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The Human Atmosphere, by Walter J. Kilner, [1920], at

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IT is not uncommon for a patient, after she has missed one or two periods, to ask a medical man "am I pregnant?" Delay in answering is not always acceptable. The difficulties in arriving at a correct conclusion in very early pregnancy are great, so that any fresh method that can aid diagnosis will no doubt be appreciated. It must be understood that no single sign of pregnancy, as described below can be accepted by itself, but that when more than one sign points in the same direction, either one way or the other, an almost certain opinion may be expressed. There are three distinct signs made manifest by changes in the aura; two are arrived at through the investigations by c.c. bands, and the third is a slight alteration in the shape of the auras and in their texture.

When inspecting an aura to determine whether an early stage of pregnancy exists, the first step in the examination is to ascertain if the shape of both auras be normal by the sides and back, and note their widths, especially the inner aura over the various parts of the body. This supplies a standard by which the measurements over the front of the body can be compared. As a rule a woman in good health and not enceinte, will show the two auras of the same width all down the front of the trunk, with the occasional exception that they may be a little wider in front of the breasts when a menstrual period is at hand. In almost every case of early pregnancy the outer aura is slightly but definitely wider at the lower part of the abdomen, the alteration commencing a short distance

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below the umbilicus; in the later stages this enlargement extends higher up. At the same time there is always an increase in front of the mammæ, which is best observed when the patient does not stand completely sideways, but only sufficiently to permit the breasts to be silhouetted one at a time against the background. When the position of the woman is such that the best view of the aura before the breast is obtained, a small ray proceeding from the nipple is often seen. In addition to the extra breadth, the aura frequently appears denser in texture.

The inner aura also participates in the alteration at the same places as does the outer. Its breadth is a little increased in the early stages of pregnancy, but not to the same extent as at a later period, and its opacity is a trifle greater, and what is extremely important, striation remains unchanged. Each case must be fully investigated and judged on its own merits, as owing to individual differences no fixed standards for auras can be laid down.

It has been constantly noticed during the inspection of a pregnant woman, that the aura is not so distinct as is usually the case in health. For some time this was attributed to various causes, such as bad light, etc., until it had been observed so frequently that there could be no doubt about its connection with the patient's condition. Looking over the different records, this decrease of brilliancy occurs in a considerable percentage of cases, so that it may be accepted as an auxiliary sign of pregnancy, and it.; presence may assist in forming an opinion in a doubtful instance

After the preliminary inspection the observer next proceeds to tests with the c.c. bands. For this part of the examination the woman should first stand facing the investigator. The vertical c.c. band will then be perceived uniform throughout its length if she be in good health and enceinte. Special attention

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must be paid to the portion of the band upon the lower part of the band near the pubes. This is of importance in ascertaining that the woman shows no sign of impending menstruation. When the c.c. band is used transversely over the breasts, the colour in women, who are neither enceinte nor nursing an infant, nor suffering from any affection of the mammæ, is naturally even (except over the areolæ and nipples), not only on the breasts themselves but also on the adjacent parts of the body. During pregnancy and lactation, the colour not uncommonly becomes paler over the mammæ. The lighter tint is due to a modification of the aura similar to that already considered in chapter viii. This alteration has no significance in itself, but affords valuable corroboration that a change has taken place in the breasts. When a transverse c.c. band is projected upon the epigastric and hypogastric regions, an alteration of colour is rare, even though the patient may be suffering from nausea and vomiting, pointing to the fact that the gastric disturbance is not so dependent upon local derangement as upon some more general influence.

Case 70 is an instance somewhat analogous to stomach troubles during pregnancy. Should, however, a woman have been suffering from some definite gastric trouble previous to gestation the above statement will, of course, not hold good. No further assistance can be obtained from the c.c. bands when employed upon the front of the body.

Allusion has been made to the fact that the majority of women in the prime of life show a change in the aura over the lumbo-sacral region of the back, when the c.c. band is darkened or even changed in hue. This patch nearly always vanishes from the sacrum during pregnancy, generally during the early stages. However, if the prospective mother suffers from more than the average amount of pain during menstrual periods, the patch will therefore be usually darker, and in consequence

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will persist longer; but in any case it generally disappears before the fourth month. But should this discoloured area be due to any other cause, such as rheumatism, gestation will exert no influence upon it. The presence of this patch rather militates against the probability of pregnancy. Absence of this mark in a woman who is known to have previously had it, or to have suffered from a considerable amount of backache during her monthly periods, is a very important if not an absolute sign of pregnancy, unless it was due to some other cause which has been removed.

