The Value of the Bluish Colora- 
tion of the Vaginal Entrance 
as a Sign of Pregnancy. 
BY' 
JAMES E. GIIAdWTcK, M. D., 
REPRINT FROM VOLUME XI 
ffijmecolosical SEransactfons. 
1886. This plate shows what is described in the text as the " characteristic " bluish tinge 
of pregnancy. The change of color is confined to the anterior wall of the vagina just 
beneath the urinary meatus. Exceptional accuracy is claimed for this reproduction, 
because it was drawn from a photograph of the vaginal entrance of a woman four 
months pregnant, taken by Dr. S. J. Mixter, and subsequently colored from life by Dr. 
H. P. Quincy. THE VALUE OF THE BLUISH COLORATION OF 
THE VAGINAL ENTRANCE AS A 
SIGN OF PREGNANCY. 
BY JAMES R. CHADWICK, M. D., 
Boston. 
My attention was first forcibly drawn to this phenomenon 
by a paragraph in a review of the first edition of Playfair's 
Treatise on the Science and Practise of Midwifery, that 
appeared in the Medical Times and Gazette of August 26, 
1876. It was as follows: "The violet color of the vagina, 
pointed out by Jacquemier and Kluge, he thinks valueless, 
on the ground that it is constantly seen when similar pressure 
is effected by large fibroid tumors of the uterus. Now, 
many obstetricians of repute attach great weight to this sign, 
and it certainly is not produced by all fibroid tumors of the 
uterus large enough to simulate the gravid uterus. We do 
not wish to question Dr. Playfair's very emphatic statement, 
but it is a very important one, and we think that a full ac- 
count of the circumstances under which this violet color is 
met with, associated with fibroids, or any other conditions, 
would be of service; although, of course, it is not called for 
iu a work like the present." 
My hastily formed determination to investigate clinically 
the value of this sign was fortified by the great diversity of 
opinion among obstetricians which I discovered on ransacking 
our literature of the subject. The first mention of it is uni- 2 
VAGINAL COLORATION IN PREGNANCY. 
versally attributed to Jacquemin (or Jacquemier ?), but no 
author refers to the original place of publication, or gives any 
definite clue to the man. The most suggestive, as well as 
the earliest, reference to the subject is made by A. J. B. 
Parent-Duchatelet.1 He says that "the examination of the 
genitals of prostitutes led to the discovery by M. Jacquemin 
of a new sign of pregnancy, which may become of great use 
in the field of legal medicine : this sign consists in a change 
of color of the whole mucous membrane of the vagina to 
a violet hue or even like the dregs of wine. The sign is 
so plain that M. Jacquemin is never misled by it, but relies 
upon it alone to establish the existence of that condition, 
independently of all other signs of pregnancy. I have been 
witness of curious tests to which M. Jacquemin subjected 
himself to prove how exact he is upon this point. . . M. 
Jacquemin was able to determine the state of the mucous 
membrane in pregnancy in so large a number tis 4,500 
women." 
Other authors of about the same period attribute'- the dis- 
covery to "Jacquemin," and I have no doubt that they mean 
Etienne Joseph Jacquemin (1796-1872), who was " medecin- 
en-chef de la Prison cellulaire de Mazas et medccin des pri- 
sonieres des madelonnettes et de la Prison de la Force," in 
which position he would of necessity have occasion to ex- 
amine a large number of prostitutes, and be in constant 
and intimate relations with Parent-Duchatelet. E. J. Jac- 
quemin was not a voluminous writer, but contributed a 
number of articles on medico-legal topics to the Annates 
dJvygiene, and the Journal de medicine et de chirurgiepra- 
none, however, upon this topic. To him I would 
therefore assign the merit of being the first to make this 
discovery in France, and not to Jean Marie Jacquemier 
(1806-' ), to whom it is quite naturally attributed by recent 
1 De la Prostitution dans la tills de Paris. Deuxieme Edition. Paris, 1837. 
Tome I, pp. 217, 218. As Parent-Duchatelet died early in the year 1836, 
this sign must have been communicated to him at least as early as the 
year 1835. R. CHADWICK. 
