When it becomes necessary to make an examination, per vaginal,. all the parts of the perineum, vulva, vagina, and cavity of the pelvis should be carefully explored in order to detect any existing abnormalities or diagnostic indications. if the patient be a supposed primipara, the condition of the vagina as constricted and presenting the evidences of increased activity of the circulation will be carefully noted.
The position and direction of the os uteri will then be ascertained; if in the early weeks of pregnancy, the uterus may be found some-what settled down in the pelvis, and the os looking towards the hollow of the secrum. Or the supposed greater advance in the pregnancy will prepare him to find the uterus in its usual position when unimpregnated, or still higher, above the superior strait. Thus, on the one hand, the indications giver by the rational signs will be either confirmed or invalidated by the these sensible evidences; will be either confirmed or invalidated by these sensible evidences; and on the other, the ration signs and history of he case will direct the physical exploration. The impregnated uterus is heavier than in the ordinary state; and its lower segment, at about the third month, will be be found so distended as to occupy nearly the whole cavity of the lesser pelvis. Its mobility is very slight; when, if unimpregnated, it would be very movable in every direction, with much easier to raise on the point of the finger.
One of the surest of the sensible signs of pregnancy at this stage consists in the softening of the extreme point of the neck. The sensation is that of a sort of velvety softness, only deeper, beyond sensation is that of a sort of velvety softness, only deeper, beyond sensation is that of a oft of velvety softness, only deeper, beyond which may be felt a certain hardness, as of a board. No other state than pregnancy can either produce or simulate this feeling of softness. And this softening, as well as a corresponding dilatability of th neck, increases from below upwards, from month to month, in almost exact proportion to the development of pregnancy.
Palpitation is a means of obtaining knowledge of the womb, by placing the hands upon the abdomen externally; and this method is more satisfactory and much pleasanter to the female than the former. if the abdominal integuments are not too thick and fleshy, by placing the patient upon her back, with her head raise and her thighs flexed, and pressing the points of the gingers gently downwards and backwards along the pubis, a hard, round tumor will be found on the median line rising out of the pelvis. This can be felt as early as the third mouth, if the walls of the abdomen are not too thick. In two or four weeks later, the increase is much more strongly marked, and the true state of the case more certainly announced. We must bear in mind that, as pregnancy advances, the tumor loses more and more of its hardness, and becomes more and more elastic, like a cyst filled with water.
Percussion is also useful in deciding as to the existence of pregnancy. In such cases the uterine tumor will invariably afford a dull sound, unless a mass of intestines should intervene, while all around may be distinguished the usual clear abdominal resonance. But, in pursuing this method of examination, care must be taken not to confuse all the indications by percussing over a full bladder. to confuse all the indications by percussing over a full bladder, Tumors of the abdomen or womb would also give a similar dulness on percussion; but such tumors are irregular as to the time of their development.
In doubtful cases, where decided enlargement of the abdomen is present, the exploration per vaginam becomes of very great importance since the softening of of he os uteri and even of the lower end of the neck, does not occur from any other cause than pregnancy. By the end of the sixth week, this softening can be detected, like a piece of velvet drawn over a table. But, where tumors occur in the abdominal cavity, unconnected with pregnancy, they may be more easily detected by simultaneous palpation and vaginal touch. This is accomplished with the finger applied to the cervix uteri, and the other hand placed upon the abdomen externally, in order to find the fundus uteri. The finger may be brought in direct opposition with lower portion of the uterus, while the other hand presses down its upper portion, so that with the exception of the abdominal walls, nothing but he uterus itself intervenes between he two hands. In this manner, a judgment may be formed as to the size of the organ, as well a of its relations to the surrounding parts., And thus, any tumor, which may have occasioned the abdominal enlargement, may be distinguished from the uterus. If unconnected with this organ, the tumor will remain stationary when the uterus is moved; if it is attached to the uterus, moving the latter will, of course, be attended with corresponding movement of the former. And, in addition to any other tumor in the pelvis, or rising above presence of of any adventitious growth in the pelvis, whether connected with the uterus or not, does by no means preclude the possibility of pregnancy also. The greatest caution should be observed, as well in making the examination as in giving a final opinion. It is not many years since the profession, in a certain city in New England, were greatly amused at the denoucement of a case of uterine tumor in the wife of a well-known practitioner. The poor woman, who had sons grown up, a nd was supposed to have passed the change of life, during a course of several months, endured all the severities of the most orthodox Allopathic treatment at the hands of her anxious husband, assisted by a much older and more eminent practitioner than himself, in which injections of solution of nitrate of silver and large and frequent doses of the most powerful drugs performed an active part. The case advanced in spit of the treatment and, the symptoms becoming more urgent, a third physician was called in consultation, who presently relieved the patient from her dangerous condition by delivering her of a full-0grown child, which had finally succumbed to the tour de force of the latest injections. The patient had had n0o other disease than this tumor, (pregnancy), but it required many months for her to recover from the effects of the protracted treatment she had undergone.(*This statement is simple fact; the circumstances were well known at the time to the public, as well as to the profession, and are by no means forgotten now. the account is given here simply to show how men of the largest experience may not only be mistaken, but remain so)
During the first three or four months it is a difficult matter to determine the existence of pregnancy; up to this time, the most certain sign is the unmistakable softening of the cervix or os tincae. By taking into consideration, together, all the rational and sensible signs and the time of their appearance, we may in most cases be able to announce pretty confidently the existence of pregnancy by other hand, from being able to ascertain that the uterus still retains its natural size, we can, with much more positiveness, determine that pregnancy does not exist in a given case. The uterus may, that pregnancy does not exist in a given case. The uterus may, indeed, be enlarged or distended by some other cause than pregnancy, but if it is not found enlarged at what should be the third month, we may be sure there is no pregnancy.,
During the last five months the active and passive movements of the chill reveal the fact of pregnancy with sufficient certainty. The active movements are felt by the woman at about four and a half months; sometimes earlier. In accordance with the strength easily child they are at first very slight and uncertain. We can easily imagine how delicate must be the sensations experienced by the female from the motions of a foetus of four months;a nd trace them to the bounding and springing of a viable child of eight or nine months. It might be imagined that these sensations experienced by the mother would be quite infallible as indications of pregnancy. But other sensations, the result even of morbid changes in the abdomen, have been mistaken by females for those occasioned by a foetus in utero. Instances are given by writes, in which the sensations produced by an incipient dropsy, in connection with the enlargement of the abdomen from the same cause, have been mistaken in this manner, to the serious disappointment of all concerned. But the physician is not liable to such misinterpretation of sensations, By placing his open hand upon the abdomen the motions of the child may easily be perceived, if the woman be pregnant;and these movements are unmistakable since to pathological conditions can simulate them. when from the inactivity of the child it becomes desirable to provoke its movement, this may be done by placing one hand upon one side of the abdomen and with the other hand gently striking the opposite side; the child will move quickly, as if to get out of the way. By some females the motions of the foetus are felt about he end of the third month; usually at about four months and a half. Some are conscious of these movements only after six, seven, or eight months; and some do not experience them at all.?this, which is owing to the great passiveness of the child, is particularly apparent in females of an inactive, sluggish temperament. After the motions have been distinctly recognized for some days, if they then evidently become weaker and weaker, or entirely fail, the physician should at once understand that there is danger. All the mother’s symptoms should be at once sought out; for some condition threatens the destruction of the life of the child. The proper remedy will remove this abnormal condition of the mother, and restore the motions of he child. In plethoric females Aconite will often do this; bleeding, the corresponding, generally advised remedy in the Allopathic practice, is said to have always produced a favorable result.
