Sex efficiency through exercises : special physical culture for women / by Th. H. van de Velde ; [photos, by E. Steinemann].

of any doubt. And careful supervision of the patient and observation of the effects of the exercises are necessary in every case. A factor of importance is the degree of practice, or the reverse, attained by the woman before her confinement. Probably all obstetricians who have concerned themselves with this subject are in agreement that a muscular system kept elastic by previous physical culture returns to nor- mality after child-birth far more easily than the slack and often overstrained abdominal walls of an unpractised patient.* All obstetricians concur equally in warning against excessive athletic training, and especially against competitive sports. The best practical differentiation of exercises after child- birth is based on (a) actual childbed, and (b) the later phases of involution. Of course, the borderline between these stages of recovery shifts and depends on individual factors. For normal cases, we may make the division at the end of the second and beginning of the third week, after delivery. As a rule, exercises implying much effort should be kept for this later phase, and, of course, women who have to attend to their domestic duties as soon as they leave their beds, must be careful to avoid fatigue. Note, however, that these later puerperal exercises cannot take the place of those which should be performed during the fortnight following birth ; if exercise during this first fortnight has been neglected owing to ignorance or adverse circumstances, the omission can only be made good with difficulty—or not at all. This may be observed in the cases of women who have had to rest completely for several weeks owing to injuries at birth, haemorrhages or other illness; and the obstetricians of an older generation who had experience of the school of doctrine which kept puerperal women as long as possible in absolute repose, have also many cases to cite and much to warn us against. For the involution, recovery, or return to normality of the abdominal and perineal muscles takes place in the fortnight after delivery and chiefly in the first week. The later exercises * Especially of a multipara.