Licence: Public Domain Mark
Credit: Practical manual of obstetrics. Source: Wellcome Collection.
Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.
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![Touch in the Recumbent Position of the Woman.—The accoucheur must place himself on the side corresponding to the hand with which he ope- rates ; the free hand, placed over the uterus, presses it backward and downward, according to the requirements, and the remainder of the ope- ration is identical with that described above, the elbow resting on the mat- tress so as to permit the index finger to follow the axes of the pelvis. In passing thus the entire vagina the finger must determine the condi- tion of all the soft and hard structures encountered; especially ascertain the exact modifications of the cervix, the presentation and position of the foetus, as well as the nature and seat of the numerous factors which may- render the delivery spontaneous, difficult, complicated, or impossible. If the vaginal touch be practised with the object of getting ballotte- ment (see below), the finger must be slightly curved like a hook and enter, preferably, the anterior cul-de-sac, as the head of the foetus is most fre- quently close to the symphysis pubis; moreover, the cervix in a primi- para hardly ever admits the finger for the purpose of obtaining ballotte- ment. It may sometimes be desirable to practise manual touch, especially for the diagnosis of presentations or positions in the case of non-engagement during labor, or else when tumors complicate. In these cases we need not hesitate to introduce all the fingers except the thumb, and sometimes the entire hand into the vagina, chloroform being given, if necessary, before the latter operation. 2. Rectal Touch. It is rarely employed. Nevertheless, it is demanded in cases of partial obliteration of the vagina, uterine displacements, extra-uterine pregnancy, and to ascertain the causes of dystocia [difficult labor] situated in the recto- vaginal septum. It is performed like rectal touch in surgery. ABDOMINAL PALPATION. In order to practise abdominal palpation methodically, the woman must be supine and all the muscles relaxed, by flexing the head toward the chest and the thighs on the abdomen. The form, the volume, the tension of the abdomen are then the objects of special examination. If we wish first to appreciate the degree of development of the uterus, we proceed with both hands, the fingers of which, all on one plane, are placed over the pubis, whence they ascend as far as the fundus of the or- gan so as to circumscribe it entirely and determine by its elevation the period of pregnancy. The ulnar side of the upper hand lightly depresses the abdominal wall: this constitutes palpation by simple pressure. Palpation by mobilized pressure is performed by placing one hand flat and keeping it](https://iiif.wellcomecollection.org/image/b2100013x_0072.jp2/full/800%2C/0/default.jpg)
