56 OBSTETRICS. 



than in the first. She seems to have recovered her energy and equa- 

 nimity, and, if this stage be prolonged, will often sleep between the 

 pains. The young practitioner should be on his guard, however, 

 in relation to this drowsiness, particularly if it occur in primiparae, 

 and be much protracted, or accompanied with headache, as it is in- 

 dicative of congestion, and may be the precursor of convulsions. 



During the descent of the presenting part, particularly if it be the 

 head, we are often informed of its progress by the occurrence of 

 an unpleasant symptom, viz., cramp in the lower extremities, pro- 

 duced by pressure upon the internal sacral nerves. Under the in- 

 fluence of another pain the head descends along the vagina and 

 begins to press upon the perineum, the rectum becomes flattened, 

 and its contents are often involuntarily expelled ; by the time it has 

 reached the floor of the pelvis it is about to meet with its greatest 

 resistance, viz. : that of the perineum. Here again we observe the 

 gradual advance and recession, until this part is distended to such a 

 degree as to allow the presentation to escape over it. This disten- 

 sion is often so great, and the perineum so thin, that the finger can 

 scarcely distinguish it from the presenting part. Occasionally it 

 happens that from this cause the part is rendered transparent, so 



Fi2. 16. 



that the presentation is visible through it. Twice Madame Laeha- 

 pelle has seen the hair of the foetal head through the distended peri- 

 neum (Fig. 16). The presenting part has now entered the inferior 



