O.L.A. A line passing from the navel to the left antero-superior iliac 'spine, and not to the ilio-pectineal eminence.
0. L. P. Maximum behind the ilio-umbilical line, or at the level of this line.
O.R.A. Maximum on the median line, or a little to the left of the median line.
0. R. P. Maximum on a line passing from the umbilicus either to the right ilio-pectineal eminence, or to the right antero-superior iliac spine. They also say that Depaul is too positive regarding the breech positions. We hold that these authors, who are right from a scientific standpoint, go too much into detail. The diagnosis of the cardinal positions, whether right or left, suffice during pregnancy, and the landmarks of Depaul lead surely to it. So far as the diagnosis of the variety is concerned, it is of little moment before labor, and only palpation can afford exact informa tion as to whether the position be anterior, transverse or posterior. We hold that the landmarks of Depaul, although not absolutely exact, are sufficiently so for practical purposes. This is particularly true of face pres entations. The main point is to recognize the presentation at once, and we admit the possibility of so doing. The diagnosis of the cardinal posi tion, whether right or left, is established by the mere diagnosis of the presentation.
The Festal Souffle.
This souffle depends on the fcetal circulation. It differs from the ute rine souffle in that it is synchronous with the fcetal pulse, and in that it is always accompanied by a pulsation. Sometimes this souffle is produced in the foetal heart, and sometimes in the vessels of the funis, whence the names cardiac souffle, intra-cardiac souffle, foetal souffle, umbilical or funicular souffle, applied to it by various authors. Thence, also, the dif ferences which it presents, according as it emanates from the heart or from the vessels. When produced in the heart, it is persistent, is heard after birth, and then, according to Scanzoni and V irchow, generally de pends on a cardiac lesion, or may occur without a lesion. (Skoda, Scan zoni). This souffle is rare. The souffle produced in the funis is less rare,
bnt is variable and intermittent, is heard now at one point, now at an other, and when it disappears, reappears after an interval varying from a few minutes to several hours. Moreover, while the cardiac souffle is always best heard over the prlecordium, the umbilical souffle is heard just.
as well at a distance. First noted by Kennedy, and then by Depaul, Devilliers, and Charrier, this souffle was, by them, attributed to knots in the cord and consequent compression of the umbilical vessel. But this view is too narrow, since many children are born with the cord encircling the neck, the limbs or the trunk, without ever having presented the foetal souffle. It is now held that the souffle is due to compression of the cord between the fcetus and the uterine wall. (Chxrrier). Pinard believes that the souffle owes its origin to a diminution in the calibre of the um bilical vessels, duo to folds or valves in the vessels. According to Pinard, the sound is single if the veins or arteries separately present these val vules, but double if both sets of vessels contain them. This explanation, although correct for some cases, does not explain all, for, were it univer sally applicable, the souffle should be permanent, and it is not.
Sounds due to Foetal Movements.
Auscultation of the uterus reveals certain sounds at the moment when the foetus moves. Some of these sounds, being slow and prolonged, are due to friction. Others are occasioned by impact of the foetal limbs against the uterine wall. Pajot, who has carefully studied the sounds, and called them sounds of foetal impact, shows that the ear simultaneously perceives the noise of the shock, and the sensation due to foetal move ment, and that, since these sounds may be appreciated after the third month, before movements are perceptible to the hand, they constitute an excellent sign of pregnancy at a time when other sure signs are wanting. Later on in pregnancy, the shocks are sometimes produced with pendu lum-like regularity.