When the doctor arrives he may want to examine the patient either externally or internally, or both. So a sheet is thrown across the lower part of the body and the night-dress pulled up as far as the breasts.
For the external examination the doctor washes his hands in warm water and green soap and scrubs with the nail brush for five minutes. This period should be prolonged to fifteen minutes, if, by any mischance, the hands have been in contact with pus or infectious material. It is extremely difficult to get them even approximately clean after such an experience.
Fig. 53.—Palpation. What is in the pelvis? (Eden.)
He now palpates the abdomen, notes the location of the head and back, finds and counts the heart tones, measures the pelvis and child, estimates the descent of the head and the character of the pains.
Fig. 54.—Palpation. What is in the fundus? (Eden.)
If he thinks an internal examination is necessary, he will now return to the bathroom, pare and clean his nails, scrub hands and arms to elbows for ten minutes in running water with green soap and a sterile brush, soak the hands in lysol solution 0.5 per cent for five minutes. Bichloride of mercury solutions have no place in obstetrics. They ruin instruments and hands, and are valueless for asepsis since the mercury unites with the albumin of the mucoid discharges and forms an albuminate of mercury, which is inert. The bichloride solutions also are nonlubricating, harsh and astringent, as well as poisonous, as soon as the mucoid protection has been removed. When the doctor takes his hands from the lysol solution, they should be wiped on a sterile towel. A sterile gown is put on, if possible. If it is not available, he should be careful not to touch anything that may destroy or contaminate his preparation. The hands are powdered and sterile rubber gloves pulled on (one will do.).
Fig. 55.—Palpation. Where is the back? Where are the small parts? (Eden.)