THE HYGIENE OF PREGNANCY.
Moreover, since pregnancies are very variable, not only with different women, but even with the same woman, it is impossi ble to establish absolute rules of hygiene, and the attitude of the obstetri cian in the majority of cases, should be absolutely expectant, but in other cases, his measures should be as active as possible. Besides the general hygienic rules applicable to all women, there are some indications, arising in the course of pregnancy, which must guide the physician. We limit our present remarks to general indications, reserving special in dications for the chapter on diseases of pregnancy. In the great majority of cases, pregnancy follows its regular course, constituting a state inter mediate between health and disease, if not of absolute health, and causing women only a little annoyance and malaise. Still, there are cases of preg nancy attended by complications, which, although different at the various stages, are none the less very painful, and demand the whole attention of the physician, who, it must be admitted, is often powerless to relieve. Without going into details which belong to a later chapter, we would here state that the greatest danger in pregnancy is that of abortion or prema ture delivery, which is always precipitated by uterine contractions. It is, therefore, the first duty of the physician to prevent these contractions, which occur normally during the whole progress of pregnancy, from sur passing physiological limits, and to render them harmless for both mother and child. The contractions tend particularly to transcend physiological limits at the time corresponding to the menstrual epoch. It is, thus, at this time, above all others, that the physician should interfere, employing measures which we consider heroic. These are absolute repose and lau danum enemata. containing twenty drops in ten ounces of water, given with a simple syringe and not with an irrigator, or a syringe with valves, so that the whole dose may be absorbed. The enemata may be repeated at intervals, which, according to the case, may vary from several hours to a number of days. The first advice which the physician should give his patients is to become accustomed to watch themselves, to learn to rest at the right time, and to take the opium themselves if necessary.
No change should be made in ordinary cases, in habits, food, or exercise, and exaggerated precautions are to be avoided as much as insufficient ones. It is just as bad for pregnant women to remain stretched out on an invalid chair or in bed, as to undertake inordinately long walks or drives. We are great advocates of moderate exercise. We hold, then, that tie pregnant woman should go out daily, either on foot or in a car riage, whichever she prefers. One sees many women who are fatigued by a carriage, but for whom walking is an agreeable and beneficial exer cise. There are, on the other hand, many whom walking tires, and who get on admirably in a carriage, particularly if they choose macadamized streets on which jolting is avoided. The climbing of long flights of stairs must be absolutely forbidden. The rule must be to make the time passed out of doors the occasion for diversion and moderate exercise, never of fatigue. As is seen, we forbid neither dinners, concerts, nor theatres. Although we favor rides and drives, we do not permit journeys. The physician must be very circumspect in this particular. Beside the jolting of railroad travel, fatigue is incurred by the woman proportionate to the duration of the journey and the length of time during which her habits are changed. When we ch permit travelling, we advise that the time of departure and of return be made to correspond with the mean time be tween two menstrual epochs. Since journeys are particularly dangerous when made early in pregnancy, they should only'be permitted between four and a half or five months and seven and a half months from the time when foetal movements come to bear witness to the foetal vitality, up to the period of viability, when, if labor occurred, the case would not be one of aliortion but of premature delivery. It seems to us a useful if not indispensable precaution to have the woman travel, if possible, stretched out in a sleeping car, or on the cushions of a carriage with good springs.