EXAMINATION BY THE FINGER.
The touch may be either vaginal or rectal. Some authors add another variety, the vesical. The essential obstetrical touch is vaginal and rectal, and vesical touch should only be employed in cases of absolute necessity. The vaginal touch is the mode of exploration which furnishes the most information to the accoucheur, but it must be combined with external palpation and auscultation, and in order to obtain all the information which of a pregnant woman can furnish, one must avail himself of all three modes of investigation. Moreover, the results of all three methods must coincide. Owing to natural feminine delicacy, the obstetrician often limits himself, during pregnancy, to external palpation and auscultation, but, if he encounters obscure points or is in doubt, he must not hesitate to employ the vaginal touch, which alone can furnish certain indispensable data, in many cases. Vaginal touch shows not only the existence of pregnancy, but the presentation, the position, the con dition of the soft parts, the dimensions of the pelvis, the changes in the cervix and in the uterus, and the progress of labor.
" Ile who hurts," says Pajot, " examines wrongly," and the proposition is equally true if reversed. It is therefore necessary to possess the Melte re crudities in order to avoid giving the woman pain, and to derive the great est benefit from the touch. The finger must acquire the habit of making the examination, and the practised finger will always put the untrained finger to shame. The accoucheur whose fingers are long has certain in contestible advantages. but the finger must, above all things be practised, for, as Cazeaux says, "the finger grows long from practice." The ex amination should be made with a single finger, and not with two fingers, as Joulin and certain German authors recommend. The information furnished by a single finger is much clearer and more precise, and only in exceptional cases should one have recourse to two fingers. In these cases, even two fingers are generally insufficient, and one must introduce the whole hand, anesthesia having been induced, both to spare the woman pain, and to facilitate the examination. The woman being examined by the finger may stand up or lie down. The latter position is preferable, both for the woman and for the examiner. The woman then assumes the dorsal decubitus, the thighs being flexed, the legs resting on the thighs, the heels closely approximated to the nates, and the thighs slightly sepa rated. If the woman stands up, she should be placed against a resisting object, as a wall or a door, the body being slightly bent forward. The obstetrician should accustom himself to practico vaginal touch with either hand, for sometimes the examination is easier with the left hand, or the position of the bed may necessitate the use of that hand. The finger should be anointed with some unctuous substance, as oil, pomade or cold cream, for the double purpose of facilitating the introduction of the finger within the genital canal, and of guarding it from contact with vagi nal secretions, chancres or mucous patches. The woman being recum bent, the accoucheur takes his place at the right of the patient, if he proposes to use his right hand, but at the left in the other case. Passing
his hand under the bed clothes, without exposing the patient, he places it between the thighs, holding the thumb and fingers doubled into the palm, and the index finger, only, extended. It is best not to pass the hand under one thigh. Lowering his hand, so that the index finger is directed verti cally to the axis of the arm, the accoucheur advances the finger ii a straight line until he encounters the perineal groove, alongwhich he passes gently, from above downward [it is preferable to pass the finger from below up ward, and thus avoid touching the clitoris—ED.], to remove the hair which may cover the vulvar orifice. Then, replacing his finger in the perineal groove, he passes slowly upward over the anus, the perineum and the pos terior vulvar commissure. He now clearly feels the opening left by the separation of the labia majors, and by the vaginal and vulvar orifices. The examiner now quickly extends the hand, and protruding the index finger, which is still extended, he penetrates easily, and without fum bling, into the vagina and passes upward and backward, until the hand is arrested by the perineum. As the finger advances, the elbow must be depressed so that, when the finger reaches the end of the vagina, the elbow shall rest on the bed. It is sometimes well to elevate the woman's buttocks upon the unemployed closed hand, so that the elbow may be farther depressed, and the finger thus made to penetrate farther. Wo generally prefer to keep the thumb and fingers flexed upon the palm. Other aceoucheurs keep the fingers flexed but the thumb extended. This plan has the disadvantage that, when the finger is carried far into the vagina, the extended thumb forcibly impinges against the vulva, causing the woman severe pain, and diminishing the reach of the finger. We ordinarily hold the other fingers flexed upon the palm, but it is some times useful to leave them extended. They are then placed in the hollow between the thighs, below the perineum, which they push upward, thus permitting the index finger to penetrate more deeply. The gentle sage of the finger across the genitals serves to push aside the hair, and to reveal the condition of the parts as regards softness, swelling, tumefac tion, or the presence of varicose veins, vegetations, cicatrices, promi nences, depressions or of mucous patches. Should any of these abnormal conditions obtain, its exact character should be ascertained. [For his own protection, the accoucheur should always examine with the eye the genitals of any woman about whom he is in doubt, before touching them with the finger. He thus will avoid, in particular, specific infection.— Ed.] The accoucheur should first examine the anatomy of the vagina, its length, its dimensions, and the smooth or rough character of its sur face. He should look for cicatrices, for septa, tumors and other lesions, making as complete an examination as possible. He next examines the cervix, the uterus, and the bony pelvis.