Mr. Gorham has related a case of this kind, in which the patient suffered severely in three successive pregnancies; she is stated to have ejected so much as three and four quarts of saliva per diem: after quickening, the discharge diminished, but did not cease until after delivery, when it immediately disappeared.' I am in the habit of seeing a lady, the mother of a large family, who during pregnancy has been so copiously salivated, that her daily supply of pocket-handkerchiefs was three dozen; and at night, it was found necessary to have a folded sheet laid on her pillow, to soak up the saliva which streamed from her mouth, while she slept. She was much debilitated thereby three of her daughters have been married, and are patients of mine, and one of them has suffered in the same way, but not to the same extent. I subjoin the lady's own remarkably clear account of her case. "MY DEAR SIR: "As you have expressed a wish to know any particulars I could give, respecting a very troublesome kind of salivation, which accompanied several of my pregnancies, and those of some of my sisters, and also within the last year was experienced by one of my daughters, I will endeavor to note down whatever I can recollect on the subject. This salivation, or secretion of water flowing constantly into the mouth, was perfectly tasteless, and devoid of any kind of smell; it continued during the first three or four months, at which time I also suffered a good deal from the sickness usually occurring at such periods; but the salivation did not appear necessarily connected with the nausea, as, when at times perfectly free from the one annoyance, the other continued unabated; in fact, except during meal-times and for a short period after taking food into the stomach, I seldom had any respite, night or day, for, even in my sleep, the water often continued to flow from my mouth, although not in the same quantity as when I was awake. I found nothing in the shape of medicine or other treatment materially to check, or even to alleviate this symptom; but I always observed that anything that weakened, or lowered, the system, aggravated it considerably. The attempt to swallow the saliva (unless when enabled to do so by keeping, and dissolving in the mouth, something of a sufficiently strong taste, or flavor, to relieve the insipidity) was quite nauseating, and could not be persevered in for any length of time. The secretion and loss of saliva Lond. Med. Gaz., June 30, 1848. was occasionally so great, as to cause a feeling of considerable exhaustion; but this was always relieved by taking food into the stomach, and I did not perceive that it otherwise affected my general health. I never had the least tendency to soreness or delicacy of the gums, or any part of the mouth or throat. This symptom, which I have thus tried to describe to you, did not accompany all my pregnancies; I was quite free from it on three or four occasions; nor could I attribute its occurrence at one time, and not at another, to any cause, or peculiarity, in my state of health. In one instance, when carrying twins, the salivation continued not only the entire period of nine months, but for several weeks after my confinement, and did not cease until my general health, which suffered considerably at the time, had been restored by change of air and a course of bracing remedies. Besides the immediate members of my family already mentioned, I am acquainted with one or two ladies, not in any way related to me, who have been affected in a similar way during the first months of their pregnancy, and who have described the annoyance they suffered from this symptom, as being greater than any one could believe, who had not experienced it in their own person. "I remain, dear Sir, "Very truly yours, "P. C." In illustration of this fact, it should be remembered that spontaneous salivation has been observed in other forms of exalted sensibility of the uterus, distinct from pregnancy; thus it sometimes accompanies hysteria, and I have seen it take place in cancer uteri. It is a curious coincidence that a sister of the lady, whose letter is given above, has suffered in some of her pregnancies, to a most distressing degree, from watery discharges from the nose and eyes. CHAPTER IV. MAMMARY SYMPATHIES.-ENLARGEMENT.-SENSIBILITY.—THE AREOLA.-SECRETION OF MILK. WHEN Conception has taken place, and the menses have been suppressed for one or two periods, the woman generally becomes sensible of an alteration in the state of the breasts, in which she feels an uneasy sensation of throbbing, or of stretching fulness, accompanied by soreness and tingling pains felt about the centre of them, and in the nipple. The breasts themselves grow sensibly larger and more firm; a circle around the nipple becomes altered in color and structure, constituting the areola; and as gestation advances, milk is secreted. But there is considerable variety in the period of gestation, at which these changes may occur, as well as in the degree of their development; for, in some instances, they may be recognized very soon after conception, and proceed with such activity as to cause the woman very considerable pain from the tension of the integuments, which, in consequence, sometimes suffer structural alteration; and, in a few instances, I have known inflammation and abscess ensue; some time since, a lady