3 
writers, because he was an obstetrician of renown, and wrote 
several articles on the vascular system of the uterus and pla- 
centa.1 
The next reference to this sign appears in a letter pub- 
lished in the Journal for Medicin og Chirurgie, Kjoben- 
havn, Bind ix, 1835, from Dr. Sommer, a Dane, then in 
Berlin; an abstract of this letter, translated into German, 
may be found in the Berliner medicinischer Central-Zei- 
tung, Jahrgang vi, Stuck 2, p. 36 (January 14, 1837), from 
which I quote: " Just imagine, on my first visit I heard an 
assistant in Kluge's wards, on examining the vagina of a 
syphilitic woman, immediately pronounce her to be preg- 
nant. ... To my question as to how this statement could 
possibly be made, Herr Geheim-Rath Kluge replied that a 
bluish coloration of the vagina existed at the cul-de-sac 
which surrounds the os uteri, and was an unmistakable sign 
of pregnancy, provided no hemorrhoidal condition was pres- 
ent. According to his assertion, it begins as early as the 
fourth week of pregnancy, or, rather, at the time when men- 
struation would have occurred had conception not taken place. 
This coloration increases with the progress of the pregnancy, 
and disappears with the lochia. The worthy Kluge was 
not content to give me assurances only, but showed me sev- 
eral pregnant women, about whom there was no doubt, as 
they were between the fifth and ninth month of pregnancy, 
and I saw "with my own eyes the bluish coloration through 
the speculum vaginae. He told me (although he had published 
nothing on the subject) that he had for years regarded this 
1 Since writing the above I have received this reference from Dr. J. S. Bil- 
lings, of Washington, which effectually establishes the correctness of my argu- 
ment. "The following quotation is from page 215 of the Manuel des accouche- 
ments, etc., par J. Jacquemier, Paris, 1846, Volume I: 'L'un de ces signes- 
indique par M. Jacquemin, est tir6 de la coloration plus foncee de la muqueuse 
vulvo-vaginale; cette coloration plus intense, qui est quelquefois portee jusqu' au 
rouge brun, est reelle ; mais, comme dans la plupart des cas, il est impossible 
de la distinguer de celle qui depend des varietes individuelles ou de circonstances 
accidentelles ; elle ne parait pas meme devoir prendre place parmi les signes 
rationnels les plus secondaires.' " 4 
VAGINAL COLORATION IN PREGNANCY. 
sign as infallible, except when the above-mentioned condition 
(hemorrhoidal) is present." The Danish editor here inserts 
a paragraph in which he says that this sign is already known 
to his countrymen. 
Between Jacquemin in France, Kluge in Berlin, and some 
unknown physician in Denmark, must consequently be divided 
the credit of first recognizing the value of this sign of preg- 
nancy, as it is no longer possible to discover whether the obser- 
vations were independent or not. Manifestly, the discovery by 
Jacquemin and Kluge is attributable in both instances to the 
freedom with which the genitals of prostitutes were exposed, 
which was in marked contrast with the restrictions imposed 
by custom upon the examination of other women. 
From this epoch we find, in most treatises on obstetrics, 
the bluish coloration of the vagina introduced among the 
signs of pregnancy, with, however, the most divergent opin- 
ions as to its value. These I deem it useless to cite, as none 
of the authors give any evidence that they have made a sys- 
tematic investigation of the subject. I have made it my pur- 
pose persistently, for the past ten years, to repair this omis- 
sion, and now beg to present to the profession the conclu- 
sions to which I have been led, together with an analysis of 
the observations and data upon which the conclusions are 
based. 
Before setting forth the results of my own study, how- 
ever, it seems not unprofitable to give a general impression 
of the current teaching on this subject at the present day, by 
quoting from those text-books which are universally accepted 
as the most authoritative. 
