Some Aspects of the Early Months of Pregnancy. JOHN B. McCook, M.D., HARTFORD, After doing a little obstetrics, one is impressed by the unexpected and abnormal way certain women behave. I except those who have an antecedent lesion of some organ or bodily deformity. Some of these women begin to vomit and in spite of all we can do they keep on vomiting, some more, some less, some in the orthodox morning fashion, others irregularly throughout the day. Then there are those who become anæmic with the usual signs and symptoms of anæmia,—and this with ordinary care and with no anæmia, so far as we can ascertain, before pregnancy. Others become hyper-nervous, and developing into the neurasthenic or melancholic pass beyond the limits of safety and appear to be saved from mental unbalance only through the interposition of nature or the physician. Still others, after sleeping and eating well, voiding a fair amount of urine, suddenly, in a few days or a few hours, pass from the category of the well into that of the acutely sick,-the transformation coming through no marked indiscretion in eating or drinking, through no intercurrent infectious disease. All these women have pelves within the recognized limits and have no discoverable organic lesion, and yet they have a pathological pregnancy. I do not think that by any means in our power we can make these women pass through an absolutely normal pregnancy, but I do feel that by a more careful examination we may take a few out of our normal class to start with, and that by listing them a little in our own minds, we may at least be taken less unawares when they begin to misbehave in one way or another. All I shall attempt in this paper is to set down my impression of these women so as to make them fall into groups, and then sketch the manner of examination that has proved most helpful to myself. L* Those who have had a chance to strip many men and see them later perform as athletes or as soldiers get to have a certain feeling about a particular individual-that he will be a good resister or the reverse. Almost another sense seems to be developed. Mike Murphy has this power as much as anyone I have ever seen. His findings are not assisted by instruments of precision, save only Nature's, yet it would be unwise to largely back a variance from his deductions. Few of us are likely to become medical Mike Murphys, yet the more searching our examination and the more we observe small details of bearing as well as anatomy, the more will we intuitively say to ourselves, "This woman is a poor resister and needs to be watched; that one should go through." The following are the five groups into which these poor resisters fall. Many, of course, show the imperfection of this nomenclature by belonging in several. 1. Taller than the average, a good deal under weight, but graceful movers, decidedly athletic, pelves within the limits regarded as normal. On careful examination and observation, they are found to have chests broad rather than deep, and they are nervous. The complexions are mixed, though most fall at either extremes of blonde or brunette. 2. Medium, both in height and weight, pelves negative, complexions negative, not well developed as to chest; hair on arms, legs and shoulders approaching in texture and manner of growth the tubercular type. Yet these do not come down necessarily with lung trouble during pregnancy. 3. Those with pelves above the average, though the measurements are harmonious. Squat build and overweight, muscles hard, in fact, they look immensely powerful, and not nervous. Yet without marked eye symptoms, they show, as a rule, some nervous eye sign, such as an occasional rolling of the eyeball. This class is composed almost wholly of brunettes. 4. The blonde type. Above the medium in height, good weight, pelves negative. Active in habit; in fact, often athletic. Skin a bit too transparent and approaching the dermographic type. Seemingly of composed demeanor, but on more intimate acquaintance, it is found to be the outcome of complete selfcommand. This type fails nervously. 5. Nothing marked in height, weight or complexion, no special deficiency in flesh, but of poor muscular and skin tone. They have a sodden look about the skin of the abdomen especially. Their pelves, livers and kidneys are negative. The urine is of good quality and fair amount; an over-acidity is about all I can find fault with. Yet in this class fall most of the eclamptics. This whole subject of anaphylaxis is just beginning to be approached scientifically by the medical profession. The thyroid has yielded something, and when we get to know our other so-called ductless glands, we may have our reason for many of the inexplicable results cropping up after surgical and other forms of trauma. In the meantime, a careful observation of the woman, a study of her past history and of her family history, will, I think, fully repay the obstetrician. The examination of women is more difficult in most ways than is that of athletes or recruits, but with the family history and personal to help out, the balance is not so greatly to their disadvantage. We must approach the subject with the resolve that whatever we do must be only an assistance to our patient; we must never frighten, much less should we be the means of setting up a train of thought that may end in a pathological mental state. The nervous and psychic side appears to be especially stimulated by pregnancy. Just as in many of the domestic animals, we see the first signs of pregnancy in a change of disposition more than in any bodily alteration. In women, the change nervously is generally of a depressive nature. Their minds seemingly retain and reproduce every exaggerated happening in the pregnancy of friend or mere acquaintance. For this reason, as well as for others, it is important to make the examination as routine and impersonal as may be. Incidents and symptoms of a nervous type cannot be personally gone into deeply, and yet I think it is of the greatest importance, not only for the sake of arriving at just conclusions but also for the very object of set |