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PREPARATIONS FOR CHILDBIRTH.

Certain foolish preparations are sometimes made by wives, with the best intentions. Perhaps one of the most common and absurd of these is the local use of sweet oil, in order to facilitate the dilatation of the parts, for which purpose it is perfectly inert. There are, however, some wise and even necessary precautions which every wife should know and employ, to guard against unpleasant and dangerous complications in childbirth.

In particular, the condition of the breasts towards the close of pregnancy demands attention. Scarcely any pain in the lying-in chamber is greater or more difficult to bear than that which the young mother suffers from excoriated nipples. This troublesome and often very intractable affection is nearly always the consequence of the want of care previous to confinement. During the latter part of pregnancy the nipples sometimes become sunken or flat, being retracted as the breasts increase in size, because of the want of elasticity on the part of the milk tubes. In order to remedy this fault, we have known a breast-pump or puppy to be applied. Such treatment is dangerous, as it may excite premature contraction of the womb, and miscarriage. Nipple-shields, with broad bases and openings, should always be obtained. They are safe, and effectually secure the prominence of the nipples, when worn constantly, day and night, during the last month or so of pregnancy. Wives who have never had children ought to take special care to ascertain before labor whether this depressed condition of the nipples exists, and to correct it in the manner indicated.

In the first pregnancy it is also important to harden the nipples. This may be done by occasionally gently rubbing them between the thumb and finger, and by bathing them twice a day during the last six weeks with tincture of myrrh, or with a mixture of equal parts of brandy and water, to which a little alum has been added. This procedure will render the surfaces less sensitive to the friction of the child's mouth, and thus avert the distress so often occasioned in the first confinement by tenderness of the nipples.

If the nipples be rough or nodulated in appearance, like a strawberry or a raspberry, they are more apt to become excoriated or fissured than if they present a smooth surface. Under such circumstances, make a solution of the sulphate of zinc, of the strength of one grain to the ounce of rose water, in a wide-mouthed bottle, then tilt the bottle upon the nipple, and allow it to remain there for a few minutes several times a day. Simple tenderness of the nipples and slight fissures may be averted by the application either of a lotion of borax (two scruples of borax in three ounces of water, and an ounce of glycerine), of the honey of borax, or of the tincture of catechu, and by protecting the parts from the pressure of the stays and the friction of the flannel vest.

It is of the greatest moment to the comfort of the mother, that all affections of the nipples should be prevented or remedied before labor; for the treatment of sore nipples when the child is at the breast is often unsatisfactory, while the suffering they occasion is very great, even sometimes giving rise to mammary abscess.

There are certain articles of clothing and dressings for the bed which should be cared for in advance, in order that they may be ready when required.

The mother should be provided with short-gowns, to be worn over the chemise instead of the ordinary night-gowns. It is of consequence to procure a proper bandage. It should be made of heavy muslin, neither too coarse nor too fine; an ordinarily good quality of unbleached muslin is the best. The material is to be cut bias, about one and a quarter yard in length, and from twelve to eighteen inches in breadth, varying, of course, with the size of the person. It should be just large enough to encircle the body after confinement, with a margin of a couple of inches, and to extend down below the fulness of the hips. The measurement should be taken, and the bandage made to fit, when four and a half months advanced. It should be narrow above, wider below, and gored in such a manner that it will be a little narrower at the lower extremity than a few inches above, so as to prevent it, when adjusted, from sliding upwards. A bandage constructed in this manner will be very comfortable; and is not apt to become displaced, after application, as is invariably the case when a towel or a straight piece of muslin is used. The way in which it is to be applied will be detailed hereafter.

