Page:The American Cyclopædia (1879) Volume XII.djvu/583

OBSTETRICS 569 earliest age at which pregnancy is positively known to have occurred is 11 years ; and the latest period at which parturition at the full term of gestation is recorded to have taken place is 64 years. The most prolific period, according to Dr. Bland, is hetween the ages of 26 and 30 years. The signs of pregnancy may be divided into two classes : 1, those which re- sult from the derangement of some functions, as suppression of the menses, nausea and vomit- ing, mammary pains, vitiated tastes, &c. ; 2, those which are to he detected only by a physi- cal examination, as the change of color around the nipple, called the areola, the enlargement of the abdomen, the movements of the foetus, the position of the uterus in the abdomen, bal- lottement or repercussion, and the signs derived from auscultation, and those ascertained by touch, of the change in form, density, and po- sition of the neck of the womb. There are some diseases which may give rise to an unjust suspicion of the existence of pregnancy, par- ticularly those that produce enlargement of the abdomen. The chief of these are spurious pregnancy, a very curious and not very infre- quent phenomenon, ovarian dropsy and drop- sy of the abdomen, fibrous tumors and large polypi of the uterus, enlargement of the liver, kidney, spleen, &c., and distention of the cavi- ty of the uterus with blood, water, or air. It is usually admitted that the ordinary duration of pregnancy is ten lunar months, or about nine calendar months, or from 274 to 280 days ; but it has long been a disputed point whether gestation may not be protracted beyond this period. The weight of authority is now in favor of the opinion that it may in some instances be prolonged to the 300th and even the 306th day. The abrupt termination of pregnancy by the premature expulsion of the product of con- ception is of frequent occurrence, the number of mothers who pass through the child-bearing epoch of life without ever aborting being small. The expulsion of the ovum may take place at any period of gestation. When it occurs du- ring the first 16 weeks, it is termed an abortion; when between the end of this period and the 28th week, a miscarriage ; and when after the latter period, but before the completion of the full term, a premature labor. When the foetus is expelled before the 28th week of pregnancy, it either dies immediately or soon after birth. The causes of abortion, miscarriage, and pre- mature labor may be classified under five heads, viz. : 1, the accidental ; 2, some de- ranged state of the mother's health ; 3, some disease of the uterus or its appendages; 4, some disease of the embryo or foetus or its membranes ; 5, when induced for criminal purposes, or necessary to preserve the life of the mother. The danger to the life of the mother depends somewhat upon the period when the abortion or miscarriage occurs. In the first or second month the ovum with its appendages generally escapes without pro- ducing any noticeable illness. In the third and fourth months there is often considerable dan- ger from haemorrhage. The danger then be- comes lessened after the fifth month. When the abortion originates from some slowly operating maternal or foetal disease, it is at- tended with much less serious consequences than when it is produced suddenly by an acci- dent, or by the exhibition of some irritating medicines, or by puncturing the membranes. Tardieu reports 34 cases of criminal abor- tion, 22 of which resulted in the death of the mother. So, too, an abortion occurring du- ring the progress of an acute inflammation of the lungs, brain, heart, liver, or bowels, forms a highly dangerous complication. The condi- tion of pregnancy occasionally results in a salu- tary change in the entire system of the moth- er, better health being then enjoyed than at any other period. But in a majority it indu- ces disagreeable symptoms, amounting merely to discomfort in some individuals ; in others, so great as to injure the health and even destroy life. The diseases of pregnancy are : lesions of digestion, as anorexia or loss of appetite, vom- iting, sometimes so persistent as to destroy life, constipation, diarrhoea ; lesions of the circulation, as plethora, hydrsemia, varices, haemorrhoids; lesions of the secretions and excretions, as ptyalism, albuminuria, an&mia, leucorrhcea, dropsy of the cellular tissue, dropsy in the great cavities of the body, drop- sy of the amnion (a morbid collection of water in the uterus) ; lesions of locomotion, as relax- ation of the pelvic articulations, inflammation of the pelvic articulations ; lesions of innerva- tion, as modifications of the organs of sense, blindness, deafness, vertigo, syncope, pruritus of the vulva; and displacements of the ute- rus. Labor or parturition consists in the spontaneous or artificial expulsion of a viable foetus through the natural parts. Previous to the commencement of labor, some precursory phenomena appear, in some cases during the last fortnight of pregnancy, in others only five or six days before labor commences. They result from the dilatation of the internal ori- fice of the womb. The uterus, which before extended up to the stomach, sensibly sinks lower, the mechanical obstruction to respira- tion is removed, the stomach is no longer oppressed, but the bladder and rectum become irritable, and locomotion is more difficult. The physiological phenomena of labor are divided into three stages : the first stage ends with the dilatation of the mouth of the womb, the second with the expulsion of the foetus, and the third with the delivery of the placenta or after-birth. The symptoms of the first stage are intermit- tent pains, resulting from the uterine contrac- tions, discharge of a glairy mucus, formation of a bag of waters, and gradual dilatation of the neck of the womb. The pains of the first stage are usually borne with more impatience than those of the second. The cries which ac- company them are sharp, and resemble those of any other species of suffering ; those of the