When the transverse c.c. band is employed upon the lowest part of the abdomen, with the patient standing sideways, the colours of the extensions are often dissimilar. If this happens, the one in front of the abdomen is more likely to be lighter than that at the back. This is due to some such alteration of the aura as has been discussed previously, and is of positive value unless some change was detected in the preceding examination of the abdomen, with the patient facing, is the cause of the variance.

To sum up, the early signs of gestation as shown by the aura are:

1. A slight increase in the size of the aura at the lower part of the abdomen and in front of the breasts. The inner, too, may be a little wider, but it always retains its striation perfect.

2. The c.c. band shows no discolouration on the lower part of the abdomen. A coloured patch over the stomach is unusual, unless there was previous gastric trouble. The band is often lighter over the breasts.

3. Absence of the dark area on the lumbo-sacral regions.

4. A general indistinctness of the two auras may be added as an auxiliary sign.

The following is the earliest case of pregnancy the writer has had the opportunity of inspecting.

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Case 86. C., a married woman thirty-three years of age, the mother of two children, having missed one period, was desirous of knowing whether she was to expect another baby. She was not a very strong woman, but at the time was in good health. There were good reasons for knowing that she could not have been pregnant for a longer time than thirty days at the most. She had been suffering from pain across her loins especially when tired, and even at the time of inspection was not quite free of it, but usually had none during menstruation.

The outer aura was distinct and the inner below the average, but striation could be easily distinguished. As she stood facing the observer, the outer aura was ten inches round the head, twelve by the trunk, and contracted to four by the ankles, being of a good ovoid shape. In addition a perceptible ultra-outer aura was present. When she turned sideways, the haze exhibited a slight bow-shaped bulge at the small of the back, commencing at the head and ending at the feet. In front of the trunk the general width was four inches, but before the lower part of the abdomen increased to six, and over the breasts to above five inches.

The inner aura was barely two and a half inches wide all over the body, except in three places, viz., in front of the lower part of the abdomen, at the small of the back where it was three inches, and in front of the mammæ, where it was nearly as broad.

The vertical c.c. band was uniform in front of the body, but the transverse showed paler areas over the mammæ. At the back there was a large dark patch on the upper part of the sacrum which reached nearly as high as the second lumbar vertebra.

In this instance all the changes from normal were those that might have been expected in early pregnancy, with the exception of the dark patch on the sacrum, which was accounted for by the rheumatic

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pain, so an unqualified opinion was given that the patient was pregnant. A child was born at the proper time.

Case 87. K., a lady twenty-nine years old, who had been married two years and hoped that she was pregnant as she had missed one period and a second was almost due. With the patient facing, the outer aura was ten inches round the head and trunk, gradually diminishing to five by the ankles. Sideways, at the back it was seen to be four inches at the level of the shoulders and nates, with a slight bulge in the lumbar region, and in front its normal width was four inches, but there was a small increase in front of the breasts, and another at the lowest part of the abdomen. In these places the inner aura looked opaque and in consequence more distinct, but striation was clearly visible. Over the whole body the inner aura was two inches in breadth, even, and displayed lineation. The extension of the c.c. band in front of the abdomen was lighter than at the same level at the back. When she again faced the investigator, the vertical c.c. band appeared uniform all down the front, except over the mammæ, where it was paler than the neighbouring portions of the body. There was no alteration in tint over the gastric region. Over the back the colour was not altered in any part. The lessons learnt from this case are, first, that the woman did not show any signs of approaching menstruation although it was just due; next, that the aura disclosed the fact ti at there was physiological activity going on in the breasts, and under that part of the abdomen near the pubes. There was no doubt about the case being one of gestation.

The lady, whose aura was described in case 49, believed herself to be pregnant after missing two monthly periods. When examined a third was nearly due. However, there was no alteration in the haze in front of the right breast, nor any increase by the lower part of the abdomen, neither was the c.c. band

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deeper in shade above the pubes, while on the back a prominent dark patch was visible on the sacrum.

In this case the only sign of pregnancy was the absence of discolouration above the pubes when the abdomen was examined by means of the c.c. bands, at a time when such ought to be usually present. The diagnosis made was that gestation was out of the question, and that menstruation would not supervene for four or five days at least, but the date could not be foretold. As a matter of fact it commenced seven days after inspection.

As pregnancy progresses the changes in the aura in front of the mammæ increase, but vary in extent and do not altogether correspond with those in front of the abdomen. The expansion is not confined to the outer aura, as in most instances the inner becomes wider. Even when the inner aura remains stationary in size, it becomes more opaque than the neighbouring parts, showing that the glands are preparing to take on their special functions. There is very rarely any difficulty in determining whether the inner aura in the vicinity of the breasts has enlarged, because comparison is so easily made with the adjoining parts above and below. Although it may look to the naked eye finely granular, yet the intervention of a dark carmine screen will disclose the striated appearance of health. The auras of a woman who has reached the fifth month of gestation will be broader than during the early stages, and may continue to expand until the time for the birth of the child approaches.

