Individual Hygiene

Individual Hygiene, otherwise known as personal hygiene, is a branch of general hygiene that studies the influence of biosocial factors (factors of external nature and socio-economic conditions) on the health and development of individuals. On the basis of this study, rules of personal hygienic behavior are established. By using these rules, each individual has the opportunity to protect their personal health as a public good, maintain the proper development of their body, and maximize their productivity with the least expenditure of energy on useless and unnecessary movements. The historical path traveled by Individual Hygiene is very long if we consider its beginning to be those prohibitions ('taboos') and those rules of personal life which, since ancient times, were collected by people and passed down orally as traditions to protect life and health from various harmful influences and dangers. When writing emerged, these rules began to take on the character of laws, whose observance was prescribed under threat of various punishments. Among the ancient Chinese, Jews, Egyptians, and Assyrio-Babylonians, we already find personal sanitary rules and regulations. Due to the lack of systematic scientific knowledge in this field, individual hygiene was initially based on simple empiricism, often even giving rise to prejudices and harmful habits in personal life and in the education of younger generations. At the same time, however, a number of high achievements in individual hygiene from earlier periods can be cited. Thus, gymnastics, dietetics, and the culture of beauty—in close harmony with health and proper physical development—were extensively developed in the ancient world (of course, for the ruling classes) and amazed with their appropriateness; scientific attempts were also made to justify these requirements of individual hygiene by studying external factors. In Hippocrates' work 'On Airs, Waters, and Places,' hygienic conclusions are already based on the study of the influence of natural factors on health. Christianity of the Middle Ages, in contrast to the body culture of the ancient Greeks and Romans, introduced asceticism and mortification of the flesh as a principle for preparation for afterlife. Along with the development of religious superstitions, acquired hygienic skills disappeared, and almost all concerns about proper physical education of the body were erased. In the era of Renaissance and humanism, the healthy ancient worldview emerged again, restoring in the first place the forgotten methods of proper physical education. In this regard, humanists and philosophers of the late 18th and early 19th centuries (Rabelais, Montaigne, Bacon, Locke, J.-J. Rousseau, Pestalozzi) played a major role, who, in accordance with the demands of the strengthening bourgeoisie, did much to free human education from routine, scholasticism, formalism, mysticism, and by the beginning of the scientific period of hygiene development, it became possible to develop freer and scientifically based principles of education, placing Individual Hygiene on the foundation of the study of biological and physical factors. With the development of experimental and social hygiene, the narrow boundaries of personal influence expanded even further; the individual acquired significance as a subject of study (anthropology, pedology, medicine in the broad sense); at the same time, he was studied against the background of the socio-economic environment and in the surrounding nature that influences him. The latest stage of development of individual hygiene thus studies the personality from the point of view of these biosocial influences, and in accordance with this, the problems of individual hygiene are considered. This also determines the methods for developing issues of Individual Hygiene. Every person should be informed about their 'biological fund' and about their suitability as a social unit in socially useful activity. By the biological fund of a person is meant the total sum of morphological and functional properties of a given organism. These properties are variable. They are changed by the material and social environment in which a person lives, the work they perform, their upbringing, and diseases. The suitability of a social unit for socially useful activity is determined primarily by methods of individual investigation—clinical in nature. The assessment of a person and their work capacity is determined by many methods, among which professional selection, assessment of achievements, capacity for work, and finally self-control and accounting of one's own work are acquiring ever greater importance, as they are based on objective data from scientific research. The individuality of a person manifests not only in the difference of morphological constitution of the body, but also in the unique reactions of