Lusk1 says: " Blood stasis, with enlargement of the vag- 
inal veins, communicates a deep purple color to the va- 
gina. As the requisite conditions (stasis from interference 
with return circulation) are fulfilled during gestation, Jacque- 
min and Kluge proposed to include this coloration of the 
vagina, which they compared to vTine-lees, among the signs 
1 The Science and Art of Midwifery, New York, 1882. JAMES R. CHADWICK. 
5 
of pregnancy. It occurs, however, though perhaps to a less 
intense degree, in prolapsus uteri, in cases of pelvic tumors, 
and the like" (page 11). "The speculum, though it fur- 
nishes us with a view of the coloration of the vagina, a most 
valuable sign, is rarely employed as a means of diagnosis " 
(page 107).1 
Leishman,2 speaking of the vagina, says : " There is clear 
evidence here, also, of increased activity of the circulation, 
corresponding to that which we have found to exist in the 
internal genital organs. It takes the form, in this situation, 
of a venous engorgement, which is due, in part at least, to 
obstruction, caused by pressure of the gravid womb, and is 
indicated by a more or less livid color of the mucous mem- 
brane-very different from the rose color of the unimpreg- 
nated state. This ocular examination of the parts, although 
it may thus reveal a sign which is far from being the least 
important, is, for obvious reasons, a method of research 
which can not be generally adopted in the practice of mid- 
wifery," etc. (page 154). 
Playfair3 says: " A peculiar deep violet hue of the vagi- 
nal mucous membrane was relied on by Jacquemier and 
Kluge as affording a readily observed indication of preg- 
nancy. In most cases it is well-marked; sometimes, indeed, 
the change of color is very intense, and it evidently depends 
on the congestion produced by the pressure of the enlarged 
uterus. The same effect, however, is constantly seen when 
similar pressure is affected by large fibroid tumors of the 
1 I am led to infer, from these rather contradictory opinions, that Professor 
Lusk attaches considerable value to the sign when the bluish color is intense, 
but not otherwise. I would protest against the inference that might be drawn 
from the first quotation, that Jacquemin and Kluge first formulated a theory 
and then claimed that the facts might be found to coincide with it. The form 
of phrase must have been used inadvertently, for there is no evidence that 
either of them entertained this theory at all, and in both instances it is clearly 
shown that their opinions are based upon exceptionally large clinical observations. 
a A System of Midwifery. Third American edition. Philadelphia, 1879. 
3 A Treatise on the Science and Practice of Midwifery. Third American 
edition. Philadelphia, 1880. 6 
VAGINAL COLORATION IN PREGNANCY. 
uterus, and, therefore, for diagnostic purposes it is value- 
less " (page 144). 
Cazeaux1 says of the vagina in pregnancy, "that con- 
gestion is perceptible even in the capillaries; for it would 
be difficult, otherwise, to explain those livid spots, that color 
of wine-lees which the mucous membrane of the vagina and 
collum uteri show, to which attention has recently been 
drawn afresh by adducing it as a sign of pregnancy" 
(page 124). 
Charpentier2 says: " The mucous membrane of the vulva 
assumes a red, more or less vinous, tint. ... It (vagina) be- 
comes of a violet-red color " (page 411). 
Naegele and Grenser3 say: "The blood which flows 
thither more abundantly gives to the mucous membrane of 
the vagina a bluish coloration " (page 86). 
" When the coloration of the mucous membrane of the 
vagina is to be examined, ... it is necessary to use a specu- 
lum " (page 112). 
Spiegelberg4 says: " The distention and congestion of 
the venous plexes, often still further increased by obstruc- 
tion, produces a dark-bluish coloration, which is visible 
throughout the whole canal, from the vaginal portion to the 
vulva. The turgescence and flabbiness of the external geni- 
tal organs keeps pace with that of the vagina. They are 
more elastic, darker, their mucous surfaces are often covered 
with ectatic veins and venous plexuses," etc. (page 55). 
Schroeder5 says: " Also the tumefaction of the vaginal 
portion, the roundness of the os, the edematous swelling, 
the velvet-like feel and increased secretion of the vaginal 
mucous membrane, as well as the wine-lees color, are impor- 
1 Traite theorique et pratique de Part des accouchements. Huititlme edition. 
Paris, 1870. 
3 Traite pratique des accouchements. Paris, 1883. Tome 1. 
3 Traite pratique de I'art des accouchements. Traduit sur la sixidme edition 
allemande. Paris, 1869. 
