Mother and child

Preface

The request of the publishers to prepare a second edition of this book brings freshly to our remembrance our loss sustained in the death of Dr. John M. Keating. It was the writer's privilege to be associated with him in the preparation of the first edition. This edition has been remodelled in accordance with the various changes which time has brought about in the department of medicine of which it treats. The plan originally adopted and carried out through many of Dr. Keating' s suggestions has been followed in the preparation of this edition.

The writer's acknowledgments are due to his nurses, from whose practical experience much valuable material has been obtained. To Miss Ellen V. Hayes, Chief Nurse of the Jefferson Maternity, and to Miss S. J. Martin, his thanks are due for the preparation of the

4 PREFACE.

illustrations ; to Miss M. E. Smith, Chief Nurse of the Philadelphia Hospital, he is indebted for formulae used in the hospital ; and to Miss Mary A. Nick, from whom he obtained recipes for the preparation of gruels, jellies, and purees. The Dietary of the Jefferson Hospital has also supplied some useful recipes.

No. 250 South Twenty-first Street, Philadelphia, June, 1902.

Introduction

This book is not intended to supply prescriptions for medicines nor to take the place of the family physician. It is designed to help him in the care of his patients by placing at their disposal information which physicians commonly give to their patients. The physical prosperity of mothers and children is so largely dependent upon the faithful observance of simple precautions, that anything which gives information regarding this care cannot fail to be useful. The form of the present edition of the book has been largely suggested to the writer by the needs of his own practice and embraces much of the advice which he usually gives to his patients.

Chapter III. The Child's Food

Formation of Milk 95

Human Milk and that of Other Animals 97 io CONTENTS.

