130 OF TRUE PREGNANCY. 



a necessarily variable intensity, on account of a great many circum- 

 stances that are difficult to characterise, it is never heard better 

 than when the child's back corresponds to some part of Ihe anterior 

 surface of the uterus; I have scarcely ever failed to detect it when 

 able to seek for it with all suitable care; the anterior curve of the 

 foetus, and the relations of the heart to the spine, are the reasons 

 why the back is the only part that is evidently capable of transmit- 

 ting the double beat to the ear of the observer. From this remark 

 it may be conceived that they may change their place if the foetus 

 changes its position, and that before affirming that they do not exist 

 at all, we should have by turns explored the hypogastrium and the 

 loins, the flanks, and all the various parts of the circumference of 

 the pelvis. 



340. In order to perform the auscultation, the woman must be 

 lying down, although in fact she might be allowed to stand up; if 

 the pregnancy be somewhat advanced the ear will suffice, and some- 

 times succeeds better than the stethoscope with persons not in the 

 habit of using that instrument. However, it can only be conveniently 

 applied on the anterior half of the abdomen. Moreover, the friction 

 of the gown or any other part of the woman's dress, whom it is un- 

 necessary to uncover during the operation, may frequently deceive us 

 as to the nature of the sounds we hear. The stethoscope in gene- 

 ral yields a clearer or more intense sound; besides, it can be applied 

 at all stages of pregnancy, and to all the points to which the foetus 

 seems able to turn its back; the end piece is to be taken off; then 

 after having felt for the womb, it is placed first on the left, then on 

 the right, and next on the middle of the hypogastrium; it is even 

 applied to the loins, the posterior face of the sacrum, the cristae of 

 the ilia, the front of the pubis, &,c. 



341. Were it always possible, the child's back, the corresponding 

 parietes of the womb and abdomen, the stethoscope and the ear of 

 the accoucher should not be separated by any void space and by nO 

 other part, and they should constitute as it were a continuous body, 

 without any interruption whatever. 



342. The sound of the heart is a certain sign both of pregnancy 

 and of the child's being alive; its strength, in general, indicates the 

 vigor and good health of the child; during labor, when accidents 

 occur, or when a serious operation appears to be indispensable, its 

 simultaneous existence at two opposite sides of the abdomen will 

 render it certain that the womb contains two children; if met with 

 in a woman whose uterus is but little developed, no doubt remains 

 of there being an extra uterine pregnancy; but its absence, like that 

 of the active or passive motions of the foetus, does, not afford a con- 

 clusive proof that there is no gestation, or that the child is not living. 



