It is not unusual for the abdomen, soon after con ception, to become flatter than formerly, and continue so tor a month or two, after which it enlarges. In other instances it very early increases in size, chiefly from a distended state of the bowels. In pregnancy the tumour is most manifest below the umbilicus, which generally becomes prominent towards the sixth month, if not sooner.
It is possible, but not usual, for all these symptoms to appear in the virgin state, in consequence of ute rine irritation ; but much more frequently they arise, if not from true pregnancy, at least from a blighted ovum, or what has been called a false conception. Many women, who have had a large family, when they advance in life, are liable to inflation of the abdo men, and irregularity of the menstrual discharge, oc casionally accompanied with slight changes in the ap pearance of the breasts. They are willing to believe themselves not past the age of childbearing, and fancy they feel the motion of the child ; but it is only wind passing along the bowels, and is known to be so by shifting its place, and generally being perceived higher than the uterus.
These signs, with the existence of what have been called the disorders of pregnant women, do, in the mar ried state, justly warrant the belief of the existence of pregnancy ; but we cannot arrive at certainty until the time of quickening, or by examination per vaginant, about that period. Earlier, even this mode cannot positively decide the question, for the womb may be enlarged by other causes. Still it affords in the third month strong presumptive evidence.
Of the Disorders incident to the Pregnant State.
It is not to be expected that the uterus can undergo the great and active changes which it experiences after conception, without affecting to a greater or less de gree the whole frame, and particular organs. The ge neral sympathy which exists amongst the different parts of the body, as well as the particular influence which individual systems and viscera exert on one another, render it impossible for out part to have its action ma terially altered, increased, or diminished, without pro ducing more extensive effects.
The effects produced by the gravid uterus may be classed under the following heads : 1st, Those which arise from the sympathy of particular parts with the ute rus, some of which have their activity increased, others diminished. Examples of these we have in the changes produced on the breasts and stomach. 2d, Those which proceed from more general sympathy, as we see exem plified in the nervous and vascular systems. 3d, Those which are occasioned chiefly by a mechanical cause, as cedeina of the feet, and swelling of the veins. Few, if ally, of these effects, however, can be said to arise purely and entirely from one class of causes. They may be individually referable to one or other class chiefly, but the causes themselves are so interwoven and mixed up with one another, and there are so many reactions, that the classification must be taken with circumspection, and a latitude allowed.
From the brisk and increased action which goes on in the uterus, so long as gestation continues, and the ovum thrives, we find that a change takes place in the state of the blood. It does not assume an inflamma tory appearance, but it becomes sizy, an effect not pe culiar to pregnancy, but produced by many other local It ritations. The arterial system is likewise excited, so that the pulse becomes sharper, sometimes stronger, and generally. in the commencement of pregnancy, variable. The functions dependent on the blood-vessels are also influenced ; animal heat is often increased, the deposition of fat, and perhaps of other constituent parts of the frame, is either actually lessened, or the process of absorption is increased, or both of these take place ; for in general the female becomes thinner. t there
is rather a redundancy than a deficiency of blood, for plethora is apt to exist during pregnancy In many cases these effects appear only in a moderate degree ; in other cases, however, the patient is actually feverish, sleeps almost none, and becomes extremely emaciated. As this condition, like the other disorders of pregnan cy, arises from the state of the uterus, it is evident that, so long .,s the latter exists, the former must continue ; and all we can do is, to mitigate what we cannot cure. This is best done by strict attention to the state of the bowels. taking occasionally the saline julep, avoiding much animal food, every thing of an irritating or heat ing nature, and even abstaining from all unnecessary quantity of the blandest liquids, sleeping on a firm ma tress, with no more bed-clothes than are requisite, pro curing a free ventilation of air, and detracting blood from the veins, if the symptoms do not yield to this re gimen. With regard to exercise, there has been some diversity of opinion ; hut all must agree, that where there is a tendency to abortion. this must be abstained from altogether, or taken in great moderation, till the period of danger be past. Where there is no cause, however, to forbid it, advantage is very evidently de rived from regular, but moderate exercise, taken daily to such extent as does not occasion fatigue. It is part ly from the opportunity of taking such exercise with facility, and partly from the salutary influence of pure air on the whole frame, that many patients experience great benefit from spending the period of pregnancy in the country, although inconveniences of a different na ture may result from this practice. The stomach and bowels very early are affected by pregnancy, producing sickness, vomiting, heartburn, fastidious appetite, cos tiveness, or an opposite condition of the bowels, and a 'rain of secondary symptoms ensuing therefrom. When these disorders are in a moderate degree, little requires to be done ; and indeed some men of judgment have reasoned themselves into a belief, that, as they arise na turally from pregnancy, we ought not to be very soli citous in removing them. This principle, if followed up, would lead to most absurd as well as dangerous practices in medicine, and, in the present case, would, particularly with regard to costiveness, make us over look, and indeed encourage a very decided cause of both distressing and formidable disease. Partly from the eflects produced by the uterus itself on the nervous system, but still more decidedly by the state of the bowels during pregnancy, many hysterical and anoma lous affections are produced, and irregular and painful actions excited in distant parts ; and, from the same cause, the brain itself is acted on, and a determination of blood made to the head, which produces severe head aches, convulsions, or apoplexy itself. We are yet ig nor.-nt of much which relates to the mutual reaction of the nervous and sanguiferous systems, and perhaps over look too much the agency of the spinal marrow in many of those severe disorders of the two systems, which have their origin in the state of the abdominal viscera. Nothing tends more to prevent those harass ing and often dangerous symptoms, styled nervous, than rigid attention to the bowels. But experience and observation have taught the writer. that when these have actually taken place, particularly if attended with a sense of fulness in the head, much giddiness, or head ach of an oppressive kind, or any degree of stupor, that the lancet is the mean chiefly to be trusted. Fashions are not confined to Bond Street, but prevail as much amongst physicians as milliners ; and perhaps the pre sent system is to trust too much to the efficacy of pur gatives, and too little to the effect of blood-letting.