244 PHYSIOLOGY CHAP. 



renal tubules is constantly observed in the urine, also leuco- 

 cytes, and, more rarely, erythrocytes and hyaline and granular 

 cylinders. 



In consequence of the compression of the bladder and relaxa- 

 tion of the muscles of the vesical sphincter, frequent need of 

 micturition and even involuntary discharge of urine, are common 

 during pregnancy. 



In pregnant women a series of changes may be noted for which 

 a cause is not easy to find. Amongst such changes we may 

 mention the abnormal pigmentations of the skin, not only in 

 the external genital organs and the areola of the nipples, but 

 also in the skin of the abdomen, face and limbs, to which the 

 older obstetricians gave the name chloasma uterinum. 



H. "W. Freund has recently called attention to the so-called 

 dermographism as an almost constant phenomenon in pregnancy. 

 A blunt point or the nail of the finger drawn across the skin 

 of the chest or abdomen will produce a red, raised line which 

 may persist for some hours. After parturition this phenomenon, 

 which is also sometimes noticed in hysterical patients, always 

 disappears. 



In about half the cases of pregnant women, from the third 

 month onwards, excrescences or thickenings, termed by Ducrast 

 and Rokitansky (1844) puerperal osteophytes, make their appear- 

 ance on the internal surface of the bones of the cranium. 



The teeth are abnormally friable and sensitive, a fact which 

 is associated with a diminution in calcium fluoride (Terrier). 



The increased bulk of the abdominal contents and the dis- 

 placement forwards of the centre of gravity bring about a change 

 in the carriage of the body, owing to the fact that in order to 

 maintain the line of gravity posterior to the axis of rotation of 

 the hips, the head and shoulders must be thrown somewhat back, 

 thus increasing the lumbar curve. This condition is naturally 

 more marked in short than in tall women, whose larger abdomen 

 affords the foetus more space. 



The organic changes as a whole which are caused by the 

 gravid state tax the functional capacity of the organs to the 

 utmost, causing in delicate or sickly women sufferings which may 

 be of considerable intensity, and belong to the realm of pathology, 

 since they do not occur in really normal women. Slight degrees 

 of hydraemia and leucocytosis, irritability and depression, disturb- 

 ances of the digestive functions, malaise, frequent vomiting, etc., 

 are abnormal phenomena, which occur most frequently in young 

 women and at the beginning of pregnancy. 



V. Parturition is the greatest physiological effort of the female 

 generative organs., as Sellheim justly remarks. 



The mechanism by which the gravid uterus empties itself of 

 its contents, when the foetus has attained the development requisite 



