"On being ushered into her chamber, we may engage her in some general conversation, which will give us an opportunity of observing the frequency, duration, strength, and character of the pains; and our conduct must be framed according. Should they be of trifling importance, we may content ourselves with giving some ordinary directions and retire from the apartment. But if they are returning with frequency and activity, we must not allow much time to elapse before we require to make an examination PER VAGINAM.[23] An objection may be raised by the patient to the necessary examination being then instituted, under the idea that _no assistance_ can be rendered her so early in the labour. As I would regard the feelings of a parturient woman in a degree only secondary to her safety, I would by no means insist on putting her to this inconvenience, unless I thought it quite indispensable. But as much valuable information may be gained by this first examination, and as it is highly desirable to obtain that information during the progress of the first stage, it is right firmly, but gently, to urge its propriety. It is seldom, indeed, that she will not accede to the recommendation of her medical attendant, provided he possesses her confidence, and conveys his request with becoming delicacy.[24] "Much knowledge must be acquired during the first vaginal examination. It is, first, whether the woman be pregnant;[25] secondly, if she be in labour; thirdly, whether the membranes have ruptured, or are still entire; fourthly, how the child is presenting; fifthly, how far the labour is advanced; and, sixthly, the state of the os uteri, vagina, and perineum, in regard to their distensibility.... She should be also covered by a light counterpane, or a blanket and a sheet. In this position (lying on her left side, with the nates brought to the edge of the bed) _the vaginal examination_ is to be conducted in the following manner:--The attendant, sitting rather behind her, and having anointed the two first fingers of his _right_ hand, with some unctuous substance, mostly in readiness, is to place them on the labia externa; then gently separating these organs, he must introduce the first finger into the vagina,[26] in the direction of its entrance, which is backwards and upwards: or he may take the perineum as his guide, and insinuate his finger within the genital fissure posteriorly, close to the fourchette. Having introduced it as high as he conveniently can, he must pronate his wrist, so that the junction of the first and second finger shall fit in under the symphysis pubis. In this way he will be able usually to reach the os uteri without difficulty. Should that organ, however, be situated so high that he cannot perfectly command it, rather than remain in ignorance of its condition, and of the presentation of the child, he may introduce the first two fingers of his left hand, and as these may be passed higher within the pelvis, they will