Midwifery opératoire : un guide des difficultés et des complications de la pratique midwifery . nounce certainement en ce qui concerne sa position. Si l'on regarde l'illustration (Fig. 9), on observe que dans les positions de sommet, l'extrémité occipitale DE LA tête est plus basse, les doigts peuvent être plus profonds dans le bassin de ce côté, Ou, pour le mettre différemment, le Bideon que les doigts s'enfoncent le plus profond est le côté à lequel l'occiput est dirigé. Dans les présentations en face et en rangée, comme nous verrons, il est quiteussinon. Avec eux l'occiput est plus élevé, et se sent immusuyproéminent

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Operative midwifery : a guide to the difficulties and complications of midwifery practice . nounce definitely regarding its position. If one looks at theillustration (Fig. 9), it will be observed that in vertex positions, the 20 OPERATIVE MIDWIFERY occipital end of the head being lowermost, the fingers can be sunkdeeper into the pelvis on that side, or, to put it differently, the Bideon which the fingers sink deepest is the side to which the occiput isdirected. In face and brow presentations, as we shall see, it is quiteotherwise. With them the occiput is higher, and is felt unusuallyprominent. These and other points, however, will be considered inconnexion with the different positions and presentations. Similarly, the appreciation of the relative size of the foetal head and maternalpelvis, so important a guide to treatment, and the appreciation ofthe presence of more than one fcetus, will be considered when thesesubjects are under discussion. Vaginal Examination.—Cntil recent years the accoucheur madehis diagnosis of the position, presentation, etc., of the fcetus entirely. ] Fig. 8.—Palpation of the Fcetal Part situated at the Sides of the Uterus. by a digital examination per vaginam. If one looks at the obstetrictextbooks of a comparatively few years ago, one finds this methodof examination the only one seriously discussed, while even at thepresent moment a large majority of practitioners still employ it almostexclusively. The perfecting of abdominal palpation, but, above all, the demon-stration that every vaginal examination is a distinct danger to theparturient, has led the more enlightened and thoughtful to limitvaginal examinations as far as possible. Some enthusiasts woulddispense with the latter altogether ; but it is perfectly evident thatsuch an extreme position is untenable, for there are many conditions, both maternal and foetal, which can only be appreciated by vaginalexamination. Amongst these may be mentioned small tumours inthe pelvis, rigidity of

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