PACK

When Shall the Child Take its Food ? 98

How Much Milk Shall the Child Take? 99

Regurgitation and Vomiting 100

The Curd of Regurgitated Milk 100

Vomiting 101

The Curd of Vomited Milk 101

Too Rapid Nursing 102

Feeble Nursing 102

Shall the Child be Wakened to be Fed ? 103

Importance of Regularity 104

Chapter IV. Artificial Feeding

Wet-Nurses 106

Cow's Milk 106

Cow-stables, Barns, and Pasture 107

The Care of Milk 107

Laboratory Modification 109

Home Modification of Milk 109

Pasteurizing and Sterilizing in

Asepsis in the care of Milk 113

Mixed Feeding 116

Feeding as Children Grow Older 116

Bread 117

Gruels and Jellies 118

Broths and Soups 118

Beef Juice 119

Purees 120

Junket and Custards 120

Eggs 121

Meat for Young Children 121

Fruits 121

Sweets T. 122

Beverages for Children 123

Solid Food 123

Conditions which Favor a Child's Nutrition 124

Personal Influence in Nourishing Children 127

CONTENTS. n

Chapter V. Air And Exercise

PAGE

Catching Cold 129

Exchanging Diseases 130

Heat and Cold 130

How Shall the Child go Out ? 131

Where Should the Child Go ? 132

Airing In-Doors 133

Sleeping in the Open Air 134

A Little Child's Exercise 135

Exercise with Toys 136

Chapter VI. The Nursery

Ventilating and Warming the Nursery 140

Nursery Furniture and Utensils 142

The Location of a' Nursery 143

Nursery Education 144

Nursery-Maids 146

Nursery-Governesses 148

The Manners of the Nursery 149

Chapter VII. The Healthy Child

Color 151

The Flesh 152

The Eyes 152

The Mouth 152

The Tongue 153

Tongue-Tie 153

The Nose 153

The Abdomen 154

The Genital Organs 154

The Back 154

The Limbs 155

Posture and Attitude 155

Motions 156

PAGE

Nursing 157

Swallowing 157

Sleep 157

Bowel Movements 158

Urine 158

Weight 158

Correct Scales 160

Conditions Influencing the Weight of a Child 161

Weight at Birth 161

Length 162

Dentition 162

The Second or Permanent Teeth 164

Dentition and Development 164

Indications for the Care of Children in the Various

Periods of Development 165

Beginning a Mixed Diet 165

Chapter VIII. The Care Of The Child During Its Crises Of Development

The Care of the Child During Dentition 167

Beginning to Walk 169

The Development of the Senses 170

The Airing of the Child 172

Puberty 173

Education During Crises of Development 174

Moral Development During Crises of Growth 176

Chapter IX. The Signs Of Illness In Children

Color of the Skin 178

Eruptions 178

Eruptions Caused by Parasites 179

Chronic Eruptions 180

Fever 180

The Pulse and Heart Action 181

The Breathing in Health and Disease 181

Vomiting 182

PAGK

Diarrhoea and Constipation 182

The Character of Bowel Movements 183

The Urine 183

The Child's Expressions of Disease 184

The Signs of Chronic Disease 185

Chapter X. Nursing Sick Children

Shall the Mother Nurse the Child? 186

Nursing in Diseases of the Digestive Tract 188

Nursing in Diseases of the Respiratory Organs . . . v . . . 190

Nursing in Diseases of the Nervous System 194

The Nursing of Chronic Diseases 195

CHAPTER XL

INFECTIOUS AND CONTAGIOUS DISEASES.

Shall Children be Deliberately Exposed to Infection and

Contagion ? 196

Methods by which Contagion and Infection are Conveyed 197

The Avoidance of Infection and Contagion 199

The Symptoms of Infection and Contagion 199

The Eruptions from Infection or Contagion 200

Isolation 201

General Nursing in Infectious Cases 202

Chapter XII. The Conveyance Of Contagion And Infection

Disinfection of the Patient 205

Disinfection of Clothing, Bedding, Utensils, etc 207

Chapter XIII. Medical Emergencies

Poisoning 210

Prevention of Poisoning 214

Acids and Alkalies 215

Convulsions 216

Heat-Stroke 217

PAGE

Nose-Bleed 218

Prolapse of the Intestine 219

Chapter XIV. Surgical Emergencies

Cuts 221

Burns 222

Falls, Fractures, and Sprains 225

Setting an Injured Limb 227

Foreign Bodies in the Air-Passages 227

Foreign JBodies in the Eye 228

Foreign Bodies in the Ear 229

Earache 233

Foreign Bodies in the Nose 233

Foreign Bodies Swallowed by Accident 234

Foreign Bodies in the Bowel or Bladder 236

Chapter XV. External Applications

The Application of Cold 237

The Application of Heat 239

Baths ; 241

Baths for Medicinal Purposes 242

Counter-Irritation 243

Injections 245

The Destruction of Intestinal Parasites by Injection . .. 247

Chapter XVI. Asepsis And Antisepsis

Asepsis 250

Antisepsis 250

Chapter XVII. Inoculation

Vaccination 252

ILLUSTRATIONS.

FIG. PAGE

Frontispiece to Part 1 17

1. Incubator containing a prematurely born infant.

The child has been bandaged with cotton, applied with cheese-cloth bandages, instead of the usual dress . . 43

2. Incubator improvised with clothes-basket, blankets,

and hot- water cans 43

Frontispiece to Part II 87

3. Bassinette 88

4. Showing infant dressed in socks, diaper, and knitted

band before long-sleeved undershirt is worn .... 91

5. Another view of dress shown in Fig. 4, usually worn

under long-sleeved flannel slip in the first weeks

of infancy 92

6. Baby with socks, diaper, knitted band, and under-

shirt, with high neck and long sleeves. Buttoned down the front 92

7. Convenient night-clothes with feet. Suitable for

child after earliest infancy 92

8. Long flannel skirt, fastened by buttons on shoulders.

No sleeves. Worn with high-necked and long-sleeved undershirt 92

9. White muslin petticoat, coming from shoulders.

Worn over flannel slip. Only necessary under fine muslin dresses. Makes too many garments on very young baby 92

10. Another view of petticoat shown in Fig. 9 92

11. Child fully dressed with simple white nainsook dress,

trimmed with lace edging; very simply but beautifully made 93

1 6 ILLUSTRATIONS.