The auras of women after the fourth or fifth month may be divided into two classes, which although not very unlike yet show a difference which is by no means artificial, and in the future may lead to important results. In one group the broadest of the aura is not so wide as in the second, while the shape is more regular, and follows with greater exactitude the contour of the body, but usually attains its maximum size 

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beneath the projecting abdomen. When such an aura is viewed with the patient standing sideways, through a deep carmine screen, it will be found that the inner aura is also slightly enlarged all over the abdomen.

In the second group the auras are wider and more distinct in front of the most prominent part of the abdomen, giving rise to the "conical aura," which often gives the impression that it is more extensive than really is the case. When the two auras are separated in the ordinary manner, the inner will also be found to be more or less conical, being a little wider at the base in front of the most prominent part of the abdomen, but hardly to the same extent as the outer. This is a good instance of the inner aura growing larger and subsequently diminishing, as it resumes its natural size after parturition.

With the c.c. bands the whole of the breasts, except the areolæ and nipples, will usually appear lighter than the neighbouring parts of the body, in whatever position the patient may be placed.

This band when projected upon the thorax and abdomen may be even in colour, but when the inner is conical it is often lighter on the front of the abdomen. If a woman, who shows a conical aura, is examined with the transverse c.c. band (antero-posteriorly), the extreme point of the distended abdomen is generally paler, and the front extension is lighter than the back extension. In the first group of cases the latter only occurs.

The paleness of the colour over the breasts and abdomen when associated with enlargement and definition of the inner aura, indicates the probability that some alteration in the aura itself has taken place, and is a good example of the statement that "a change in the texture of the aura is a sufficient cause to produce an alteration in the tint of the c.c. band." (Vide chapter vi.) The following is a very interesting and instructive case.

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Case 88. Mrs. T. was pregnant for the fourth time. Inspection took place soon after she had reached the sixth month of gestation. The history was that she had been feeling exceedingly well during the whole of the period until the last three weeks, when she was suddenly roused from her sleep by a row in the house. From that moment all movement of the child ceased, and the abdomen decreased in size, although previous to the upset the movements of the infant had been uncomfortably active. She was depressed thinking that the baby was dead.

The aura at the sides and back were normal in every respect. In front, as she stood sideways to the investigator, the inner aura was about three inches all down the thorax and lower extremities except that it was a little more pronounced in front of the nipples. Before the prominent abdomen it had increased in width. The outer aura was about four inches down the whole of the front, except over the abdomen, where it was conical and eight inches in breadth. The main interest was centered in the inner aura. This above the sternal notch and down the legs and thighs was finely striated in the usual manner. The part before the lowest part of the abdomen was distinctly and coarsely granular, while in front of the upper two thirds it was roughly striated and well marked. Here it was in the transitional stage between the granular and naturally striated states. Thus it could be seen that the aura was normal all round the body, with the exception of the part in front of the abdomen, where it was pathological. The c.c. band disclosed nothing unusual, but it may be worth stating that it was lighter on the left breast and darker on the right than the remaining portion of the band, while at the same time the extensions were even. The explanation of this effect happened to be quite easy, because the shade on the left breast is that which was common during pregnancy, but the right breast was distinctly

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pigmented. Being healthy it did not affect the extension beyond the body.

It was thought that in this case a diagnosis of a dead child would be justified. Subsequent to the inspection of the aura, the uterus was palpated, and was found to be softer than usual at the sixth month of gestation No signs of any uterine souffle nor of fœtal heart-beats could be distinguished. Two months later she was delivered of a dead child.

In conclusion the writer is conscious of many shortcomings which he hopes his readers will overlook. The whole subject is fraught with vast difficulties, not merely in practice but in description, as there are a large number of minutiæ, very important, which is almost impossible to put into words. He has tried to be as free from ambiguity as possible, but at the same time feels that he has by no means done justice to the subject. Time after time new phenomena have come to hand upsetting previous ideas, and compelling him to begin afresh. He is positive that some of the hypotheses which have been advanced to assist progress will have to be rejected. He is firmly convinced that the study of the aura physically will gradually come to the fore, as one of the aids to diagnosis. Investigations upon the aura open up a large number of questions for future observers.

To him the study of the aura has been a labour of love, but the main object, which is to help medical diagnosis, has been perpetually kept in view. He will be quite satisfied if true science has been advanced even a little.

He cannot finish without thanking his many friends for their kind aid, more especially those who have put themselves to great personal inconvenience to forward his researches.