ACTIVE FOETAL MOVEMENT.
Besides the communicated and passive movements of the fcetus, which constitute ballottement, the embryo shows proper and spontaneous or active motions.
It is hardly until four, or four and a half months, that active foetal movements are perceptible to the mother; and even then it is only a kind of tickling, a trembling, which, insignificant at first, increases as preg nancy advances, until these foetal motions may occur sometimes so violently as to be extremely painful to the mother. It is not until five, or five and a half months, that they become perceptible to the obstetrician. We shall see that auscultation enables us to appreciate them much earlier.
These motions are of two kinds. Some are very extended, and cause considerable change of shape in the uterus; they are due to a total dis placement of the fcetus. Some are due to movements of the head and especially of the limbs, which strike the uterine wall sharply and cause it to bulge out at a certain point. The women then say that they feel life at such and such a place.
All infants are not equally active in their movements, and the move ments themselves vary in frequency at different hours of the day. It is usually in the morning, when the woman is just awakening, that they are most active; at other times they appear with certain motions or attitudes of the mother. They may be very marked for several days, and then cease for twelve or twenty-four hours, or even more. A cessation pro longed beyond this point is, however, of very great importance, especially when the cessation has not been sudden, but has been preceded by a gradual diminution in intensity of the movements. It often means the death of the child, though auscultation is necessary to decide the point. Certain circumstances may prevent the perception of active fetal move ments. Hydramnion, paraplegia, ascites, will do so. Finally, Mauriceau, Cazeaux and Campbell have cited cases in which fetal motion was never perceived by the mother, although the pregnancy ran a perfectly nor mal course. It is generally admitted that the periods during which mo tion is not felt, are those during which the child is sleeping; while it is awake during those in which they are felt.
Abdominal palpation is the best mode of awakening active fatal mo tion; it usually causes fatal reaction, and total or partial movements.
The recognition of active fatal motions is a certain sign of pregnancy; but the motions must be perceived by the accoucheur. If we rely upon the evidence of the woman we will fall into grievous errors. In fact all women who are tormented either with the desire or the fear of having children, believe that they feel life; and it is especially in women at the menopause that one must be cautious, and not deliver judgment until one has with certainty perceived active movements.
[Under the head of abdominal palpation, reference should be made to intermittent uterine contractions, which, almost infallibly, are peculiar to the uterus, which contains a product of conception; such contractions may be felt as soon as the uterus has ascended above the pubes, and they may be evoked by pressure or friction over the fundus. At an early stage of gestation, the third to the fourth month, the bladder should especially be emptied before endeavoring to obtain this sign.
For this sign we are indebted, in particular, to Braxton Hicks. It is a constant sign, it is not simulated by any other condition, and, as we will note under the head of extra-uterine pregnancy, it is, in our opinion, the most valuable of all our radical means of reaching a differential diagnosis. —Ed.] Ause LTATION.
Mayer, of Lausanne, first conceived the idea of discovering the existence of the foetus by auscultation, but he did not appreciate the full importance of his discovery. It was not until 1821 that Lejumeau de Kergaradec explained the results furnished by obstetrical auscultation, and the ad vantages to be derived from its employment. The ideas of Kergaradec, at first opposed, were soon disseminated through Germany, England and France, and were defended, from 1831 to 1839, by P. Dubois, Bodson, Kennedy, Kohl, Kiliin, Velpeau, Jacqnemier, Stoltz and Carriere. In 1839, Depaul applied auscultation to the diagnosis of fcetal presentations and positions, and after that time, all obstetricians adopted it. Finally, in 1847, Depaul's " Traitt d'anscultation obstetricale " appeared, and at. the present time it still remains the most complete work on the subject.