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diff --git a/19594.txt b/19594.txt new file mode 100644 index 0000000..f3a534c --- /dev/null +++ b/19594.txt @@ -0,0 +1,6427 @@ +The Project Gutenberg EBook of The Eugenic Marriage, Volume I. (of IV.), by +W. Grant Hague, M.D. + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: The Eugenic Marriage, Volume I. (of IV.) + A Personal Guide to the New Science of Better Living and Better Babies + +Author: W. Grant Hague, M.D. + +Release Date: October 21, 2006 [EBook #19594] + +Language: English + +Character set encoding: ASCII + +*** START OF THIS PROJECT GUTENBERG EBOOK EUGENIC MARRIAGE *** + + + + +Produced by K.D. Thornton, Jason Isbell, Keith Edkins and +the Online Distributed Proofreading Team at +http://www.pgdp.net + + + + + +Transcriber's note: A few typographical errors have been corrected: they +are listed at the end of the text. + +[Illustration: Eugenics Hath Its Own Reward] + +The Eugenic Marriage + +A Personal Guide to the +New Science of Better +Living and Better Babies + +By W. GRANT HAGUE, M.D. + +College of Physicians and Surgeons (Columbia University), New York; Member +of County Medical Society, and of the American Medical Association + +In Four Volumes + +VOLUME I + +New York + +THE REVIEW OF REVIEWS COMPANY + +1916 + +Copyright, 1913, by W. GRANT HAGUE + +Copyright, 1914, by W. GRANT HAGUE + + * * * * * + + + [i] +INDEX OF THE FOUR VOLUMES + +NOTE--The Roman numerals I, II, III and IV indicate the volume; the Arabic +figures 1, 2, 3, etc., indicate the page number. + +Accidents and emergencies, IV, 629. + +Accouchement Beds, how to prepare, I, 65. + +Acne, IV, 576. + +Adenoids, IV, 519; how to tell when child has, IV, 520; treatment of, IV, +521. + +Adentitis, acute, IV, 558; causes of, IV, 558; symptoms of, IV, 558; +treatment of, IV, 558. + +Advice to young wives, III, 357. + +After-birth, expulsion of, I, 101. + +After-pains, I, 103. + +Age at which to marry, III, 331. + +Albumen water, II, 245. + +Alcohol, in patent medicines, III, 455. + +Alcoholic drunkenness, I, 44; Dr. Branthwaite on, I, 45; Dr. Sullivan on, +I, 44. + +Amenorrhea, causes, II, 192; absence of menstruation, II, 191; treatment +of, II, 192. + +Anemia, severe, IV, 567; simple, IV, 565; treatment of various forms, IV, +567. + +Anesthetics, new, IV, 654; use of in confinements, I, 112. + +Angina, IV, 508. + +Anti-meningitis, serum, IV, 656. + +Aperient waters, abuse of in constipation, III, 326. + +Appendicitis, IV, 546; treatment of, IV, 546. + +Appetite, loss of, II, 287; poor, II, 286; treatment for loss of, II, 288. + +Arrest of hemorrhage, IV, 635. + +Artificial Food, II, 249; formulae for, II, 253; mistakes in preparing, II, +267. + +Aseptic surgery, IV, 653. + +Baby, amusing the, II, 217; bathing the, II, 213; care of eyes, II, 215; +care of genital organs, II, 216; care of mouth and teeth, II, 215; care of +newly-born, II, 210; care of skin, II, 216; clothing of, II, 214; +constipation in bottle-fed, II, 309; food for first year, II, 261; fresh +air for, II, 232; how it gets nourishment in womb, II, 183; how long it +should sleep, II, 236; how to weigh, II, 220; hygiene and development of, +II, 209; intervals of feeding, II, 225; night-clothes of, II, 215; +overfeeding the, II, 224; proper way to lay in bed, II, 235; what to +prepare for the coming, II, 209; why it cries, II, 237. + +Baby's comforter, II, 241. + +Bacteria, what happens if we inhale, III, 410. + +Barley gruel, II, 244. + +Barley water, II, 244, 256. + + [ii] +Bath, bran, IV, 591; cold, for reducing fever, IV, 590; cold sponge or +shower, IV, 592; during pregnancy, I, 76; hot air or vapor, IV, 591; hot, +IV, 591; mustard, IV, 590; tepid, IV, 592; various kinds of, IV, 590. + +Bathing, the baby, II, 213. + +Bed, proper way to lay baby in, II, 235. + +Bed-wetting, IV, 580. + +Beef juice, II, 262. + +Beef or meat pulp, II, 244. + +Bichloride of mercury solution, IV, 627. + +Binder, how to apply, I, 66. + +Birth, management of, I, 99. + +Birth-chamber, the, I, 61. + +Birth marks, I, 128. + +Bites, dog, IV, 638. + +Blackheads, IV, 576. + +Blood, children suffering from poor, IV, 566; poor, IV, 565. + +Boils, IV, 559. + +Boracic Acid, solution of, IV, 626. + +Bottle-feeding, method of, II, 256; what a mother should know about, II, +264. + +Bowels, daily movement necessary, II, 307; how to wash out, IV, 586; +importance of clean, II, 306. + +Boy, building of, II, 139; chancre, the, II, 145; gonorrhea or "clap," II, +142; sex-hygiene for, II, 139; social evil, II, 141; sources of immorality, +II, 141; syphilis or "pox," II, 144. + +Brain, complications of in syphilis, II, 146. + +Bran, as a food, II, 292; bath, IV, 591; muffins, recipe for, II, 311. + +Branthwaite, Dr., on alcoholic drunkenness, I, 45. + +Bread, II, 273. + +Breasts, care of when weaning, I, 125; colostrum in, I, 108; how long +should baby stay at, II, 225; putting baby to after labor, I, 108. + +Bronchitis, IV, 511; chronic, IV, 515; diet for, IV, 513; drugs in, IV, +514; external applications for, IV, 514; inhalations for, IV, 513; in older +children, IV, 512; symptoms of in infants, IV, 512; treatment of IV, 512. + +Broncho-Pneumonia, acute, IV, 516; symptoms of, IV, 516; how to tell when +child has, IV, 517; treatment of child with, IV, 517. + +Bruise, or contusion, IV, 633. + +Burbank, Luther, on education, I, 24. + +Burning Clothing, how to extinguish, IV, 641. + +Burns, and scalds, IV, 641. + +Calomel, II, 297; how to take, II, 297. + +Cancer, in women, III, 442; what every woman should know about, III, 442. + +Carron oil, solution of, IV, 627. + +Castor oil, II, 295; how to give dose of, II, 296. + +Catarrh, acute nasal, IV, 500; symptoms of, IV, 500. + +Catarrh powders, III, 458. + +Cathartics, calomel, II, 295; castor oil, II, 295; citrate of magnesia, II, +298; how to give children, II, 295. + +Cereals, II, 273. + +Chancre, the, II, 145. + +Change of life, conduct during, III, 446; the menopause, III, 443; symptoms +of, III, 444. + +Cheerful wife and mother, III, 400. + +Chicken broth, II, 244. + + [iii] +Chicken-pox, IV, 606; symptoms of, IV, 607. + +Child, the delicate, II, 281; diet of sick, II, 279; most helpless living +thing, II, 279; rate of growth of, II, 221; sick, should be in bed, II, +277; washing mouth and eyes after birth, I, 102. + +Child-Birth, I, 61; fear of, I, 111. + +Children, acute intestinal diseases of, IV, 529; constipation in, II, 303; +hysterical, II, 293; rheumatism in, IV, 569; temperature in, II, 217; with +whom milk does not agree, IV, 535. + +Cholera infantum, IV, 540. + +Chlorosis, IV, 566; symptoms of, IV, 566. + +Chronic Nasal catarrh, IV, 503; treatment of, IV, 504. + +Circumcision, should it be advised, II, 169. + +Citrate of magnesia, II, 295; how to take, II, 298. + +Clap, or gonorrhea, II, 142. + +Clothing, baby's, II, 214. + +Coddled egg, II, 245. + +Cold-pack, IV, 589. + +Colds, catching, IV, 497. + +Colic, IV, 544; symptoms of, IV, 545; treatment of, IV, 545. + +Colitis, chronic, IV, 538. + +Colon, irrigation of, IV, 587. + +Colostrum, uses of, I, 108. + +Condensed milk feeding, II, 227; objections to, II, 257. + +Confinement, choice of physician, I, 69; convalescing after, I, 131; +domestic problem following first, I, 131; how to calculate date of, I, 66; +how to prepare bed for, I, 65; lacerations during, I, 116; how long woman +should stay in bed after, I, 114; position and arrangement of bed for, I, +64; preparations for, I, 61; selection of a nurse, I, 70; use of +anesthetics in, I, 112; what to provide for, I, 62. + +Confinement chamber, presence of friends in, I, 113; presence of relatives +in, I, 113. + +Constipation, II, 315; abuse of cathartics and aperient waters, II, 326; +always harmful, II, 321; chief cause of, II, 315; cost of, II, 317; +diseases of women and, II, 320; during pregnancy, I, 84; in bottle-fed +infants, II, 309; in breast-fed infants, II, 308; in girls between 16 and +20, II, 321; in children over two years old, II, 309; in infants and +children, II, 303; lack of bulk in food, II, 326; lack of exercise and, II, +325; lack of water, II, 325; negligence of, II, 324; pregnancy and, II, +321; significance of, II, 305; social exigencies and, II, 319; treatment +of, II, 323; treatment of obstinate, II, 311. + +Consumption cure, III, 461. + +Consumptives, information for and those living with, III, 421. + +Contagious diseases, IV, 599; conduct and dress of nurse for, IV, 600; +convalescence after, IV, 603; rules to be observed in treatment, IV, 599; +what isolation means, IV, 600. + +Contusion, or bruise, IV, 633. + +Convulsions, IV, 577; treatment of child with, IV, 579. + +Cord, cutting, the, I, 102; dressing the, II, 210. + +Cough, treatment of, IV, 505; nervous or persistent, IV, 504. + + [iv] +Cream, for constipation in infants, II, 309. + +Croup, false, IV, 506; treatment of false, IV, 507; spasmodic, IV, 507; +treatment of spasmodic, IV, 507. + +Deaf and dumb, I, 37. + +Detention, symptoms of, II, 219; treatment of, II, 219. + +Desserts, II, 273. + +Diarrhoea, inflammatory, IV, 535; summer, IV, 539; symptoms of summer, IV, +540; treatment of inflammatory, IV, 537; treatment of summer, IV, 541. + +Diet, of nursing mother, I, 121; of the pregnant woman, I, 77; of sick +child, II, 279; for constipated child, II, 310; older children, II, 271. + +Dinner, the first after labor, I, 109. + +Diphtheria, IV, 610; symptoms of, IV, 611; treatment of, IV, 613. + +Disease, how we catch, III, 409; tendency to, III, 416; vice and, I, 4; of +womb, ovaries or fallopian tubes, II, 199. + +Disinfecting, Clothing and linen, IV, 601; mouth and nose, IV, 602; sick +chamber, IV, 604. + +Dislocations, IV, 640. + +Dog-bites, IV, 638. + +Douche, how to give after labor, I, 108; the use of when pregnant, I, 76. + +Draw-sheet, the, I, 65. + +Dried bread, II, 245. + +Dusting and cleaning, II, 391. + +Dysentery, cause of, IV, 535; symptoms of, IV, 536. + +Dysmenorrhea, II, 193. + +Ear, foreign bodies in, IV, 631; inflammation of, IV, 556; method of +removing foreign bodies, IV, 632; treatment of inflammation, IV, 556. + +Earache, IV, 555. + +Ears, do not box, IV, 554; do not pick, IV, 554; let them alone, IV, 554. + +Eczema, IV, 562; of the face, IV, 563; rubrum, IV, 563. + +Education, and the educator, I, 29; eugenics and, I, 4; Dr. C. W. Saleeby +on, I, 22; Dr. Helen C. Putnam on, I, 27; Havelock Ellis on, I, 33; Herbert +Spencer on, I, 35; Luther Burbank on, I, 24; Wm. D. Lewis on, I, 25; true +province of, I, 35; what place sex hygiene will find in, II, 162; Ella +Wheeler Wilcox on, I, 22. + +Educational systems, difficulty in devising, I, 27; inadequate, I, 22. + +Efficiency, requisites of, III, 346. + +Egg, coddled, II, 245; white of, II, 262. + +Ellis, Havelock, on Education, I, 33. + +Emergencies and accidents, IV, 629. + +Enema, High, IV, 588; hot, 586. + +Enteritis, cause of, IV, 535; symptoms of, IV, 536. + +Entero-colitis, IV, 535. + +Enuresis, IV, 580. + +Environment, I, 3. + +Eruptions of the skin, II, 145. + +Establishing toilet habits, II, 240. + +Eugenic clubs, mother's, I, 54. + +Eugenic idea, the, I, 9. + +Eugenic principle, I, 10. + +Eugenics, I, 12; definition of, I, 12; education and, I, 21; and history, +I, 5; husband and, I, 19; marriage and, I, 11; motherhood and, I, 16; [v] +parenthood and, I, 15; the unfit and, I, 37; what every mother should know +about, I, 47. + +Exercise enough for husband, III, 347; lack of and constipation, III, 347. + +Eye, foreign bodies in, IV, 630; method of removing foreign bodies from, +IV, 631. + +Fake medical treatment, for venereal diseases, II, 167. + +Father and the boy, II, 163. + +Fault-finding, III, 350. + +Feeble-minded, the, I, 37; Dr. John Punton on, I, 42; Dr. Max Schlapp on, +I, 39; segregation and treatment of, I, 42. + +Feeding, artificial, II, 249; artificial from birth to twelfth month, II, +254; the delicate child condition which will justify artificial, II, 266; +during second year formulae for artificial, II, 253; how to prepare milk +mixtures, II, 259; intervals of, II, 225; overfeeding, II, 223; regularity +of, II, 227; what a mother should know about, II, 264; why regularity is +important, II, 228. + +Felon, run-around, or whitlow, IV, 640; treatment of, IV, 641. + +Female, beginning of, disease, III, 434; chief cause of diseases, III, 436; +diseases are avoidable, III, 439; generative organs, II, 178; weakness +cures, III, 470; what woman with disease should do, III, 441. + +Fermentation, of the stomach, II, 304. + +Fertility, conditions which affect women, II, 196. + +Fever, cold packs for, IV, 589; cold sponging for reducing, IV, 589; ice +cap for reducing, IV, 589; methods of reducing, IV, 589. + +Finger, biting the nails, IV, 585. + +Fit, the, only shall be born, I, 10. + +Fits, IV, 577. + +Fly, dangerous house, IV, 645; to kill, IV, 648. + +Fomentations, hot, IV, 593. + +Food, allowable during first year, II, 261; bran as a, II, 292; formulae for +baby, II, 243. + +Foodstuffs, IV, 647. + +Foreign bodies, in nose, IV, 632; in throat, IV, 633. + +Formative period, the, III, 339. + +Fraudulent testimonials, III, 467. + +Friends, choosing your, III, 367; your husband's, III, 363. + +Fruits, II, 273. + +Garbage, IV, 647. + +Gastric indigestion, acute, IV, 527; treatment of, IV, 527. + +Gastro duodenitis, IV, 547. + +Generative organs, female, II, 178. + +Genital organs, care of, II, 26. + +Girl, what a mother should tell her little, II, 173. + +Glands, swollen, IV, 558; treatment of swollen, IV, 558. + +Gleet, II, 143 + +Gonorrhea, symptoms of in a man, II, 142; wife infected with, II, 147. + +Good health, requirements of, II, 316. + +Government investigation of patent medicines, IV, 486. + + [vi] +Habits, of delicate child, II, 285. + +Hair, falls out in syphilis, II, 146. + +Headache, IV, 585; during pregnancy, I, 83; remedies, III, 457; treatment +of, IV, 585. + +Heartburn, during pregnancy, I, 84. + +Hemorrhage, arrest of, IV, 635; nasal, IV, 522. + +Heredity, I, 3; and eugenics, I, 16; function of education, I, 32. + +Hiccough, IV, 523. + +High School, system fallacious, I, 29. + +Hives, IV, 559; cause of, IV, 559; treatment of, IV, 559. + +Home, good housekeeper, III, 389; owning a, III, 400; the ideal, III, 393; +what makes the, III, 394. + +Honeymoon, the, III, 335; marital relations during, III, 336. + +Hot pack, IV, 589. + +Housefly, dangerous, IV, 645. + +Housekeeper, what constitutes an efficient, III, 390. + +Husband, and home, III, 404; is he to blame, II, 151; the, and eugenics, I, +19. + +Hysterics, and children, II, 293; treatment of, II, 294. + +Ice-cap, for reducing fever, IV, 589. + +Ileo-colitis, chronic, IV, 538; treatment of, IV, 539. + +Imperial Granum, II, 245. + +Incontinence, IV, 580. + +Indigestion, acute gastric, IV, 527; acute intestinal, IV, 532; symptoms of +acute intestinal, IV, 532; treatment of acute gastric, IV, 527; treatment +of acute intestinal, IV, 533. + +Infants, constipation in bottle-fed, II, 309; jaundice in, IV, 547; +mortality of, I, 2; records of, II, 222. + +Infection, direct, IV, 499. + +Infectious diseases, IV, 599. + +Inflammatory diarrhea, IV, 535. + +Influenza, IV, 608; symptoms of, IV, 608; treatment of, IV, 609. + +Injections, oil, II, 312. + +Insane, care of, I, 43. + +Insomnia, during pregnancy, I, 86. + +Interior organs, complications of in syphilis, II, 146. + +Intermittent fever, IV, 571. + +Intestinal diseases of children, IV, 529. + +Intestinal Indigestion, acute, IV, 532; symptoms of acute, IV, 532; +treatment of, IV, 533. + +Intestinal worms, IV, 548. + +Jaundice, catarrhal, IV, 547; in infants, IV, 546; in older children, IV, +547. + +Junket, II, 244. + +Kelly pad, the, I, 65. + +Knowledge, two ways of gaining, III, 377. + +Labor, after-pains, I, 103; beginning of, I, 95; clothing during, I, 95; +conduct during second stage of, I, 96; conduct immediately following, I, +103; douching after, I, 107; first breakfast after, I, 105; first dinner +after, I, 109; first lunch after, I, 109; first stage of, I, 96; importance +of emptying bladder after, I, 106; the Lochia, or discharge after, I, 104; +management of, I, 93; putting baby to breast after, I, 108; second stage +of, I, 96. + +Lacerations during confinement, I, 116. + + [vii] +La Grippe, IV, 608; treatment of, IV, 609. + +Laryngitis, acute catarrhal, IV, 506; treatment of, IV, 507. + +Leucorrhea, cause of sterility, II, 201; in girls, II, 190. + +Lewis, Wm. D., on education, I, 25. + +Life and insurance, III, 400. + +Lithia water, III, 458. + +Lochia, or discharge after labor, I, 104. + +Lunch, the first after labor, I, 109. + +Malaria, intermittent fever, IV, 571; serum for, IV, 656; treatment of, IV, +571. + +Malformation, II, 201. + +Man, building a, II, 151. + +Marital relations, when they are painful, III, 337; when they should be +suspended, III, 337. + +Marriage, and motherhood, I, 2; best age for, III, 331; certificate and +vice, I, 15; certificate, utility of, I, 13; evils of early, III, 333; +failures in, I, 2. + +Mastitis, in infancy, IV, 553; in young girls, IV, 554. + +Masturbation, or self-abuse, II, 157. + +Meats, medical essentials of good, III, 393; preparation and selection of, +III, 390. + +Measles, IV, 616; complications in, IV, 618; Koplik's spots in, IV, 617; +rules of department of health, IV, 619; symptoms of, IV, 616; treatment of, +IV, 618. + +Medical, letter brokers, III, 482; reliable advice, III, 486. + +Medicine chest, contents of family, IV, 629. + +Medicine concern run by women, III, 475. + +Menstruation, II, 187; irregular, II, 187; painful, II, 193; should not be +accompanied with pain, II, 189; symptoms of, II, 189; treatment for +painful, II, 194; why it occurs every 28 days, II, 180. + +Milk, children with whom it does not agree, IV, 535; difference between +human and cows, II, 252; mixture, how to prepare, II, 259; peptonized, II, +262. + +Mind, training the, III, 360. + +Miscarriage, II, 202; after treatment of, II, 205; causes of, II, 203; +course and symptoms of, II, 204; what to do when threatened with, II, 204; +tendency to, II, 206; womb displacement in, II, 198. + +Mosquitoes, regarding, IV, 572; rules of Department of Health, IV, 574. + +Mother, the cheerful, III, 400; education of the, II, 277; existence of the +average, III, 437; what she should know about eugenics, I, 47; what she +should tell her little girl, II, 173; what she should tell her daughter, +II, 173. + +Motherhood, eugenics and, I, 16; function of, I, 17; preparing for, II, +187. + +Mothers, eugenic clubs, I, 54; girls must not become, II, 184. + +Moths, IV, 648. + +Mouth, how to disinfect, IV, 601; sore, IV, 523; treatment for ulcers in, +IV, 525; treatment of sore, IV, 524. + +Mucous patches, and ulcers, II, 145. + +Mumps, IV, 605; symptoms of, IV, 605. + +Mustard bath, IV, 590. + +Mustard paste, how to make, IV, 593. + + [viii] +Mustard pack, how to prepare and use, IV, 594. + +Mutton Broth, II, 244. + +Napkins, sanitary, I, 66. + +Nasal discharge, chronic, IV, 502. + +Nausea, during pregnancy, I, 80. + +Nettle-rash, IV, 559; cause of, IV, 559; treatment of, IV, 559. + +Night losses, or "wet dreams," II, 158. + +Nightmare or night terrors, IV, 583; treatment of, IV, 581. + +Nipples, care of, I, 121; cracked, I, 122; tender, I, 122; treatment of +cracked, I, 122; what mother should know about bottle and, II, 264. + +Normal salt, solution of, IV, 627. + +Nose, chronic discharge of, IV, 503; complications of in syphilis, II, 146; +foreign bodies in, IV, 632. + +Nose-bleeds, IV, 522. + +Nosophobia, or the dread of disease, III, 380. + +Nursery maid, qualifications of, I, 129. + +Nursing mothers, I, 121; diet of, I, 121; mastitis in, I, 122; nervous, I, +126. + +Oatmeal water, for constipation in infants, II, 309. + +Oat-water, II, 244. + +Obstetrical outfits, ready to purchase, I, 63. + +Oil injections, II, 312. + +Oiled silk, IV, 594; what it is and why it is used, IV, 594. + +Orange juice, II, 262; for constipation in infants, II, 309. + +Organs, transplanting from dead to living, IV, 655. + +Otitis, acute, IV, 556. + +Ovaries, disease of, II, 199; function of, II, 179. + +Overeating, II, 289; III, 327; symptoms of, II, 290. + +Overfeeding the baby, II, 223. + +Parents, and the Boy, II, 153; a word to, II, 161; eugenics and, I, 15. + +Parotitis, epidemic, IV, 605. + +Patent Medicines, and education, III, 493; and eugenics, III, 494; and the +newspaper, III, 484; conspiracy against freedom of press, III, 483; dangers +of, III, 489; fraudulent testimonials, III, 467; intoxicating effects of, +III, 453; government investigation of, III, 486; pure food and drug act, +III, 452, 490. + +Patent Medicine Evil, III, 451, 489; and the duty of mothers III, 489; what +mothers should know about the, III, 451. + +People, two kinds of, III, 363. + +Peptonized milk, II, 262. + +Physicians, what they are doing, IV, 649. + +Pimples, IV, 576. + +Pneumonia, IV, 516. + +Poultices, IV, 593. + +Pox, or syphilis, II, 144. + +Precautions to be observed, IV, 647. + +Pregnancy, avoidance of drugs during, I, 90; clothing during, I, 77; +constipation during, I, 84; headache during, I, 83; heartburn during, I, +84; hygiene of, I, 75; insomnia during, I, 86; minor ailments of, I, 76; +morning nausea, I, 80; sexual intercourse during, I, 76; social side of, I, +79; undue nervousness during, I, 82; vagaries of, I, 90; vaginal discharge, +I, 88; varicose veins, cramps and neuralgia during, I, 85. + + [ix] +Pregnant, few ailing women become, III, 435; conduct of woman, I, 75; diet +of woman, I, 77; mental state of woman, I, 78; when woman should first call +upon physician, I, 68. + +Prickly Heat, IV, 560; treatment of, IV, 560. + +Principle, differences of, III, 344. + +Privy Vaults, IV, 647. + +Procreative Function, abuse of, II, 153; III, 440. + +Procreative Power, period of, II, 155. + +Puberty, age of, II, 179; period of in the female, II, 178. + +Pulse, rate in children and adults, II, 221. + +Punton, Dr. John, on feeble-minded, I, 42. + +Pure Food and Drug Act, III, 452, 490. + +Putnam, Dr. Helen C., on education, I, 27. + +Quacks, how they dispose of confidential letters, III, 481. + +Quarrel, the first, III, 349. + +Quinsy, IV, 523. + +Race Culture, I, II. + +Radium, IV, 652. + +Rashes, of childhood, IV, 574; other, IV, 575; treatment of, IV, 576. + +Records, Infant, II, 222. + +Rectal Irrigations, to reduce fever, IV, 590. + +Reproductive Organs, changes in, II, 178; function of the, II, 179. + +Resolves, making, III, 371. + +Rest and recreation, III, 398. + +Rest and sleep, III, 347. + +Rheumatism, in children, IV, 569; treatment of acute attack, IV, 570; +treatment of tendency to, IV, 570. + +Rhinitis, chronic, IV, 503. + +Rice water, II, 244. + +Ringworm, of the scalp, IV, 561. + +Rubbers, practice of wearing needs consideration, IV, 498. + +Run-around, or felon, IV, 640; treatment of, IV, 641. + +Rupture, IV, 551. + +Saleeby, Dr. C.W., on education, I, 22. + +Sanitary napkins, how to prepare, I, 66. + +Santonin, for worms, IV, 549. + +Scalds and burns, IV, 641. + +Scalp, ringworm of, IV, 561; wounds of, IV, 640. + +Scarlet Fever, IV, 620; complications in, IV, 621; eruptions, IV, 621; +measures to prevent spread of, IV, 621; treatment of, IV, 622. + +Scarlatina, IV, 620. + +Scientific Dressing, III, 427. + +Schlapp, Dr. Max, on the feeble-minded, I, 39. + +Self-abuse or Masturbation, II, 155. + +Self-culture, young wife's incentive to, III, 379. + +Serum, Anti-meningitis, IV, 656; for malaria, IV, 656. + +Sexual excesses, II, 159; treatment of, II, 160. + +Sexual intercourse, during pregnancy, I, 76. + +Shock, the condition of, IV, 637. + +Sitz bath, during pregnancy, I, 87. + +"606," IV, 655. + +Skin, care of, II, 216; care of in contagious diseases, IV, 602; eruptions +of, II, 145. + +Sleeplessness, causes of, IV, 583; treatment of, IV, 583. + +Social Evil, what parents should know about, II, 161. + +Solutions, normal salt, IV, 627; various, IV, 626. + +Soothing syrup, III, 458. + +Sore Mouth, IV, 523; treatment of, IV, 524. + + [x] +Sore throat, IV, 508. + +Sowing wild oats, II, 167. + +Spasms, IV, 577. + +Spencer, Herbert, on education, I, 35. + +Spermatozoa, functions of the, II, 181; the male, or papa egg, II, 181. + +Sprains, IV, 639. + +Sprue, IV, 525; treatment of, IV, 525. + +Stables, IV, 646. + +Sterility, II, 195; causes of, in women, II, 198. + +Sterilizing, food for day's feeding, II, 260. + +Stomach, diseases of, IV, 527; fermentation of, II, 304; function of the, +II, 304. + +Stomach bitters, alcohol in, III, 455. + +Stomatitis, IV, 523. + +Story, Dr. Thomas A., on education, I, 26. + +Study habit, the, III, 374. + +Sullivan, Dr., on alcoholic drunkenness, I, 44. + +Success, attainment of, III, 345; formula of, III, 373. + +Summer Diarrhea, IV, 539; symptoms of, IV, 540; treatment of, IV, 541. + +Summer diseases of intestines, IV, 529. + +Surgery, aseptic, IV, 653. + +Syphilis, or the "pox," II, 144. + +Tape worms, IV, 551. + +Teeth, care of the, II, 219; how they come, II, 218. + +Temperature, in children, II, 217. + +Thiersch's solution, IV, 627. + +Thought, bad habits of, III, 360; what is a, III, 359. + +Thread worm, IV, 549. + +Throat, foreign bodies in, IV, 633; sore, IV, 508. + +Thrush, IV, 525; treatment of, IV, 525. + +Thumb-sucking, IV, 585. + +Tonsilitis: Angina, "sore throat," IV, 508; treatment of acute, IV, 510. + +Transplanting organs of dead to living, IV, 655. + +Tuberculosis, best treatment for, III, 418; facts about, III, 414. + +Turpentine stupe, the, IV, 594. + +Typhoid, how to keep from spreading, IV, 625; how to prevent getting, IV, +624; symptoms of, IV, 623; vaccine in, IV, 654. + +Ulcers, in mouth, IV, 525; mucous patches and, II, 144. + +Vacant lots, IV, 647. + +Vaccination, method of, II, 299; symptoms of successful, II, 299; time for, +II, 299; treatment, II, 300. + +Vaccine in typhoid fever, IV, 654. + +Vapor bath, IV, 591. + +Varicella, IV, 606. + +Varicose veins, during pregnancy, I, 85. + +Vegetables, II, 272. + +Venereal Diseases, fake medical treatment for, II, 167; ten million victims +of, I, 11. + +Vomiting, of children between feedings, II, 226; significance of after +feeding, II, 230. + +Washing dishes, III, 391. + +Water, drink plenty of, III, 429. + +Weaning, I, 123; care of breasts when, I, 125; menstruation and, I, 124; +methods of, I, 123; rapid, when it is necessary, I, 124; when to start, I, +124. + +Wedding night, its medical aspect, III, 334. + +What to eat and wear in hot weather, III, 426. + +When delays are dangerous, III, 423. + +Whey, II, 244. + +Whitlow, or felon, IV, 640. + + [xi] +Whooping Cough, IV, 613; symptoms of, IV, 614; treatment of, IV, 615. + +Wife, her part, III, 353; the cheerful, III, 400; the indifferent, III, +401; what she owes to herself, III, 357. + +Wifehood, first weeks and months of, III, 336. + +Wilcox, Ella Wheeler, on education, I, 23. + +Womb, function of, II, 180; how baby gets nourishment in, II, 183; how held +in place, II, 189. + +Women, ailing, are inefficient, III, 434; diseases of, III, 433; who don't +want children, III, 439; medicine concern run by, III, 475; most popular, +III, 365; use of patent medicines in diseases, III, 473. + +Work, must be interesting, III, 351. + +Working for something, III, 395. + +Worms, intestinal, IV, 548; round, IV, 548; symptoms of tape, IV, 551; +symptoms of thread, IV, 549; tape, IV, 551; thread, IV, 549; treatment of +round, IV, 549. + +Worry, freedom from, III, 348. + +Wound, cleaning a, IV, 637; closing and dressing a, IV, 637; removal of +foreign bodies from, IV, 636. + +Wounds, IV, 634; of the scalp, IV, 640. + +X-Ray, treatment and diagnosis, IV, 652. + + * * * * * + + +VOLUME I + + * * * * * + + + [xv] +TABLE OF CONTENTS + +EUGENICS. RACE CULTURE + +CHAPTER I + +CONDITIONS WHICH HAVE EVOLVED THE SCIENCE OF EUGENICS + +Infant mortality--Marriage and +motherhood--Heredity--Environment--Education--Disease and +vice--History--Summary ... PAGE 1 + +CHAPTER II + +THE EUGENIC IDEA + +The value of human life--The eugenic principle--"The fit only shall +live"--Eugenics and marriage--The venereal diseases--The utility of +marriage certificates--The marriage certificates and vice--Eugenics and +parenthood--The principle of heredity--Eugenics and motherhood--Eugenics +and the husband ... PAGE 9 + +CHAPTER III + +EUGENICS AND EDUCATION + +The present educational system is inadequate--Opinions of Dr. C.W. Saleeby, +Ella Wheeler Wilcox, Luther Burbank, William D. Lewis, Elizabeth Atwood, +Dr. Thomas A. Story, William C. White, Dr. Helen C. Putnam--Difficulty in +devising a satisfactory educational system--Education an important +function--The function of the high school--The high school system +fallacious--The true function of education ... PAGE 21 + +CHAPTER IV + +EUGENICS AND THE UNFIT + +The deaf and dumb--The feeble-minded--A New York magistrate's +report--Report of the Children's Society--The segregation and treatment of +the