The child's clothing should consist first of a piece of flannel or some woollen material for a binder. This should be from four to six inches in width, and from twelve to sixteen inches in length; that is to say, wide enough to extend from the armpits to the lower part of the abdomen, and long enough to go once and a half times around the child, having the double fold to come over the abdomen. There should be no embroidery about this. A shirt, which it is desirable should be woollen, is to be provided to place over the binder. It should be made to come up tolerably high in the neck, and to extend down the arm. Neither it nor any other portion of the child's clothing should be starched. The petticoat, which may be open its whole length behind, is to be put over the shirt; two may be used—a short and a long one. Next comes the child's ordinary frock or slip, and above this an apron to protect the dress from the frequent discharges from the stomach. Then a shawl, of flannel or any other warm material, is to be provided, to throw over the shoulders if the weather be cold. Socks, and pieces of old soft linen, free from stiffening, for napkins or diapers, complete the child's outfit.

For the permanent and temporary dressing of the bed there should be provided a piece of impervious cloth (oiled silk is the neatest) about a yard square; a piece of ordinary table oil-cloth or rubber-cloth; a number of old sheets and comfortables, and a piece of thick carpet. The manner in which these are to be used will be explained shortly.

A pair of small rounded scissors; a package of large pins, one and a half inches in length, for the bandage of the mother, and smaller ones for that of the child; some good linen bobbin for the doctor to tie the navel-string; good toilet soap and fine surgical sponge for washing the child; a piece of soft linen or muslin for dressing the navel; a box of unirritating powder; and a pile of towels,—should all be had and laid aside many weeks before they are wanted. These, together with the material for dressing the bed, the child's clothing, and the mother's bandage, ought to be placed together in a basket got for the purpose, in order that they may all be easily and certainly found at a time when perhaps the hurry and excitement of the moment would render it difficult otherwise to collect them all immediately.

SIGNS OF APPROACHING LABOR.

One of the earliest of the preliminary signs of the coming on of confinement occurs about two weeks before that event. It is a dropping or subsidence of the womb. The summit of that organ then descends, in most cases, from above to below the umbilicus, and the abdomen becomes smaller. The stomach and lungs are relieved from pressure, the woman breathes more freely, the sense of oppression which troubled her previously is lost, and she says she feels 'very comfortable.' This sensation of lightness and buoyancy increases, and a few days before the setting in of labor she feels so much better that she thinks she will take an extra amount of exercise. The mother of a number of children is acquainted with this sign, but the wife with her first child may exert herself unduly in the house or outdoors, and induce labor when in the street or away from home. Hence the importance of a knowledge of this premonitory symptom.

A second precursory sign of labor is found in the increased fulness of the external parts, and an augmented mucous secretion, which may amount even to a discharge resembling whites, and requiring the wearing of a napkin. This symptom is a good one, indicating a disposition to relaxation, and promising an easy time.

The third preliminary sign which we shall mention, is the change in the mental state of the pregnant woman. She has a feeling of anxiety and of fidgetiness, sometimes accompanied with depression of spirits. This condition of emotional distress, modified in particular cases by reason, self-control, and religion, may continue for several days, perhaps, when

THE SYMPTOMS OF ACTUAL LABOR

make their appearance. The first of these is generally the 'show.' It is the discharge of the plug of mucus which has occupied the neck of the womb up to this time, and is ordinarily accompanied by a little blood. Perhaps before this, or perhaps not for some hours after, the 'pains' will develope themselves. These recur periodically, at intervals of an hour or half an hour at the outset, and are 'grinding' in character. True labor pains are distinguished from false by the fact that they are felt in the back, passing on to the thighs, while false pains are referred to the abdomen; by their intermittent character, the spurious pains being more or less continuous; and by the steady increase in their frequency and severity. In case of doubt as to their exact nature, the doctor should be summoned, who will be able to determine positively whether labor has begun.

The other symptoms which point to the actual commencement of labor are a frequent desire to empty the bowels and bladder, nausea and vomiting, which, in the early part of confinement, is a good sign; shiverings, unattended with any sensation of cold; and, finally, the rupture and discharge of the contents of the 'bag of waters.'

Before passing on to the consideration of the management of the confinement into which the wife has now entered, a few words may be appropriately said upon the

CAUSE OF LABOR.

