A few of the early signs of pregnancy are not made available to the physician ordinarily when his opinion is demanded. A woman is naturally unwilling that her physician, if he be a man, should make even a digital examination, and this makes it more necessary that the nurse should know all the rational signs. One of these signs is the changed color of the mucous membrane of the vagina and labia. This membrane is of a pale red color, but it becomes of a violet hue during the time of menstruation, and if a woman becomes pregnant, the violet or deep red color becomes continuous. There is also, even in the commencement of pregnancy, a peculiar odor to the secretion from the vagina and os uteri, which has been compared to that of the vernix caseosa. There is no sign of pregnancy by which we can always distinguish it in its early stages; in some instances nearly all the rational signs are absent. The general condition of a pregnant woman is changed in a greater or less degree, but all are not changed alike. Generally she is plethoric, the pulse is fuller and quicker; the quantity of circulating fluid is augmented, the quality altered by the increase of fibrine; but these changes are not always obvious. Well marked sympathies are excited in various organs; the nervous system may suffer especially; the woman’s temper and disposition may change; she may become capricious, may have likes and dislikes in eating, especially if her digestion is weak; there may be loss of appetite, heartburn, increased flow of saliva, toothache, excitability of mind, sleepiness, etc.; but even when many of these symptoms are present, even when the liver and kidneys are affected, so that the skin is sallow or discolored in patches, and irritability of the bladder causes much pain and distress, these various signs may only furnish a sum of probabilities amounting _almost_ to certainty. In some cases of pregnancy the skin, instead of becoming sallow, is more florid, with occasional eruptions on the face. Some women become fat during pregnancy; others lose flesh; their faces, in the early months, are pinched and pointed, and their features altered. _Milk in the breasts_, especially in the first pregnancy, is a sign which is said to be reliable; but it is true of some women that, during their period of menstruation, their breasts enlarge; there is a sensation of fullness, with throbbing and tingling pain in them, and that a milk fluid may be secreted; the same symptoms that are present with others at the second month of pregnancy. Another change is a more marked sign in the breasts. There is at first a soft and moist state of the skin, and the little glandular follicles around the nipples are bedewed with a secretion. This may often be seen at the second month, and it may also be noticed that the veins of the breast look more blue, and that the breasts themselves are firmer and more knotty to the touch.