feeble-minded--What the care of the insane costs--The +alcoholic--Drunkenness ... PAGE 37 + +CHAPTER V + +WHAT EVERY MOTHER SHOULD KNOW ABOUT EUGENICS + +PAGE 47 + + [xvi] +CHILD-BIRTH + +CHAPTER VI + +PREPARATIONS FOR THE CONFINEMENT + +The birth chamber--What to provide for a confinement--Ready to purchase +obstetrical outfits--Position and arrangement of the bed--How to properly +prepare the accouchement bed--The Kelly pad--The advantages of the Kelly +pad--Should a binder be used--Sanitary napkins--How to calculate the +probable date of the confinement--Obstetrical table--When should a pregnant +woman first call upon her physician--Regarding the choice of a +physician--How to know the right kind of a physician for a confinement--The +selection of a nurse--The difference between a trained and a maternity +nurse--Duties of a confinement nurse--The requisites of a good confinement +nurse--The personal rights of a confinement nurse--Criticizing and +gossiping about physicians ... PAGE 61 + +CHAPTER VII + +THE HYGIENE OF PREGNANCY + +Daily conduct of the pregnant woman--Instructions regarding household +work--Instructions regarding washing and sweeping--Instructions regarding +exercise--Instructions regarding passive exercise--Instructions regarding +toilet privileges--Instructions regarding bathing--Instructions regarding +sexual intercourse--Clothing during pregnancy--Diet of pregnant +women--Alcoholic drinks during pregnancy--The mental state of the pregnant +woman--The social side of pregnancy--Minor ailments of pregnancy--Morning +nausea, or sickness--Treatment of morning nausea, or sickness--Nausea +occurring at the end of pregnancy--Undue nervousness during pregnancy--The +100% baby--Headache--Acidity of the stomach, or +heartburn--Constipation--Varicose veins, cramps, +neuralgias--Insomnia--Treatment of insomnia--Ptyalism, or excessive flow of +saliva--Vaginal discharge, or leucorrhea--Importance of testing urine +during pregnancy--Attention to nipples and breasts--The vagaries of +pregnancy--Contact with infectious diseases--Avoidance of drugs--The danger +signals of pregnancy ... PAGE 75 + +CHAPTER VIII + +THE MANAGEMENT OF LABOR + +When to send for the physician in confinement cases--The preparation of the +patient--The beginning of labor--The first pains--The meaning of the term +"labor"--Length of the first stage of labor--What the first stage of [xvii] +labor means--What the second stage of labor means--Length of the second +stage--Duration of the first confinement--Duration of subsequent +confinements--Conduct of patient during second stage of labor--What a labor +pain means--How a willful woman can prolong labor--Management of actual +birth of child--Position of woman during birth of child--Duty of nurse +immediately following birth of child--Expulsion of after-birth--How to +expel after-birth--Cutting the cord--Washing the baby's eyes immediately +after birth--What to do with baby immediately after birth--Conduct +immediately after labor--After pains--Rest and quiet after labor--Position +of patient after labor--The Lochia--The events of the following day--The +first breakfast after confinement--The importance of emptying the bladder +after labor--How to effect a movement of the bowels after +labor--Instructing the nurse in details--Douching after labor--How to give +a douche--"Colostrum," its uses--Advantages of putting baby to breast early +after labor--The first lunch--The first dinner--Diet after third day ... +PAGE 93 + +CHAPTER IX + +CONFINEMENT INCIDENTS + +Regarding the dread and fear of childbirth--The woman who dreads +childbirth--Regarding the use of anesthetics in confinements--The presence +of friends and relatives in the confinement chamber--How long should a +woman stay in bed after confinement--Why do physicians permit women to get +out of bed before the womb is back in its proper place?--Lacerations, their +meaning, and their significance--The advantage of an examination six weeks +after the confinement--The physician who does not tell all of the truth ... +PAGE 111 + +CHAPTER X + +NURSING MOTHERS + +The diet of nursing mothers--Care of the nipples--Cracked nipples--Tender +nipples--Mastitis in nursing mothers--Inflammation of the breasts--When +should a child be weaned?--Method of weaning--Nursing while +menstruating--Care of breasts while weaning child--Nervous nursing +mothers--Birthmarks--Qualifications of a nursery maid ... PAGE 121 + +CHAPTER XI + +CONVALESCING AFTER CONFINEMENT + +The second critical period in the young wife's life--The domestic problem +following the first confinement ... PAGE 131 + + * * * * * + + + [xix] +INTRODUCTION + +Despite the fact that much has been written during the past two or three +years with reference to Eugenics, it is quite evident to any one interested +in the subject that the average intelligent individual knows very little +about it so far as its scope and intent are concerned. This is not to be +wondered at, for the subject has not been presented to the ordinary reader +in a form that would tend to encourage inquiry or honest investigation. The +critic and the wit have deliberately misinterpreted its principles, and +have almost succeeded in masking its supreme function in the garb of folly. + +The writer has yet to meet a conscientious mother who fails to evince a +reasonable degree of enthusiastic interest in eugenics when properly +informed of its fundamental principles. + +The eugenic ideal is a worthy race--a race of men and women physically and +mentally capable of self-support. The eugenist, therefore, demands that +every child born shall be a worthy child--a child born of healthy, selected +parents. + +No one can successfully assail the ethics of this appeal. It is morally a +just contention to strive for a healthy race. It is also an economic +necessity as we shall see. + +The history of the world informs us that there have been many civilizations +which, in some respects, equalled our own. These races of people have all +achieved a certain success, and have then passed entirely out of existence. +Why? _And are we destined to extinction in the same way?_ We know that the +cause of the decline and ultimate extinction of all past civilizations was +due primarily to the moral decadence of their people. Disease and vice +gradually sapped their vitality, and their continuance was impossible. [xx] +It would seem to be the destiny of a race to achieve material prosperity at +the expense of its morality. When conditions render possible the fulfilment +of every human desire, the race exhausts its vitality in a surfeitment of +caprice. The animal instincts predominate, and the potential vigor of the +people is exhausted in contributing to its own amusement. Each succeeding +civilization has reached this epochal period, and has fallen, victim of the +rapacity of stronger and younger invading antagonists, _themselves to +succumb to the same insidious process_. + +The present civilization has reached this epochal--this transition--period. +In one hundred years from now we shall either have accomplished what no +previous civilization accomplished, or we shall have ceased to exist as a +race. Our success depends on the response of the people to the eugenic +appeal. Few appreciate the responsibility involved. + +It is not necessary, however, to combat or deplore the evils of the past. +Civilization has failed in the task of race-maintenance; it failed, +however, in ignorance. We cannot plead the same excuse. We are face to face +with conditions that we must solve quickly or our destiny will be decreed +before we apply the remedy. + +A function of the eugenist is to gather and attest statistics, and to +establish conclusions based on these statistics. It has been conclusively +demonstrated that, if the race continues to progress as it exists now--that +is, if conditions remain the same, and our standard of enlightenment, so +far as racial evolution is concerned, does not prompt us to adopt new +constructive measures--_every second child born in this country, in fifty +years, will be unfit; and, in one hundred years, the American race will +have ceased to exist_. We mean by this that every second child born will be +born to die in infancy, or, if it lives, will be incapable of self-support +during its life, because either of mental degeneracy or physical +inefficiency. This appalling situation immediately becomes a problem of +civilization. No state can exist under these conditions. If these +statistics are reliable--and we know they are true and capable of +verification by any individual who will go to the trouble of [xxi] +investigating them--it is self-evident that a radical change must +immediately be instituted to obviate the logical consequences that must +follow as a sequence. The eugenic demand, that "every child born shall be a +worthy child," is, therefore, the solution of the problem. + +This does not imply, however, that the eugenist must solve the elementary +problem of how the state will ensure its own salvation by guaranteeing +worthy children. Worthy children can come only from fit and worthy (clean +and healthy) parents. It becomes the imperative function of the state--the +function on which the very life of the state depends--to see that every +applicant for marriage is possessed of the qualities that will ensure +healthy, worthy children. We must, therefore, sooner or later devise a +system of scientific regulation of marriage, and it is at this point we +stumble against the problem that has prompted the ebullitions of the wit +and the sarcasm of the critic. A casual reference to the science +immediately