FIG - PAGE

12. View of long white nainsook dress. Baby fully

dressed 03

13. Baby dressed to go out, with sensible cloak with

capes, and cap with very little trimming, with wadded silk cap underneath white muslin one 93

14. Model of best shoe for child's foot,— narrow heel,

broad toe. For child not walking, buttoned shoe is most easily put on. After a child begins to walk, the laced shoe is better, with the same model, — narrow heel and broad toe 94

15. Arnold sterilizer 112

16. Interior of Arnold sterilizer 113

17. Abdominal massage: rubbing up the child's body

along the course of the ascending bowel 135

18. Abdominal massage: rubbing down the child's body

along the course of the descending bowel ...... 135

19. Dentition 163

20. Irrigating the bowel 189

21. Crib made into a tent by blankets and poles, and

croup kettle in position 192

22. Formaldehyde lamp prepared for disinfecting a

room. The lamp stands upon bricks placed in

a large pan containing several inches of water . . . 208

23. A blanket splint applied to a child's thigh and leg . . 226

24. Douching an inflamed eye with antiseptic solution.

The affected eye is the left or lower one 230

25. Baby in bath. Showing most convenient arrange-

ment of soap, powder, cotton sponges, brush, and all necessaries for the toilet. Screen behind nurse to keep off any possible draught. Screen also useful for hanging long petticoats, dress, etc 241

26. Rubber bath-tub 242

PART I.— THE MOTHER.

Chapter I. Pregnancy

Conception.

In order to comprehend clearly the method of reckoning the duration of pregnancy, the relation between menstruation and ovulation must be understood. Ovulation, or the formation of ova by the ovaries, is independent of menstruation. Conception may occur at any time during the active physical life of woman. Cases are sometimes seen in which menstruation has been absent for months, but in which conception occurred. It is also possible for a woman to conceive while nursing a child and for menstruation to be continually absent for a number of years. Conception is most apt to occur either before or after the usual time

2 17 for menstruation. If the month be reckoned at thirty days between menstrual periods, the ten days immediately preceding menstruation and the ten days immediately following the time when it occurred or should have occurred are the most favorable periods for conception. As menstruation occurs in most patients, it affords the only basis which we have for computing the duration of pregnancy.

The conditions which favor the occurrence of conception are in many cases obscure. General good health is often not present in women who bear children frequently. Recovery from severe illness seems in some cases to make the patient more liable to conception. The fecundity of the poor shows that luxury is not a requisite for fertility. Unfortunately, the drunken and vicious bear children much too frequently. In general, sound health and a life as normal as surroundings will permit favor healthful pregnancy, and abnormal conditions do not conduce to healthful conception.

Signs and Symptoms of Pregnancy.

Pregnancy may exist for several weeks and occasionally for several months without signs or symptoms. Some time is required for the passage of the impregnated ovum to the

THE MOTHER. i 9

uterus, and during this time there is no physical evidence of pregnancy. After the ovum reaches the womb the uterus commences to enlarge very gradually, and several weeks may pass before sufficient change has occurred in the uterus to make a diagnosis possible. In complicated cases a positive diagnosis cannot be made until seven months have elapsed, and in cases where pregnancy exists in patients having tumors it may never be suspected. From these facts it follows that the patient may not receive a positive statement from her physician regarding the existence of pregnancy for some time after she suspects it herself. In most cases, within the first ten weeks after the last menstruation, the physician can state that in all probability pregnancy is present or is absent.

The most usual symptoms of pregnancy are cessation of or very much diminished menstruation, nausea and vomiting in the morning, enlargement of the breasts, often with tingling sensations or shooting pains, enlargement of the neck, gradual enlargement of the abdomen, and disorders of digestion. These, however, may all be present and the patient be positive that she is pregnant when no real pregnancy exists. Only a physician can positively determine the presence or absence of pregnancy.

Where pregnancy is really present, nausea and vomiting gradually cease, the abdomen steadily enlarges, the movements of the child are recognized, milk gradually forms in the breasts, and by examination the presence of the child and its position in the mother's womb may be ascertained.

Duration of Pregnancy.

There is no fixed limit to the duration of pregnancy. The average is from two hundred and seventy to two hundred and eighty days. Cases are sometimes seen in which the pregnancy lasts three hundred days and more. A child has been born at twenty-six weeks pregnancy and has survived. There are several reasons for the inability to determine definitely the duration of pregnancy. We cannot tell exactly the time of conception, and circumstances influence the duration of pregnancy greatly. Thus, a woman who is perfectly tranquil in mind, sound in body, and amid peaceful surroundings, will go to the natural limit of gestation ; while another, harassed by care or over-taxed by pleasure, frail and nervous, will not go to the natural limit of pregnancy, but will give birth to a child prematurely. The proportion between the size of the mother and that of the child has something to do with the duration of pregnancy. Nature usually brings about the birth of the child when fully developed, but when not too large to pass safely through the body of the mother. Examination can usually determine with considerable accuracy the period of pregnancy. It is far better to rely upon the physician's examination than to make plans based exclusively upon the date of the last menstruation. After the patient is seven months advanced, a skilful physician can usually recognize the period of gestation with accuracy.

