vi PREGNANCY PARTURITION PUERPERIUM 243 



upwards aiid outwards. In many cases of pregnancy the resulting 

 pressure on the heart produces accidental cardiac murmurs, which 

 are no longer heard after parturition. 



The raising of the diaphragm in pregnancy also causes a 

 displacement of the lungs, by which the transverse diameter of 

 the thoracic cavity becomes larger and the vertical diameter 

 smaller (Dohrn). The diminished downward movement of the 

 diaphragm and hence of the lungs also should bring about a 

 considerable diminution of the pulmonary capacity during in- 

 spiration ; this effect is, however, completely balanced by the 

 increased activity of the muscles of the thorax (Vejas). 



The progressive development of the uterus and foetus during 

 pregnancy is naturally associated with a corresponding modifica- 

 tion of the whole exchange of material in the mother. The woman 

 gradually increases in weight, even when the quantity of food 

 taken daily does not exceed the normal. Hence it follows that 

 the gravid state increases the capacity for digesting and utilising 

 food. From exact records of the increase in weight from the 

 beginning to the end of pregnancy, Gassner concluded that 

 during this period not only do the weights of the foetus and the 

 genital apparatus increase, but also the bulk of the other organs 

 and tissues. 



The excretion of urine increases in a marked degree during 

 pregnancy, especially towards the fifth month. It is a simple 

 polyuria, accompanied by a diminution of the specific gravity of 

 the urine. The production of urea, uric acid, sulphates, phosphates, 

 and chlorides varies within physiological limits. 



The total quantity of nitrogen discharged in the urine and 

 the faeces during pregnancy does not exceed the normal ; this 

 signifies that a considerable part of the protein taken serves to 

 augment the weight of the maternal and foetal organism. 



A certain accumulation of fat, which is specially noticeable 

 in the hepatic cells, is also found in pregnant women (Miotti). 

 The glycogenic content of the hepatic cells also increases (Charin 

 and Guillemont). 



The glycosuria which is sometimes noticed is not more marked 

 than that which is physiologically accounted for in normal man 

 (Leduc). At the end of pregnancy, when the secretion of milk 

 begins, lactosuria replaces glycosuria (Leduc, Brocard). 



The urine very often contains albumen during the second half 

 of pregnancy ; it increases in quantity up to the time of parturi- 

 tion and then rapidly disappears. This phenomenon leads in 

 many cases to a degenerative change in the renal parenchyma 

 (von Leyden), which is usually attributed to various mechanical 

 factors or to a form of auto-infection due to the change of meta- 

 bolism, or even to micro-organisms. 



During the second half of pregnancy epithelium from the 



