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demonstration on the manikin, Mrs. O'Flaherty, of the conduct of labor. He taught that it was good for the young physician to familiarize hiin- self with the process of parturition by keeping his hand in Vytorin Discount Card contact with the parts. This was modestly done under cover until the presenting part was about to be born; and this I think was typical of obstetrical practice at the Cost Of Vytorin end of the last century. Now the fashion has changed ; the pendulum has swung to the other extreme and even vaginal ex- aminations are anatheina with some physicians. Let us consider briefly — 1. Wsat can we Vytorin Price learn from a rectal examination? 2. What advantage do we Generic For Vytorin 10 40 gain by this method? and 3. Is Generic For Vytorin there any ob- jection to a vaginal examination? Considering the last question first, it cannot be denied that in a well conducted clinic or proper environment, vaginal examinations with the gloved hand or Buy Vytorin the carefully cleansed bare hand can be practised without detriment from the examiner's hand. And every one who has attended women even in very unsanitary surroundings, without clean towels or bedding, knows that they commonly succeed in avoiding infection. This fact, however, "Rtad Vytorin Gel before tlie Philadelpliia Clinical Association, October 4, 1920. November 6, 1920.] PARKE: RECTAL EXAMINATION IN OBSTETRICS. 717 does not warrant one in disregarding the ordinary Vytorin Cost rules of sterility. As Vytorin Cholesterol to the patients themselves they are the hosts of a variety of organisms Is Vytorin A Statin which increase in virulence from the cervix to the vulva. The folds about the clitoris and the glandular dis- charges about the posterior commissure of the vulva are especially likely to harbor infective germs. The Doderlein bacillus is credited with immunizing the upper part of the vaginal tract against infection. Now it is impossible to make a vaginal examination without carrying germs from the lower to the upper part of the vaginal canal : and if these are of a virulent type the risk to the patient is not avoided by any preparation of the doctor's hands, no matter how careful he is. Routh, of London, has shown, with respect to Ca?sarean section, that where repeated vaginal examinations have been made and where attempts Vytorin Generic Equivalent at forceps de- livery have been undertaken the mortality Is There A Generic For Vytorin follow- ing the operation was vastly greater than where the same operation was done on patients in labor with unruptured membranes and few examinations. Dr. Beck in reporting a series of Vytorin Online Csesarean sections done at the Long Island College Hospital observed that the morbidity following the operations was thirty per cent, in cases where vaginal examina- tions had been made, whereas it was only twelve per cent, in cases where no vaginal examinations had been made. DeLee (1) records the occur- rence of two deaths from infection in the serv- ice of the Chicago Lying-in-Hospital due to coitus shortly before parturition. These citations — and many more could be adduced — show the harmful effect of invading the birth canal shortly before labor. Let us consider, for example, the patient to whom we wish to give the test of labor. Such a one is a potential case for operation and examination from time to time over a period of twetity-four hours or Vytorin Generic Name more would Generic Vytorin 10 40 be the usual practice. If in the end section is resorted to, the patient's well- being both as to morbidity and mortality will be enhanced if no vaginal examinations have been made, or what is only a little less satisfactory if only one vaginal examination is made immediately prior to delivery; for it is the repeated examina- tions Vytorin Statin over a long period that are most likely to give rise to infection. In the normal course of delivery Nature pro- vides a flushing of the birth canal when the Generic Name For Vytorin bag of waters ruptures, when the fetal ellipse advances, and again when the afterbirth and membranes are discharged — the current being always from above downward. Such patients quite uniformly do well, if the doctor fails to arrive on time, thus emphasizing the implied suggestion not to meddle with Nature's Vytorin 10 Mg plan by introducing something from below to the upper part of the canal. What can we learn from a rectal examination ? The tyro learns nothing, and it is difficult to Merck Vytorin con- vince the beginner that it is worth while to practise the method often enough to acquire confidence in his findings, for a large experience is required to learn the finer points. The reason for making any examination is, of course, to learn whether the patient is in labor ; how far advanced the labor is ;

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