suggests to the layman an impossible or quixotic system of +marriage by force. Even the word "eugenics" is associated in the minds of +many otherwise estimable old ladies, and others who should know better, +with a species of malodorous free love, and their hands go up in holy +horror at the intimation of a scientific regulation of this ancient +function. + +Unfortunately, the popular mind has received the impression that this +incident constitutes the sum total of the eugenic idea, while the truth is +that the eugenist is only slightly concerned with its modus operandi. This +feature has been so magnified by widely published disingenuous discussion +that it has assumed the aspect of a test problem, a judgment on which shall +decide the utility of the science itself. Should this decision be +unfavorable, it would seem, according to its exponents, that it would not +be worth while promulgating the doctrines of the science beyond this point. +It is as though we were asked to deny ourselves the inspiration and +pleasure of a trip abroad because the morning of the day on which the ship +sailed happened to be cloudy. + +It is certainly no part of the function of the eugenist to uproot [xxii] +instinct, or to trample into the dust age-long rights, though the instinct +is simply the product of an established habit, based on an erroneous +hypothesis, and the so-called rights simply acquired privileges, because +the intelligence that would have builded differently was not awakened. +Eugenic necessity will render imperative the state's solution of this +fundamental problem, for the reason that civilization will be driven to +demand its just inheritance--the right to exist. The eugenist will not be +compelled to open the door; it will be opened for him. We can afford, +therefore, to wait with supreme confidence, because the good sense of the +people will not always submit to the tactics of the jester when it needs a +saviour. + +The eugenist does not seek to interfere with the liberties of the rising +generation: a boy may choose whom he will; the girl may select the one who +appeals to her most, and they may enjoy all the vested rights and romance +that custom has decreed the lover; but, when they resolve to marry, _the +state must decide their qualifications for parenthood_. This must be the +crucial test of the future. The life of the state depends on it. The +continuance of the race must be the supreme object of all future +constructive legislation. We must recognize that "life is the only wealth," +and that every other criterion of an advanced civilization must measure its +success according to its wealth in worthy parenthood. + +The eugenist does not even dictate what the test for parenthood shall be. +Common sense, however, suggests that it will assume some form that will +eliminate those physically or mentally diseased. He believes that, when the +people are sufficiently educated to appreciate the object in view, they +will devise a system that will meet with universal approval. + +Eugenics concerns itself with problems on which the destiny of the race +depends. It must not, therefore, be limited to questions relative to mating +and breeding. Every factor that contributes to the well-being and uplifting +of the race, every subject that bespeaks physical or mental regeneration, +that aids moral and social righteousness and salvation, and promises a +greater social happiness and contentment, has a eugenic [xxiii] +significance. So long as there exists an unsupported mother or a suffering +child; so long as we rely on hospitals and prisons, penitentiaries and the +police, to minister to the correction and regeneration of the unfit and +degenerate; so long as we tolerate grafting politicians and deprive the +poor of breathing spaces, sanitary appliances, and a hygienic environment; +so long as war and pestilence deprive posterity of the best of the race for +parenthood; so long as we emphasize rescue rather than prevention, so long +must the eugenist strive unceasingly to preach his propaganda of race +regeneration. + +The scope of eugenics is too far-reaching in its beneficent purpose to be +fettered by the querulous triflings of the ancient or intellectual prude; +nor should it be belittled by the superficial insight of the habitual +scoffer. It is not a fantasy nor an idle dream. It is not even an +inspiration. The destiny of the race has brought us face to face with +conditions unparalleled in the history of this civilization, and the very +existence of the race itself may be wholly dependent on the foresight of +the minds that have made the science of eugenics possible. + +A brief consideration of the conditions that actually exist, with which we +are face to face, and which certainly justify the existence of a science +whose function it should be to demand serious investigation of methods of +race regeneration, may help the reader to an intelligent and practical +understanding of the tremendous importance of the subject. + +It has been already remarked that, at the present rate of decrease, the +birth-rate will be reduced to zero within a century. If the birth-rates in +England, Germany, and France should continue to decrease as they have since +1880, there would be no children born, one hundred years hence, in these +countries. While we do not assert, and probably none of us believes that +either or all of these nations will actually be out of existence in a +hundred years--unquestionably because we feel, at least we hope, that our +methods will be so changed in that time that the necessary modification +will ensure a continuance of the race, nevertheless, the fact remains that +_the inevitable result of continuing along present lines will be [xxiv] +that, within the period of one hundred years, these peoples will cease to +perpetuate themselves_. + +It is not necessary to enquire closely into the various causes for this +unparalleled situation. The falling birth-rate in itself is not the prime +cause. Even admitting that there are enough babies born, too many of them +are born only to die in infancy. We need no further proof of the urgent +need for conscientious inquiry, call it by what name you please. The +science of common sense is all-sufficient. The seemingly intelligent +individual who can only find material for ribaldry in this connection is a +more serious buffoon than he imagines. It is apparent that our methods are +wrong. Any constructive effort to correct them is commendable. When it is +stated that 20 per cent. of the American women are unable to bear children, +and that 25 per cent. of all the others are unwilling to assume the burden +and responsibility of motherhood, we partly realize the gravity of the +case. + +On the other hand, statistics show that the majority of men have acquired +disease before they marry, and that a very large percentage of these men +convey contagion to their wives. This condition, to a very large extent, +accounts for the inefficiency of women as mothers. It is responsible for at +least 75 per cent. of the sterility that exists. The effect of this +deplorable condition is directly responsible, also, for the ill health that +afflicts women and that renders necessary the daily operations of a serious +nature that are conducted in every hospital in every city in the civilized +world. As a result of the dissemination of this poison, children are born +blind, or are born to die, or, if they live, they are compelled to carry +all through their helpless lives the stigma of disease and degeneration. It +would surely seem that the individual to whom God has given intelligence +and a conscience cannot think of these, the saddest facts in human +experience, without resentment and humility. _Surely the time has arrived +when every boy should know, from his earliest youth, that there is here on +earth an actual punishment for vicious living as frightful as any that the +mind of man can conceive._ [Page xxv] + +When we inquire into the cause of this trend toward race degeneracy, we +find that poverty and the inability of the workingman to support large +families, luxurious living, and the life of ease and amusement on the part +of the women of wealth; the fact that an increasingly large number of women +have entered professions that prevent motherhood, and that the number of +apartment-houses where children are not wanted are on the increase, all +play their part. In this age of intense living, it is not to be wondered at +that many shrink from the responsibility of rearing children, and the same +conditions that contribute to this decadent ideal intensifies sex-hunger, +and it is this dominating passion that tolerates and makes possible the +most frightful crime of the age--infanticide. Greece and Rome paved the way +for their ultimate annihilation when their beautiful women ceased to bear +children and their men sought the companionship of courtesans. + +Baby contests have demonstrated that only one child in ten was found to be +good enough to justify a second examination. In a test examination in the +public schools, only eight in five thousand were competent to qualify in +all the tests. One of these eight was a Chinese boy and another an +American-born son of a native Greek. Of the twenty million school-children +in the United States, not less than 75 per cent. need immediate attention +for physical defects. + +While man has been assiduously improving everything else, he has neglected +to better his own condition. Every animal that man has taken from its +native haunts and domesticated, he has efficiently improved. He has even +produced more marvelous results by