Neither the size nor the vigor of the child has any influence in bringing about delivery at full term. The ancient theory—which received the support of the distinguished naturalist Buffon—that the infant was the active agent in causing its own expulsion, is an exploded one. It was asserted by some that hunger excited the foetus to struggle to free itself from the womb; others were disposed to attribute its efforts to accomplish its entrance into the world, to the need of respiration which it experienced. But all these ingenious theories, which presupposed the embryo to be actuated by the same feelings which would influence a grown person if shut up in such a confined abode, are unsatisfactory, and not tenable. It is well known that the child may die in the womb, without retarding or interfering in any way with the coming on of the process of labor. This fact alone shows that the foetus is, or at any rate may be, absolutely passive either in regard to the induction or advancement of delivery. The determining cause of labor is seated in the womb itself. The contractions of this organ occasion the 'pains' and expel the child, assisted by the muscles of the abdomen and the diaphragm. That the assistance of the latter forces is not necessary, is conclusively proved by the occurrence of childbirth after the decease of the mother. For instance, a case is on record in which labor commenced and twins were born after the mother had been dead for three days.

CARE DURING LABOR.

We will suppose labor to have commenced. The preparation of the bed for the occupancy of the mother is now to be attended to. As she is to lie on the left side of the bed, this is the side, and the only one, which is to be dressed for the occasion. In order to do so, remove the outer bed-clothes one at a time, folding them neatly on the right side of the bed so that they can easily be drawn over when desired. The permanent dressing is to be placed beneath the lower sheet and upon the mattress. A soft impervious cloth—which, in speaking of the preparation for confinement, we directed to be procured—is placed next to the surface of the bed. The upper edge should be nearly as high as the margin of the bolster, and it should extend down to a distance at least a foot below the level of the hips, so as to certainly protect the bed from the discharges. Upon the top of this a blanket or sheet is laid, and the whole fastened by pins. The lower sheet of the bed, which had been turned over to the right side, to permit the application of the dressing, is now to be replaced. Over the position of this permanent dressing, on the top of the bed-sheet, a neatly-folded sheet, with the folded edge down, is adjusted and pinned in its place. It is upon this sheet that the patient is to be drawn up after her confinement, which will take place upon the temporary dressing of the bed now to be arranged. It consists of an oil-cloth, which should extend up beyond the lower edge of the permanent dressing, overlapping the folded sheet which has been placed above it, and should fall over the side and bottom of the bed. A comfortable or any soft absorbent material is placed over this impervious cloth and covered with a folded sheet, completing the temporary dressing. The bed-clothes may now be adjusted, concealing the dressings from view until they are wanted. The valances at the foot of the bed should be raised, and a piece of carpet placed on the floor. The bed should have no foot-board, or a very low one.

The dress of the mother.—Either a folded sheet should be adjusted around the waist as the only skirt, so as not to interfere with the walking, or a second chemise should be put on, with the arms outside the sleeves, to extend from the waist to the feet. Then the chemise next the body should be drawn up and folded high up around the breast. It should be plaited neatly along the back, and brought forward and fastened by pins. This should be thoroughly done, so that the linen may not be found wet nor soiled when it is drawn down after confinement. A wrapper or dressing-gown may be worn during the first stage of labor, before it is necessary to go to bed. When, however, that time comes, the wife will take her place on her left side on the temporary dressing, with a sheet thrown over her, her head on a pillow so situated that her body will be bent well forward, and her feet against the bed-post. A sheet should be twisted into a cord and fastened to the foot of the bed, for her to seize with her hands during the accession of the 'bearing-down pains.' Care should be taken to have a number of napkins, a pot of fresh lard, and the basket containing the scissors, ligature, bandage, etc.—which have been previously enumerated in the remarks on preparations for childbirth—at hand, for the use of the doctor.

We have now noted all that it is useful for the wife to know in regard to the preparation for and management of confinement, when a physician is in attendance, as, for obvious reasons, he should always be. In some instances, however, the absence of the doctor is unavoidable, or the labor is completed before his arrival. As a guide to the performance of the necessary duties of the lying-in room under such circumstances, we give some

HINTS TO ATTENDANTS.

