When the woman leaves her bed, we allow her to wear corsets, but we insist on an abdominal supporter being also worn for at least six weeks. This is particularly important in women who are very stout, and in those who have borne many children, since the abdominal walls have lost more of their elasticity.
As for the food of the puerpera, we make it as generous as possible, allowing her to resume her ordinary food on the second day after delivery. On the appearance of the milk, if the woman is not going to nurse, we reduce greatly the amount of food until the breasts have diminished in size.
Constipation is the rule during the puerperium. We never order either enemata or purgative before the third day. If enemata of oil and glycer ine do not suffice to move the bowels, or if the woman is not going to nurse, we await the advent of the milk, and on the fourth day order a purgative, renewing it every two to three days until the breasts have di minished. These should be covered with cotton soaked in warm camo mile oil, and sustained and lifted forward by a napkin; in case of excess ive distension, the mamma should be gently poulticed. In many instances it is good practice to compress these organs. To accomplish this, the breasts are covered with plaster, over this is applied a number of layers of cotton, and the whole is held in place by a tightly pinned bandage.
[It is frequently a problem to the general practitioner to determine the best and most painless manner of treating excessive distension of the breasts, or of drying up the milk in cases where lactation, for one or an other reason, is not possible. The method in use at the Maternity com mends itself as the simplest, most effective and least painful. Equable com pression is what is aimed at, and this is obtained by means of the breast binder referred to, (Fig. 267). The dimensions in the cut will suit the average case. In case of simple distention, equable compression is alone necessary, and under it the milk will ooze through the bandage, and the mammEe diminish in size. Where the object is to dry up the milk, the following is the method. A full saline purge is administered. The breasts are rubbed with an atropia ointment (gr.j to g j). A layer of cotton is placed evenly over them. The binder is then tightly pinned down the centre, and finally over the shoulders. This binder remains in place for at least one week, being tightened as it relaxes.—Ed.]
If the woman intends to nurse her infant, it should be applied to the breast at the end of eighteen to twenty-four hours, and no earlier, in order that the woman may obtain complete rest. It is not unusual for after-pains to follow on the application to the breast. [It seems to us bet tor practice to apply the child to the breast within three to four hours after delivery. The woman is then sufficiently rested, and we further obtain the earlier action of the breast on the uterus, firmer uterine contraction, and this we want.—Ed.] As for general hygienic rules, they are as follows: keep away from tile patient all causes of worry or excitement; do not allow many visits to be made during the first ten to twelve days; do not burden her with too much bed-clothing; keep the temperature of the room at about 80° F. In winter, have a fire night and day. Air the room frequently, and re move at once all causes of foul air.
If the woman is going to nurse, regulate the child's nursing periods from the start, and see that fissures do not form on the nipples. It is our custom to cause the nipples to be washed, during the first few days, with tincture of arnica. When the infant has finished nursing, wipe the nipple carefully, and grease it with cocao butter. [We cannot be too careful of the nipples, and it is an excellent plan to wash them carefully each time the child is applied to the breast, and at once after. Pure water answers as well as anything else, except where the nipple is tender, and then the compound tincture of benzoin will harden them effectively. Further, it is not alone sufficient to wash the nipples, but the child's mouth should be washed as well, before applying it to the breast. Thus we assist in the prevention of fissure and erosion for the mother, as well as of sore mouth to the child.—Ed.1 In certain women, lactation is followed by hemorrhage, which re turns at each nursing. If this continues longer than two or three days, nursing should at once be interdicted. In otter women, it is only at the end of a few weeks that such hemorrhages occur, and they may be so marked as to become alarming. Ergot internally, or subcutaneously, as tringent injections, vaginal and uterine, avail nothing. The one thing to do is to put a stop to lactation: if this do not suffice, there is one measure which has answered us, and 'filmier, and Bailly admirably—this is a hot bath at 98.5° F.