4 Lehrbuch der Geburtshulfe. Band 1. Lahr, 1878. 
5 Lehrbuch der Geburtshulfe. Tie Auflage. Bonn, 1871. JAMES H. CHADWICK. 
7 
tant elements in the diagnosis, although I can not admit that 
they are decisive as Holst asserts " (page 77). 
These quotations from the most accredited text-books of 
America, England, Germany, and France show, by the mea- 
gerness of the paragraphs, and the guarded or skeptical na- 
ture of the opinions, how little value is generally assigned to 
this change of color as an indication of pregnancy. 
Dr. Robert Barnes1 expresses, on the other hand, a most 
emphatic appreciation of this sign: " The most valuable sign 
of all is the violet coloration of the vaginal portion and the 
vagina, described by Jacquemier." 
Dr. J. H. Carstens2 is still more decided in his assertions, 
saying that the violet hue is not produced by any pathologi- 
cal condition; that he depends upon it for diagnosis in the 
first, second, and third months of pregnancy; and that it has 
never failed him. 
I can find no other references to this sign in current 
periodical literature. 
It will have been noticed that the above descriptions al- 
most all speak of the violet color as seen on the collum uteri, 
or the whole extent of the vagina, and consequently require 
the use of a speculum; now, while I do not claim that the 
change is not perceptible throughout the whole extent of the 
vagina and collum uteri, I do maintain that it is equally 
manifest at the introitus vaginae, when the labia are simply 
separated by the fingers. After satisfying myself on this 
point by numerous investigations with the speculum, I was 
consequently able to dispense with that instrument, and thus 
render the sign more generally and easily applicable. 
As evidence that my conclusions are the result of a thor- 
ough study of the problem, I would say that during the ten 
years of this research I have made records of the examina- 
tions of about six thousand different women in an exclusively 
gynecological practice. The women were all placed upon 
1 Diagnosis of Early Pregnancy. British Medical Journal, 1868. Vol. ii, 
pp. 631-632. 
2 Detroit Lancet, 1880. Vol. iv, p. 112. 8 
VAGINAL COLORATION IN PREGNANCY. 
their backs on my gynecological table, with their thighs 
flexed to a right angle and their knees separated (Simon's 
position). The labia were then parted by the fingers, and 
the entrance of the vagina inspected. I made notes of any 
divergence of color from the normal in every patient, before 
any other method of examination was employed, seeking 
thereby to escape any bias that might be created in my mind 
by knowledge of the patient's condition otherwise derived. 
Of course I could not escape being influenced to a limited 
extent by the statements that had been previously made by 
the patient as to the absence of menstruation, and the super- 
vention of symptoms suggesting the probability of preg- 
nancy. That the presumption thus liable to be established 
in my mind was not allowed undue weight in guiding my 
pen, I would adduce the fact that, of the 347 observations 
recorded 56 were made upon women who believed or feared 
themselves to be pregnant, yet in only two did I record the 
existence of such a change of color as to be diagnostic of 
pregnancy, according to the characteristics hereafter to be 
described. 
The color begins as a pale violet in the early months, be- 
comes more bluish as pregnancy advances, until it often as- 
sumes finally a dusky, almost black, tint; this last is familiar 
to every obstetrician. It is not due to pigmentation, but to 
an hypertrophy of the venous plexuses in the mucous mem- 
brane of the vagina (or a dilatation of the minute veins), in- 
duced by the afflux of blood to the uterus under the stimulus 
of pregnancy. The predominance of the veins in this loca- 
tion could alone account for the bluish color; moreover, 
when, toward the end of pregnancy, the color is most intense, 
varicose veins are plainly visible in the labia and in the legs. 
A. Breisky1 thus describes the veins of the vagina: " In the 
columns the veins are large, numerous, and arranged in the 
form of plexus, their capacity increasing as we go backward. 