the organism to irritations. These reactions are either typical for many people or individual, and therefore not all dietary prescriptions, physical culture prescriptions, physiotherapy prescriptions, and any others, conducted for hygienic or therapeutic purposes, can be the same. External factors of nature—sun, air, water, soil, climate—as well as any work and labor, often give their own unique reactions, which should be taken into account. Despite the diversity of these reactions, when comparing them, it is still possible to find common features in them and unite them into groups; the more accurate the accounting, the easier the unification and the more correct the characterization. On the basis of this, the foundations are created for establishing individual indications and contraindications in the field of Individual Hygiene. The improvement of the workforce should begin as early as possible to prepare a healthy and capable replacement. An unconsolidated organism requires careful attention in terms of individual prevention and, if necessary, treatment; an individual approach is also necessary. On the examples of prevention of scoliosis, kyphosis, stooping, round back, etc., one can see a striking example of the importance of timely preventive intervention, while delayed help already requires orthopedic treatment and correction. The problems of individual hygiene are closely intertwined with the problem of labor. Hardening and physical culture, i.e., methods of personal hygiene, are in this regard no less important than the hygienic environment. Questions of hygienic regime, i.e., daily routine, questions of rest and sleep, questions of fatigue and the struggle against it, are also closely connected with human labor. Individual Hygiene must give answers to these questions in application to the individual and provide scientific justifications for them. On the basis of data from Individual Hygiene, the hygiene of daily life can also be built. In conditions of a low-culture society, the doctor is first of all in the role of a sanitary educator; for the success of his sanitary-preventive work, he must fight against hygienic prejudices and ignorance, thereby clearing the way for broader social activity. A doctor working in difficult living conditions deals with 'minus deviations' of variation statistics, and he has to show great creativity in establishing standard hygienic requirements, consistent with the peculiarities of a given region or locality in terms of climate, cultural level, economic factors, etc. Individual Hygiene aims to strengthen the body's forces. An extremely important moment in this is the study of the body's reserve forces. One of the measures to increase the body's reserve forces is hardening—an educational method that gives very valuable results with a rational technique. Individual Hygiene must provide tested examples of this technique. The adaptation of the organism to external factors of nature, living conditions, and various types of labor is very significant, but it can be used without harm to development and health only with the help of Individual Hygiene, which operates by scientific methods and cautious empiricism accompanied by scientific control. A brilliant example of systematic adaptation of the organism under the influence of work can be training for one or another purpose. If work is properly dosed, for example, in terms of strength, speed of movement, its duration, and if on the other hand protocols of all increasing achievements and exact S72 records of all influences of work on the body (scientific control) are kept, then as a result one can obtain a characterization of a trained person and note with precision the path that leads to one or another improvement and strengthening of his organs and himself. At the same time, so-called physical culture, closely connected with individual hygiene, also acquires special significance. The hygienic effect that a doctor can have on an individual for preventive or therapeutic purposes depends to a large extent on the reaction of the latter's organism to a given irritant. The hygienic effect is stronger and more durable the more often it is repeated. In their nature, the hygienic habits that are acquired in this way resemble conditioned reflexes; as a result of them, hygienic habits are formed. Fixed in childhood, they have enormous significance in social life. The basis of the so-called care for a healthy and sick person lies not only in creating a favorable sanitary environment, but also in forming hygienic habits that have become almost automatic acts. Adult patients who have been in dietetic sanatoriums and various kinds of health resorts return from there with a whole stock of, if not hygienic skills that are difficult to acquire in a short time, then with a stock of hygienic requirements that have become understandable.

