THE PRELIMINARY PHENOMENA OF LABOR. Ordinarily, it is preceded by symptoms which have been called the preliminary phenomena of labor. The symptom which most impresses the patients is subsidence of the abdomen. Being due to the foetal engagement and subsequent descent of the inferior segment of the uterus, it occurs, of course, at a variable time before labor, according to the period of foetal engagement, producing, when it comes, changes in the shape and size of the abdomen. As a result of this descent, the fundus uteri recedes from the ribs and the diaphragm, the respiration becomes more free and easy, digestion is more active, and the woman ex periences a sense of well-being which may be likened to the calm before a storm. In other cases this abdominal subsidence augments the oedema of the lower extremities, and produces a feeling of pressure upon the in testine and the bladder, which results in frequent urination, and is often accompanied by leucorrhcea, which, causing the patients to feel moist, makes them believe that the waters are escaping. Sometimes the women are attacked twenty-four or forty-eight hours before confinement by profuse diarrhoea, which contrasts strongly with the pre-existing constipa tion.
At times, the patients are gay and lively, at other times sad and vaguely apprehensive, which latter feeling is encouraged by the occurrence of ir regular pains, which, appearing at long intervals, and during several hours, finally cease, leaving the woman exhausted. The woman notices that her
abdomen grows tense and hard. These contractions exist, it is true, dur ing the entire course of pregnancy, but are, up to a late stage, painless and often imperceptible to the woman. If an examination be made at this time, we find, beside the thorough engagement of the foetus, marked changes in the cervix, the chief of which is its effacement. In primipara3 the cervix forms a slightly projecting prominence, often a simple depres sion, either completely closed or hardly open, so that it is hard to distin guish it. In multipare the effacement is less pronounced, and the foetus less deeply engaged, but the cervix is often widely dilated, and the os in ternum so large that the finger reaches the membranes, which, at the moment of contraction, bulge slightly outward. Millot has given the name of secret labor to these phenomena, but they are not constant, and it is not rare to see, particularly in primiparEe, the effacement of the cer vix delayed until a few hours before labor. Parturition, having once begun, announces itself by two unfailing signs—regularly recurring pains. and cervical dilatation.