the case of a lady who assured me, that she always knew when she was with child, by feeling a violent antipathy to wine' and tea, which at other times she took with pleasure. I had an op. portunity of observing the accuracy of this indication, in three successive pregnancies of the lady alluded to. A patient of Dr. Dewees' used to consume enormous quantities of chalk, when pregnant; and Capuron knew a woman whose principal food was long pepper, which she used to swallow by handfuls; under the same circumstances, one patient of mine eats quantities of cloves, for the first three or four months; and another indulges with equal freedom in eating dry oatmeal. There is a curious and interesting coincidence between such facts as these, and others not unfrequently observed in certain states of uterine disturbance, connected with suppressed, or deranged menstruation: especially about the time when that function is first established; when it is not unusual to find girls eat with avidity the most uninviting substances, such as cinders, dry mortar, or clay; and in a case, about which I was some time ago consulted, the young lady used to pick the bog-wood out of the grates and eat it. This morbid state of the appetite did not escape the notice of Ben Johnson, who thus alludes to it:3 "She can cranch A sack of small coal, eat you lime and hair, Such caprices of appetite may at first, perhaps, only excite a smile, but experience appears to have sufficiently shown that their indulgence cannot always be permitted without imminent risk of injury to the mother, or child, or both: thus, Dr. Merriman relates the case of a young woman who, during her first pregnancy, took a fancy to chew ginger, of which she consumed several pounds; her child was born small and meagre; its skin was discolored and rough, much resembling the furfuraceous desquamation that follows scarlatina; it lived in ill health a few 1 This particular aversion is expressly noticed by Hippocrates as a sign of pregnancy: "Vinum odio habent, cibos aversantur."-De Infecundis, cap. 6. 2 Traité des Accouchemens, p. 42. The Magnetic Lady, act i. sc. 1. weeks, and then died. The fancy for ginger did not return in her subsequent pregnancies, and she gave birth to vigorous and healthy children. In a second case, indulgence in large quantities of gin and water was followed by the birth of a child, which he describes as small and lanky, with a weak voice, its face wrinkled and ghastly, and its belly collapsed: its skin was mahogany colored, and hung in folds all over the body, there being no muscular fulness to keep it distended; it lived in much suffering for about ten days, and then died in convulsions. The writer some years since attended, with Dr. Evanson and Dr. Alcock, the post-mortem examination of a child which had lived only nine weeks; at birth, an unusual fulness was observed about the perineum and anus, which increased rapidly, until these parts became greatly protruded, and a tumor was formed of the size of a very large orange; convulsions came on, and the child died after much suffering. The tumor, on examination, was a perfect specimen of fungus hæmatodes, and the earliest instance of the disease then known to the writer. In this case, the mother had indulged, during all the time of her pregnancy, in continually eating brown paper; she had done the same in her former pregnancy, which was her first, and the child was stillborn, under a foot presentation. I cannot, of course, undertake to assert that there was certainly a connection between the effect observed in the child and the depraved appetite of the mother; but the fact appeared to me sufficiently remarkable to be noticed (see p. 38); and I quite agree with Dr. Merriman, that these cases tend to prove, what no man, who has had opportunities of observation, has ever doubted, that the popular doctrine is false and indefensible, which teaches that pregnant women should be "allowed to indulge all the capriciousness and wanton absurdities of their appetites;" it being most certain, that however safe and uninjurious some of the articles of diet longed for may be, others cannot be taken without danger of hurting either the mother or the child. On the other hand, however, if a pregnant woman takes a fancy to some unusual article of diet, of a kind not likely to be injurious to her, it would be better to let her gratify the whim: 1 Merriman's Synopsis, &c., p. 320. because the want of the indulgence not unfrequently excites nervous apprehensions of consequences, which, although altogether improbable, may yet render her anxious and unhappy. Notice has been already taken of the pigmentary depositions which so constantly take place as the result of pregnancy, in the areola, middle line of the abdomen, &c.; and owing to the same cause, there occurs in some women the development of dark blotches over the face and other parts of the skin, of which I have seen many instances, sometimes to the great annoyance of the subject of them. I am in the habit of attending a lady of rank, who took very ill indeed, the appearance on her forehead and nose, of two streaks exactly resembling the marks that would be made by two very dirty fingers drawn along those parts: and Dr. Harty informed me of the case of a lady, who, in her first pregnancy, observed brownish spots, or patches on the sides of the forehead and temples, which she at first mistook for accidental soils on the skin; but they remained permanent; and when she became pregnant again, a further addition was made to them; so that, after several pregnancies, the dark marks extended so far down each side of the face, that the lady was obliged to dress her hair in such a way as to cover