Hence the role of these institutions as special health schools. - Care can be for the body as a whole or for its individual organs. In the first case, the correct distribution of time allocated to work and rest, the scientific organization of labor, a rational regime and in particular a food and dietary regime, the proper use of external natural factors and hardening are of particular importance. As for the hygiene of individual organs, empirical knowledge and scientific knowledge have developed a significant number of requirements and rules for individual systems. Special importance is attached to care for the skin and the mucous membranes of the eyes, mouth, and nasal cavity. Contamination of the skin, its microbial flora often lead to various diseases, the spread of which depends to a large extent on harmful habits in an uncultured environment. The creation of good hygienic habits here constitutes a serious task of Individual Hygiene. The oral and nasal cavity is a place of invasion for numerous infections, from which children die most often. An uncultured hygienic environment presents the greatest danger, and here the doctor has extensive scope for combating harmful habits, prejudices, and unsanitary conditions. The struggle must be conducted in two directions: on the one hand, regulations and sanitary education, which have guiding significance and direct attention to dangers; on the other hand, the improvement of living conditions through good examples of behavior and good examples of sanitary conditions. This includes the vigorous introduction of hygienic skills, such as: proper cleaning of the oral and nasal cavity, protection of teeth from decay. All this requires prolonged and active hygienic intervention. In children's homes, kindergartens, schools, and dispensaries, these hygienic skills are instilled, and in sanatoriums and health resorts they are additionally reinforced with special instructions depending on the type of disease. - Among the uncultured population, trachoma and purulent inflammation of the eyes spread extremely easily and in turn raise questions of personal eye hygiene. The same applies to pulmonary tbc and other diseases of the respiratory apparatus. In addition to broad sanitary education, it is necessary to create, adapted to socio-living conditions, a sanitary environment most favorable for proper breathing of clean air; secondly, it is necessary to familiarize oneself with the dynamics of the respiratory apparatus in a given person (determination of lung capacity, amplitude and character of breathing), in order to give hygienic advice most suitable in this case, to choose appropriate physical exercises, etc. In a preventive aspect, timely instruction in correct deep and complete breathing is of great importance (see Respiratory Gymnastics). The development of correct breathing should go through physical culture, as physical exercises automatically increase the amplitude of breathing and help to master breathing to the fullest extent. The above applies to all labor processes carried out in schools, factory schools, in the field, in the garden, in each production; next to learning the technique, learning how to maintain the most favorable position of the body and how to breathe during work should go; such teaching creates a great economy of strength and preserves health. Methodological instructions are also necessary when conducting pulmonary gymnastics for therapeutic purposes in many diseases. Individual Hygiene pays special attention to hardening as a method of action through the nerve and thermoregulatory apparatus of the skin on the whole organism. When prescribing water procedures, when using air and sun baths, one should avoid stereotypes and take into account the individual reaction to each of these irritants. By this method, it is proposed to establish a more correct individual dosage. Hygienic healing (healing by means of a hygienic regime) has long existed in medicine. This is one of its most relevant methods. Bed rest, diet, proper regime, conservation of the patient's strength by all possible and carefully thought-out means - all these hygienic measures give great success and help any other treatment. Hygienic healing cannot in essence be stereotyped; it is individualized primarily depending on the type and form of the disease. Dietary and physical culture assignments and dosing of labor are carried out on the basis of nosological peculiarities and the resulting requirements. These requirements can be not only specific but sometimes also general (group), for example, in diseases of metabolism, the cardiovascular system, the respiratory system, etc. - Hygienic indications and contraindications are developed not only in relation to individual diseases but also in relation to individuals susceptible to the same disease. In the fight against occupational diseases, social measures play a leading role, but the reaction to occupational harm in different people can be different; therefore, to reduce the harmful effect of production, from the point of view of Individual Hygiene, one should first establish what this harmful effect is on a given organism. Having noted the peculiarities of individual reaction to occupational harm, one should strengthen those organs that are most traumatized by the disease. In a sedentary profession, the spine curves, the abdominal press weakens, blood circulation and breathing are impaired, and in women the muscular apparatus of the pelvis very often weakens. Depending on the data of the study, treatment and preventive measures are prescribed - diet, physical exercises; in other cases, this depends on a change of profession or reduction of the DOSE of labor.

Individual Hygiene.

