The changes to be noticed are in the form, and size, of the neck and body of the womb, and in its mouth, and also in the weight of the whole organ. No one, of course, can expect to recognize these changes who is not acquainted with the parts in the unimpregnated state, both in the virgin and in those who have borne children.
The mode of conducting the requisite examination is, by introducing the index finger of the right hand, covered with oil or mucilage, into the Vagina, and then carrying it upwards till it reaches the Os Tincæ. By means of this finger the position and length of the neck of the womb are ascertained, and also the state of its mouth, whether it is opened or closed, and to what extent. If it be then placed at the top of the neck, on the under side, and the other hand upon the fundus of the womb externally, and pressing firmly upon it, the organ is enclosed as it were between the two hands, so that its size and form may be pretty accurately ascertained, and also its degree of firmness, by which a judgment may be formed as to whether it is occupied by any solid body, or fluid, or whether it is empty. In addition to this a pretty accurate estimate may be made of its comparative weight, by balancing, and raising it up on the finger. This is called by the French Ballotment, and, as will be shown further on, is a valuable means, at certain stages, of ascertaining pregnancy.—(See Plate XVI.)
The female may be examined either standing or lying down, though the recumbent position is best, except in certain displacements of the womb, when it is most likely to be thrown into a position in which the neck can easily be reached by the female standing. The position of the neck is very different in many of these displacements, and during pregnancy, to what it is in the ordinary state, and a person not acquainted with these changes might frequently be much puzzled to find it. As we have already remarked, also, there are certain differences between those who have had children and those who have not. The following three diagrams represent the changes just spoken of at three different periods:—
PLATE XIV.
Figure 1, represents the form and size of the body, neck, and mouth of the Womb, at about the third month.
Figure 2, the same at about the seventh month.
Figure 3, the same at the ninth month.
The references are the same in all. a. The Neck of the Womb.—b. b. The Body of the Womb.—c. The Os Tincæ, or Mouth of the Womb.—d. d. The cut edges of the Vagina.
Fig. 1.
Fig. 2.
Fig. 3.
Plate XIV.
The form and size of the body, neck, and mouth of the Womb, at about the third, seventh and ninth months.
It will readily be seen by these diagrams that the alterations in the neck and mouth of the womb are very marked, and of a character easily to be ascertained by the touch. These three should be compared with the section of the womb in Plate IV, which represents it in the unimpregnated state.
The difference between those who have borne children, and those who have not, is well represented in Plate XV—the drawings being one-third of the natural size, and representing the appearance at about three months.
PLATE XV.
Primipara, or the first Pregnancy.
Woman who has borne children before.
a. a. The neck of the Womb.—b. b. b. The body of the Womb.—c. The Os Tincæ, or mouth of the Womb.—d. d. The cut edges of the Vagina.—e. The Fœtus.—f. f. The Fallopian Tubes, Ovaries, and Round Ligaments.—g. The Placenta.
Most of the changes produced can be readily distinguished by the finger, after seeing this representation, and making a proper comparison between it and the natural state in Plate IV.
The Neck is not much enlarged at this period, but its lower part is somewhat soft to the feeling. The Os Tincæ is more rounded than in the unimpregnated state, particularly in the Primipara, in whom in fact it is nearly circular, the lips being quite smooth and closed. In the female who has already borne children it is somewhat open, so that the finger may often be introduced; and the lips feel rough, owing to scars and laceration in previous deliveries. It is also larger altogether, and softer, than in the primipara. The whole length of the neck at this stage is about two inches.
The body of the uterus, when pressed between the two hands, will be found much larger than ordinary, and more round, and it will feel heavy when pushed up by the finger.
In regard to the precise value of these probable signs, it can only be said, when they are observed, that it is certain that the womb is enlarged, and most probably from pregnancy. But at the same time it must be remembered that several diseases, and particularly suppressed and irregular menstruation, or the development of tumors and polypi, will effect very similar changes, and that it is not always possible to say whether they arise from these abnormal growths or from pregnancy, though it can generally be done. But though we cannot, in every case, say when these signs exist, that the female must be pregnant, we can nearly always say, when they do not exist, that she cannot be so, particularly if the other usual signs are absent.
End of the fourth month.—By this time the neck has become a little shorter still, and the mouth more open, but on the whole there is not much change to be felt internally. The body of the womb however, has now ascended above the superior strait of the Pelvis, and begins permanently to enlarge the Abdomen. It may be distinctly felt between the two hands, like a firm round ball, somewhat elastic, and resisting when pressed. This is the period when the motions of the fœtus are usually felt first, and these motions, with the ascension of the womb, are sometimes experienced very suddenly, so as to alarm the female, and produce certain curious sensations, with much nervous derangement. This is called quickening, and, with some persons, is always so well marked as to indicate not only their condition, but the very period, with great precision. Many however, never experience anything at all peculiar at this time.
It is customary for the medical attendant, as a means of making the child move, to put his hand first in cold water, and then over the fundus of the uterus; the sensation of cold thus conveyed usually causing it to move immediately. Great care must be taken however, that other motions be not mistaken for those of the child, an error not at all uncommon. Many a female, and many a medical man also, has been deceived in this way, particularly in cases of uterine or ovarian dropsy, and tumor, and even in ordinary flatulence and hysteria. Females who much desire offspring frequently deceive themselves in this way, and it is sometimes next to impossible to convince them of their error. Some women possess the power of imitating the movements of the child, with great exactness; and instances have been known where they have successfully imposed, both on their friends and medical attendants, for a long time, in this way. Mr. Dubois mentions instances of females who possessed this extraordinary power, and who, though not pregnant, used to present themselves to his class, for the pupils to ascertain the motions of the child. In short, this sign must not be too much relied upon, nor too confidently expected, for many females observe no fœtal motions at all till the sixth or seventh month, and even then very indistinctly. Sometimes also, after having been distinctly felt,