286 DYSTOKIA. 



is empty, or if it already contains some portion of the foetus or its 

 membranes, and what these are ; if there is any normal condition or 

 contraction of the vagina, or any tumours either within or external to 

 that canal, as well as 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, frac- 

 tures, 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 ene^'gy and frequency of 

 the labour 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 disposed, 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 exploi'ation has to be 

 made, and labour 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 ; 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, 

 however, they are flaccid, a portion is seized between the 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 ordinaiy circumstances, the hand 

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

 anterior limbs, and the plantar surface of the feet is turned downwards, 

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

 presentation ; 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 