Gorinevsky. Hygiene of Women. The necessity of isolating women's hygiene into a special chapter of Individual Hygiene stems from the biological peculiarities of the female organism, adapted by nature for the function of motherhood. Therefore, women's hygiene, regardless of the general requirements of Individual Hygiene, has its own special tasks, mainly aimed at protecting the function of motherhood. These tasks change depending on the different periods of a woman's life. Women's hygiene should cover 1) hygiene of the girl, from birth to the onset of sexual maturity; 2) hygiene of the girl and woman of childbearing age, which includes hygiene of the menstrual period, hygiene of marriage (sexual life), hygiene of pregnancy, childbirth, and the postpartum period, and 3) hygiene of the period of decline of sexual function (climax). - I. Hygiene of the girl begins from the first days of life and has the task of preventing the development of diseases that can result in both insufficiency of the entire organism and underdevelopment of the sexual apparatus, and consequently can also affect the function of motherhood. The most important moments, a) Prevention of vulvovaginitis (most often of gonorrheal nature) with its consequences, which often arises already in the first days of life (using the same care items as the sick mother, sleeping together, etc.); this is also important from the point of view of preventing masturbation (itching) in later childhood, b) Prevention of rickets, leading to deformation of the pelvis. In addition to measures of a public nature (hygiene of cities, housing, nutrition), individual measures are important: Fresh air, sun, proper feeding, supply of antirachitic vitamins. c) Prevention of infantilism of the sexual sphere (general toning measures; fight against intestinal sluggishness). Increased intra-abdominal pressure affects the entire topography of the pelvic organs. In particular, when straining the abdominal muscles, all the force of intra-abdominal pressure is directed to the posterior surface of the uterus, causing a sharp bending of it forward. With prolonged action, a persistent anteversion of the uterus develops - one of the frequent causes of infertility (Okintchits). Hence the harmfulness of certain physical work for girls (village girl-nannies), chronic constipation (developing, among other things, on the basis of habitual stool retention), retention of urination. It is necessary, along with rational nutrition, to educate the intestine in the spirit of automatic correctness of its action (Menge, Baisch). II. Hygiene of the girl and woman of childbearing age.- 1. General requirements, a) Women's clothing after the war better meets the requirements of hygiene than it did in the pre-war period. The main drawback of clothing was wearing corsets, now going out of use, and tight lacing of the waist with various ties. The latter still exists today, especially in the village. When wearing a corset, the muscles of the back, iliac region, and anterior abdominal wall are compressed, the thoracic and abdominal cavities are constricted, intra-abdominal pressure sharply increases. This leads to difficulty in blood circulation, atrophy of muscles, partly to compression of important organs (lungs, heart, stomach and intestines, large vessels), partly to their displacement. The sexual apparatus is pushed downward, the elastic pelvic floor is stretched (Menge). With a high corset, the breast nipples are compressed and their development is delayed. A low soft corset to which skirts are attached is acceptable. It is even better to transfer the weight of the clothing to the shoulder girdle. For supporting the breasts, it is advisable to use a special brassiere. Wearing round rubber garters that restrict blood circulation is harmful, especially when there is a tendency to varicose veins. Stockings should be held by suspenders attached to a special belt. Recently, so-called "combinations" (shirt with panties) and closed panties (women's tights) have become widespread, protecting the genital organs from dust and cooling. They are quite hygienic. - b) Care of the genital organs should consist of daily external washing with warm water and soap. Douching of the vagina with water or weakly disinfecting solutions, which was still common recently, is now abandoned in healthy women. It is considered harmful, as it first promotes the introduction of infection and secondly weakens the natural self-defense of the vagina. -c) Physical culture and sports, applied in accordance with the peculiarities and strength of the female organism, constitute an integral part of women's hygiene. 2. Hygiene of the menstrual period-see Menstruation. 