A peculiar case came to hand a short time ago of a middle-aged woman, and I will give it as it appeared to me. Such cases are, I believe, rare, it being the first I have seen or, in fact, heard of, in my practice of over twelve years; to the younger members of the profession it will be interesting if not instructive, and perhaps the older ones may learn something from it.
The case is as follows: A woman of forty years of age presented herself at my office for consultation in regard to her confinement, which she said would be in about six weeks, she at the time being in her eighth month of pregnancy, basing her calculation on the fact that for four months she had felt the movements of the foetus, and learning that this was not her first pregnancy, I thought she knew what she was talking about.
After questioning her I elicited the following:
She had menstruated regularly, although when carrying her other children she had stopped, hence this sign was in a measure lost to me, and she being so positive of the motion threw me off my guard.
This was her third pregnancy, the last one occurring about five years before. I questioned her in regard to her symptoms and also examined her breasts. I found these enlarged and swollen, the areola tissue and pigment present, but could not find the colostrums as I wanted, or, perhaps, better, as I expected from her story. I told her I wanted to see her in two weeks, as I was not quite sure that she was pregnant.
At the appointed time she again presented herself for examination. I found by digital examination the uterus was much enlarged and high up. The so presented that peculiar feel of one in pregnancy; I also got ballottement. Abdomen was much distended and bore the appearance of one in the eighth month of pregnancy. She said she had the morning sickness; the smell of food made her sick at the stomach and she frequently vomited. Her breasts were still enlarged and showed the unmistakable signs of gestation, but I could not get the colostrums, which I so much desired to find. The abdomen was very much distended, but did not feel as tense as one in the last month or week of pregnancy.
According to her own time and word she would not be confined for one or two weeks, and I had some doubts whether she was pregnant or not. I, however, told her I would call on her in ten days if not called sooner. Accordingly, at the appointed time, I was there prepared to ascertain what we had, whether a case of pregnancy or pseudo-cyesis. After having all tight clothing removed from her body and about her waist I made an examination. The uterus and so, as I have before stated, and lower down the vagina had the characteristic feel as one in pregnancy, and on placing my hand on the abdomen I could feel a movement like a foetal motion, but no heart sounds could be heard. I tried palpation and could not find any tumour.
Now what had I to contend with? If not pregnancy, certainly it must be pseudo-cyesis. Certainly it looked rather shady for pregnancy, and after much deliberation I decided it was a case of pseudo-cyesis. Now the question that arose in my mind was how was I to prove to my patient’s satisfaction that she was not pregnant. Certainly that must be done, as my repartition was at stake. Surely had I administered ether and placed on a binder I could have proved my diagnosis as correct, but she would not allow ether to be given, nor would the family here to such a thing. Finally I decided to try to remove the trouble with medicine, and hence gave her Plus. And Ignatia. Not being satisfied with the strength which I had with me, I sent her some of the tinctures that afternoon.
In two weeks she again presented herself to my office, and surely here was a change indeed, for she had lost a part of her abdomen, and she said, with a beaming smile; “I am better and am having a good appetite.” Nor was she troubled with the nausea which had been so troublesome I continued the same remedies which she took for one month, when the abdomen was of a natural size; also thee breasts were bleached out as they were before she supposed pregnancy had begun. Two months later she again visited me, and said she thought that there was no doubt of her condition this time, her menses having stopped; and I consider her to be in the fourth month of pregnancy. EDGAR C. GATES, M.D.
