For the prevention of pendulous abdomen, the abdomen is laced. The relaxation of the abdominal walls causes the intestines to become inflated, and the blood and lymph-vessels in the suspensory ligaments of the organs to become abnormally distended with fluid, which causes them to relax. When the patient gets up all the organs sink, giving rise to floating kidney, gastroptosis (falling of the stomach), and flatulence, as well as to retro flexion, prolapse, and catarrh of the womb. After evacuation of the bladder and intestine, and after the abdominal massage, two towels should be placed under the patient below the sacral region, then drawn firmly over the abdomen and hips, and securely fastened together with several safety-pins. The abdomen may be compressed also by means of several sheets or by a sand oag ; this, however, should not he done until it has been laced, since, other wise, it will merely flatten the abdomen. Later on, gymnastic exercises for the abdominal muscles may be resorted to as effective remedies for the prevention of pendulous abdomen.
The diet to be observed during confinement must necessarily be strict and simple. This is of importance not only in regard to the return to their normal condition of the abdominal walls and organs, but also for certain other reasons. Our ancestors knew this well enough, even if they did not understand the reasons for, or the limits of, a restricted diet. They recom mended an exclusive liquid diet consisting of milk and paps. Such a diet prevented digestive disturbances, promoted the secretion of milk, and assisted perspiration. There was great need of such a procedure in former pre-antiseptic times, on account of the frequent occurrence of puerperal fever. It is imperative to avoid digestive disturbances ; not because they may be the cause of puerperal fever, but because such disturbances readily occur during confinement, and interfere with the proper involution of the pelvi-abdominal viscera and with the secretion of milk. Taking into con sideration the fact that the diet should be easily digestible, and remembering its effect on the secretion of milk, the following dietary is advisable in cases of confinement : During the first three days liquid food only should be given, particularly milk, sweetened water, cocoa without spices, and eggs ; a small quantity of zwieback or dry toast may be added. From the fourth to the sixth day (if the bowels have moved) the diet may include also some white meat, the sweetbread or brains of calves, squabs, white bread, and stewed fruits. After the seventh clay beef (roasted, broiled, or smoked), ham, vegetables easy of digestion, and light puddings may be eaten. Spices, alco holic drinks, food insufficiently cooked, fat meat or pork, unripe fruits, salads, and bread or pastry not readily digestible should be entirely avoided.
An inclination of the womb to retroflexion, dropping, and prolapse, which frequently accompanies a tendency to pendulous abdomen, is also best overcome during confinement. For women who are thus afflicted, a lateral position is best ; but above all else they must be scrupulous about emptying the bladder at regular intervals. Apart from the healing of the
womb, it is necessary that all tears in the perineum should be immediately repaired, for experience teaches that otherwise there will be insufficient support for the generative organs, thus contributing to the causes of sinking and prolapse of the womb. The sewed wound must be carefully treated and kept clean ; otherwise it will not heal.
The patient's room should contain only such furniture as is necessary, and everything which tends to collect dust should be taken out. The room should not be kept dark, and must at all times be well ventilated ; heavy draperies are, therefore, superfluous, or even harmful. Usually, the patient is confined in her own bedroom. For the sake of good health in general, a bedroom must never have damp walls, and to avoid this is especially impor tant in cases of confinement ; in the winter the room should have proper heating facilities. No bed which has previously been occupied by a patient suffering from an infectious disease should ever be used in a case of confine ment, unless everything connected with it has been thoroughly disinfected by professional disinfectors. The mattress, especially, should be dry and clean. The sheets, pillows, and covers must be clean and perfectly dry, and this applies also to the linen worn by the patient. The bedpan, chamber pot, syringe, etc., must be in faultless condition ; the syringe should be provided with four to five feet of rubber tubing and two glass tubes. Near the expected tiwie of confinement, it is advisable to give the room a thorough cleaning in all corners, and to hang new curtains. The floors should be scraped and washed with chloride of lime. A large supply of body-linen, bed-linen, and towels should be kept in an accessible and dry place ; and the nurse or midwife should be shown in good time the arrangement of the room and the wardrobes.
In addition to general bodily hygiene, mental rest is essential to the patient during pregnancy and childbirth, as well as during confinement and throughout the entire period of nursing. Sudden excitement may cause severe hEemorrhages and permanent relaxation of the pelvic organs, in conse quence of disturbances in the circulation of the blood. The same applies to bodily and mental exertions. The proper time for the patient to get up depends upon her pulse and temperature, as well as upon the character of the lochial discharge (whether bloody or otherwise), and upon her general condition. In all cases the family-physician should decide, as in this way threatening accidents (as thrombosis, etc.) may be guarded against. It is not as burdensome for the patient to take mild exercise as it is to assume the full control of the household ; and at least two weeks should elapse before taking up these duties. Women who cannot get the necessary care and attention in their homes ought to go to a lying-in hospital.
CHILDBIRTH.—See PARTURITION.
CHILDLESSNESS.—See STERILITY.