the application of the same principles +to the vegetable kingdom. In his haste to civilize himself, however, he has +failed to apply the principles that are essential to self-preservation. It +is regrettable, also, to know that, while the government has spent many +thousands of dollars in sending out literature to the farmers, instructing +them how to raise profitable crops and to breed prize horses and pigs, +absolutely none of the public money has been used in instructing American +mothers how to raise healthy children. [Page xxvi] + +A distinguished insurance expert has proved that there was an increase of +nearly 100 per cent. in the mortality from degenerative diseases in the +United States between 1880 and 1909. The growing prevalence of these +diseases indicates a falling-off in the vitality of the race. It means that +the diseases of old age are invading the younger ranks. + +The Life Extension Institute, of New York City, in its recent report, +states that "forty of every hundred men and women employed in the Wall +Street district require medical attention; twenty of the forty need it +immediately, and ten of the forty must have it to avert serious results." + +There are from one-quarter to three-quarters of a million of preventable +deaths every years in this country. That number of individuals could have +been saved with proper care and attention to health in the early stages of +disease, or before it gained a start. Practically all the diseases that +carry business men off prematurely are curable in the early stages. + +Of the percentage of Wall Street men who need medical attention +immediately, most have kidney or heart disease. The others are victims of +typical unhygienic habits, such as fast, gluttonous eating, neglect of +exercise, too much tobacco and liquor, and bad posturing in the office. The +business man considers these trifles, but they count heavily. + +Business efficiency is greatly increased, first, by selecting men +physically fit for work, and, second, by keeping them in that condition. +There is a tremendous waste from inefficiency constantly going on, due to +impaired health. Wall Street has an astonishing corps of neurasthenics. + +We need a broader interpretation of the term Eugenics, so that we may gain +a more sympathetic and tolerant audience. The remedy does not lie in an +academic discussion of these problems; to continue the debate behind closed +doors will not lead anywhere: the public must be educated to a just +appreciation of existing conditions and the remedy must be the product of +effort on its part. + +Any condition that fundamentally means race deterioration must be [xxvii] +rendered intolerable. The prevalant dancing craze is an anti-eugenic +institution, as is the popularity of the delicatessen store. No sane person +can regard with complacency the vicious environment in which the future +mothers of the race "tango" their time, their morals, and their vitality +away. We do not assume to pass judgment on the merits of the dance; we do, +however, emphatically condemn the surroundings. + +The moving-picture shows, vaudeville entertainments, dancing carnivals, the +ease of travel, the laxity of laws, the opportunities for promiscuous +interviews, all tend to give youth a false impression of the reality of +life and to make the path of the degenerate easy and attractive. + +The history of civilization is, curiously enough, the story of masculine +brutality, self-indulgence, and vice. The history of the world also proves +that woman's sphere has been to submit patiently and silently to injustice +and imposition. _Practical eugenics is the first worthy effort in the +history of all time to hold men and women responsible for their mode of +living._ It is a mighty problem. There is no greater nor more difficult one +to be solved. It has taken eons to bring men to the point of questioning +their right to do as they please; it will take time to compel them to +realize their disgrace and acknowledge their duty. When we consider that +there are eighty thousand women condemned to professional moral degradation +in the City of London, and that every so-called civilized city on the globe +contributes its pro rata share to this army of potential mothers, we begin +to appreciate the vastness of the task. + +Eugenics has already accomplished what no other movement has ever +accomplished: it has created the spirit that gave birth to the thought of +men's responsibility, and it has taught us that the female of the race has +rights. We can now speak without fear; the light is no longer hidden. + +Women must realize, however, that they have contributed, and continue to +contribute, to race degeneracy. We hear and read much about the double +standard of morals. As long as woman are willing to marry their daughters +to reformed rakes, providing they have money and social position, [xxviii] +so long shall we have a double standard. So long as young society women go +into hysterics over pedigreed dogs and horses and then marry men reeking in +filthy unfitness for parenthood, mothers cannot expect any other standard +of morals. So long as one marriage in twelve ends in divorce, the ethics of +the female need enlightenment. We shall not get another standard of morals +until women themselves demand it and insist on it. If they lend themselves +to breaking down the conspiracy of silence, the women may solve the +marriage problem by refusing to marry rakes. + +We need a more liberal construction of the intent of eugenics in order to +clarify the obtuse minds so that its propaganda of education may be easily +and justly comprehended. + +There is no field for speculation in the analysis of right living. It +conforms to the law of cause and effect. It is positively concrete in +substance. A recital of the life history of Jonathan Edwards, in comparison +with that of the celebrated "Jukes" family, emphasises this assumption with +a degree of positiveness that is tragic in its significance. + +Jonathan Edwards was born in England in Queen Elizabeth's time. He was a +clergyman and he lived an upright life. So did his wife. His son came to +the United States, to Hartford, Connecticut, and became an honorable +merchant. His son, in turn, also became a merchant, upright and honored. +His son, again, became a minister, and so honored was he that Harvard +University conferred two degrees on him on the same day; one in the morning +and one in the afternoon. This learned man again had a son, and he became a +minister. Jonathan Edwards was his name. + +Now let us see, in 1900, what this one family, started by a man in England +who lived an upright life and gave that heritage to his children, produced: +1,394 descendants of this man have been traced and identified; 295 were +college graduates; 13 were college presidents; 65 were professors; 60 were +physicians; 108 were clergymen; 101 were lawyers; 30 were judges; 1 was +Vice-President of the United States; 75 were Army and Navy officers; [xxix] +60 were prominent authors; 16 were railroad and steamship presidents; and +in the entire record not one has been convicted of a crime. + +Twelve hundred descendants have been traced from the one man who founded +the "Jukes" family. This record covers a period of seventy-five years; out +of these, 310 were professional paupers, who spent an aggregate of two +thousand three hundred years in poorhouses; 50 were evil women; 7 were +murderers; 60 were habitual thieves; and 130 were common criminals. + +It has been estimated that this one family was an economic loss to the +state, measured in terms of potential usefulness wasted; costs of +prosecution; expenses of maintenance in jails, hospitals and asylums; and +of private loss through thefts, and robberies, of $1,300,000 in +seventy-five years, or more than $1,000 for each member of the family. + +_It would seem to be worth while to be well born, after all._ + +In order to succeed in the regeneration of the race, we must believe that +race regeneration is possible, and, that it is worth while. We must preach +its principles as we would a religion. The power of knowledge is a mighty +lever. We are living in a period of transition, but we are nearer the +future than the past. + +We are told by the average individual that it will be impossible to arouse +the public to an intelligent appreciation of the scope of race +regeneration. When the writer conceived the happy phrase, "Better Babies," +a few years ago, he builded better than he knew. It has become the slogan +of splendid achievement already, and there are a multitude of signs and +tokens that the propaganda is established on a sure foundation. + +If the annihilation of all past civilizations was due to the refusal of its +members to breed for posterity, may we not reasonably assume that we have, +according to our statistics, reached the same crisis? If this is logical +reasoning, and every factor warrants this conclusion, have we not reached +the time when the perpetuation of the race is the most serious question of +our times? Is it not a problem for the enthusiastic and immediate [xxx] +support of every statesman, politician, teacher, and preacher alike? Can +any question be of more importance? What will our marvelous material +splendor avail if the race is destined to immediate extinction? + +We need the assistance of every intelligent citizen, we need most, the +awakening impulse of the mothers of the race. We who are alive are +responsible for environment and nurture, and we must believe that the +purpose to be achieved is of supreme importance. Every mother, through the +power of knowledge, may