OF TRUE PREGNANCY. 131 



343. *As to the bruit de souffle, its- nature is still too little under- 

 stood to enable a circumspect practitioner, at present to pronounce 

 from its single testimony that such or such a woman is or is not 

 pregnant. 



343. To determine the stage of pregnancy. After having by 

 means of the simple touch, of ballottcment, of muscular movements, 

 or of auscultation, ascertained that there is pregnancy, it is still fur- 

 ther useful, sometimes, to determine its stage; on this subject I shall 

 not repeat what has already been said concerning the changes ef- 

 fected every month in the state of the cervix, the body and fundus of 

 the womb; I shall content myself with remarking that, in order to 

 obtain a just idea of these changes, especially those of the neck, it is 

 often needful to touch in a diflerent manner from that in which it is 

 commonly done. In the first place we are not to understand by 

 the neck that portion merely of the womb that projects into the 

 vagina, but rather all the cylindrical portion of the summit of the 

 uterine ovoid, a kind of appendix which cannot be completely felt 

 except by pushing back the vaginal cul de sac with the finger, in the 

 centre of which is felt the os tincae; in the second place, in women 

 who have had children, we should make an allowance for the thick- 

 ness of its lips; lastly, when the uterus is oblique in front, and the 

 pelvis not very large, the orifice may be so high up, that in order to 

 reach it, the radial side of the finger must be turned backwards, or 

 the perineum somewhat depressed, while with the other hand ap- 

 plied upon the epigastrium, the fundus of the womb is thrust back- 

 wards towards the vertebral column. In other cases, particularly 

 where the superior strait is very ample, the neck looks directly to- 

 wards the anterior surface of the sacrum; to touch here, we are 

 obliged to carry the finger almost horizontally backwards, and then 

 to bend it forwards in the shape of a hook; in other women we meet 

 in the superior half of the excavation, a rounded tumor, in the pos- 

 terior part of which the neck appears to be obliquely hollowed out 

 like the ureters in the parietes of the bladder: with all these precau- 

 tions, a skilful accoucheur can say, what is, within from fifteen to 

 thirty days, the period of pregnancy; but it would be dangerous to 

 forget that there are numberless causes of error, and that we should 

 never, before a court, give a decisive opinion until we have previ- 

 ously acquired a mathematical certainty of the fact concerning which 

 we have to pronounce. 



344. Compound pregnancy. It was natural to suppose that the 

 uterus would be larger when containing two or more children, than 

 when it encloses only a single one. Hence also almost all those 

 appearances that depend upon the pressure upon and displacement 



