ovum, the fetal envelopes, or the fetal body; or on the detection of the characteristic fetal symptoms, especially the "fetal heart-sounds," about 140 short, rapid beats per minute, resembling the muffled ticking of a watch, or the soft "funic souffle," heard synchronously with the fetal heart-beats.

A knowledge of the anatomical conditions is essential in making the diagnosis. It is necessary to know:

(1) The size and shape of the fetus in the different months of pregnancy;

(2) The position of ovum and fetus in utero;

(3) The changes in the uterus itself accompanying the development of the ovum, and the manner in which these changes manifest themselves in the different months;

(4) The changes observable in other portions of the genital tract;

(5) The influence of pregnancy on the other organs of the body.

Relative Value of the Signs of Pregnancy.The findings under (1), which emanate from the child, are called infallible signs of pregnancy; those under (3) and (4), emanating from the maternal organs, are called probable signs, while those under (5), which might be observed in the male as well as in the female subject, are classed as unreliable signs. The existence of pregnancy may be considered more or less probable according to the number of signs observed belonging to the last two groups. They acquire importance only when it is impossible to elicit any of the "infallible" signs, as, for instance, in the first month of gestation, or after the death of the fetus, which had escaped recognition by palpation on account of its small size or marked malformation. They must be utilized whenever no fetal murmurs can be heard-as in cases of polyhydramnios, in myxomatous degeneration of the ovum (so-called vesicular mole), in the case of a co-existing tumor, or in ectopic gestation.

The detection of many of these "probable" and "un

FIG. 1. Ovary with Ampulls of Tube. The fimbriated extremity of the tube, loosely held in plus by the ovariopelvic fold of peritoneum, is attached to the broad ligament, although les firmly than the isthmus. The gaping morsus diaboli in s with a stalked hydatid hanging from it; a small cyst is also seen on the fimbria grarica. These structures are present in four fifths of all individuals and represent, when situated in the anterior layer of the broad ligament, the atrophic remains of the transverse tubules of the lower part of the Wolffian body; or they may be pedunculated fimbriae covered with epithelium. The surface of the ovary is grayish-red and presents on its upper margin a structure of similar appearance, which is a Graafian follicle, while several deeper lying follicles can be made out by their bluish color shining through the tunica albuginea. The furrows represent the scars of follicles which have burst and been converted into corpora fibrosa or candicantia. The upper border of the ovary is covered by peritoneum, or rather embedded in a fold of the membrane; the boundary, known as Farre's line, can be seen in the figure (original water-color, natural size).

FIG. 2. Ovary with Corpus Luteum (original water-color, natural size) laid open; underneath, a cyst laid open, with myoma of the uterus. The follicle, which may attain the size of a pea, is ruptured by the internal pressure at the time of the menstrual congestion, the ovum escaping into the peritoneal cavity. The follicle then becomes filled with clotted blood and large cellular elements containing fat and a yellow pigmentthe lutein-cells, derived from the follicular epithelium, or, according to others, from the granular cells of the internal tunic (membrana granulosa), and is then called a corpus luteum. It is often traversed by radiating connective-tissue septa, and the center is occupied by coagulated blood, which may persist a long time and contain hematoidin crystals.

FIG. 3. Longitudinal Section of an Ovary (original water-color, natural size), showing the cortex, in which Graafian follicles in various stages of development are embedded, and the medulla, richly supplied with bloodvessels. The outermost layer is formed by the fibrous tunica albuginca, covered with cuboidal epithelial cells.

reliable" signs of pregnancy must be learned by constant practice, and the search for them should never be neglected. If the physician has had an opportunity of examining the patient before she became pregnant the diagnosis is, of course, much easier, as the size, position, and consistency of the unimpregnated uterus are known. During the first month the picture of a normally progressing pregnancy is obtained by comparing the changes observed at two successive examinations made at an interval of three to four weeks.

These changes affect the shape, size, blood-supply, consistency, color, and specific functions of the organs.

1. DEVELOPMENT OF THE OVUM. CHANGES OBSERVED IN THE ORGANS OF GESTATION DURING PREGNANCY.

The ovary, in which the ova are formed, is an almondshaped organ, measuring from 1 to 2 in. (3 to 5 cm.) in length, partially covered by a fold of peritoneum, the mesovarium, and embedded in the posterior layer of the broad ligament. It is attached to the uterus by means of the ovarian ligament, and to the Fallopian tube or oviduct by means of the fimbriæ, which are covered with ciliated epithelium and form part of the tubo-ovarian ligament. The pull of this ligament gives to the ampulla, which is freely movable, a downward curve, so as to bring its opening, the morsus diaboli or ostium abdominale, nearer the ovary. The free portion of the tubo-ovarian ligament, together with the curved tubal portion of the broad ligament, with which it is continuous, forms a tent-like covering for the ovary-the ovarian sac (bursa ovarii).

The ovary is usually found below the pelvic inlet, in a sagittal plane midway between the superior spine of the ilium and the symphysis, corresponding in height and direction to the iliopectineal line at its center (Waldeyer), and embedded in the posterior portion of the obturator fossa. It is surrounded by the ureter, the internal iliac, and uterine arteries, and lies within the fossa ovarii, which occupies the posterior part of the lateral wall of the pelvis near the margin of the sacrum. At this point it is attached by the suspensory ligament of the ovary, the infundibulopelvic band, which transmits the ovarian vessels. The vermiform appendix usually descends as far as this region, being sometimes connected with the oviduct by a narrow fold of peritoneum, the plica ovarico-enterica.

The surface of the ovary (Figs. 4 and 5) is covered with a single layer of cuboidal epithelial cells, derived from the same source as the large endothelial cells of the peritoneal covering, although there is a distinct boundary-line between them. In the third