They give to the columns, especially in their lower segments, 
1 Die Krarikheitcn der Vagina. Stuttgart, 1879, p. 9. JAMES E. CHADWICK. 
9 
the appearances of a cavernous structure. The veins which 
collect the blood from the mucous membrane form in the 
submucous tissue meshes running in the direction of the long 
axis of the vagina. They unite to form large trunks, which 
permeate the muscular layer, and contribute to form the so- 
called plexus venosus vaginalis between the vagina and the 
urethra and bladder in front, and vagina and rectum behind. 
Into this plexus pass numerous veins anteriorly from both 
bulbs of the vestibule, and posteriorly those venous branches 
of the labia which do not open into the pudenda. The blood 
is carried from this plexus by two quite large veins, which 
run along the posterior vaginal wall, on either side of the 
vaginal artery, and inosculate with the hemorrhoidal plexus. 
Gussenbauer finds the trabecular distribution of the venous 
plexus of the vagina to be analagous to the cavernous erectile 
organs, but, by its filling, the vagina never attains the degree 
of rigidity which is found in the erectile structure of the 
vestibule, but resembles, as Hunter asserts, a full sponge, the 
resistance of which is easily overcome." This being the 
normal condition of the venous system in the female, it may 
readily be conceived that, under the stimulus of pregnancy, 
the veins should so increase in number and size as to impart 
to the transparent mucous membrane more or less of their 
bluish color. 
The natural color of the vaginal entrance does not 
differ materially from that of mucous surfaces elsewhere 
in the body, being of a pinkish hue in women of ordi- 
nary habit, more pale in anemic, and more red in plethoric, 
women. 
In scrutinizing the color of this part in a large number of 
women I early discovered that, while in the majority the 
bluish tinge appeared over the whole vaginal entrance, there 
was a fair proportion in which the violet tint was confined 
to the anterior wall of the vagina, just below the urinary 
meatus, whence it shaded off into the normal pink color 
laterally. This, when distinctly perceptible, I soon found to 
be, in my practice, an absolutely sure sign of pregnancy. 10 
VAGINAL COLORATION IN PREGNANCY. 
There were, furthermore, a very few in whom the blue tint 
was universal, but more accentuated on the posterior wall of 
the vaginal entrance, which I found was valueless as a sign of 
pregnancy, unless the color was quite deep. The recognition 
of this peculiar localization of the blue tint on the anterior 
wall as a sure sign of pregnancy I feel is the most important 
new point in this communication. 
My final division of the cases of pregnancy, according to 
the degree and localization of the blue tint, is as follows: I 
make two groups in which the women, though pregnant, 
exhibited: (1) Ab color, or a (2) doubtful one; in these, 
of course, the appearance of the parts gave no clue to the 
condition of the women ; (3) a group in which a faint bluish 
tint was perceptible over the whole vaginal entrance, but 
was not sufficiently pronounced to be distinctive, I desig- 
nated and always had my suspicions aroused; 
(4) a group in which the bluish tint was as faint as in group 
3, but was confined to the anterior wall, I termed char- 
acteristic; finally (5), a group in which the blue color was 
universally distributed, but so intense as to be unmistakable: 
this I called deep general tint. It is seen, therefore, that 
two groups (1 and 2) supply no aid in the diagnosis of preg- 
nancy ; one group (3) presents a sign which has value as pre- 
sumptive but not conclusive evidence of pregnancy; while 
two groups (3 and 4) afford nearly absolute evidence of preg- 
nancy. I qualify the last claim by the word " nearly," for the 
reason that I have seen the " deep general " hue once when the 
woman proved not to be pregnant. As the total number of 
cases in which the color was diagnostic was 146, the qualifi- 
cation is very slight. 
The total number of cases in which there was reason for 
recording the color was 440, but in a certain number the 
data was imperfect, or the conditions of the patients indeter- 
minate, so that the number of subjects available for calcula- 
tion and analysis was reduced to 337, of which 281 were 
pregnant and 56 were not pregnant. JAMES R. CHAR WICK. 
11 
PERIOD. 
Valveless. 
Sug- 
gestive 
color. 
Diagnostic. 
Total. 
No 
color. 
Doubt- 
ful 
color. 
Charac- 
teristic 
color. 
