SPURIOUS PREGNANCY.
Pregnancy exists or it does not exist. Spurious pregnancies are only errors in diagnosis. We can not do better than to give here an analysis of the remarkable article of our master.
Pajot divides the errors into three principal classes. 1. Diagnosis of pregnancy when it does not exist; 2. Denial of existing pregnancy; 3. Confounding one kind of pregnancy with another.
1. Diagnosis of Pregnancy when it does.not causes of this error are: a. .A false interpretation of functional ailments; b. The exist ence of various abdominal and pelvic tumors; c. Changes in the cervix simulating those of pregnancy; d. Auscultatory signs similar to foetal and uterine bruits; e. Deceptive sensations of movement, felt by the motlier.
We have already recorded our belief that there is, in reality, only one certain sign of pregnancy, the foetal heart-sounds. The three other signs, ballottement, either abdominal or vaginal, objective movements and foetal souffle, are incontestably, also, certain signs, but the last does not always exist. Ballottement has been perceived in two or three conditions other than pregnancy. The active foetal movements, plainly perceived by the obstetrician, are as certain as the heart-sounds, but one must always rely upon the latter. Unfortunately, in some cases the accoucheur is called after the death of the foetus, when the diagnosis becomes very difficult.
2. Fhilure to recognize existing mistakes, although less common than those of the former class, are yet not very rare, and many most justly distinguished physicians and surgeons have not always avoided them. This error may be due to ovarian cysts, fibroids and other tumors, ascites, dropsy of the amnion and versions or flexions. There is only one sure means of making a correct diagnosis, waiting until the foetal heart-sounds appear. If the foetus is dead, the diagnosis must be made by exclusion. Pajot insists upon the importance of what he terms the foetal impulse in cases where the foetus is alive. This sign is often per ceptible to the ear before the appearance of the foetal heart-sounds, and imparts to that organ a sensation at once tactile and auditory. We must, therefore, never fail to look for it.
3. Mistaking Pregnancy of one Kind for some other is to say, mistaking a uterine pregnancy for an extra-uterine, and vice versd, or a double pregnancy for a single one, and the reverse. The error, in the former case, is a grave one. In the article on Extra-uterine Pregnancy we shall see that this error has been committed, and shall then give the diagnostic points. We need not study the diagnosis of pregnancy in de
tail. For us, a single sign embraces all, viz., the heart-sounds. Let us cite the causes which have most frequently led to the commission of errors. These are, amenorrhoea, uterine affections, congestions, metritis, fibroids, hEematometron or retention of menstrual fluid, ovarian tumors, ascites, tympanites, embonpoint and abdominal tumors. Ascites, fibroids, ovarian cysts, and abdominal tumors may co-exist with pregnancy, and thus render the diagnosis more difficult still. But there is one condition to which we must recur, death of the fcetus in utero, either before the certain signs were appreciable or afterward, if the accoucheur could not himself distinguish them. Sometimes the woman does not present her self for examination until these signs have disappeared, as a result of death of the fcetus. In these cases, the diagnosis is made with great difficulty. Auscultation is useless and palpation only gives imperfect sen sations. On account of changes which the fcetus undergoes, the uterus, as a result of the reabsorption of the amniotic fluid, undergoes a retro gression more or less pronounced. The cervix resumes the characters it possessed before pregnancy began, and vaginal touch is insufficient to completely clear up the diagnosis, because of the absence of ballottement and of the sensation conveyed by contact with festal members. In these cases we hold that great importance attaches to two signs. One of these, to our mind, is absolutely certain, and, in one case, enabled us to surely establish the diagnosis of pregnancy. (Vide Hydramnion). The first of these signs, which is obtained by combined manipulation, is the develop ment of the uterus, which seized between the finger introduced into the vagina, and the other hand applied to the abdominal wall, is thus often appreciable. The other sign, which enabled us to make a clear diagnosis in one case, was likewise observed by Bud in in an analogous, although different case. This sign is the perception of a uterine contraction, in duced by abdominal palpation, or gentle massage continued for some time. Under the influence of this contraction, the abdomen, which was before supple and yielding, became harder and more tense. This sign is, in our opinion, absolutely certain, for although, as some authors say, vesical con tractions sometimes occur, these contractions disappear after evacuation of the bladder with a catheter, while a genuine uterine contraction will recur after withdrawal of the urine.