se can be removed after the confinement and new, clean warm clothes put
in their place. The objection to this is the woman may be too tired to be
moved, while, with the permanent and temporary bed arrangement she need
not be moved at all, only lifted, while the temporary bed is being removed
and she is then let down easily upon clean bedding.

Preparation of the Patient.--The patient, if she desires, can take a full
bath. The bowels should be moved thoroughly with a soap and water
injection so that the rectum will be fully emptied. This makes labor not
only easier, but pleasanter, as no feces will be discharged during labor.
The bladder should also be emptied. The external organs should be
scrupulously cleansed and bathed with some antiseptic solution, like
glycothymoline, listerine, borolyptol, etc. A fresh suit of underwear may
then be put on and over this a loose wrapper.

[OBSTETRICS OR MIDWIFERY 531]

Examination of the Patient.--The physician needs to satisfy himself as to
the position of the child, etc. This can be done by an examination of the
abdomen and also of the vagina. He must determine whether the child is
alive, its position, the condition of the cervix and mouth of the womb. In
making such examination a routine plan should be adopted. The coat must be
removed, the shirt sleeves turned up and the hands and arms washed with
soap and water. The abdomen should be thoroughly palpated (felt) and
listened to with the ear or stethoscope to determine the character of the
child's heart beat, whether it be very slow, one hundred and twenty or
less, or a very rapid one, one hundred and fifty or more. It may indicate
danger to the child and necessitate a hurried delivery. After these things
have been done, the hands and arms must again be thoroughly washed and
sterilized, the fingers anointed with carbolated vaselin and the
examination of the vagina made.

This cleanliness is necessary, and if this plan were carried out by
everyone connected with the patient during the whole confinement, there
would be fewer cases of "child-bed" fever, with its resultant diseases.
The patient should lie on her back with the knees drawn up. There is no
need for any exposure now, for the covering can be held up by an attendant
so that it will not touch the physician's hands. The soft parts are now
separated by the fingers of one hand while the examining fingers are
introduced into the vagina. These fingers should never touch any ex