A manual of midwifery : including the pregnancy and the puerperal state / by Karl Schroeder ; translated into English from the third German edition by Charles H. Carter.

Karl Schroeder

Date:: 1873

Credit: A manual of midwifery : including the pregnancy and the puerperal state / by Karl Schroeder ; translated into English from the third German edition by Charles H. Carter. 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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$places ; according to the position of the foetus, the uterus feels uneven. Usually a Large part is felt in the fundus, on one side of it smaller parts more or less pointed, and at the other a considerable and uniform resistance. To rind out what portion of the foetus is placed, if any, on the brim, the accoucheur must rise and stand at the side of the bed. He must place both his hands upon the abdominal walls above the symphysis, in such a way that the tips of the fingers are directed towards it. If now sudden pressure is made on the abdominal walls with both hands simultaneously, or alter- nately, and if a large foetal part is there movably placed, a distinct sensation of ballottement is obtained, that is, a sensation of a hard body being pushed away by the tips of the finger, and again striking against them. If the larger part is fixed in the pelvis, it is in this way also felt with equal distinctness ; if this lias already entered the pelvis, it can only be determined whether the tumour is continued into the true pelvis also or not. The breech es] »ecially of a very small foetus and in an anomalous position may, by an in- experienced observer, be taken for a small fcetal part. But it always gives rise to the sensation of ballottement, and may therefore with certainty be distinguished from one of the smaller parts. Percussion is rendered quite superfluous by the results of palpa- tion in advanced pregnancy, and in the earlier months by the combined internal and external examination. On auscultation of the abdomen of pregnant women different sounds are heard. They are the sounds of the heart of the foetus, and sometimes a peculiar whizzing noise synchronous with the foetal heart, and sounds originating in the umbilical cord. On the part of the maternal organism there is heard, besides the pulse of the aorta and gurgling in the intestines, the so-called uterine soullle which corresponds with the pulse of the mother. Auscultation is best made by using the stethoscope. Immediate auscultation does not give any better results ; it is disagreeable to the woman and to the accoucheur, and not applicable to every region of the abdomen. The sounds of the fcetal heart are heard as frequent double beats. Their peculiarity is best studied by listening to the sounds of the heart of a newly born infant. Normally they are heard from the eighteenth to the twentieth week, but in exceptional cases much earlier. If th«' woman is healthy and the foetus alive the heart's sounds can always be heard by a careful, and if necessary repeated, examination« They vary from about l-2<> to 160 beats or more in a minute; their frequency is increased by the movements of the foetus. Their intensity is also very variable. Sometimes they are so loud as to be heard even without applying the ear to the abdomen, at other times so feeble that 1 hey n\ ii only just be made out as such. But they uinsi always be heard bo distinctly as to be able to count each beat. If this is not possible, there is no certainty that they have really been heard. The sound in the umbilical »on! is characterised by a whizzing murmur synchronous with and accompanying the sound of the fcetal heart, it LS also heard OH Certain Spots in the abdomen. This is l'\ no means rare, and occurs, according to Eecker's and our own observations, in 11 to L5 per cent, of all cases. It, doubtless, originates in the umbilical cord, although the intimate conditions of$