General 
deep 
color. 
At end of 4th week.. 
1 
1 
ll 
5th 
(1 
2 
1 
3 
ll 
6 th 
ll 
1 
1 
3 
1 
6 
« 
7th 
ll 
1 
1 
2 
H 
2 months 
17 
13 
21 
4 
4 
59 
ll 
2| 
ll 
4 
5 
12 
5 
3 
29 
ll 
3 
ll 
4 
3 
15 
6 
13 
41 
ll 
3| 
ll 
1 
7 
2 
3 
13 
ll 
4 
ll 
2 
8 
9 
8 
27 
ll 
4£ 
ll 
1 
1 
1 
5 
14 
22 
ll 
5 
ll 
1 
5 
4 
15 
25 
ll 
5| 
ll 
3 
2 
5 
10 
ll 
6 
ll 
. - 
2 
19 
21 
ll 
6| 
ll 
1 
2 
4 
7 
ll 
7 
ll 
1 
6 
7 
ll 
7£ 
ll 
1 
3 
4 
ll 
8 
ll 
4 
4 
Total.. 
31 
28 
78 
42 
102 
281 
TABLE OF 281 PREGNANT WOMEN. 
This table establishes certain facts with reference to this 
coloration of the vaginal entrance beyond reasonable doubt. 
1. That its absence is not to be accepted as evidence that 
pregnancy does not exist, especially in the first three months, 
when satisfactory evidence is most needed. 
In the first seven weeks it is shown to be rarely of much value, 
yet in five of the twelve cases it was sufficiently apparent to sug- 
gest to my mind that the woman might be pregnant, and thus 
protect me from involuntarily causing an abortion by the passage 
of the uterine sound, as it did in several of these instances. 
It was practically absent (" no color," " doubtful color ")- 
At the end of 2 months in 51 % of the cases. 
" 2| " 31% " 
" 3 " 17% " 
" 3| " 8 % " 
" 4 8 % " 
" 4} " 9 % " 
" 5 " 4% " 
Of course, it is not claimed that these percentages, or many 
that will be offered hereafter, represent the true ratios, for the 12 
VAGINAL COLORATION IN PREGNANCY. 
number of cases is inadequate to warrant such a claim, but they 
are surely approximations to the truth. 
2. That from [and including) the second month, this color is 
generally present, and often of such character as to be diagnostic. 
In one instance it was diagnostic at the end of the sixth 
week-this woman had had six children and had a retroverted 
uterus ; the color of the vagina was the only evidence of preg- 
nancy except the non-appearance of the catamenia two weeks 
before. 
The color was suggestive of pregnancy- 
At the end of 2 months in 34 $ of the cases. 
" 21 " 41$ " 
" 3 " 27$ " 
" 81 " 45$ " 
" 4 " 30$ " 
" 41 " 4$ " 
" 5 " 20$ " 
" 51 " 30$ " 
The color was diagnostic- 
At the end of 2 months in 13 % of the cases. 
" 2| " 28$ " 
" 3 " 46$ " 
" 8| " 38$ " 
" 4 " 63$ " 
" 41 " 86 $ " 
" 5 " 72$ " 
" 61 " 70$ " 
After (and including) the end of the sixth month, the color 
was diagnostic, in all but one case, in which it was suggestive, 
and one in which it was doubtful. 
The analyses on the positive side are supplemented, and the 
general conclusions strengthened, by the evidence of the fol- 
lowing table, compiled from the records of patients who, for 
more or less good reasons, supposed themselves to be pregnant. 
In this class it must be observed that any bias, transferred 
from the patient's mind to my own, would work against the 
value of this sign in the diagnosis of pregnancy. Despite this 
disadvantage, the result confirms my statements in a most em- 
phatic manner JAMES R. CHADWICK. 
13 
TABLE .OF 56 WOMEN WHO PBOVED NOT TO BE PEEGNANT. 
PERIOD. 
Valueless. 
Sug- 
gestive 
color. 
Diagnostic. 
Total. 
No 
color. 
Doubt- 
ful 
color. 
Charac- 
teristic 
color. 
General 
deep 
color. 
