7. QUICKENING – In popular language, this term is applied to the mother’s perception of the first movements of the foetus, on the incorrect assumption that it was not alive from very moment of conception. Quickening may be briefly explained thus:- As soon as the uterus has become too large to remain in the pelvis, it rises into the abdomen, sometimes suddenly, causing faintness and sickness; after this, the movements of the child, pressing directly upon the sensitive walls of the abdomen, are felt. If any doubt exists as to the date of conception, four months and a half from the date of quickening may be reckoned as a tolerably safe guide to the time of labour.
The sign of pregnancy is by no means a reliable one, unless the movements are certainly felt by another person, as the patient may be deceived by flatus in the intestines, or by the force of her own imagination; for women who think themselves pregnant often assert that they plainly feel the motions of the child, persisting in such statement until the lapse of time convinces them of their error. On the other hand, cases occasionally occur in which no sensation of the motion, of the child is perceived by the mother, from the beginning to the close of pregnancy.
8. FLUCTUATION – As early as the second or third month, pregnancy can often be diagnosed with certainty by this test. The tactus eruditus, possessed by the practised physician alone, is essential to make the test available. Holding the uterus steady with the left hand, an examination with two fingers of the right hand, an examination with two fingers of the right discovers the os uteri closed, the womb more or less enlarged, and by pressure or percussion a sense of fluctuation or perceptible movement of fluid is communicated. The fluctuation is a most importing sign, giving reliable evidence in a majority of cases. After the second month the fluctuation is more perceptible, but it may be recognised by the sixth or seventh week by a careful examination.
9. BALLOTTEMENT – At the expiration of a few weeks the uterus will be found lower than usual, heavier, and its os more circular, and closed; but afterwards it becomes higher, more difficult to be reached, and its neck shortened. If the woman be placed on her knees, and an impulse given to the finger, ballottement, or the floating of the child, may be felt, for it rises a moment in the liquor amnii, or fluid in which the foetus floats, and then, by its own gravity, sinks again on the finger. The most favourable period for this test is between the fifth and sixth months. Before the fifth month the foetus is too light and after the sixth month it is closely paced to admit of this feat. Ballottement is very conclusive of pregnancy and especially when corroborated by other signs, but determines nothing is to the life of the foetus.
10. KIESTEINE IN THE URINE – By keeping the urine of a pregnant woman a few days, a whitish scum, of a fatty or curdy appearance, forms on the surface, and then gradually breaks up again from decomposition, emitting a strong odour as of decaying cheese. Kiesteine is a mucilaginous principle, and probably exists in the urine from the first month of pregnancy until delivery, and arises from the excess of nutriment formed in the blood of the mother of the child.
11. SOUNDS OF THE FOETAL HEART. – By applying the stethoscope to the lower portion of the abdomen of either side, usually on the left, about midway between the umbilicus and the anterior superior spinous process of the ilium, the foetal heart may be heard at twice the rate of the mother’s. The sound has been compared to the muffled tickling of a watch, and the earliest time it can be heard is the beginning of the fifth month. When the pulsations of the foetal heart are heard, they are most positive of all the signs of pregnancy. At the same time, the pulsation may be inaudible, and yet the woman may be enceinte, as the foetus may have died, or the pulsations may be rendered inaudible only for a time.
It is by these pulsations that the SEX OF THE CHILD can in a large proportion of cases be ascertained during gestation. When the foetal pulsations reach 144 per minute, the child is probably female, but when they are 124 per minute probably a male. Any little variation from 124 upwards, and from 144 downwards, will not alter the diagnosis, provided auscultation be practised towards the end of pregnancy. Steinbach was correct in forty-five out of fifty-seven cases which he examined; while Frankenhauser was right in all the fifty cases which he examined with a view to determine the sex of the foetus in utero.
