GENERAL CONSIDERATIONS. 267 



the seat of these, and if possible their nature. He has also to satisfy 

 himself that the pelvis is wide, regular in form, or more or less deformed 

 and diminished in size from exostoses, fractures, or other causes. 



The state of the soft parts will likewise engage his attention, and 

 he must learn whether the vulvo-uterine canal is dry, or contains suffi- 

 cient mucus to facilitate manipulation or delivery, as well as its tempera- 

 ture. Having satisfied himself on these points, the fingers are again 

 brought together, and their extremity pushed as far as the cervix uteri, 

 the condition of which is carefully studied. The chief points to be noted 

 are : whether it still projects into the vagina, or if it is completely 

 effaced ; whether the uterus has descended on the floor of the abdomen, 

 or is yet in its ordinary position ; whether the os is closed or open, 

 and the extent of its dilatation ; whether the texture of the cervix is hard 

 or soft, healthy or altered by morbid degeneration, and if it lies in 

 the axis of the vagina or deviates therefrom, or is more or less twisted. 

 Passing the hand into the uterine cavity, if necessary and possible, and 

 with all care and gentleness, the explorer will meet with the " water- 

 bag," if it is not already ruptured, and the foetus, if he has not already 

 encountered it; at the same time the energy and frequency of the labor 

 pains can be ascertained. If the membranes are ruptured, the hand must 

 be passed into them in order to discover the situation of the foetus — the 

 kind of presentation and position, the manner in which the limbs are dis- 

 posed, and any complications which may be present. If the membranes 

 are not ruptured, and it is deemed necessary to open them — which not 

 unfrequently happens when an exploration has to be made, and labor is 

 advanced, the pains being well marked, the os dilated, and the water-bag 

 in the vagina — the hand may be passed between them and the uterus, 

 the palm being towards the foetus j or it may not be required to pass so 

 deeply. 



When the membranes are tense, pressure against them with the end of 

 the index finger during a throe is usually sufficient to open them ; if, how- 

 ever, they are flaccid, a portion is seized between ^he thumb and middle 

 finger and torn by their nails, or by the nail of the first finger against 

 that of the thumb. Sometimes the fingers alone are not sufficient, 

 as when the envelopes contain but little fluid ; then a pair of scissors, a 

 small trocar, or even an ordinary pen will effect this object. 



In examining for presentation and position, each region of the body of 

 the foetus should be familiar to the touch, as it can be distinguished by 

 its own proper characters. Under ordinary circumstances, the hand of 

 the operator first meets with the limbs of the foetus ; if they are the ante- 

 rior limbs, and the plantar surface of the feet is turned downwards, then 

 the foetus is in the natural or vertebro-sacral position, anterior presenta- 

 tion ; but if the plantar surface of the feet is inclined upwards, and they 

 really belong to the fore limbs, then it is in the vertebro-pubic position. 

 To distinguish the fore from the hind limb, the shape of the joints and 

 their mode of flexion must be taken into account — the fetlock and knee 

 of the former bend in the same direction, while in the latter the fetlock 

 and hock flex in opposite directions ; the knee, in addition, is large, 

 round, and rather flattened in front, while the hock is flattened on each 

 side, and offers the calcis as an unmistakable guide. There is also a 

 difference in the shape of the feet. 



The explorer should take time to assure himself of the real state 

 of affairs, and conduct his examination with all the care, attention, and 



