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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    month of gestation, there should be at this time a tumour disco- verable in the abdomen; failing to find a tumour, we should at once conclude further investigation of the case to be necessary. The mistakes which have been committed in the diagnosis of pregnancy will on enquiry be generally found to have resulted from the observer attaching an undue importance to some one sign on which he has been accustomed to rely, and from his having omitted to ascertain the presence or absence of other, perhaps more important, signs of pregnancy. Comparative Estimate of the Value of different Signs of Preg- nancy.—Perfect evidence of the existence of pregnancy is not- obtainable until after the third month, unless in those very rare cases where the foetal heart may be heard just at the end of this time. The evidence obtainable before this date only enables us to come to the conclusion that pregnancy is probable. The signs (probable ones) of pregnancy up to this time are—suppression of the menses, swelling of the breasts, descent of the lower part of the uterus in the pelvis, flattening of the abdomen.* An exami- nation will not usually enable us to give a positive opinion, if undertaken at this time. After the end of the third month, during the fourth and fifth, an abdominal and a vaginal examination give, or may give, deci- sive indications. Menstruation is still absent in ordinary cases ; the breasts continue to enlarge, and the areolar changes become developed; the os uteri undergoes its characteristic changes; the uterus can be felt to be enlarged from the vagina and above the pubes ; the vagina assumes a dusky hue; the motions of the foetus can be felt by the observer and by the patient; ballotte- ment is recognisable ; the sounds of the fcetal heart can be heard. After the fifth month and up to the end of pregnancy, the symptoms just described continue and become intensified. The signs of pregnancy have been divided into three classes by Dr. Montgomery: 1. Presumptive; 2. Probable; 3. Unequivocal. Practically, however, there is no great difference between what is presumptive and what is probable; and if distinctions are to be drawn between shades of belief, the division might be extended ad infinitum. It appears quite sufficient to arrange these signs * This flattening of the abdomen was reckoned by the older authorities as an early sign of pregnancy. ' En ventre plat Enfant il y a.' Thus ran the old proverb. Montgomery, op. cit. p. 157.