become a practical eugenist. It is to aid her in an +intelligent appreciation of the practical intent of the science that this +work is presented. + + W. GRANT HAGUE, M.D. + + New York City. + + * * * * * + + + [1] +THE EUGENIC MARRIAGE + +CHAPTER I + + "Nations are gathered out of nurseries." + + CHARLES KINGSLEY. + + "To be a good animal is the first requisite to success in life, and to + be a nation of good animals is the first condition of national + prosperity." + + HERBERT SPENCER. + +CONDITIONS WHICH HAVE EVOLVED THE SCIENCE OF EUGENICS + + INFANT MORTALITY--MARRIAGE AND + MOTHERHOOD--HEREDITY--ENVIRONMENT--EDUCATION--DISEASE AND + VICE--HISTORY--SUMMARY. + +There has been evinced during recent years a desire to know something more +definite about the science of eugenics. + +Eugenics, simply defined, means "better babies." It is the art of being +well born. It implies consideration of everything that has to do with the +well-being of the race: motherhood, marriage, heredity, environment, +disease, hygiene, sanitation, vice, education, culture,--in short, +everything upon which the health of the people depends. If we contribute +the maximum of health to those living, it is reasonable to assume that the +future generation will profit thereby, and "better babies" will be a direct +consequence. + +We are frequently told that we must take the world as we find it. This has +been aptly termed, "the motto of the impotent and cowardly." "Life is what +we make it," is the more satisfying assertion of the optimist, and most [2] +of us seem to be trying to make existence more tolerable and more happy. It +is encouraging to know that intelligent men and women to-day seek an +opportunity to devote serious consideration to the betterment of the race, +while yet the pursuit of wealth and pleasure are enticing and strenuous +occupations. + +It would be superfluous in a book of this character to enter into any +lengthy explanation as to how the science of eugenics proposes to work out +its problems. We hope only to excite the interest of mothers in the +subject, and to instruct them in its rudiments and principles. + +It will be of distinct advantage, however, first to briefly consider the +conditions,--which are known to all of us,--which have led up to the +present status of the subject. + +INFANT MORTALITY.--No elaborate argument is necessary to prove that the +present infant mortality, in every civilized country, is too high. It is +conceded by every authority interested in the subject, no matter what +explanation he offers, or what system he advances as a solution of the +problem. + +MARRIAGE AND MOTHERHOOD.--Every intelligent person knows that most young +girls enter into the marriage relationship without a real understanding of +its true meaning, or even a serious thought regarding its duties or its +responsibilities. We know that their home training in domestic science is +generally not adequate, and that their educational equipment is +inefficient. We also know that economic necessity has deprived them of the +tutelage essential to social progress and physical health, and has endowed +them with temperamental characteristics undesirable in the mothers of the +race. Maternity is thrust upon these physically and mentally immature young +wives, and they assume the principal role in a relationship that is onerous +and exacting. We know that the duties of wife and mother require an +intelligence which is rendered efficient only by maturity and experience. +We know that many, if not most, young wives acquire habits which undermine +their health and their morals unwittingly, and we also know that the +product of this inefficiency results in the decadence and the [3] +degeneration of the race. + +HEREDITY.--Much remains inexplicable at the present time regarding this +intensely interesting department of science. We do know, however, that its +truths are being investigated and tabulated. Our present knowledge of its +principles has demonstrated the existence of laws from which we can +ethically deduce explanations of conditions which were, in the past, not +amenable to any classification. These relate to individual and racial +characteristics. We are beginning to learn that we can modify these +characteristics by proper selection, by environment, and by education. This +process will, to an eminent degree, redound to the permanent advantage of +mankind. We may reasonably aspire to a system of race-culture which will +eliminate the undesirable or unfit, and conserve all effort in the +propagation of the desirable or fit. This is a consummation to be desired, +and if by any system of eugenics the promise of the future is realized it +is deserving of the intelligent interest and the active cooeperation of +every aspiring mother. + +ENVIRONMENT.--By environment we mean the provision of suitable surroundings +in its largest sense. A child to be fit and efficient must be born of +selected parentage, the home surroundings must be desirable, the +educational possibilities must be advantageous, the sanitary and hygienic +conditions must be suitable, opportunities for physical and spiritual +culture must be provided, and the State must ensure justice and the right +to achieve success. We know that--generally speaking--these conditions do +not exist. We know that the dregs of the human species--the blind, the +deaf-mute, the degenerate, the imbecile, the epileptic, the criminal +even,--are better protected by organized charity and by the State than are +the deserving fit and healthy. We know that in the slums thousands of +desirable children waste their vitality in the battle for existence, and we +know that, though philanthropy and governmental supervision and protection +are afforded the deaf, the dumb, the blind and degenerate child, no helping +hand is held out to save the healthy and efficient child, who must pay in +disease and inefficiency the price of his normality in degrading toil, [4] +in factory and pit, where child labor is tolerated. We need the awakening +which is the promise of the eugenist, that these wrongs will be righted, +not by the statesmanship which believes that empires are founded and +maintained by the power of material might, but by a process which will +ennoble selected motherhood and give to every child born its due and its +right. + +EDUCATION.--The present system of education is one of the great reflections +on the intelligence of the human race. One of the greatest of contemporary +writers has characterized it as "a curse to modern childhood and a menace +to the future." Even the humblest of us--who would willingly believe the +system efficient, who have no desire to invite criticism as to our +opinion--are forced to acknowledge that there is something wrong with the +educational system now in vogue. The writer is disposed to believe, +however, that the fault is not wholly one of art. The conditions with which +education has to contend are essentially hypothetical. It may be that the +laws of heredity and psychology, when fixed, will evolve, at least, a more +rational and a more ethical hypothesis. So far as eugenics is concerned +with education, its limitation is defined and fixed. If the innate ability +is not possessed by the child, no system of instruction, and no art of +pedagogy, will ever draw it out. When the proper material is supplied by an +adequate system of race culture, science may probably supply the requisite +complementary data which will ensure an educational system that will really +educate. + +DISEASE AND VICE.--The eugenic idea is more directly concerned with disease +which tends to deteriorate the racial type. The average parent has no means +of adequately estimating the significance of this type of disease. It has +been estimated that one-half of the total effort of one-third of the race +is expended in combating conditions against which no successful effort is +possible. Think what this means. The struggle of life is a real struggle, +even with success as an incentive and as a possible reward. It becomes a +tragedy when we think of the wasted years, the hopeless prayers and the +anguish of those who fight the battle which is predestined to end in [5] +apparent failure. We are disposed to doubt the justice of the Omnipotent +Mind who created us and left us seemingly alone--derelicts in the eddies of +eternity. + +This is but a finite fault, however. The truth is that the scheme of the +universe is unalterable, we are but part of the whole and must share in the +evolution of the process. An apparent failure is not necessarily a +discreditable one. Most lives are failures, if appraised by human estimate. +Take for example the life of a young wife who marries a man with disease in +his blood. She begins her wedded life with certain commendable ideals. She +is young, enthusiastic, ambitious, strong, and she inherently possesses the +right to aspire to become an efficient home-maker and a good mother. She +gives birth to a child, conceived in love, and during her travail she +beseeches her Creator to help her and to help her baby, as all women do at +such a time. Her baby is born blind and it is a weak and puny mite. The +mother recovers slowly, but she is never the same vigorous and ambitious +woman. Later her strength fades away, her enthusiasm falters, the home is +blighted and seems a desecrated spot. The baby is a constant worry, it is +always sick, it needs expensive care and it exhausts the physical remnant +of its mother's health. It finally dies and is laid away, not forgotten, +but a sad, sad memory. The ailing and dispirited mother is informed that +she must submit to an operation if she desires to regain her health, if not +to save her life. She returns from the hospital--not a woman--a blighted +thing, an unsexed substitute for what once was a happy, sunny, healthy, +innocent girl. + +This is not an overdrawn tale,--it is a true story, a common, every-day +story. Who was to blame? Why were her prayers not heard? Why, indeed? One +might as well ask why seemingly splendid civilizations decayed into +forgotten dust, or why empires rotted away. The answer is the same. + +HISTORY.