3. Hygiene of marriage. The question of the optimal marriage age is closely connected with the question of the most favorable age for the first childbirth. Opinions on this matter differ. Until recently, the age above 20 years was considered best (Kleinwachter, Strassmann, Wernich). Recent observations rather tend to a younger age, approaching the views of Mauriceau, who taught: "A woman over 15 years of age gives birth the more easily, the younger she is." According to Bondy, the optimum is 18-20 years, when the strength of contractions and the resistance of soft tissues are most favorable. Prolapse and displacement of the genital organs occur mainly after delayed first births (Sellheim, Fetzer). The growth of pelvic bones is completed by 20 years (Klein); by that time the uterine muscle also reaches its full development. Apparently, physiologically the most favorable boundaries can be considered 18-23 years (Guggisberg).--The first sexual intercourse is associated with the violation of the integrity of the hymen (defloration) and sometimes can be a source of severe injuries. Ruptures of the vulva and vagina up to the destruction of its posterior wall, pelvic cellular tissue, and the entire perineum ("Venus cruenta"- Neugebauer) have been described. Among the causes of injuries, along with the inelasticity of the hymen, peculiarities of the anatomical structure of the sexual apparatus (narrow and short vagina), there can be rough violence by the man, especially if the sexual act is performed in a state of intoxication. A certain role can be played by the woman's ignorance of the essence of the sexual act, and perhaps the man's unfamiliarity with the structure of the sexual sphere (Rohleder). Usual tears of the hymen are not accompanied by significant bleeding. They rarely lead to infection. Nevertheless, for preventive purposes, it is advisable to wash the external genital organs with weak disinfectant solutions and temporary abstinence from repeating the sexual act.-The frequency of the sexual act from the point of view of hygiene cannot be determined numerically, as it depends on individual peculiarities, temperament, race, etc. Women are much more resistant in this respect than men (Rohleder). The measure of excess and the basis for limiting sexual life for a woman are her poor appearance, general exhaustion, prolonged fatigue, back pain, and in general painful sensations (Selitsky, Frenkel). The so-called "preventive" intercourse for the purpose of preventing pregnancy has acquired an extremely important role in marriage. Methods of preventing pregnancy, often used and for a long time, can be harmful to both the man and the woman. 4. Hygiene of pregnancy should be based on our knowledge of the mechanical and physiological processes characteristic of this condition. The work of the most important systems and organs during pregnancy reaches the extreme limits of their physiological capabilities. This brings the pregnant organism into a state of certain instability, standing on the border of pathology. Pregnancy does not require a radical change in the usual way of life, but requires special persistence in carrying out all the rules of hygiene. At the same time, the protection of pregnancy should also provide for all the requirements of antenatal protection of the infant. The study of metabolism in pregnant women gives important guiding indications for the scientific substantiation of the main moments of their life regimen. The following facts can be considered established, a) Incomplete combustion of the protein molecule, leading to the accumulation of intermediate products of protein metabolism. In relation to protein metabolism, the organism at the end of pregnancy is at the limit of its ability to cope with the tasks before it. The slightest deviation in the direction of intoxication makes it incapable. b) Incomplete oxidation of fats, leading to the accumulation of intermediate products of their metamorphosis-acetone, acetoacetic and oxymalic acids, c) Acidosis of the blood as a result of the accumulation in it of under-oxidized products of fat metabolism, partly lactic acid and some acidic products of protein metabolism (uric acid, amino acids), d) Instability of carbohydrate metabolism, leading to physiological and alimentary (Noorden, Hofbauer) glycosuria of pregnant women.-From these basic facts follow the most important directives of pregnancy hygiene, a) Labor regime. Any work requiring muscular activity is beneficial for pregnant women: it increases lung ventilation, increases oxygen consumption and consequently favors the oxidation of proteins and fats. As an additional effect of work, the improvement of blood circulation (elimination of stagnation) and muscle development are important. Physical overexertion is harmful: it not only exhausts the organism but also leads to its overload with products of muscular activity (lactic acid).