A Successful Pregnancy.

A pregnancy is successful which results in the birth of a healthy living child, followed by the complete recovery of the mother. An unsuccessful pregnancy is one in which the child does not survive or is not sound in health, or in which the mother does not regain good health. In sound women, pregnancy under favorable conditions predisposes to good health. Even where patients are not themselves perfectly sound, so much can be done by modern science to guard them against the dangers of pregnancy that healthy children may be born, and the mother's health preserved in such cases. While pregnancy cannot be called a disease, it is a condition which requires observation and care from its earliest time. The circumstances of modern life are such that few women lead natural lives, and hence the modern woman is exposed to dangers during pregnancy which others might not have. These dangers can usually be overcome and pregnancy be successfully conducted to its natural termination. To accomplish this, the mother must consent to make her condition of paramount importance. The demands of society, various enterprises, the care of other children, — everything, in short, but matters of life and death, — must be made secondary to the purpose of fulfilling the natural function. When we remember that upon the mother's condition and surroundings during pregnancy depend the life and health of her child, and especially its physical happiness in the future, this view does not seem unreasonable. If all patients were willing and able to subordinate the other factors in their lives to their care during pregnancy, there would be sounder, healthier, and happier children born into the world.

The Dangers of Pregnancy.

It would be false and wrong to unduly alarm pregnant patients. As we have said, pregnancy is a natural function, and usually results in improved health and strength to the patient. This, however, is true when she receives good care and when she is willing to avail herself of it. It is sufficient to intimate the principal dangers to which the pregnant patient is exposed by reason of her condition.

The danger that abortion will occur and that the product of conception will be lost before it can live outside the mother's body is present in all cases. While abortion is not a deadly danger to the mother, it is a very serious menace to her health, and often prevents subsequent pregnancy. It is most important that abortion should not occur if it can possibly be prevented.

The conditions of the mother's life change during pregnancy. She virtually carries on two physical lives ; and so the problem of nutrition and waste becomes double in its importance. If proper care is taken at this time, the matter is readily adjusted with most patients. If attention is not given to the patient's food and to the disposal of the waste of the body, severe illness may result.

These are the two great dangers to a successful pregnancy which exist in all cases. Each may be avoided successfully in nearly all patients by the exercise of good sense and reasonable care. Only a physician can appreciate the signs and symptoms of danger in these cases, and so the patient must expect to place herself under his guidance and with his aid to pass through a successful pregnancy.

The Discomforts of Pregnancy.

The discomforts of pregnancy may cause considerable suffering, although they may not be dangerous. Disturbances of digestion, altered sensations in the skin, inability to sleep naturally, weight and heaviness as pregnancy advances, and discomfort caused by the pressure of the growing child, may greatly annoy the patient. Fortunately, the physician can do much to lessen such discomfort, and modern methods of treatment have robbed pregnancy of many of its greatest annoyances.

Chapter II. The Hygiene Of Pregnancy

Food.

By the hygiene of pregnancy we understand that general care of the health which greatly lessens the patient's discomfort, and often avoids dangerous complications. We can best understand what such care must be if we consider the needs of the patient in a healthful pregnancy.

The patient is nourishing two lives, — her own and that of the child. It would seem natural that her appetite should be increased and that she should be able to take a greater amount of food than usual. In some healthy women this occurs. The patient is not sick in the morning, but takes more food and feels better during pregnancy than when she is not in that condition. In most patients, however, digestion is more or less disordered. It is evident that the quantity and the kind of food taken must be governed by the condition of the patient's digestion. If the patient cannot digest an ordinary mixed diet, her physician will advise the simplest foods, and trial will be made until that diet which best agrees is finally selected. Patients experience the greatest comfort when during pregnancy a successful diet is chosen. Physicians will supply to their patients diet-lists varying with the physical needs of each individual. In general, it may be said that those substances which are the most valuable foods are to be selected for use during pregnancy. Thus, milk, good bread, fruits, vegetables, and the most nourishing meats are selected. As pregnancy advances, the ability of the patient to digest meat often grows distinctly less. In many cases the quantity of meat must be reduced to a minimum, and with many patients it is omitted from the diet during the latter portion of pregnancy. Indigestible articles of food are never indicated during pregnancy. Those substances which are not foods, but which are drugs, are rarely needed in this condition. Such are alcohol, and tea and coffee in large quantities. In order that food may nourish, abundant water is necessary for the body, to provide fluids which act upon the food and to secure the dissolving of waste matter. While water is not a food, nutrition cannot proceed without it, and hence it is most valuable at this time when the patient is feeding two beings.

