Palpation of the Uterus per Rectum 125 



are soft and flabby with a moderate amount of thickening, 

 or they are tense and at some place an abscess may point, or 

 the organ is very dense, with thick, hard walls. 



As pregnancy advances, additional evidences appear. The 

 uterus becomes very greatly enlarged, the walls are tense, 

 and the fetal fluids are quite readily recognized as such. 

 Later, cotyledons are palpable through the uterine wall and 

 when pregnancy has reached four to five months one will 

 occasionally recognize the fetus itself floating in its fluids. 

 The fetus becomes increasingly easy of recognition as preg- 

 nancy advances. In some cases, however, both fetus and 

 uterus fall forward into the abdomen and may be beyond 

 the reach of the examiner. In such cases there is still good 

 evidence of pregnancy. The vagina is drawn far forward, 

 the cervix has been dragged anterior to the pubis, and the 

 vaginal end of the uterus constitutes a large, thick, firmly 

 stretched band passing downward and forward beyond the 

 examiner's reach. This of itself does not indicate preg- 

 nancy with absolute certainty, because the same displace- 

 ment of the uterus also occurs from the presence of large 

 uterine or ovarian tumors, from extensive pyometra, or from 

 other pathologic conditions which would cause an increased 

 weight of the organ. The application of the uterine forceps 

 to the cervix, followed by traction on these, thus drawing 

 the uterus upward and backward, to or into the pelvis, as 

 already advised, is of supreme importance in making an 

 accurate diagnosis in these cases. No other means alone 

 can afford so great assistance and security. In this emer- 

 gency, however, other signs appear to aid the examiner in 

 making his diagnosis. As a general rule, the diagnosis can 

 be verified by the presence of the uterine seal, by abdomi- 

 nal ballottement, or by palpation of the enormously en- 

 larged uterine arteries. In some instances it is practicable 

 to diagnose the physical well-being of the pregnancy. It is 

 easy to diagnose desiccation of the fetus from the time 

 when the interplacental hemorrhage occurs. When the 

 metritis of pregnancy is so far advanced that abortion is 

 not very distant, it may be diagnosed by vaginal and rectal 



