The pathology, diagnosis, and treatment of diseases of women : including the diagnosis of pregnancy / by Graily Hewitt.

  • Hewitt, Graily, 1828-1893.
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: The pathology, diagnosis, and treatment of diseases of women : including the diagnosis of pregnancy / by Graily Hewitt. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    of being simulated by that sudden and spasmodic contraction of the recti muscles occasionally liable to be set up by the applica- tion of the hand in hysterical subjects ; possibly also by the peri- staltic movements of the intestines. The celebrated Joanna Southcott appears to have deceived her medical attendants by thus contracting the recti muscles. They believed that she really was pregnant. It has been recommended that the hand should be dipped in cold water in order more easily to excite foetal movements, but this is unnecessary. The following remarks of Dr. Tanner are very much to the purpose: ' I would especially mention that the cold diminishes the acuteness of the sense of touch, while it is very likely to induce spasmodic contractions of the recti muscles, which are almost certain to be mistaken for foetal movements.' * There is still another sign of pregnancy derivable from palpation of the tumour through the abdominal walls, viz. hypogastric reper- cussion or ballottement. The patient is to be placed on the side, or, as Dr. Montgomery recommends, on the knees,' with the shoulders depressed, so that the foetus may be caused to gravitate towards the fundus uteri, which is also brought into more complete con- tact with the abdominal parietes.' The fingers are then to be pressed against the most dependent part of the tumour firmly but gently, and then very suddenly this pressure is to be withdrawn. In the act of withdrawing the pressure the foetus is felt to fall against the retiring finger, and this constitutes the sign in ques- tion. It is identical with the internal ballottement previously described. (See p. 1.52.) Without placing the patient in this position, this external ballottement is often practicable when the pregnancy is far advanced; that is to say, the patient lying on the back, pressure is steadily made by one hand on one side of the uterus, and manipulation by the other hand is performed on the opposite side of the uterus as above directed. The value of this ballottement as a sign of pregnancy is great, but it is possible that an inexperienced observer might be led into error by it. Thus if the abdomen contained a solid pedunculated movable tumour, together with ascitic effusion, the sensation de- scribed above might be communicated. The internal ballottement from the vagina is not so liable to be simulated, and indeed if the previous instructions have been duly attended to, it is not possible to mistake the external ballottement due, to a foetus within the uterus for anything else. * Signs and Diseases of Pregnancy, p. 76. M