them. The most remarkable circumstance in this case was the permanence of the marks, which almost always disappear after delivery. Lecat relates the case of a woman whose face, in three successive pregnancies, became quite black. Camper observed the same circumstance. The occurrence of salivation, epiphora, and coryza, in consequence of pregnancy, has been already noticed (pp. 91, 93), as has also the return of diabetes mellitus, in several successive pregnancies of the same individual (see p. 53): pains in the teeth, face, and other situations, are, with some, the invariable accompaniments of pregnancy. Some women always have varicose veins during gestation, who are not subject to such an affection at any other time. Under such circumstances, especially if the woman appears in good health, and otherwise unaffected with any complaint likely to induce such a condition of the veins, their varicose state appears to the writer not unworthy of consideration as a diagnostic sign. 1 See other instances by Gardien, tom. i. p. 485. Some women are much troubled with frightful dreams whenever they are pregnant. Dr. Lowder used to relate the case of a lady who was obliged to have a nurse sitting at her bedside all night, to watch her countenance while she slept, and to awaken her as soon as she perceived her exhibiting distress, under the influence of her dreamy terrors. Disorder of the alimentary canal, disturbing the already irritated nervous system, is, probably, the most frequent cause of this affection: it may also be induced by irregular, or undue circulation of blood in the brain; relief has been obtained by acting on such a presumption, administering aperients, and detracting blood by cupping on the nape of the neck. According to Dr. Beccaria there is a peculiar kind of headache accompanying pregnancy, which he describes' as an acute pulsating pain in the occipital region; occupying particularly the part in which Gall places the organ of the instinct of reproduction this pain, he says, is accompanied with giddiness on the least motion of the head, and with difficulty in supporting the light; it comes on suddenly, and, continuing for some time, is succeeded by an inclination to sleep; after sleeping some minutes, the patient is said to awake free from the pain, and with a strong desire for food. This pain, he says, returns at nearly the same hour, for about eight days, and often disappears without the use of any remedy. This symptom, according to Dr. B., commonly appears unaccompanied by the signs usually laid down as denoting pregnancy, previous to the fourth month; and he observed it in women who were not aware of their pregnancy, and who did not even suspect the fact. Dr. Alexander Hamilton, also, enumerates headache2 amongst the early signs of pregnancy immediately consequent on the suppression of the menses: but headache, in whatever form occurring, may be produced by such a variety of causes, connected with derangements of the nervous or uterine system, or of the alimentary canal, that, except under very peculiar circumstances, its occurrence could hardly be made available as an assistance to our judgment. I have met with many instances of women who were affected 'Annali Universali di Med., Sept., 1830. Archives Générales de Médecine, tom. xxiv. p. 443. * On Female Complaints, p. 121, ed. 4th, 1797. with faintness, or even actual fainting, at certain times of the day, whenever they were pregnant, but not at other times; and I may make the same remark regarding hæmoptysis, of which I have met several instances happening only during gestation, and which had so occurred in several successive pregnancies; one very remarkable case of this kind, that of Mrs. McG., I shall have occasion to relate in Chapter XI.; and very recently, I was consulted by a lady to whom it had occurred in three successive pregnancies, and on no other occasion. From the character of these occasional phenomena it must fʊllow, as already observed, that, in first pregnancies, we can gain little or no information from such accidental peculiarities, but their constant occurrence, in successive instances, ought to give them value in our eyes; the degree of value, however, must depend altogether on the distinctness with which we can ascertain their existence, or the reliance which we can place on the sincerity and accuracy of observation of those who report them to us, and if we are satisfied on both these points, it will be prudent not to reject lightly, or undervalue the evidence derivable from such sources. "That we may not, therefore," says Morgagni,' "take a true pregnancy for a false one, we must have a peculiar regard to the signs that are not present, as well as to those that are; and above all, if the woman has been pregnant before, we must consider whether the signs from which she judges herself to be pregnant now, are the same that had preceded in the beginning, at other times. For, by reason of this circumstance being despised, which is sometimes fallacious, indeed, but not to be neglected for that reason, I have seen physicians fall into error," &c. I would wish to observe, here, that this suggestion is by no means to be restricted in its application to the consideration of peculiar or unusual signs, but should be adopted as a general principle in the investigation of all cases, of which those related by Morgagni, in proof of the above remark, are highly interesting illustrations. But, at the same time, we should be equally careful not to run into an opposite extreme, and exclude the idea of pregnancy because the existing symptoms happen to differ, however widely, from those that have been usually experienced 1 Epist. xlviii., art. 4. 2 * See p. 123. |