of the abdomen; in the first two months of pregnancy the abdomen is flattened and the umbilicus is depressed; after this the abdomen begins to enlarge.  There is also an increase in the size of the breasts, with a deepened color of their areolae and later a watery secretion.  The external genitals become swollen and of a bluish color.  Feeling of the fetal movements—­ that is, the movements of the small parts of the child in the womb—­ by the mother is not always reliable, since gas in the intestines has sometimes been mistaken for this.  These signs are more valuable when several exist together.

The nausea and vomiting of pregnancy, the so-called morning sickness, consists of nausea accompanied often by vomiting or retching of a glairy fiuid, showing itself most frequently on rising in the morning, but sometimes appearing after breakfast.  It is aggravated by the assumption of the erect position.  It may begin within a few days, but as a rule it does not show itself until the fourth week of pregnancy; and it generally ceases about the fourth month, rarely persisting throughout the entire time.  In the majority of cases it does not sensibly impair the health.  It is a sympathetic disorder reflected from the uterus; it is aggravated by indigestible food, by sexual excitement, and by emotional disturbances; it is most marked in first pregnancies and in women of highly emotional natures.  It is not infrequently due to some inflammation of the uterus or erosion about the external orifice, and disappears on the removal of the cause.

Mammary Changes.—­ During pregnancy the mammary glands are in immediate sympathy with the growing reproductive organs of the pelvis; consequently a genuine physiologic enlargement commences in these organs from the beginning of gestation.  Their glandular structure becomes larger, fuller, and firmer; a sensation of weight or pricking is felt by the patient; the veins become more prominent.  The nipples also become enlarged, more elongated, and somewhat erect.  Surrounding the nipple is the areola; this becomes darker in color.

In most women a drop of watery fiuid, the so-called colostrum, may be squeezed out from the nipple at the end of the third month of pregnancy.

The signs of pregnancy are divided into the presumptive, the probable, and the positive.  The presumptive signs are:  menstrual suppression, morning sickness, irritable bladder, mental and emotional phenomena.  The probable signs are:  mammary changes, abdominal enlargement, changes in the neck of the womb, and certain changes which are felt on bimanual examination.  The positive signs are:  feeling the various parts of the fetus, active movements of the fetus, and hearing the fetal heart sounds.

Functional disturbances of the bladder are quite often noticeable in the early part of the pregnancy.  In the first part of the pregnancy the bladder is dragged upon, and later it is pressed upon by the enlarged uterus so that the bladder capacity is lessened and frequency of urination is the result.  In the fourth month, when the uterus ascends into the abdominal cavity, these bladder symptoms subside, until the very close of the pregnancy, when by the descent of the now greatly enlarged uterus there may be even incontinence of urine.