite to what might naturally be expected, are due to the sinking of the uterus a little down in the pelvis, as described in the preceding chapter. And in connection with these changes there may be more frequent calls to urinate. But the uterus soon recovers from this depressed position; and about the third month the abdomen is seen to be visibly enlarged, and the enlargement steadily goes on till towards the close of pregnancy. After the eighth week the uterus remains stationary, depressed in the pelvis for a time; then it gradually rises to its original and natural position, where it continues till after the third, fourth or four and a half month, according to the capacity of the pelvis to give it room. It then rises above the superior strait, either suddenly or gradually, according as it has been more or less impacted in the pelvis.
This rising out of the cavity of the pelvis into the abdominal cavity, constitutes what is called quickening; and sometimes it occurs so suddenly as to quite alarm the mother. It was at one time erroneously supposed that no life was present in the foetus till the occurrence of quickening; but it is now well known that at the very earliest moment of conception a living human soul is there. Motion probably takes place at a much earlier period than it is perceptible to the mother; but it is not usually sensibly recognized till the uterus has finally risen from the smaller into the larger or abdominal pelvis Usually after the beginning of the third month the enlargements being to show itself just above and behind the symphysis pubis, being always more considerable on the median line. After the commencement of the fourth month, if the pregnant female be not too corpulent, by placing her upon her back with her thighs flexed upon the abdomen, the enlarged uterus can be felt like a half moon rising behind the symphysis pubis; and this ascent of the uterus goes on regular, and usually at the rate of about two fingers breadth, per month, until within two weeks of the full term. But this enlargement is not always so regular in its development; since it may be veried by dropsical accumulations, multiple pregnancies, a greater or less projection of the spinal column, breadth of the pelvis, or other individual peculiarities.
An important means of distinguishing the enlargement of abdomen which results from pregnancy from caused by dropsies, tumors or other morbid conditions will be found in observing the manner in which this enlargement is developed, very nearly on the median line and always proceeding from below upwards. Just above the symphysis pubis the tumefaction begins to show itself, at first being more considerable on the median line than elsewhere; the sides are flattened and the middle portion projects considerably. And the constant, steady and uniform enlargement of the abdomen, in the manner just described, and under favorable attendant circumstances as to health, appetite, etc., affords substantial ground for a conclusion in favor of the existence of pregnancy.
IV. The umbilicus also affords some indications of value among the rational signs of pregnancy, since the changes which occur here are almost always present and can always be observed. During the first two moths of pregnancy, the depression of the umbilicus is greater than usual, owing to the descent of the uterus, into the pelvis, and to its dragging down the fundus of the bladder, but which tension is made upon the urachus. This umbilical depression continues and gradually increase during the continuance of the descent of the uterus; and during this period the female may be seen to walk stooping in order to relieve the dragging sensation experienced by this strain upon the umbilicus. As soon as this sinking downward is rested, and the uterus begins to rise again, the umbilicus is gradually restored to its normal condition. It next beings to lose its depression, growing decidedly superficial during the fifth and sixth months; becoming entirely flattened out in the seventh moth and on a level with the surrounding integuments; and during the last two months the umbilicus really pouts or protrudes beyond the general surface of the abdomen. This course of changes in the umbilicus during pregnancy is the general rule; there may be some deviations; but usually the phenomena afforded by the umbilicus are regular and a great value. Tumors or ascites may cause appearances somewhat similar, but these do not arise in the same regular order of time. When the three successive and well-defined stages of umbilical depression, restoration and projection occur as above described, they constitute a natural sign of pregnancy very easily observed and of very great value.
V. The mammae, about two months after conception, begin to afford indication of much value. Although from various causes some of these indications, except in primiparous women, are less reliable in the early stages than many others, still taken n connection with other signs, they cannot but have some weight. As described by Tyler Smith, these indications consist in a certain sense of fulness and weight and shooting pains in the breast; subsequently the circulation becomes more active and there is an actual increase of volume; the gland becomes hard, knotty, and tender to the touch, and large blue veins may be seen meandering over its surface just beneath the integument. About the end of the second month the nipple swells, becomes more erectile, sensitive and projecting; its colour is also deeper. The surrounding skin assumes and emphysematous appearance, and becomes also a little darker. By the end of the fourth month a dark brown areola is seen to surround the nipple in every direction, at a distance of three-quarters of an inch from its base. In blondes or in feeble, delicate women, this appearance is not so well marked as in those who have black hair and eyes, and in brunettes. “As pregnancy advances, especially if it be a first pregnancy, the deposit of pigment in the areolae increase, the areolae themselves become moister, and the follicles studding their surface are prominent, distended and bedewed with transuded fluid. These follicles or little glandules which appear near the base of the nipple within the areola, attain an elevation of one or two lines above the surface of the skin. Each little gland has an excretory duct, and by pressing upon its base a little serous or sero lactescent fluid is made to escape. In several instances I have seen this flow in considerable quantities during lactation.. and sometimes these glandules become very sore, when Calendula will effect a speedy cure. About the fifth month a sort of shadow of the first areola makes its appearance outside the first, very place, although quite similar to the first; and outside of these again somewhat later, or about the seventh month, we have often seem dark veins running across the breasts in various directions. Minute streaks, glistening like silver threads, are also observed running near these darker vessels.
These appearances of the mammae, occurring in regular order, particularly when taken in connection with other rational signs, afford almost conclusive evidence of the existence of pregnancy. But it should be borne in mind that the discoloration of the areolae, from never entirely disappearing when it has once taken place, is of little value as a sign of pregnancy except in primiparae; and also that both the enlargement of the mammae and the discoloration of the areolae, may be occasioned by distension of the uterus from other causes than pregnancy.
