months in the case of one who has previously borne children.

The third method, that of adding forty weeks, or ten lunar months, to the date of conception, is too uncertain to be of much practical use. Examination of the patient by an intelligent physician who knows and appreciates the distinctive signs of the several months offers a fourth method of computing the date of pregnancy.

Numerous tables for a rapid computation of the date of confinement have been made. The accompanying table is one much used. By taking the upper figure in each pair of horizontal lines as representing the date of the first day of the last menstrual period, the figure immediately beneath it will represent the probable date of confinement.

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 I 2 3 4 5

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I 2 3 4

67 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I 2 3 4 5 6

7 June.

June

8

9 10 11 12 13 14 15

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 I 2 3 4 5 6 7

July.

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I 2 3 4 5 6 7 Aug.

Sept

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30... 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 I 2 3 4 5 6 ...

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 I 2 3 4 5

7 Oct.

Dec.

Sept.

CHAPTER III.

MANAGEMENT OF PREGNANCY.

The management of pregnancy consists, for the most part, in greater attention to the laws of health. The increased activity of all the organs of the body, together with the disturbances caused by pressure, necessitates this.

Constipation is an almost invariable accompaniment of pregnancy. In the early months it is a sympathetic condition; later, the effect of direct pressure upon the bowels. It is also, undoubtedly, in part due to the want of exercise.

The treatment of constipation is the same as in other conditions, except that only mild laxatives are used. Regularity in attention to the bowels, a glass of cold water at night and again in the morning, liquids (either milk or water), not taken with the meals, but in the intervals, a teaspoonful of common salt in the water occasionally, the use of uncooked fruit and coarse bread, the avoidance of starches and fine flour-all these are helpful in overcoming this condition. There is an objection to the use of sugared fruits, as confections of fruit, senna leaves, etc., because of their liability to disturb.

the stomach. Prunes are, perhaps, the least objectionable; licorice powder, because of the senna which it contains, is apt to cause griping pains. Rhubarb is, perhaps, the best of the mild laxatives. A small piece of rhubarb root, the size of a pea, may be taken at night, followed by a glass of water. If there is an objection to its taste, it may be taken in pill form. Cascara sagrada is also useful.

Cream of tartar, a half a teaspoonful being taken at night in a cup of cold water, is often efficient. In some cases it may be necessary to repeat the dose in the morning.

Massage of the abdomen, so efficient in the management of constipation, should never be resorted to in the pregnant state, as it is apt to excite uterine contractions and may lead to miscarriage. There is an objection to the too frequent use of enemata on the same ground; also, the habit is thus acquired of depending upon this stimulus, and overdistention of the bowel is the result. It may be necessary, however, occasionally to alternate an enema with a laxative, especially when the patient suffers from piles.

Diarrhea is rather a rare disturbance of pregnancy, but it sometimes occurs as a direct result of constipation-small, hardened masses forming in the bowel, known as scybala," which produce an irritation of the mucous lining. The use of rhubarb night and morning, in the manner described above, until all the masses are removed from the bowels, will serve to check the

diarrhea. Should the condition be due to other causes, as indigestion, etc., appropriate remedies will have to be prescribed by a physician.

Changes in the Urinary Organs are mainly due to direct pressure. In the first three months of pregnancy there is direct pressure on the bladder, hence great irritation, due to interference with the distention of the bladder, producing a constant desire to pass water. For this the recumbent position is the only help. The uterus rises in the abdomen at the end of the third month, and the bladder being thus relieved from pressure, this symptom passes away.

The tendency from the fourth to the ninth month is to the accumulation of urine, because there is less than the proper irritability of the bladder, the organ being flattened between the uterus and the abdominal walls, and its walls thereby suffering a partial paralysis.

In the last month there is incontinence of urine, because the pressure is so great that there is no room for the accumulation of urine.

During labor there is pressure upon the neck of the bladder and urethra, leading to retention. This may exist for the last two weeks of pregnancy. Necessity for the use of the catheter is confined, as a rule, to this period. The distention of the bladder may impede labor. With the drawing up of the uterus the bladder is drawn up and the urethra elongated, hence the use of the long rubber catheter, known as the English catheter, will be necessary. Nos. 8 and 9 are those ordinarily used.