Both idleness and inactivity, which promote relaxation of the muscles, sluggishness of metabolism (development of toxicoses, excessive fat deposits), stagnation, and constipation, are equally harmful. Thus, a pregnant woman can and should continue her usual professional and domestic work, provided the latter does not require excessive physical exertion. Obviously, muscular activity in the fresh air should enhance the beneficial effect of moderate physical work. Movement in the open air, energetic walks (exercise) are absolutely necessary for a pregnant woman. In regard to physical culture and sports, the views tend to be that women accustomed to them can continue them during pregnancy without harm. Work in industries with professional poisons requires special protection for pregnancy. The interests of the mother and antenatal protection of the infant require complete rest for pregnant women for some time before childbirth (6-8 weeks). The average weight of the fetus in women who rested before childbirth is 289 grams higher than in women who worked until the end of pregnancy (Pinafd, Bachimont). The duration of pregnancy is somewhat longer in the former. Our legislation Article 77 provides every working woman with maternity leave (Article 132 of the Labor Code) with full salary retention. Unburdening domestic work is permissible until childbirth, and exercise is mandatory. b) The diet should take into account the peculiarities of metabolism in pregnant women along with their need for plastic and energy material (construction of the fetus, hypertrophy of the uterus, mammary glands, compensation for losses during childbirth, etc.). The calorie requirement of a healthy pregnant woman exceeds the normal requirement by no more than 5% in the first and 10% in the second half of pregnancy (Noorden and Salomon). Taking into account the physiological increase in weight of pregnant women, these authors determine the necessary increase as 100-150 calories in the first and 300-400 calories in the second half of pregnancy. In terms of milk, this will amount to 450-600 cm³ of milk. At present, general views tend to limit protein intake for pregnant women and cover the calorie requirement with other nutrients (mainly carbohydrates) (Neumann, Rissmann, Gessner and others). Such a diet consciously aims to facilitate kidney function and prevent nephroses of pregnancy and eclampsia. Noorden warns against excessive reduction of protein intake (from 80-100 g to 50-70 g), allowing for the possibility of adverse effects on subsequent generations. For the same preventive reasons, modern dietetics for pregnant women requires a reduction in fat intake (Seitz, Jaschke). - The intake of sufficient carbohydrates is favorable, among other things, for more complete combustion of fats. The reduced tolerance of pregnant women to sugar requires its limitation in food. Thus, the diet of a pregnant woman should be mixed with a predominance of plant and dairy food over meat food with limited sugar intake. Plant food, especially fresh vegetables, provides the body with vitamins in sufficient measure.--The need of pregnant women for calcium salts should be taken into account. Along with Kehrer, many believe that toxicoses of pregnancy are associated with a deficiency in calcium salts. Kehrer, Rissmann and others as a rule prescribe preparations of lime for pregnant women, especially when they have a tendency to nephroses or eclampsia. Milk (butter) is rich in lime. Regular consumption of milk (about 1 liter) makes the prescription of calcium preparations unnecessary.--In order to spare the kidneys, restriction of chlorides is required. Their daily norm should not exceed 7-8 g (Noorden). Further restriction of chlorides is required in cases of water retention in the body-edemas with subsequent nephropathy. With the restriction of chlorides, the preventive value of calcium salts is increased, among other things. The amount of fluid consumed by a pregnant woman should be controlled by the sense of thirst; in cases of hydropic phenomena, it requires sharp restriction in combination with chloride-free food.-Iron is an essential ingredient in the diet of pregnant women. Experiments by Fetzer showed that the mother steadfastly protects her reserves of Fe. With insufficient intake, the fetus suffers. This is attributed to congenital anemia of infants (anemie des nourrissons a type chloro-tique of French authors, Sauglings-Schrotoid of Noorden). Spinach, lettuce, green vegetables, eggs contain iron. For pregnant women prone to anemia and chlorosis, Fe preparations are appropriate. Somatose, ferzan, Ferrum lact cause constipation less than others. In the fight against intestinal sluggishness, along with its training, vegetables and fruits in raw and cooked form, black bread, especially rye (250-300 g per day), give good results. Milk sugar can have a good effect: 20 g per 120 cm³ of water in the morning. Legumes, as well as old cabbage, cause flatulence. If appropriate dietary measures do not give results, then medium salts, especially magnesium, which is poorly absorbed and limits its