them as depicted in the illustrations found in works on urinary pathology, and comparing these with specimens viewed under the microscope.

EXAMINATION OF THE INTESTINES.

In examining the course of the intestinal canal, the hand may encounter masses of hard focal accumulations, the recognition of which is very important.

These sort of tumours are usually felt on the right or left side of the abdomen in the course of the colon, as irregular, movable, somewhat tender masses. The diagnosis is made certain by noting the effect of purgatives and enemata in removing the accumulation. When there is a stricture of any part of the intestine, the peristaltic movements of the bowel can be seen and felt in the portion of the canal above the stricture. Large collections of fluid in the stomach and intestinal canal give rise to dulness on percussion, and gurgling, splashing movements on alpation by the applied hand. Gas in the intestine or stomach yields a more or less tympanitic note on percussion.

The diagnosis of stricture of the rectum, and of fissure, piles, or cancerous disease of that part, is made out by examination with the oiled finger passed well up into the gut, and also by the use of the rectum bougie and the anal speculum.

EXAMINATION OF THE UTERUS.

PREGNANCY.

Only when the uterus is enlarged can it be felt through the abdominal wall. At times firm sub-peritoneal fibroid tumours grow from the womb, and extend into the abdominal cavity, where they are felt as hard masses.

By passing the uterine sound into the cavity of the womb, it will be discovered that the abdominal tumour moves as the uterus moves, and this is a proof of their intimate connection. It may be observed that the passage of the metallic sound into the uterine cavity at times gives rise to discharge, much pain, and sometimes even peritonitis; hence, before using the instrument, the practitioner should study the method of its employ

ment in some special work, and after its employment the patient should be caused to rest during the remainder of the day on a sofa or bed.

By means of tactile examination of the uterus per vaginam, we ascertain if there be any hardness, irregularity, or thickening about the os and cervix uteri. We further observe any undue heat, tenderness, weight, and want of mobility about the uterus. By means of the sound passed through the cervical canal into the uterine cavity, we discover the length of the cavity, and whether the cervical canal be duly patulous and free from constriction.

The adult healthy uterus measures from the margin of the lip to the fundus nearly three inches, and its breadth between the two Fallopian tubes is about two inches or rather more. The length of the transverse chink, or os uteri, is from three-eighths to half an inch. The os, it may be observed, varies in form in different individuals; usually it is a transverse slit, but with some it is circular, and in others triangular, like a leech-biteespecially is it thus found in women who have borne many children. It is generally about the size of a goose-quill, or rather smaller.

The cervical canal is from half to three-quarters of an inch long; it first widens, then contracts again, where it enters the cavity of the uterus. The mucous membrane lining the canal of the cervix is disposed in rugæ, branching out from a centre, and this has been called the arbor vitæ. In passing the sound, especially if it be a small one, care must be taken not to get the bulbous point hitched and arrested among these rugæ of the arbor vitæ.

The weight of a virgin uterus is from seven to eight drachms, but after child-bearing it amounts to an ounce and a half.

The lower portion of the uterus can be investigated by the finger per vaginam, and examination with the vaginal speculum which show any erosion or ulceration of the os or change of colour, and through the speculum local applications to diseased parts can be made.

THE OVARIES.-These are the essential organs of generation in the female, and are oval bodies, each about an inch and a

quarter long, hanging loosely in the pelvis, and attached to either side of the uterus by the posterior duplicature of the broad ligament known as the ligament of the ovary.

To investigate diseased conditions of the ovary in an early stage, the intestines and bladder being emptied, the patient must lie on her back with knees drawn up so as to relax the abdominal muscles, and then pressure should be made backwards towards the brim of the pelvis from a point a little above the curve of Poupart's ligament. Swelling and tenderness of the ovary will thus be detected. Professor Simpson used to get the diseased ovary between two fingers introduced well up the vagina, while the other hand was pressed down into the brim of the pelvis on the same side.

Ovarian dropsy and its distinction from ascites has been already considered, and for the diagnosis of pelvic cellulitis and pelvic hæmatocele and the more special forms of uterine tumour and uterine displacement, we must refer the reader to some of the special works on gynæcology and uterine pathology.

In pregnancy the uterus rises as a rounded tumour above the symphysis pubis about the fourth month. The abdominal enlargement increases uniformly, and when the gravid uterus reaches the umbilicus, it pushes it forward, so that in the sixth and seventh months it is about level with the surrounding skin, and afterwards it projects beyond it in most women.

To the feel, the uterine tumour is well defined, firm, and elastic, preserving its form in all positions of the body.

To hear the foetal heart pulsating and the whirring sound of the uterine souffle or bruit placentaire, the patient must lie on her back, and all disturbing noises, such as watches or clocks, be removed to a distance. The abdomen should be uncovered, and then the stethoscope placed on a line from the umbilicus towards the crest of the ilium, first on one side, then on the other; and it is usually on the left side that we succeed best in discovering the rapid, short, regular, muffled tickings that mark the total heart-beat. The number of sounds varies from 120 to 160 in the minute, and the earliest period of pregnancy at which

they may be heard is the end of the fourth month. The fœta heart in the female is more rapid than in the male.

The bruit placentaire, or placental murmur, is heard in the second half of pregnancy; it is synchronous with the arterial pulse, and is developed in the dilated uterine arteries at the part where they terminate in the uterine veins.

THE END.