Nausea and Vomiting.

Morning sickness, or nausea, from which many persons suffer, can often be relieved by very simple means. It is better for the patient to quickly and gently empty the stomach as soon as she rises in the morning, if she can do so. She will expel a small quantity of mucus and often a burning or acrid fluid. This is made easy if the patient will drink rapidly a full glass of water. This will be immediately rejected and with it the mucus and fluid. If the patient will then lie quietly, with her head low, she may be able to retain food after a few hours. If not, her physician will advise some method of treatment which will relieve her suffering. Vomiting during early pregnancy is a usual and not an unfavorable symptom, and should not occasion concern. If the patient is nauseated during the greater part of the time, even though she may not vomit, she should consult her physician at once.

Beverages.

In early pregnancy, especially, much can be done for the patient's comfort by a judicious selection of beverages. Effervescing water, such as Apollinaris, Poland water, Vichy, and any pure aerated water, will often be found of great comfort. A pure water is desirable ; and if this is not readily obtainable, water may be boiled, and then exposed to the air and used as desired. Most patients are in the habit of drinking either tea or coffee when in good health. Neither of these is necessary during pregnancy ; but if the patient desires them, they should be used in small quantities only, freshly made and taken with food. Light cocoa agrees well with many ; buttermilk is very useful with some patients, and, in cases of necessity, other beverages may be prepared which prove most acceptable. Not only is alcohol not necessary in healthful pregnancy, but it is positively injurious to mother and to child. If there were no physical reason for abstaining from alcohol during pregnancy, the fear of inebriety in the after life of the child should be sufficient warning. Pregnant patients should drink more than the usual amount of water. From one to two quarts in twenty-four hours should be taken. This may be between meals, on rising in the; morning, and before retiring. The temperature of the water may be agreeable to the patient, but extreme cold or heat should be avoided.

Clothing.

As pregnancy advances, the growth of the child obliges the patient to loosen her clothing. We occasionally see patients who do not accommodate the clothing to the growth of the child, and in whom the interruption of pregnancy or injury to the child results. Most patients are much more comfortable if their clothing is arranged to accommodate the growing womb very early in pregnancy. There is one point of great importance in dress, and that is, that during pregnancy pressure upon the abdomen should be avoided. The patient may fulfil this in any manner best suited to her comfort and to her purse ; but the indication remains positive and the same with all patients. The suspension of clothing from the shoulders and the substitution of a suitable waist for the corset is usually. successful in relieving the patient's discomfort and in preventing considerable danger of abortion. There are several sorts of waists available in the shops from which the patient may select. A well-fitting waist is comfortable about the bust, does not press upon the abdomen, is supported by the shoulders, and is so made that the underclothing may be buttoned to the waist, and not fastened about the abdomen. If the patient prefers, she can have made for herself a waist fulfilling these indications. The earlier the dress is adjusted after pregnancy is recognized, the better for the patient in every way. Those who decline to accede to the needs of the situation are very apt to suffer greater inconvenience during pregnancy and confinement.

Not only is the question of pressure important as regards clothing, but also the texture of the clothing next the skin. Here again each patient is a law to herself. If she is to continue in good health during pregnancy, the blood must circulate freely through the skin. With some women this circulation is good when linen only is worn next the skin ; others can use silk ; others require woollen. The climate in which the patient lives has an important bearing upon the choice of clothing. Thus, a patient who goes from a hot city to the northern sea-coast must guard against the chilling of the body which follows a radical change of temperature. Woollen clothing is indicated in such a case. The patient living inland, where the air is warm and dry, is often better without woollen, or with underclothing containing but a small quantity of wool. Here also the physician's advice must be invoked, and it should be conscientiously followed.