in the fifth month of pregnancy, told me that she suffered such distress from the swelling and painful state of her breasts, that she was obliged, several times a day, to expose them to the heat of a fire, while she rubbed them with oil, from which proceeding she experienced more relief than from any other; in others, the changes are hardly perceptible until gestation is far advanced, or even drawing to a close. In general, however, we may expect to find these sympathies (except the secretion of milk) becoming developed when two months of pregnancy have been completed; but any opinion, deduced from their existence, must be modified by several considerations. We must recollect that the changes of form and size may be the result of causes unconnected with conception. In many women, the breasts enlarge merely in consequence of marriage, and the habits thence arising; in others, it may happen from the person becoming fat; it may be caused by accidental suppression of the menses, or their retention by an imperforate hymen,' or other causes capable of distending the uterus, under which circumstances, especially in women of a sanguine temperament, the breasts often become both hard and painful. The enlargement from pregnancy may, however, in general, be distinguished from that produced merely by fat, by the greater firmness of the breast, and the presence of developed veins on its surface, which also feels more knotty and uneven when pressed by the hand, and a corresponding fulness not being found in the other parts of the body. With some women of an irritable habit, swelling and pain of the breasts accompany each return of the catamenia, especially if they are the subjects of dysmenorrhoea; but under such circumstances, the tension and uneasiness subside on the appearance of the discharge, and, in two or three days, have altogether ceased; whereas, that caused by pregnancy continues to increase, except when the ovum happens to be blighted, in which case the breasts become flaccid, and lose the characters which they had previously assumed. It not unfrequently happens, that, in women of weakly and delicate constitution, very little change can be observed in the breasts till pregnancy is far advanced, or even up to its termination; I, some time since, attended a lady whose health had been delicate during her pregnancy, and no perceptible change took place in the breasts until the fifth day after delivery. Gardien asserts that the swelling of the breasts is not ob servable in women who menstruate during the early months of pregnancy; and Mahon3 makes the same observation. I cannot undertake to affirm how far this may be correct, as a general rule, but I have observed that when women have irregular hemorrhages during gestation, especially with placental presentation, the mammary sympathies are in general very feebly exerted, 1 See cases noticed in the preceding chapter, pp. 82, et seq. 3 Médecine Légale, tom. i. p. 151. thus rendering a doubtful case still more so by such a combination. (See case of M. S., p. 106.) It should also be recollected, that such a condition of fulness of the breasts may be natural to the individual, or it may take place at the turn of life, when, the menses becoming naturally suppressed, the person grows, at the same time, fatter, and the breasts, under such circumstances, become full, and are not unfrequently painful, a sero-lactescent fluid exudes from the nipples, and, irritability of stomach being at the same time experienced, the woman believes herself pregnant. There is, however, one of those changes which, if carefully observed, is of the utmost value, as an evidence of pregnancy, which, according to my experience, can alone produce it, in its perfect state-I allude to the altered condition of the areola. The Areola.-The alteration which takes place in that part of the breast which immediately surrounds the nipple, and is called the areola, appears to me not to have received, until within the last few years, that degree of notice which its importance merits, as being one of the most certain external indications of pregnancy, arising from the operation of sympathy. On this, however, as on many other points connected with this investigation, a very marked difference of opinion exists; for while some suppose, with Denman, that the alteration in the areola "may be produced by any cause capable of giving to the breasts a state resembling that which they are in at the time of pregnancy,' many others of equal authority maintain the opinion of Smellie and William Hunter, who regarded it as the result of pregnancy only; an opinion in which I entirely concur, and think I shall be able to show that much of the discrepancy of opinion on this subject has arisen from want of sufficient care in observing, and accuracy in describing, the essential characters of the true areola. Most of those who have noticed this change appear, from their observations on it, to have attended to only one of its characters, namely, its color, which is, in my opinion, the one, of all others, most liable to uncertainty. I should here perhaps except the description by Roederer, which is by far the most accurate I have met with: "Menstruorum suppressionem mammarum tumor insequitur; quocirca, mamma crescunt, replentur, dolent interdum, indurescunt: venæ earum coeruleo colore conspicuæ redduntur, |