Gynecological diagnosis . regnancy. Themammary signs are among the earliest of the indications of preg-nancy and are especially valuable as indicative of the probablecondition in the case of the unmarried where it is necessary forthe physician to proceed with caution. A physical examination ofthe chest gives opportunity to inspect the breasts, and their showingsometimes warrants further investigation. Inspection of the Vulva and Vagina.—On separating the labia the 422 NORMAL UTERINE PREGNANCY vagina will be found to be abnormally moist and covered withwhitish shreds of desquamated epithelium,
Gynecological diagnosis . regnancy. Themammary signs are among the earliest of the indications of preg-nancy and are especially valuable as indicative of the probablecondition in the case of the unmarried where it is necessary forthe physician to proceed with caution. A physical examination ofthe chest gives opportunity to inspect the breasts, and their showingsometimes warrants further investigation. Inspection of the Vulva and Vagina.—On separating the labia the 422 NORMAL UTERINE PREGNANCY vagina will be found to be abnormally moist and covered withwhitish shreds of desquamated epithelium, and the anterior vag-inal wall just under the urethra shows a dusky, purplish discolora-tion sometimes called Jacquemins sign because first noted by thisauthor in 1837. The discoloration is to be seen first in the bottomsof the furrows of the mucous membrane, therefore it is well to putthe anterior vaginal wall on the stretch. This sign may be apparentas early as the end of the first month and is present in over half of. Fig. 177.—Diagrammatic Side View of the Pregnant Uterus of the Sixth Week,during Relaxation. (After Dickinson.) all cases by the end of the third month. It is more distinct in mul-tipara) and is more apt to be absent in primiparse. Speculum examination of the upper vagina shows the cervix tobe of a purplish color, soft to the feel, and in primiparse the ostincsc becomes rounder. Erosions arc of a deeper purple color thanthe surrounding tissues. Many observers consider the discolorationof the cervix an earlier and more constant sign than Jacqueminssign. As congestion of vagina and cervix may be found in pelvicdisease, such as large ovarian and uterine tumors obstructing thevenous circulation, and in certain constitutional diseases, as heart FIRST THREE MONTHS OF PREGNANCY 423 disease and cirrhosis, the physician must be on his guard. Thetypical discoloration of pregnancy is, however, limited to the loweranterior vaginal wall, about the lower urethra, and to
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectwomen, bookyear1910
