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Full text of "Medical Jurisprudence And Toxicology"

296                                                MEDICAL JURISPRUDENCE

to increase in size. The superficial veins are se-en more distinct and
enlarged. The nipples are harder, firmer and more prominent, and the
areolae surrounding them become wider and darker. By the third month
a clear, transparent secretion can be squeezed out of the nipples on pressing
the breasts. This contains colostrum or milk, as pregnancy advances.
Milk has, however, appeared in the breasts of women who have not been
pregnant. Jago5 reports a case in which a woman, who had never been
pregnant, had a copious flow of milk from her breasts, and suckled a child
of another woman. David Krestin6 also reports the case of an unmarried
woman, aged 25 years, with hymen intact, who had enlarged breasts, which
yielded milk on compression due to enlargement of the pituitary fossa.

After the sixth month silvery lines or striae similar to the linea?
albicantes of the abdomen are seen especially in^^prEnlparae on account of
the stretching of the skin.

All these changes may occur from various uterine and ovarian diseases.
Sometimes, they also occur independently of pregnancy when women have
reason to expect it shortly after marriage or after illicit intercourse.

Rarely, pregnancy may occur without any changes in the breasts, or the
breasts may even diminish in size after the middle of pregnancy.

These changes are also of very little diagnostic value after the first
pregnancy as the areolse retain their colour permanently, and the secretion
of milk from the breasts is more or less permanent.

2.    Pigmentation of the Skin.—This is well marked in dark women. The
abdomen, axillae and pubes become darker due to the deposit of pigment,
and a special dark band   (linea nigra)   is   observed extending from the
ensiform cartilage to the pubes.

3.    Changes in the Vagina,—-After the fourth week of pregnancy the
normal ginMshcolour of the mucous membrane of the vagina and vulva
changes to^vIoIeX deepening to blue, as a result of venous obstruction owing
to pressure of the gravid uterus.   This is known as Jacquemier's sign, as
it was first described by him.   This sign may, however, be found just before,
as well as immediately after, menstruation.

The anterior wall of the vagina is found flajtgned. This results from
backward traction by the upward tilted cervix, and has been described by
Dr. Barnes as a sign of pregnancy.

When introduced into the vagina the fingers may feel the jnil§£|tion of
the vaginal arteries consequent on the high arterial tension of the pelvis.

4.    Changes in the Cervix Uteri.—From the very first month of preg-
nancy the cervix which is normally as hard as the tip of the nose begins to
soften from below upwards, and is felt as soft as the lips.   By the fourth
month this softening can be very well felt by the fingers introduced into the
vagina.   This is a diagnostic sign of pregnancy, and is known as GoodelTs
sign, though certain morbid conditions, such as  acute  metritis,  hsemato-
metra, etc, may produce softening of the cervix.

As softening continues, and involves the whole, neck of the uterus, there
is an apparent shortening of the cervix towards the last months of
pregnan&y. The orifice, instead of being transverse, becomes circular, and
admits the point of the finger more readily, and to a greater depth.

5.   Softening wA Compressibility of the ILower Segment of the Uterus.

—This is known as H&gat's sign,, and is elicited by bimaimal examination,
It is regarded as a Yafeable sign, <rf earZy pregnancy         tfaes^copd tothe

5.   Kenya and Eosl jyStat, ifeck Joitr^ July 19££7r p. 144.

' ~ •' *"         T*       of ^aWttjtf"Sbc-,o]f J^ei, April 1^2, p, €93^