The subsidence of the lower end of the uterus into the pelvis, however, causes many unpleasant symptoms. The pressure upon the bladder renders a frequent evacuation of its contents necessary; there is often an ineffectual desire to urinate, and sometimes strangury. There is often a sense of weight about the anus, an irritable state of the bowels, occasional griping pains, and a desire to go to stool when but little is passed, and sometimes diarrhœa. The œdema and varices of the lower extremities augment, the hemorrhoidal vessels swell up, and the piles are larger. These precursory symptoms are manifested more in primapara than in others. To some, walking becomes at this time impossible. There are during the last month, and especially toward the close of it, painless uterine contractions; there may be at first a sort of squeezing sensation with it. But about twenty-four hours previous to the commencement of actual labor, these contractions are accompanied with some pain and are periodical, recurring perhaps every twenty or thirty minutes. If an examination be made of the os tincæ at the COMMENCEMENT OF LABOR it will be found that the rounded collar of the os is already effaced. The pains then suddenly become acute, and it can be observed that the uterus contracts if we notice its greater hardness and roundness during a pain. The os uteri if somewhat dilated closes partially with each contracting, and it can be observed that its margins are growing thinner though tense and resistant at the time of the pain. The contractions distend the membranes; these are first pressed _on_ the neck, then _into_ it, then as soon as the dilatation is sufficiently advanced engage in it in the form of the segment of a sphere, whose dimensions progressively increase with the dilatations. There is now and perhaps has been for several hours a glairy discharge from the vagina, which becomes streaked with blood, there are perhaps shiverings or rigors (not accompanied with a cold skin), the pains increase in force and frequency, the pulse is hard, full, and rather frequent, the countenance is flushed, often there is vomiting, and the patient is prone to despond and be discouraged.