At this time however, Ballotment can begin to be practised, though it is not quite so certain as at a month later. The manner of performing this important manipulation has already been partly described, and by examining Plate XVI, and attending to the following remarks, it may be readily understood and practised.
PLATE XVI.
This Plate represents the mode of performing the Ballotment, to detect pregnancy. The outline of the figure is the same as in Plate I, and most of the organs are lettered the same.
The index finger of the right hand is passed into the Vagina till it touches the body of the Womb, the neck being thrown back, owing to the tilting of the Fundus forward. The left hand is pressed firmly upon the Abdomen, just over the pubic bone.
1, Is the Fœtus.—2, The Placenta, connected with the Fœtus by the cord.—3, Is the index finger of the right hand, within the Vagina.—4, Is the left hand.
The development of the Womb, and the change in its position, are very well represented in the Plate, and so are the alterations in some of the other organs. The manner in which the Bladder, A, is pressed out of its usual shape and size, may be seen by comparing this with Plate I. The shortening of the Vagina, and the expansion of its upper part, are also equally obvious, and the manner in which the mouth of the Womb is thrown back against the Rectum.
Plate XVI.
This Plate represents the mode of performing the Ballotment, to detect pregnancy. The outline of the figure is the same as in Plate I, and most of the organs are lettered the same.
When the right hand finger (1 Plate XVI,) is carried to the top of the Vagina, it meets with a round soft tumor, which is the head of the child felt through the walls of the womb. As soon as this is distinctly felt, the finger must be withdrawn a little, and then pushed suddenly against the tumor with a jerk; this will displace the fœtus, and cause it to rise in the liquor amnii towards the Fundus, so that the round tumor will have disappeared. In a few moments it will sink down and may be again felt, and again displaced in the same manner. This is called the Ballotment, or balancing it on the end of the finger. The sensation conveyed on touching the Fœtus, and when it rises after being pushed, are so peculiar that they are not likely to be overlooked, or mistaken for anything else, after being once experienced. The jerk is not required to be at all violent, and had better be made at first very slight, as it can easily be repeated a little more forcibly if the tumor does not rise at first. Some practitioners practice the Ballotment in this way, using the one hand only; but others place the left hand also on the Abdomen, (4 Plate XVI,) at the same time, and immediately after jerking upwards with the right hand, they suddenly depress the Abdomen, just over the pubes, with the fingers of the left, so as to send the Fœtus down again more quickly and more forcibly. This is seldom needed, but if the first way does not succeed the two hands may be tried.
A species of ballotment may even be practised externally, in the following way:—The fingers of the right hand are placed on the Abdomen, just over the fundus of the womb, like the left hand in Plate XVI, and a smart jerk is given downwards and backwards, several times in quick succession. This also displaces the Fœtus, which may be distinctly felt to float away, each time the percussion is made. No one can mistake this peculiar motion who has once felt it.
Sometimes one of these manœuvres will succeed when the other fails, so that it is well to practise them all. They may be performed with the female either standing or lying down, and will sometimes succeed one way when they will not the other.
It is requisite to remember that in presentations of the breech, or trunk, the ballotment may not succeed as well as when the head presents; or it may even fail altogether, so that when it is unsuccessful we must not immediately conclude there is no pregnancy. Tumors in the womb, stone in the bladder, and various uterine displacements, may also create uncertainty, or cause failure, but these accidents are rarely met with, and only interfere materially at an early stage; afterwards ballotment can be practised notwithstanding them, or auscultation may be resorted to.
In short, this mode of detecting pregnancy is one of the most certain, and the most generally applicable, that we possess.
End of the fifth month.—At this time the Uterus has increased considerably in size, and has ascended so high in the Abdomen that the Fundus is level with the umbilicus, or navel, in a first pregnancy, though somewhat lower in those who have borne children before. This rising of the womb makes the Vagina longer, and brings the neck of the womb nearer to its centre. In the previous stage the neck was thrown so far back that it was difficult to reach, but now it is much more favorably situated, though much higher. Its substance is softer than before, and the two lips are nearly on a level, and somewhat opened, particularly in those who have borne children before. Indeed, in them the point of the finger may be introduced, as seen below:—
PLATE XVII.
Neck of the Womb in a first Pregnancy, very slightly opened.
Neck of the Womb in a female who has borne children before, showing how it admits of the introduction of the finger.
This is at the end of the Fifth Month, and the drawings are about one-third of the natural size.
Ballotment is now much more easily practised, and is more conclusive. A new sign is also to be distinguished, by which we are furnished with another valuable means of detecting pregnancy. The child's heart begins to beat so strongly, and its circulation is so vigorous, that the sound of it can be heard externally. The same means are taken to ascertain this that are used in sounding the chest of an adult. If the ear be placed on the Abdomen, over the womb, the beating of the fœtal heart may be heard quite plainly; and if the stethoscope be used it will be still more distinct. This practice is called Auscultation. The signs furnished by it are certainly of the greatest value, and frequently enable us to detect pregnancy with unerring certainty. Indeed, not only can we tell by them that a child is in the womb, but often even the very position in which it lies, and whether there be twins, or more. This is done by noting where the heart is situated, by the sound, and whether the beating is single or double.
The nature of these sounds, and the manner of detecting them, require to be carefully explained.
If the person wishing to notice this sign is not already familiar with the beating of the adult heart, he had better become so first. The ear should be placed on the left side of a grown up person, on the skin, just beneath the breast, and held very still. The heart will then be heard to beat very distinctly, there being two sounds, a long one and a short one, alternating with each other. When this has been listened to for some time, the ear will be able to catch any similar sound, and the auscultation may then be practised to detect pregnancy.
The ear must be placed on the Abdomen, about midway between the Pubes and the umbilicus, and towards the left side. No weight should be borne on the body, but the ear must be laid sufficiently close to exclude all external sounds, and no motion should take place, particularly with the clothes. If the sound be not heard in the position first assumed, move a little, in different directions, till that point is attained where it is most distinct. It can scarcely fail to be heard, with ordinary care. A practised ear will sometimes distinguish the sound as early as the fourth month, but generally it cannot be heard before the end of the fifth, or even till the sixth month. There are several sounds that may either be mistaken for it, or that may confuse the ear. The beating of the mother's heart will sometimes be very distinct, as far as the lower part of the Abdomen, but it is much slower; the child's heart throbbing nearly twice as fast. The movements of the Fœtus, and the rumbling of the intestines, will also interfere; but when once the proper sound has been caught it may be kept independently