OBSTETRIC AUSCULTATION. 
275 
the course of two or three weeks the murmur became gradually 
distinct, and was generally more prolonged as the pregnancy was 
more advanced. The murmur differed in different individuals. 
In some it was of a blowing character; in others of a file-sound ; 
and in some a cooing murmur. The sound was synchronous 
with the pulsations of the arteries in the neighbourhood. 
Writers differed as to the seat of this sound. By some it was 
considered to arise from the pulsations of the blood passing into 
the placenta ; but as it was heard for a short time after delivery, 
and after the placenta had become impervious from the death of 
the child, this explanation was not satisfactory. He believed that 
the sound depended on the circulation in the uterine vessels 
generally. 
An opinion had lately been broached, that the sound depended 
on the pressure of the uterus on one of the iliac arteries. This 
appeared at first plausible; but the facts which had been stated 
by Dr. Evory Kennedy were against it; for when the uterine 
vessels were obstructed by the death of the child, the murmur 
soon ceased, although the pressure of the uterus on the artery 
was not removed. This sound also was very rare in ovarian 
disease. 
Regarding the time at which the sound is to be first dis¬ 
tinguished, Dr. Kennedy had detected it at the tenth week of 
gestation; earlier writers mention a much later period. He had 
heard it at the end of the eleventh week. Now, did this sound 
occur from other causes besides pregnancy ? We knew that 
the pressure of an artery produced a bellows-murmur; but this 
pressure was very uncommon in the parts in question. There was a 
bellows-murmur over the arteries in cases of anemia; but this was 
observed to be the case all over the body, and the sound was not 
confined, as in cases of pregnancy, to one particular spot. The 
presence of this murmur in one of the iliac regions was not alone 
to be taken as demonstration of pregnancy ; but it was a surer 
sign of that state than any of the general symptoms, and, when 
combined with these, amounted to a certainty. 
The second sign, the pulsation of the fcetal heart, was heard 
later, and, when distinctly detected, was a conclusive sign of 
pregnancy. In the advanced stages of gestation^ when this sound 
was not heard by the experienced auscultator, pregnancy was 
not present, or the foetus was dead. The sound of the heart was 
to be heard in a circumscribed spot, midway between the umbi¬ 
licus and the pubis, a little on one side of the mesial line. In 
the earlier stages, it required great attention and perfect quiet in 
order to detect the sound. In later stages, it was very clear and 
distinct, and was heard over a larger s])ace. At first the sound 
was single, averaging about IGO to 180 beats in a minute. At 