12. OTHER SIGNS OF PREGNANCY, which we can here only enumerate, are change of colour of the mucous membrane of the vagina to a dusky, livid hue, often well marked, and very characteristic; salivation; the uterine souffle, caused by the rush of blood through the tortuous arteries of the uterus over the placenta; sharpness of the features; irritability of temper; and, frequently, toothache, and other nervous complaints. Lastly, a frequent desire to pass water, especially in the night, is another early and valuable sign.
From the foregoing statements the reader will perceive that the diagnosis of pregnancy, especially in the early months, is far from being certain; the evidence is cumulative, no one sign being alone trustworthy, probability rising in proportion to the accumulation of the signs. Errors in the diagnosis of pregnancy usually arise from the attention of the observer being restricted to one or two signs only, and omitting to inquire for other corroborative ones.
29 – GENERAL HABITS DURING PREGNANCY
1. DIET – The diet should be simple, nutritious, and easy of digestion; it should be thoroughly masticated, and but little fluid drunk at meal-times, especially cold, since cold retards digestion. It is an error to suppose that women require more nourishment in pregnancy than at other times; and large quantities of rich food, taken in the belief that it will contribute to the sustenance of the child, cannot but be productive of baneful consequences. Spices, spiced meat, sausages, and all highly seasoned food, and late suppers, must be refrained from. Plainly cooked animal food (once a day), well- boiled vegetables, ripe fruits, and such articles as rice, tapioca, arrowroot, will, if taken in moderation, rarely disagree with the stomach. Pie-crusts, smoked hams, salted meats generally, rich sauces, and every article that has been known to occasion indigestion, must be eschewed. All substances that have a tendency to produce a costive state of the bowels should be especially avoided, and, unless some reason exists to the contrary brown bread should be eaten in preference to white,. Stimulating drinks – wines, ardent spirits, ale, porter, strong tea, and coffee – are, generally, hurtful both to the mother and the foetus.
2. DRESS – Under this head, the origin of the word enceinte, used to signify the pregnant condition, is highly suggestive. It was the custom of the Roman woman to wear a light girdle or cincture round their waists; but on the occurrence of pregnancy this restraint was removed. Hence a woman so circumstanced was said to be inciencta (onbound), and thus the term enceinte has been adopted to indicate pregnancy.
It would seem scarcely necessary to make any remarks upon the dress to be worn, were it not that some women, considerably advanced in pregnancy, often lace tightly for the sake of attending public entertainments, or of diverting notice from their condition. At no time should stays be worn, for the simple reason that they are never required. But they should especially be avoided during pregnancy, since a continual and forcible compression of the abdomen while nature is at work to secure its gradual enlargement in order to accommodate the growth of the foetus, must be attended with serious injury to the health of both mother and child. During gestation, the uterus increases on an average from two inches to fourteen in diameter. It will be obvious, therefore, how vain, as well as criminal, must be any effort to contract it, and thus to conceal its enlargement. Palpitation of the heart, indigestion, diseases of the liver, and costiveness; difficulty of breathing, spitting-of-blood, and persistent coughs; enlarged veins in the legs, swellings in the lower limbs, disorders of the womb, deformity of the offspring, and numerous other affections, have their origin in tight-lacing; and finally, if the child be born alive and moulded aright, and the mother escape her self-created perils, it may be questioned if compressed breasts and nipples can afford the requisite ailment.
The dress should be arranged both as to material and quantity, with the view of comfort and to the season. There must be no pressure on any part; even the garters should be loosely worn. The feet and abdomen should be kept warm, since habitual coldness of these parts predisposes to colic, headache, and Miscarriage.
3. EXERCISE – Exercise is a most important means of retaining good health during gestation, of securing a natural delivery, and of favouring the health of the infant. Walking in the open air is most useful kind; for this calls into action more of the muscles of the body than does any other exercise suited to this condition. Walking exercise is even more necessary in the winter than in the summer, and produces a much healthier and more lasting warmth than sitting before a fire. It should, if possible, be taken in the morning before dinner, and be of such a character as to interest the mind as well as to strengthen the body.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."