By laying the hand flat in the rectum and pressing gently downwards the anterior border of the pubis may be felt, somewhat more deeply placed. The rectum is then thrust slightly to the right, and the ascending branch of the right ilium, as high as the sacro-iliac articulation, and the lower surface of the sacrum, are directly examined; lastly, the hand is directed towards the left, gliding down the left ilium, and returning to the point of departure. In this way the state of the pelvic floor, of the arteries, veins, and lymphatic glands, etc., the degree of mobility, tension, or fulness of the uterus, as well as the condition of the broad ligaments, are all ascertained.
Still more deeply placed, and at the extreme limit to which the arm can be introduced, will be found some or all of the above-mentioned organs—viz., the small intestine, large intestine, kidney, etc.
Defæcation: Examination of the fæcal material. The character of the fæces is very important in certain diseases; e.g., diarrhœa assumes a varying importance, according as the discharges are of an alimentary, serous, mucous, or sanguinolent type, and are slight, temporary, intense, profuse, or continued. In other cases defæcation is slow, becomes difficult, and various degrees of constipation exist. Defæcation may be completely suppressed, as in invagination or strangulation of the intestines; on the other hand, one may observe diarrhœa, dysentery (microbic or sporozoic diarrhœa), and intestinal hæmorrhage. The last named may be of varying degrees of acuteness, from the passage of simple drops or streaks of blood, distributed over almost normal excreta, to the passage of unchanged blood in liquid jets or in clots.
Macroscopic examination. Macroscopic examination takes cognisance, firstly, of the quantity (40 to 80 lbs.), consistence (firmness or softness), colour (olive green, blackish green, greyish black, sooty, or tarry) and odour (normal, fœtid, putrid, etc.) of the fæces.
Sometimes the excreta are moulded and covered with glairy mucus, or contain such abnormal products as undigested food (a sign of chronic diarrhœa), false membranes, false membranes due to pseudo-membranous enteritis, fibrinous clots, or parasites like liver flukes, tæniæ and strongyles.
Microscopic examination. Microscopic and bacteriological examination is sometimes useful; and even when macroscopic examination has revealed nothing, it is possible to detect the presence of the eggs of parasites like flukes, strongyles, hooked worms, etc., the presence of sporozoa (as in intestinal coccidiosis) and of specific microbes, as in the diarrhœa of calves, etc.
It is only by the synthesis of methodically collected signs that one finally succeeds in exactly diagnosing the numerous diseases which may affect the intestine: intestinal congestion, invagination, volvulus, intestinal strangulation (mesenteric or diaphragmatic herniæ, etc.), atresia of the anus, acute or hæmorrhagic enteritis, or intestinal helminthiasis.
Liver. The liver is situated in the right sublumbar region. It is fixed behind the diaphragm and under the hypochondriac region, and extends from the ninth to the thirteenth rib. It can be examined by palpation through the last intercostal spaces and behind the thirteenth rib. In health it is difficult to pass the fingers sufficiently under the hypochondriac circle to reach the liver; but in case of morbid hypertrophy it extends more or less beyond the last rib, and palpation between the last ribs sometimes reveals abnormal sensibility.
Percussion better than palpation enables one to delimit the space occupied by the liver, particularly towards the back, where there is no interposed layer of lung. Percussion is especially useful in detecting hypertrophy due to cancer, tuberculosis, echinococcosis of the liver, etc., or hepatic atrophy. In isolated cases icterus may exist, confirming the conclusions otherwise arrived at.
Pancreas. The pancreas is situated rather deeply in the right sublumbar region, below the kidney, behind the liver, above the floating colon, and within the duodenal loop. It is therefore very difficult to examine; moreover, the diseases which affect it are still little understood.