34 OBSTETRICS. 



SIGNS OF PREGNANCY. 



These are divided into the rational and sensible^ the latter of 

 which only can be depended upon, as the former may occur in ab- 

 normal conditions of the uterus, independent of pregnancy. The 

 rational signs occur in the earlier months ; the sensible or physical, 

 after the ovum is somewhat developed. The diagnosis is at all times 

 difficult in the early periods. 



Rational signs. — Plethoric condition and fibrinous blood; varia- 

 tions in temper and taste ; altered functions of stomach, bowels and 

 kidneys; change in the colour of the skin; cessation of the menses, 

 though not invariable, is one of the earliest signs ; ynorning sickness, 

 from the sympathy between the uterus and stomach ; salivation, not 

 to be confounded with mercurial ptyalism, from which it may be 

 distinguished by the absence of sponginess of the gums, and the pe- 

 culiar fetor ; enlarged and painful niammcB, and in many cases a 

 darkened areola, and enlargement of the follicles situated in it, with 

 a soft and moist state of the integuments ; milk i7i the breasts ; this 

 fluid is sometimes found in the breasts during the latter stages of 

 gestation, but is not invariable, nor always to be depended on when 

 present. Quickening ; this sensation has been variously described, 

 some authors say it is caused by the first movements of the child ; 

 others assert that it is caused by the sudden rise of the uterus from 

 the pelvis into the abdominal cavity, producing fainting, sickness, 

 &c. As a sign of pregnancy it is almost valueless, since females are 

 very apt to be deceived in this respect by the movements of flatus in 

 the bowels, by occasional spasmodic twitching of the abdominal 

 muscles, &c. 



Kiesteine. — During pregnancy a peculiar substance, analogous to 

 caseine, is found in the urine, forming a thin pellicle upon its surface 

 when it is allowed to stand, which emits an odour resembling cheese. 

 It is not, however, peculiar to pregnancy, but may occur whenever 

 the lacteal elements are not eliminated by the mammary glands. At 

 the same time the probabilities are as 20 to 1, that the female is 

 pregnant, if the kiesteine be present. 



Blue colour of the vagina, has also been looked upon by M. Jac- 

 quemiex, and M. Parent Duchatelet, as among the rational signs of 

 pregnancy. 



The Sensible or physical signs o^ pregnancy, are those by which 

 the presence of a foetus in utero are detected by an exploration of the 

 organ itself. 



Enlargement qftlie abdomen, begins to be perceptible about the 

 end of the second month ; before this the abdomen is often flatter 

 than usual. " A ventre plat, enfant y'a." 



Ballottement, is practised thus : The patient should be in the 

 upright position, or at least in a semi-recumbent posture ; now let 



