Only a word about clothing. The developing uterus fills the abdomi nal cavity more and more, and forces the woman to renounce, of her own accord, all tightly-fitting garments, and to adopt loose clothing, which gives better play to the thoracic and abdominal organs. Corsets should be absolutely proscribed. So-called pregnancy corsets, however loose they may be, still compress the breasts more or less, and, pressing on the diaphragm, displace the intestines, compress the liver and stomach, and thus often become the source of discomfort, which disappears when the corset is re moved. We however recommend, almost without exception, the use of a light abdominal supporter, which adapts itself well to the shape of the abdomen, does not annoy the patient, and is, above all, essential for mul tiparaa. In these patients the abdominal walls, distended by preceding pregnancies, no longer afford, to the uterus, the support afforded by the abdominal parietes in primiparre.
The linen alba often yields to the pressure, and the uterus falling for ward by its own weight, gives to the abdomen the shape known as pen dulous abdomen. This is more frequent in women with pelvic defor mities, fibroids, etc. Tife supporter, besides sustaining the abdomen, affords it lateral support, and thus favors the accommodation of the long axis of the foetus to that of the uterus. We have seen what role Pinard attributes to the abdominal walls, in producing this accommodation. We consider his ideas valuable, although not agreeing entirely with them. Who has not heard women express the desire " not to have their figure spoiled by pregnancy ! This disaster may, we believe, be best averted by wearing the abdominal supporter, which, by keeping the uterus ver tical, and by sustaining the abdominal walls, is the best means of prevent ing them from being over-distended transversely. The constitution of the woman largely affects the result. Women naturally fleshy, blonde, of lymphatic temperament, and short in stature always retain a larger abdo men than thin, slender brunettes, of a nervous temperament, whose tis sues possess greater elasticity. We would mention that, near the end of pregnancy, women are usually tormented by a sensation of weight and pressure in the pelvis, as if some object must be expelled, and that the desire to urinate recurs so often as to become almost unendurable, and to oblige the women to stay in doors. We have seen these difficulties yield to the influence of rest, followed by the application of a well-made supporter, slightly padded at the points intended to sustain the hypogas tric and supra-pubic regions. Pregnant women, being more susceptible to cold, should so choose their garments as to avoid colds, thoracic and renal trouble, rheumatism and the resulting heart lesions. Thoracic affections, aside from their inherent danger, may, by further interference with the functions of the lungs and heart, and by the jarring of the uterus due to cough, excite abortions or premature deliveries. Pregnant women should particularly avoid coming in contact with cases of contagious dis ease (eruptive fevers, typhoid fever, sore throat, etc.), both in the inter est of themselves and of the foetus. Rules about diet are hard to give. In some women pregnancy develops an enormous appetite, and in others, appetite is absent or perverted. This we will recur to, under the head ing, Diseases of Pregnancy. Among the many indications, thus furnished, one is very important. It is to make good for the mother the alimen tary losses occasioned by the foetus, by means of a nourishing and invigo rating diet. For women who are well, and whose digestion is good, we advise meat-juice, tonics and Spanish wine for supper. If necessary, we increase the number of meals, making them less bountiful. These measures are especially adapted to young and feeble women. We are not strong advocates of ferruginous preparations. Besides being occasion ally badly tolerated, they often produce obstinate constipation, to which the women are already only too much predisposed, both by habit and by pregnancy. Constipation is, indeed, habitual with pregnant women, and, in some, it attains alarming proportions. It must be antagonized by all possible means. Enemata constitute the most classical treatment but must often fail, and we advise the frequeftt repetition of mild laxa tives, even from the first. A capital point is to keep the bowels open.
We have seen a glass of cold water, on awakening, a cup of cold milk or, in women not accustomed to its use, a cup of coffee, meet the require ments of the case. If enemata are inefficient we advise mild purgatives, particularly castor oil, either taken in tea, coffee, lemon-juice or beer, or in capsules, magnesia, rhubarb, podophyllin, etc., or mineral waters. Drastics are to be avoided. In some cases diarrhoea, often very persis tent, takes the place of constipation and is to be met with astringents, above all with sub-nitrate of bismuth. This is, however, rare, and it is more usual to see critical diarrho3as succeeded by intervals of constipa tion. If these diarrhceas do not last more than one or two days, they are not to be too much interfered with, as they often give the patients marked relief. We shall consider perversions of taste or longings among the diseases of pregnancy. Pregnant women are often tormented by tooth ache, and if they have carious teeth, they come to ask if they may safely have them extracted. We absolutely veto this course. Aside from the excitement which the little operation occasions, even under anaesthesia, we consider it useless. The pain is often purely neuralgic, and the proof is that it often persists in spite of the extraction of the tooth. For the rest, only absolutely necessary operations should be undertaken during preg nancy. Baths are to be recommended even from the beginning of utero gestation, in spite of the current opinion that women should not bathe before the sixth or seventh month. Baths are useful, and should only be withheld from women subject to abortion. They should be short and not very warm (between 90° and and it is wise to take them at home, and to remain in bed for a half hour or an hour after the bath. We permit sea-baths, and cold baths and douches, but the sea-baths must be taken when the water is warm, they must only last five minutes at the longest, and must be taken, when the sea is calm, on a sandy beach. Cold baths should also be short, and no swimming is allowed. We do not advocate douches, unless the woman has been accustomed to hydro therapeutics before pregnancy. Even then the douches must be admin istered by experienced persons. We prefer in this case cold ablutions in a bath-tub. We forbid, absolutely, lukewarm or cold injections and vag inal douches. Local treatment of uterine disease which antedated preg nancy, must be avoided or be limited to close surveillance or more careful precautions. The toilet is to be made as usual, with the simple precau tion of using lukewarm water, rendered fragrant by cologne or eau de toilette. The breasts of women who intend to nurse their children re quire especial care. For a month before confinement the nipples are to be washed morning and evening with dilute brandy and water, tincture of arnica or tincture of benzoin, and the woman should endeavor to elon gate the nipples by traction and friction, slight and repeated. These measures are particularly useful for women whose nipples are short and re tracted. The delicate question of conjugal relations has been differently answered by various authors. Although intercourse has. often caused abortion, it has in other cases been quite harmless. Its effect depends on the health of the woman. In the beginning of pregnancy, when there is marked malaise, the woman needs absolute repose, particularly at the time corresponding to the catamenial period. In the hiterval, the separation of the sexes is less necessary. Toward the end of pregnancy, intercourse becomes more and more difficult, and we have the statement of many women that, in many cases, premature rupture of the membranes had been brought about by conjugal relations. Although we, therefore, do not absolutely forbid intercourse, we recommend that it be indulged in only after careful consideration of the duration of pregnancy, and of the woman's state of health.
These are the general rules governing the hygiene of pregnancy. They are not absolute and vary as we shall see, according to the phenomena accompanying pregnancy, each of which may furnish particular indica tions.