Upon the fœtal head after it is delivered there is almost always a protuberance to be found—a tumefaction, more or less considerable upon some point of the vertex; its greater size indicating a longer continuance of the labor, and its seat indicating in what position the child was born. This tumor is almost always located on one of the posterior superior angles of the parietal bones, and shows that the occiput escaped under the pubic arch. During the labor the whole head is strongly compressed except at one point on the vertex, which therefore becomes the seat of a sero-sanguinolent infiltration. This tumor disappears usually within forty-eight hours; if it does not, it may properly be punctured. It may contain either serum, or serum and blood, or grumous blood. CHAPTER V. DIAGNOSIS OF ARTIFICIAL LABOR. When the expulsion of the fœtus takes place from the efforts of nature alone, the labor is called by some authors spontaneous or natural, but when art is obliged to interfere it is called artificial. It would be very useful to us if we could always decide in the commencement of labor whether the assistance of art would be required, and I will group together in a few pages such instructions as I am able to give on this important subject. The nurse or midwife will not very generally be able to decide any point by auscultation, but she as well as the physician may judge from the appearance of the woman, from her past history, from palpation of the abdomen, and from vaginal touch. She should accustom herself to judging by all these means, that she may be able to decide early whether the help of an accoucheur will be _imperatively_ needed. No one can decide certainly from simply seeing a patient in the beginning of labor, whether her labor will be natural and spontaneous, or artificial; but I have many times when first looking at a lady, if her complexion was fair, and her form good, but rather tall, predicted that her accouchement would proceed regularly and favorably. But in forming our opinion we need to know something of the previous health and present ailments of the patient, and, if a multipara, the character of former labors. If nausea and vomiting or any other ailment has reduced her strength so that she is exceedingly weak, this may give rise to some reasonable apprehension; but I have known a woman that could scarcely retain a morsel of food on her stomach for seven or eight months, that had become very weak indeed and exceedingly emaciated, who yet endured her labor well and soon recovered. The general rule is, that the more perfect the woman’s health is, the better she is fitted for child bearing, but if her general health and strength is reduced below its proper standard by some previous or accompanying disease, such for example as consumption, she may endure the labor very well, and succumb to the disease afterwards.