The room during confinement should be kept quiet. Too many persons must not be allowed in it, as they contaminate the air, and are apt by their conversation to disturb the patient, either exciting or depressing her. So soon as the head is born, it should be immediately ascertained whether the neck is encircled by the cord; if so, it should be removed or loosened. The neglect of this precaution may result fatally to the infant, as happened a short time since in our own practice; the infant, born a few minutes before our arrival, being found strangled with the cord about its neck. It is also of importance at once to allow of the entrance of air to the face, to put the finger in the mouth to remove any obstruction which may interfere with respiration, and to lay the babe on its right side, with the head removed from the discharges. The cord should not be tied until the infant is heard to cry. The ligature is to be applied in the following manner:—A piece of bobbin is thrown around the navel-string, and tied with a double knot at the distance of three fingers' breadth from the umbilicus; a second piece is tied an inch beyond the first, and the cord divided with the scissors between the two, care being taken not to clip off a finger or otherwise injure the unsuspecting little infant, as has occurred in careless hands more than once. When the child is separated from the mother, a warm blanket or a piece of flannel should be ready to receive it. In taking hold of the little stranger, it may slip out of the hands and be injured. To guard against this accident, which is very apt to occur with awkward or inexperienced persons, always seize the back portion of the neck in the space bounded by the thumb and first finger of one hand, and grasp the thighs with the other. In this way it may be safely carried. It should be transferred, wrapped up in its blanket, to some secure place, and never put in an arm-chair, where it may be crushed by some one who does not observe that the chair is already occupied. The head of the child should not be so covered as to incur any danger of suffocation.

ATTENTION TO THE MOTHER.

When the after-birth has come away, the mother should be drawn up a short distance—six or eight inches—in bed, and the sheet which has been pinned around her, together with the temporary dressing of the bed removed, a clean folded sheet being introduced under the hips. The parts should be gently washed with warm water and a soft sponge or a cloth, after which an application of equal parts of claret wine and water will prove pleasant and beneficial. We have also found the anointing of the external and internal parts with goose grease, which has been thoroughly washed in several hot waters, to be very soothing and efficient in speedily allaying all irritation. This ought all to be done under cover, to guard against the taking of cold. The chemise pinned up around the breast should now be loosened, and the woman is ready for the application of the bandage, which is to be put on next the skin. If properly and nicely adjusted, it will prove very grateful. The directions for making it have already been given. In order to apply it, one half of its length should be folded up into plaits, and the mother should lie on her left side; lay the plaited end of the bandage underneath the left side of the patient, carrying it as far under as possible, and draw the loose end over the abdomen; then let the mother roll over on her back upon the bandage, and draw out the plaited end. If the abdominal muscles are much relaxed and the hip-bones prominent, a compress of two or three towels will be wanted. The bandage should be first tightened in the middle by a pin applied laterally, for strings should never be employed. The pins should be placed at intervals of about an inch. The lower portion of the bandage should be made quite tight, to prevent it slipping up. The mother is now ready to be drawn up in bed upon the permanent dressing: this should be done without any exertion on her part. A napkin should be laid smoothly under the hips (never folded up), to receive the discharges. If she prefer to lie on her left side, place a pillow behind her back.

ATTENTION TO THE CHILD.

The baby may now be washed and dressed. Before beginning, everything that is wanted should be close at hand, namely a basin of warm water, a large quantity of lard or some other unctuous material, soap, fine sponge, and a basket containing the binder, shirt, and other articles of clothing. First rub the child's body thoroughly with lard. The covering can only be removed in this way; the use of soap alone will have no effect unless the friction be so great as to take off also the skin. The nurse should take a handful of lard and rub it in with the palm of the hand, particularly in the flexures of the joints. In anointing one part, the others should be covered, to prevent the child from taking cold. If the child is thus made perfectly clean, do not use any soap and water, because the skin is left in a more healthful condition by the lard, and there is risk of the child's taking cold from the evaporation of the water. But the face may be washed with soap and water, great care being taken not to let the soap get into the child's eyes, which is one of the most frequent causes of sore eyes in infants. The navel-string is now to be dressed. This is done by wrapping it up in a circular piece of soft muslin, well oiled, with a hole in its centre. The bandage is next to be applied. The object of its use is to protect the child's abdomen against cold, and to keep the dressing of the cord in its position. The nature, shape, and size of the binder have been described. It should be pinned in front, three pins being generally sufficient. The rest of the clothing before enumerated is then put on.