action to the intestine, are prescribed. Noorden warns against the abuse of laxative mineral waters containing chlorides (effect on the kidneys). Small enemas of plain or soapy water, glycerin microclysters (10 g) are useful. Acute and piquant substances should be excluded from the diet of pregnant women. The harm of alcohol in any form must be emphasized. c) Skin care. Overloading of the pregnant woman's body with products of incomplete metamorphosis with a tendency to intoxication requires perfect work of the excretory apparatus. It is necessary that the skin to some degree replace the work of the kidneys (Gruzdev). For this, its pores must be free, which is served by warm soap baths (1-2 times a week) or showers. Many consider baths harmful in the last weeks of pregnancy, considering the possibility of water, and with it infectious agents, entering the gaping genital cleft, and therefore advise replacing baths with warm washing or showering. Frenkel limits the requirements to the fact that baths should not be used by persons with purulent ulcers, tuberculosis, etc. Cold showers and rubdowns are permissible for pregnant women who are accustomed to them. Special care is required for the external genital organs due to increased secretion of the sebaceous glands (soil for microbes). Warm douching is sufficient, vaginal douching-only for special indications (III and IV degree of vaginal cleanliness with purulent discharge, gonorrhea, etc.).-Care for the breasts and nipples. A brassiere is necessary. Daily washing with water and soap. The method of preparing the breasts for feeding by 'hardening' is widely spread. For this, rubbing the nipples with coarse linen (Opitz), wiping with an alcoholic solution of tannin or simply alcohol is recommended. To soften the effect of alcohol, glycerin is added according to the following prescription: Rp. Spirit, vini 80°-30.0, Glycerini-1.0, Acidi tannici-2.0. Many consider hardening with alcohol 38° harmful, since dry skin is especially prone to the formation of cracks. In contrast, treatment of the nipples with soft creams or ointments from lanolin (Baisch) is recommended. For women with poorly defined nipples, it is recommended to pull them out daily with fingers or a breast pump. Eisenreich considers the attempt to correct a retracted nipple in this way problematic. Recently, some schools (Skrobansky) propose to limit oneself to washing the body and breasts, since all methods used to prepare the mammary glands do not reduce the percentage of nipple cracks during feeding (Pavlova). d) Care for the oral cavity and teeth requires special attention due to the tendency of pregnant women's gums to looseness and hyperemia and teeth to caries (decalcification). Soft toothbrushes are recommended. Treatment of teeth during pregnancy is not only not contraindicated but necessary (possible source of postpartum infection) Contrary to some opinions (Opitz). e) Clothing of a pregnant woman. The requirements that were above remain in full force. Most gynecologists consider it necessary to wear a special bandage or binder from the second half of pregnancy. The binder prevents stretching of the abdominal wall, which can cause a persistent sagging of the abdomen (Gruzdev). There is a huge number of models of such binders. An ordinary knitted bandage 25-30 cm wide and 105-110 cm long, equipped with hooks, achieves the goal (Gruzdev recommends a more complex knitted binder according to Lebedev). A good abdominal binder should lift the abdomen upward, without compressing it and giving sufficient room for the abdominal organs. Some prescribe an abdominal binder only for a sagging or pointed abdomen, enteroptosis, diastasis, etc. (Frenkel). The shoes of a pregnant woman should be light, if possible open (in the room) to facilitate skin respiration. Heels are harmful from a static point of view, increasing the inclination of the pelvis and compensatory lordosis. f) Sexual intercourse. Most authors consider moderate sexual life in the first half of pregnancy harmless and require complete abstinence only in the second half. In establishing the period of abstinence, views differ (from 2 weeks to 4 months before childbirth). At times coinciding with menstruation, sexual life should be prohibited. Bumm considers coitus harmful throughout the entire pregnancy.

Practically, the practice of sexual abstinence throughout the entire pregnancy is of course completely impossible. According to the data of Ruge, women engage in sexual activity almost up to the very moment of delivery: 31% of them had coitus still a week before delivery, 20% three days before, and 9.5% on the day of delivery. Possible complications: early rupture of the membranes, bleeding (placenta praevia), premature delivery, infection. Clinically established harmful consequences of coitus in the last two months of pregnancy require, in the interests of both mother and fetus, complete sexual abstinence for at least this period of pregnancy (Ruge). For the hygiene of childbirth, the postpartum period, and the climacteric, see Climax, Postpartum period, Childbirth.

m. Levi.