nancy, the movements sometimes become so violent as to produce
perceptible movements of the womb and the abdominal muscles, and sometimes
they are the cause of the pain.

The Blood.--The blood is increased in quantity and slightly altered in its
composition. The water, fibrin and white corpuscles are increased; the red
cells are at first relatively diminished, but later return to normal.

Nervous System.--The nervous system is over sensitive and the disposition
of the woman may undergo a radical change, mental exaltation and
depression are often exhibited.

Constipation is the Rule.--Neuralgias in different parts of the body,
especially in the face and teeth, are common. Palpitation of the heart and
difficulty in breathing may be experienced. A discharge from the vagina is
almost always present, due to the increased circulation in the cervix and
vagina.

The Foetal Heart-beat.--This is the one positive sign of pregnancy and it
may be heard as early as the sixteenth to the twentieth week. It has been
compared to the ticking of a watch under a pillow. It ranges in frequency
from one hundred and ten to one hundred and fifty to a minute.

[OBSTETRICS OR MIDWIFERY 519]

Pelvic Signs.--As early as the first month of pregnancy a faint violet
color of the anterior wall of the vagina just below the opening of the
urethra may be distinguished. In the third month this color has become
purplish and pronounced. This sign is present in eighty per cent of cases.
There is also a more or less marked lividity of the vaginal portion of the
cervix from the first month of pregnancy. Also there is softening of the
cervix as early as the sixth week, and as pregnancy advances the whole of
the cervix is softened.

Duration of Pregnancy.--This is for all practical purposes two hundred and
eighty days.

How to Determine Date of Confinement.--The best rule is to count backward
three months from the first day of the last menstrual period and add seven
days to it. To be more accurate, in April and September only six days
should be added; in December and January, five days; and in February, four
days.

Position of the Womb.--At four months the top of the womb has risen above
the pelvic brim bone in front; at five months, it is midway between the
bone (pubic) and the navel; at six months, it is at the navel; at seven
months, it is four fingers breadths above the navel; at eight months, it
is midway between the navel and the bottom of the bre