A good mixed dietary is the one best adapted for the normal pregnant woman. If the bowels are kept regular, and if the patient take the requisite amount of fresh air and exercise, no special dietary precautions are called for. Too much importance cannot be laid on the necessity of preventing constipation, and on the value of fresh air and exercise for the parturient woman. In many pregnant women, however, it is advisable to modify the diet. The necessity for this is shown by the presence of certain symptoms or physical signs in the patient which indicate the existence of a special strain on the kidneys and other organs of excretion. Thus, morning sickness in an exaggerated degree, albuminuria, and dropsy are serious symptoms in pregnancy, and their presence calls for very special attention being directed to the diet. In these circumstances the lightest possible diet, one that throws the least strain on the kidneys and other glands, must be given. Such a regime is a milk diet. In severe cases it may be necessary to have recourse to an exclusive milk- regime; in less severe a diet of milk, bread, farinaceous foods and fruits may suffice, while in the milder forms of derangement all that is necessary is that the patient should avoid red meats and richer dishes of all kinds, and live on the lacto-vcgetarian diet described on p. 5 The quantity of nourishment must not exceed what is usually required by a healthy woman; the meals should be taken at regular intervals, and all indigestible articles of food and any that are known to disagree with the patient should be avoided. The morning sickness and pyrosis of pregnant woman are not markedly affected by diet, small simple meals at frequent intervals are the best.

In the later months it is necessary to take food in smaller quantities, more frequently, since over-distension of the stomach causes discomfort, owing to the size and position of the uterus. "Longings" for particular foods, so far as they are kept within reasonable bounds, can be gratified; but there is no evidence that the refusal to satisfy unreasonable caprices has any effect on the physical or mental development of the child.

Pregnancy may be associated with glycosuria, diabetes, heart disease, tuberculosis, obesity, and other disorders. These must be treated along the lines laid down in these sections. In glycosuria and diabetes, special restrictions are called for in the sugars and starchy foods; in heart disease, on account of the dangers associated with over-distension of the stomach from flatulence or food, very special care is necessary in regard to the forms in which starchy foods are taken, and also to the amount and nature of the fluid taken with meals. In tuberculosis a special supply of protein is called for, but the extra strain thrown on the kidneys by a diet rich in protein food must be kept in view. Pregnancy complicated by obesity should be treated by gentle exercises, massage over the abdomen, and a careful restriction of the carbohydrates and fluids in the dietary. Further details on these points will be found in the sections dealing with these diseases.

Diet Adopted To Modify The Size Of The Child

The trend of modern thought, experience, and to a certain extent scientific research, tend to show that diet to a certain extent can modify the maternal and faetal tissues in such a way as to make the labour more easy, and to increase the probability of a viable child being born. This is of special importance in the case of women who have a small pelvis, and who have in consequence of the dangers associated with this, given birth to one or more still-born children.

According to Prochownick, Paton, and other investigators, a diet deficient in carbohydrates and fluids will result in a small child, which is otherwise perfectly developed. Prochownick claims that with a conjugate diameter of 8 cm. a difficult labour can be obviated, and even induction of premature labour can be rendered unnecessary. A special diet should be begun three months before labour is expected, and should be rigidly followed out, more particularly for the last two months. The diet he recommends is as follows: -

Breakfast

Small cup of coffee, 3 ounces. Breadstuff, 1 ounce, with a little butter.

Dinner

Meat, eggs, or fish, with a little sauce. Green vegetables, prepared with cream. Salad cheese.

Supper, much as Dinner - 1 to 1 1/2 ounces of bread with butter.

(Water, soups, potatoes, desserts, sugar, and beer are strictly withheld).

Thirst is complained of during the earlier part of this treatment, but passes off". The large amount of animal food was objected to by some patients. All the confinements reported were much easier than on former occasions, even when the child was large and fat. All the children were born alive. The children were usually lean at birth, with the bones of the head unusually mobile; they were apparently mature in every way, and in the majority of cases the child gained normally after birth, and the diet had apparently exercised no injurious effect whatever on the child, or on the mother during pregnancy or the lactation period. On such a diet it is essential that the condition of the urine should be carefully observed, the amount of urea and the presence or absence of albumin in the urine being specially noted. Unlike what might have been expected, it was found that this diet did not apparently favour the onset of eclampsia.

Diet During The Puerperium

After labour the exhaustion of the patient may be relieved by the administration of a cup of beef-tea or warm milk, and for the first twenty-four hours the diet should be restricted to milk and beef-tea. During the second day it is advisable to keep mainly to fluid food, with a little bread and butter. After a thorough clearing out of the bowels has been effected, there is no reason why we should not begin a light convalescent diet, including plenty milk. The amount of milk and milk foods can be overdone; the addition of one good meat meal a day (rump-steak, grilled chop, or underdone roast beef) is advantageous for the milk supply, probably on account of its stimulating effect on the thyroid gland (sec Appendix). No benefit is obtained either to the mother or infant by attempting to stuff the patient.

Diet During Abnormal Pregnancy

The diet for cases complicated by heart disease, glycosuria, diabetes, and tuberculosis has already been referred to. The pernicious vomiting of pregnancy is a condition which may be very intractable. In bad cases it is essential to keep the patient at complete rest, and administer food in little more than teaspoonful doses at a time. Milk and beef-tea preparations strengthened by the addition of plasmon, sanatogen, or other concentrated foodstuffs are the mainstay in treatment. In exceptional cases nothing arrests the vomiting, and it becomes necessary to terminate the pregnancy by inducing labour. Pronounced salivation is another condition which is occasionally a troublesome feature in pregnane)-. There is no evidence that diet plays any special role in connection with this; a lactoetarian diet is probably the best. The dietetic treatment of chorea in pregnancy is on the same lines as for chorea in the non-pregnant individual. Any mental disorders developing during pregnancy should be treated by a meat-free diet, the food consisting of milk, farinaceous foods, and fruits.

Special attention must be paid to the albuminuria of pregnancy. This is frequently only discovered by the practitioner in the course of his examination of the water; in its earlier stages the patient may show no symptoms, but later there is great liability to eclampsia. The diet for this condition is the milk diet of acute nephritis (p. 410).