The child is now to be applied to the breast at once. This is to be done, for three reasons. First, it very often prevents flooding, which is apt otherwise to occur. Secondly, it tends to prevent milk fever, by averting the violent rush of the milk on the third day, and the consequent engorgement of the breast and constitutional disturbance. The third reason is, that there is always a secretion in the breast from the first, which it is desirable for the child to have; for it acts as a cathartic, stimulating the liver, and cleansing the bowels from the secretions which fill them at the time of birth. There is generally sufficient nourishment in the breasts for the child for the first few days. The mother may lie on the one side or the other, and receive the child upon the arm of that upon which she is lying. If the nipple be not perfectly drawn out so that the child can grasp it in its mouth, the difficulty may be overcome by filling a porter-bottle with hot water, emptying it, and then placing the mouth of the bottle immediately over the nipple. This will cause, as the bottle cools, a sufficient amount of suction to elevate the sunken nipple. The bottle should then be removed and the child substituted,—a little sugar and water or sweetened milk being applied, if necessary, to tempt the child to take the breast.

FURTHER ATTENTION TO THE MOTHER.

The patient should be cleansed every four or five hours. A soft napkin, wet with warm soap and water, should for this purpose be passed underneath the bed-clothing, without exposing the surface to a draft of air. After using the soap and water, apply again the dilute claret wine and the goose grease. Much of the safety of the mother depends upon the observation of cleanliness. The napkin should not be allowed to remain so long as to become saturated with the discharges.

The mother should maintain rigidly the recumbent position for the first few days, not raising her shoulders from the pillow for any purpose, and should abstain from receiving visitors, and from any social conversation for the first twenty-four hours.

For the first three or four days, until the milk has come and the milk fever passed, the mother should live upon light food,—oatmeal gruel, tea and toast, panada, or anything else of little bulk and unstimulating character. Afterwards the diet may be increased by the addition of chicken, lamb, mutton or oyster broth, buttered toast, and eggs. The object of light nourishment at first is to prevent the too rapid secretion of milk, which might be attended with evil local and constitutional effects. If, however, the mother be in feeble health, it will be necessary from the outset that she shall be supported with nourishing concentrated food. Beef-tea will then be found very serviceable, particularly if made according to the following recipe:—Take a pound of fresh beef from the loins or neck. Free it carefully from all fat. Cut it up into fine pieces, and add a very little salt and five grains of unbroken black pepper. Pour on it a pint of cold water, and simmer for forty minutes. Then pour off the liquor, place the meat in a cloth, and, after squeezing the juice from it into the tea, throw it aside. Return to the fire, and boil for ten minutes.

After the first week, the diet of the lying-in woman should always be nutritious, though plain and simple. The development of the mammary glands, the production of the mammary secretion, and the reduction which takes place in the size of the womb, all require increased nourishment, that they may be properly performed.

After the third or fourth day the dress should be changed. The dress worn during labor, if our directions have been carried out, will not have been soiled. The clothing should be changed without uncovering the person, and without raising the head from the pillow. Pull the bed-gown from over each arm, and draw it out from under the body. Then unfasten the chemise in front and draw it down underneath her so that it can be removed from below, as it should not be carried over the head. Place her arms in the sleeves of the clean chemise, throw its body over her head, and, without lifting her shoulders from the bed, draw it down. Then change the bed-gown in the same manner.