1 
1 
1 
2 
2 
weeks " 
ll 
2 
2 
3 
u u 
Cl 
2 
2 
4 
u u 
ll 
5 
3 
1 
9 
5 
G u 
ll 
3 
2 
1 
6 
6 
a u 
ll 
12 
1 
13 
7 
it u 
ll 
1 
1 
0 
months " 
ll 
6 
6 
21 « « 
ll 
2 
1 
3 
3 
H Cl 
ll 
4 
4 
4 
ll Cl 
ll 
1 
2 
3 
5 
ll ll 
ll 
3 
1 
4 
6 
ll ll 
ll 
1 
• • 
1 
Total 
43 
9 
3 
1 
56 
It is clearly a waste of time to calculate percentages with 
such figures. One case calls for special comment, in -which, 
four weeks after menstruation, a woman exhibited the " gen- 
eral deep " bluish coloration otherwise diagnostic of pregnancy. 
There was noted an absence of the customary moisture of the 
vagina, which prevented my giving the color its full value as 
diagnostic of pregnancy. I could discover no other peculiarity 
to account for the color. It may be accepted as evidence of 
the occasional manifestation of the color at the time when 
menstruation was imminent, as is asserted by some of the early 
writers. This must be extremely rare, as I have observed no 
other instance. 
The problem, why some women show this coloration of the 
vaginal entrance in pregnancy and some do not, I have sought 
to solve by tabularizing certain possible modifying circum- 
stances, but the data are so few as to be of little worth. I 
have included only women who were two, two and a half, and 
three months pregnant, because the numbers are most evenly 
distributed at these periods, and the value of the sign is 
greatest. 
The average age of 45 women, who showed "no" or 
"doubtful" coloration, was 26 years and 5 months; of 34 14 
VAGINAL COLORATION IN PREGNANCY. 
women, who showed " characteristic " or " general deep " color- 
ation, 26 years and 4 months. 
The average number of years of married life in 36 women, 
who showed " no " or " doubtful " coloration, was 6 years and 
8 months; in 29 women, who showed "characteristic" or 
" general deep " coloration, 8 years. 
The average number of previous children in 44 women, who 
showed " no " or " doubtful " coloration, was 1 '82 children ; 
in 32 women, who showed " characteristic " or " general deep " 
coloration, 2'22 children. 
The average number of miscarriages in 43 women, who 
showed " no " or " doubtful " coloration, was 0'50 miscarriages ; 
in 31 women, who showed "characteristic" or "general deep" 
coloration, 0'51 miscarriages. 
The average number of previous pregnancies in 44 women, 
who showed "no" or "doubtful" coloration, was 2'32 preg- 
nancies ; in 32 women, who showed " characteristic " or " gen- 
eral deep " coloration, 2'73 pregnancies. 
The average number of months since the last child-birth in 
18 women, who showed "no" or "doubtful" coloration, was 
30 months; in 16 women, who showed "characteristic" or 
" general deep " coloration, 29 months. 
The average number of months since the last miscarriage in 
6 women, who showed " no " or " doubtful " coloration, was 17 
months ; in 6 women, who showed "characteristic" or "gen- 
eral deep " coloration, 9 months. 
The average number of months since the last pregnancy in 
24 women, who showed " no " or " doubtful " coloration, was 
26 months; in 22 women, who showed "characteristic" or 
" general deep " coloration, 23 months. 
The contrasts presented by these figures are not suffi- 
ciently striking to warrant me in attributing any influence 
to these considerations in determining the presence or absence 
of the blue color of the vagina in pregnancy. 
Another question of great moment is answered by the 
above tables: Do fibroid or ovarian tumors ever give rise 
to this color by pressure or otherwise, as asserted by most 
writers on this topic ? I answer most emphatically, No. I JAMES R. CHADWICK. 