Patients feel a natural modesty in concealing the condition of pregnancy as long as possible. This can readily be done by a proper adjustment of the clothing. Those who imagine that the corset is valuable for this purpose are greatly mistaken. Alterations in the clothing which bring out the lines of the entire figure are more successful in this regard. The effort to compress the waist causes protrusion of the bust and of the lower part of the abdomen, which draws attention to the altered shape. Loosely-fitting clothing properly adjusted to the figure will often permit the patient to enjoy perfect comfort without attracting attention to her altered condition.

No portion of the body should be tightly constricted by clothing during pregnancy. Circular garters should give place to those attached at the sides. Tight bands should be loosened, as swelling of the limbs and other parts of the body may follow their use. In the latter part of pregnancy the patient may require shoes larger than she is accustomed to wear. This requirement should be promptly met, as much discomfort is sometimes caused by the effort to wear the shoe usually employed.

While it is possible to go through the entire pregnancy with but little alteration in clothing, still the best results for mother and child are not obtained in this way. The mother is far less comfortable and her general health far less good than if she adjusts her clothing to her altered condition. It is possible to seriously injure the unborn child by prolonged compression of the abdomen. A further reason for adjusting the clothing to suit the case lies in the fact that it is of the utmost importance that the patient's muscles should be free from restraint while she is pregnant. During labor these muscles are needed to assist in the birth of the child ; and if they are dwarfed by compression, the labor is longer and more painful. The figure of the patient will be regained more quickly after her recovery from labor and will be much better if she has not practised compression during pregnancy. She cannot prevent a permanent increase in the bones and in the general framework of the body, but this increase is symmetrical and not ungraceful. If nature be not interfered with, patients often develop physically during pregnancy and are much improved in appearance after their recovery.

Exercise.

Some kinds of exercise are exceedingly beneficial during pregnancy, while others are most injurious. During early pregnancy the patient may feel too badly to undertake active exercise ; and should this be the case, she may yield to her feelings and keep as quiet as possible. As pregnancy advances, however, she should be able to take exercise, and feel much better for so doing.

Walking at a comfortable pace upon a level surface is the most beneficial exercise which a pregnant woman can take. Driving in a comfortable carriage over good roads is also useful in this condition. Injurious exertion is going up and down steep stairs, lifting considerable weights, reaching high above the head for some time, using a treadle, as in running a sewing-machine, or any exercise which tends to jar or shock the body. Riding a horse or a bicycle is unsafe during pregnancy. Playing golf should be done with great caution only ; and swimming, to those accustomed to it and who have access to still water, may be indulged in with moderation.

After pregnancy reaches the seventh or eighth month, exercise is a necessity. Walking and going about the house performing the ordinary household duties should be freely carried out, as they serve a useful purpose in strengthening the mother's muscles and in bringing the child downward into the birth-canal. Confinement can be made somewhat easier and shorter if the patient takes exercise freely during the latter weeks of pregnancy.

Exercise cannot be taken with comfort unless the patient is suitably dressed and wears easy and comfortable shoes. She will be obliged to adjust her clothing if she is to take exercise in any form.

Sleep.

The patient needs an abundance of sleep during pregnancy. Occasionally cases are seen in which pregnancy seems to prevent sleep ; but when such is the case, the physician must be consulted at once. Before pregnancy is sufficiently advanced to have fcetal movements develop actively, the patient usually rests without difficulty. As pregnancy advances, many patients require an increased supply of fresh air during the night. If this be supplied, sleep will often follow. With those who cannot sleep during the entire night, opportunity must be taken during the day to obtain sleep. If the patient's digestion is poor, it will often be much improved if she can sleep just before a meal.

Baths and Bathing.

It is of paramount importance that the patient's skin be kept freely active during pregnancy. In addition to cleanliness, baths frequently aid in relieving nervous irritability and in securing sleep. During pregnancy, baths should be neither hot nor cold. A cool sponge bath in the morning and a warm full bath in a tub at night are most useful during this time. The warm bath at night often aids in procuring sleep and adds greatly to the patient's comfort. If the action of the skin is deficient, a sponge bath with cool salt-water in the morning is often useful. In cases where patients are annoyed by itching and burning, or by eruptions upon the skin, medicated baths are often prescribed by physicians.

Constipation.

Many patients suffer greatly from constipation during pregnancy. In some this is but an exaggeration of a usual condition. In others constipation becomes pronounced during pregnancy.