In changing the upper sheet, it should be pulled off from below, and the clean one carried down in its place from above, underneath the other clothing, which can be readily accomplished by plaiting the lower half. In introducing a clean under-sheet, one side of it should be plaited and placed under the patient, lying on her left side; when she turns on her back, the plaits can then be readily drawn out. These directions, though apparently trivial, are important. The object is to guard against the great danger to which the mother is exposed by sitting up in bed for even a few minutes during the first week.

Cathartic medicine should not be administered the first, the third, or any other day after confinement, unless it is needed. If the patient is perfectly comfortable, has no pain in the abdomen, no headache, and is well in every respect, she should be let alone, even if her bowels have not been moved. If a laxative be called for, citrate of magnesia is much pleasanter and equally as efficacious as the castor-oil so frequently administered on this occasion.

TO HAVE LABOR WITHOUT PAIN.

Is it possible to avoid the throes of labor, and have children without suffering? This is a question which science answers in the affirmative. Medical art brings the waters of Lethe to the bedside of woman in her hour of trial. Of late years chloroform and ether have been employed to lessen or annul the pains of childbirth, with the same success that has attended their use in surgery. Their administration is never pushed so as to produce complete unconsciousness, unless some operation is necessary, but merely so as to diminish sensibility and render the pains endurable. These agents are thus given without injury to the child, and without retarding the labor or exposing the mother to any danger. When properly employed, they induce refreshing sleep, revive the drooping nervous system, and expedite the delivery.

They should never be used in the absence of the doctor. He alone is competent to give them with safety. In natural, easy, and short labor, where the pains are readily borne, they are not required. But in those lingering cases in which the suffering is extreme, and, above all, in those instances where instruments have to be employed, ether and chloroform have a value beyond all price.

MORTALITY OF CHILDBED.

The number of the pregnancy affects the danger to be expected from lying-in. It has been declared by excellent authority, that the mortality of first labors, and of childbed fever following first labors is about twice the mortality attending all subsequent labors collectively. After the ninth labor the mortality increases with the number. A woman having a large family, therefore, comes into greater and increasing risk as she bears her ninth and successive children.

The age of the woman also affects the mortality accompanying confinement. The age of least mortality is near twenty-five years. On either side of this, mortality increases with the diminution or increase of age. The age of the greatest safety in confinement therefore corresponds to the age of greatest fecundity. And during the whole of child-bearing life, safety in labor is directly as fecundity, and vice versÂ. Hence modern statistics prove the correctness of the saying of Aristotle, that 'to the female sex premature wedlock is peculiarly dangerous, since, in consequence of anticipating the demands of nature, many of them suffer greatly in childbirth, and many of them die.' As the period from twenty to twenty-five is the least dangerous for childbirth, and as first labors are more hazardous than all others before the ninth, it is important that this term of least mortality be chosen for entering upon the duties of matrimony. This we have already pointed out in speaking of the age of nubility.

The sex of the child is another circumstance affecting the mortality of labor. Professor Simpson of Edinburgh has shown that a greater proportion of deaths occurs in women who have brought forth male children.

The duration of labor also influences the mortality of lying-in. The fatality increases with the length of the labor. It must be recollected, however, that the duration of labor is only an inconsiderable part of the many causes of mortality in childbirth.

WEIGHT AND LENGTH OF NEW-BORN CHILDREN

The average weight of infants of both sexes at the time of birth is about seven pounds. The average of male children is seven and one-third pounds; of female, six and two-thirds pounds. Children which at full term weigh less than five pounds are not apt to thrive, and usually die in a short time.

The average length at birth, without regard to sex, is about twenty inches, the male being about half an inch longer than the female.

In regard to the relation between the size of the child and the age of the mother, the interesting conclusion has been arrived at, that the average weight and length of the mature child gradually increases with the age of the mother up to the twenty-fifth year. Mothers between the ages of twenty-five and twenty-nine have the largest children. From the thirtieth year they gradually diminish. The first child of a woman is of comparatively light weight. The first egg of a fowl is smaller than those which follow.