15 
have had a large number pass under my observation during 
the past ten years, and have examined them with special care, 
invariably with a negative result. I must fain believe that 
the contrary opinions expressed have not been based upon 
observations, but upon the transmitted authority of the ear- 
lier writers, whose statements were made to accord with the 
theory that the blue color was due to stasis of blood from 
pressure upon the larger veins by the pregnant uterus, 
whence they inferred that the same wTas likely to result 
from the pressure of the uterus enlarged by a fibroid. I 
see no reason for believing that the change of color at 
such times is, in the slightest degree, due to pressure, but at- 
tribute it exclusively to the great afflux of blood caused by 
the necessity of nourishing the fetus. 
I have observed but one cause of bluish color, apart from 
pregnancy, which may at times give rise to doubt, and to a 
certain extent detract from the absolute confidence reposed 
in this color as a sign of pregnancy. I allude to erotism on 
the part of the woman. In two or three instances among 
patients, seen in consultation, of which I can not now find the 
records, I have seen a very " suggestive," almost diagnostic, 
general bluish hue at the vaginal entrance when pregnancy 
did not exist. In one of these I was led to the true cause 
by observing the incessant, exaggerated flow of secretion 
from the utero-vaginal glands. I must further admit that a 
single woman who was exposed to pregnancy consulted me 
one week after the occurrence of the catamenia, which had 
been absent for three months before. There was consider- 
able enlargement of the abdomen by ascitis, and the "charac- 
teristic " blueness of the anterior wall of the vaginal en- 
trance, the blue tinge did not, as is usual, extend up the an- 
terior vaginal wall. The cervix was hard and not patulous. 
My recorded opinion was that pregnancy seemed highly im- 
probable. The case could not be included in my tables, be- 
cause the correctness of the diagnosis was never established 
by subsequent examinations. I have never since seen the 
blue color in cases of.ascitis. 16 
VAGINAL COLORATION IN PREGNANCY. 
The diagnosis of pregnancy is, under ordinary conditions, 
easy after the end of the third month of pregnancy. The 
degree of value attributable to the color of the vaginal en- 
trance, in my practice, has been made apparent by the above 
tables. Complications occasionally exist which render the 
diagnosis doubtful even at a much later period. The princi- 
pal of these are: 
1. Retroversion of the pregnant uterus, when the body of 
the womb is less accessible to digital (or bimanual) examina- 
tion, so that its softness and enlargement can not be made 
out, or may be confounded with old perimetritic effusion. I 
could adduce many cases in which the color has been the 
main reliance for the diagnosis. 
2. Extra-uterine pregnancy.-In one of the only two cases 
that I have seen in the early months, the color of the vagina 
was "suggestive" as early as three and a half months, and 
helped to establish the diagnosis. 
3. Pregnancy complicated with fibroid tumors of the 
uterus.-I have had in my practice seven cases of this com- 
plication, three of them before my attention had been 
called to this sign; one of them I did not see during the 
pregnancy; in the other three I noted the " deep, general 
color " at six months (when she was first seen), at three and 
a half months, and at five weeks, respectively; in the last case 
it was the only physical sign of pregnancy.1 
4. Pregnancy complicated with an ovarian tumor.- 
Ivly notes of several cases are mislaid, so that I can not ad- 
duce actual observations. 
5. Pregnancy in women with very fat or tense abdomi- 
nal walls. 
6. Ignorance of the existence of pregnancy, or a desire to 
conceal it. 
1. When the catamenia have continued after conception. 
8. Conception while nursing, without the intervention of 
menstruation. 
1 Cases of Pregnancy and Labor complicated by Fibroids, by James R. Chad- 
wick, M. D. Proceedings of the Massachusetts Medical Society, June 9, 1885. JAMES E. CHADWICK. 
17 
Numerous instances of these last four complications have 
established the great value of this sign of pregnancy in daily 
practice. 
With reference to the length of time that the color per- 
sists after delivery, I can not speak from a large observation, 
but my impression is that the color ceases to be characteristic 
within a month. By the end of that time, such faint bluish 
tinge as is present is of a livid hue, and has assumed a gray- 
ish tint, presumably from the fatty degeneration going on in 
all the tissues of the vagina. 
In conclusion, let me beg fresh observers of this sign not 
to judge of its worth until they shall have trained their eyes 
to detect the different shades and distribution of the color by 
many years' experience, as I have done.