2. During Labor.
Palpation and auscultation give the signs already mentioned.
Vaginal diagnosis is easy by this means. The face pro duces sensations peculiar to itself. On one side of the pelvis we fiud a hard, rounded body, the forehead, upon which we feel the coronal suture, ending at the anterior fontanelle. On the other side of the pelvis, we feel a series of inequalities which, with patience and care, we may clearly dif ferentiate. In the first place, there is, below the forehead, a depression limited by two prominent, curved margins, the supra-ciliary ridges, below which we feel two soft, prominent, rounded tumors, due to the projection of the eyeballs. Between these tumors is placed a depression, and still lower, a triangular prominence, the free base of which, turned away from the forehead, presents two orifices separated by a thin partition. This is the nose with its nostrils. Below is a transverse fissure, bounded by two projecting borders, viz., the superior and inferior maxilla. If we intro duce the finger into the fissure, which is the mouth, we feel the e. Sometimes the foetus sucks the finger introduced into its buccal cavity. Finally, the finger, passing over the inferior maxilla, clearly makes out, below the mouth, the prominence of the chin. Even if we cannot reach the lower jaw, the direction of the nostrils will necessarily show the situ ation of the chin. The complete diagnosis of the presentation simultane
ously shows the position. This diagnosis, which is so plain, is yet diffi cult if the membranes have been long ruptured. Since the face corre sponds to the pelvic cavity, the caput suceedsneum forms on it, and the (edematous swelling and tumefaction of the face completely alter the sensations afforded by palpation. The cheeks, in fact, being much tume fied, tend to approach each other, forming a furrow, at the bottom of which the nose disappears. The buccal orifice, instead of remaining transverse, is rounded. The swollen lips bound this orifice, and, giving it the appearance of the anus, lead to the erroneous diagnosis of a breech presentation. This mistake has been made by very experienced men. The finger, introduced into the vagina, reaches a cheek which, on account of its softness and the resistance it offers, is taken for one of the buttocks. The furrow separating the cheeks is thought to be the fold between the buttocks and the rounded mouth to be the anus. There is, however, a sign by which the error may be prevented. The anus presents, on its margin, the prominence due to the point of the coccyx, which is charac teristic of this region.