The new-born children in our Western States seem to be larger than the statistics show them to be in the various States of Europe, and apparently even than in our Eastern States. In the Report on Obstetrics of the Illinois State Medical Society for 1868, it is stated that Quincy, Ill., produced during the year six male children whose average weight at birth was thirteen and a quarter pounds, the smallest weighing twelve pounds, and the largest seventeen and a half, which was born at the end of four hours' labor, without instrumental or other interference. A recent number of a Western medical journal reports the birth at Detroit, in February last, of a well-formed male infant twenty-four and a-half inches long, weighing sixteen pounds. The woman's weight, after labor, is stated as only ninety-two pounds. An English physician delivered a child by the forceps which weighed seventeen pounds twelve ounces, and measured twenty-four inches. These are the largest well-authenticated new-born infants on record.

DURATION OF LABOR.

The length of a natural labor may be said to vary between two and eighteen hours. The intervals between the pains are such, however, that the actual duration of suffering, even in the longest labor, is comparatively very short. The first confinement is much longer than subsequent ones.

The sex of the child has some influence on the duration of labor. According to Dr. Collins of the Lying-in Hospital of Dublin, the average with male births is one hour and four minutes longer than with female. The weight of the child also affects the time of labor. Children weighing over eight pounds average four hours and eight minutes longer in birth than those of less than eight pounds weight.

STILL-BIRTHS.

The statistics of nearly fifty thousand deliveries which occurred at the Royal Maternity Charity, London, show a percentage of nearly five still-born, or one in twenty-seven.

There are more boys still-born than girls. We have already spoken of the fact that male births are more tedious, and that a larger number of males die in the first few years of life than females. This series of misfortunes has been attributed to the large size which the male foetus at birth possesses over the female.

IMPRUDENCE AFTER CHILDBIRTH.

After the birth of the child at full term, or at any other period of pregnancy, the womb, which had attained such wonderful proportions in a few months, begins to resume its former size. This process requires at least six weeks after labor for its full accomplishment. Rest is essential during this period. A too early return to the ordinary active duties of life retards or checks this restoration to normal size, and the womb being heavier, exposes the woman to great danger of uterine displacements. Nor are these the only risks incurred by a too hasty renewal of active movements. The surface, the substance, and the lining membrane of the womb are all very liable, while this change from its increased to its ordinary bulk is occurring, to take on inflammation after slight exposure. The worst cases of uterine inflammation and ulceration are thus caused. A 'bad getting-up,' prolonged debility, pain, and excessive discharge, are among the least penalties consequent upon imprudence after confinement. It is a mistake to suppose that hard-working women in the lower walks of life attend with impunity to their ordinary duties a few days after confinement. Those who suffer most from falling of the womb and other displacements are the poor, who are obliged to get up on the ninth day and remain upright, standing or walking for many hours with an over-weighted womb. Every physician who has practised much among the poor, has remarked upon the great frequency of diseases of the womb, which is to be attributed to the neglect of rest, so common among them, after childbirth. If this be true of vigorous women accustomed to a hardy life, how much more apt to suffer from this cause are the delicately nurtured, whose systems are already, perhaps, deteriorated, and little able to resist any deleterious influences!

A mother should remain in bed for at least two weeks after the birth of the child, and should not return to her household duties under a month; she should also take great pains to protect herself from cold, so as to escape the rheumatic affections to which at this time she is particularly subject. If these directions were generally observed, there would be less employment for physicians with diseases peculiar to women, and fewer invalids in our homes.

TO PRESERVE THE FORM AFTER CHILDBIRTH.

This is a matter of great anxiety with many women; and it is proper that it should be, for a flabby, pendulous abdomen is not only destructive to grace of movement and harmony of outline, but is a positive inconvenience.

To avoid it, be careful not to leave the bed too early. If the walls of the abdomen are much relaxed, the bed should be kept from two to three weeks. Gentle frictions daily with spirits and water will give tone to the muscles. But the most important point is to wear for several months a well-fitting bandage—not a towel pinned around the person, but a body-case of strong linen, cut bias, setting snugly to the form, but not exerting unpleasant pressure. The pattern for this has already been given.

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