--From the eugenists' standpoint history is prolific only in +negation. A correct interpretation of its pages teaches us that it has not +taught the lesson of the "survival of the fittest," but rather the survival +of the strongest. That the strongest is not always the "fittest" needs [6] +no commentary. That the fit should survive is the genetic law of nature, +and it has been strictly obeyed by biology and humanity when these sciences +have adhered to, and have been under the jurisdiction of the natural law. + +When religious schisms swayed the world, the stronger party, in material +strength or in actual numbers, massacred the weaker, which was frequently +the fitter from the standpoint of desirability as progenitors of the race. +Thus posterity was deprived of what probably was the representative, +potential strength of generations. + +At a later date religious schism changed her _modus operandi_ but +accomplished the same pernicious purpose, as the following shows: + +"Whenever a man or woman was possessed of a gentle nature that fitted him +or her to deeds of charity, to meditation, to literature or to art, the +social condition of the time was such that they had no refuge elsewhere +than in the bosom of the Church. But the Church chose to preach and exact +celibacy, and the consequence was that these gentle natures had no +continuance, and thus, by a policy, was brutalized the breed of our +forefathers." + +When religion was not the dominating power, mankind was ruled by militant +tyrants. The non-elect were slaves,--uneducated, uncivilized, debased and +diseased. The elect were licentious and indolent. Neither class practised +any domestic virtues, or respected the institution of motherhood. The +process of the selection of the fittest for survival for the purpose of +parentage, and for the consummation of the evolutionary gradation, through +which the human race is apparently destined to pass, was again in abeyance +for a series of generations. + +In our own times, the fate of nations and the destiny of their people would +seem to depend upon the size of the fighting force and the efficiency of +the ships we build; our ability to dicker and barter, to gain a +questionable commercial supremacy, and the loquaciousness of our +politicians. This, at least, is the criterion upon which the modern +statesman estimates the quality of present-day civilization. He is not [7] +apparently interested in the story of the ages. The progress of God's +supernal scheme through aeons of bigotry and darkness neither suggests nor +inspires in him a loftier constructive analysis. He is content to leave the +destiny of nations to tons of material, tons of men and tons of talk. + +Nowhere do we find any reference to the quality of the blood-stream of the +people. Nor does it seem to have been discovered by those who wield +authority, that the glory of a nation depends upon its brains, not its +bulk; nor do they apprehend that the greatness of a people is not in its +past history, but in its ever-existing motherhood; and that its battles, in +the future, must be fought, not on battlefields, but in its nurseries. When +we judge our national worth and wealth by the quality of our maternal +material, and estimate our greatness and our glory by the record of our +infant mortality, we will have carved an enduring niche in the celestial +scheme that will be unchangeable and for all time. + +There are in Britain to-day over a million and a quarter females of +marriageable age in excess of the number of marriageable males. A war +between Britain and Germany would unquestionably be the bloodiest war in +all history, and it probably would be the last one, because it would only +end in the dominance of one power over all the others. If we concern +ourselves only with Britain--from the eugenic standpoint--who would dare +compute the ratio of marriageable females over the males after the war was +over? The consequence of such a war on posterity would be tragic. It would +mean the annihilation of the fittest for fatherhood for generations. Only +the unfit would be left from which to begin a new breed. + +The multitude of females who would necessarily be left unable to +participate in the highest function of womanhood would have to be +self-supporting. The economic problem would, therefore, have a far-reaching +influence and even if solved adequately as an economic problem, it could +never be solved satisfactorily as a sociological, or as a problem in +eugenics. + +Infant mortality is too high. Apart from the statistical proof which [8] +shows it, we may rightly construe as further proof of it, the widespread +effort being made in every civilized country in the world to ameliorate the +condition. + +The laws and ethics of marriage are inadequate. Its true purpose is +frustrated and racial and individual injustice and imperfection are the +products of existing conditions. + +Motherhood, in its every aspect is not, and has not in the past, been +elevated to the plane which a true estimate of its supreme importance to +the race justifies. + +Heredity as a scientific principle is undeveloped, and because of +maladministration in past generations, the present generation is +endeavoring to do the work, the fruits of which it should be enjoying. + +Environment in its highest sense is impossible because of inadequate laws, +imperfect hygienic and sanitary knowledge, incomplete education, vice and +disease. + +If there was not some supremely important, cardinal error somewhere, it is +reasonable to suppose that in one or other of the departments of human +effort we would have reached the summit of idealism. The State, as an +institution, would have evolved a perfection which would enable it to exist +as an independent mechanism, complete and ideal in all its ramifications. +We have had no such state, however. The highest type of empire has been +ludicrously dependent upon the minor exigencies of individual human +existence. + +Science would have evolved the superman, but history, as we have seen, has +persistently deprived science of the material wherewith to contribute him. + +The institution of marriage would have been a fixed and an inviolable +guarantee of the happiness of the home, but human wisdom has erred and the +solution is as yet apparently undiscovered. + +Investigation into every field of human effort shows that the ultimate aim +in view, if any, was something other than the welfare of the race, as a +race or as individuals. + + * * * * * + + + [9] +CHAPTER II + + "The public health is the foundation on which reposes the happiness of + the people and the power of a country. The care of the public health is + the first duty of a statesman." + + LORD BEACONSFIELD. + +THE EUGENIC IDEA + + THE VALUE OF HUMAN LIFE--THE EUGENIC PRINCIPLE--"THE FIT ONLY SHALL + LIVE"--EUGENICS AND MARRIAGE--THE VENEREAL DISEASES--THE UTILITY OF + MARRIAGE CERTIFICATES--THE MARRIAGE CERTIFICATES AND VICE--EUGENICS AND + PARENTHOOD--THE PRINCIPLE OF HEREDITY--EUGENICS AND + MOTHERHOOD--EUGENICS AND THE HUSBAND. + +The eugenist believes the cardinal error of the past has been a failure to +recognize the worth or value of human life. In the past human lives have +counted for absolutely nothing. As we have seen, each generation has +practically deprived posterity of the best of its breed, and we shall see, +when we consider the facts which affect the present vitality of the race, +that the same preposterous conditions still exist. + +It is not necessary to waste the reader's time in an effort to prove, +simply from an argumentative standpoint, the logic of the eugenic idea. +There is no existing economic problem that has established itself so firmly +in the hearts of the people who understand it, as has the study of race +culture. It is not the subject, but its scope of application, that is new. +Biologically, we see the manifestations of eugenics on every side. In the +flower garden we breed for beauty, in the orchard for quality. In the +poultry yard and on the stock farm the same process weeds out the unfit and +cultivates the desirable. The value of the eugenic idea is most strikingly +illustrated in the cultivation, or breeding, of the horse from a primitive +creature into the splendid animals which represent the various types of +equine present-day perfection. It has taken generations of the most [10] +painstaking intelligence to understand the traits which had to be evolved +in scientific mating to reach the present standard. If the same rules, or +lack of rules, applied to the mating of horses as applied to ourselves, +there would be few, if any, "thoroughbreds" among them. The principle which +we must recognize is that "Life is the only wealth." + +Progress and efficiency will be ensured and of an enduring character, when +all human effort is consecrated to this fundamental principle as a basic +law, and not till then. + +To cultivate the human race on prescribed scientific principles will be the +supreme science of all the future, the object and the final goal of all +honest governmental jurisprudence, and the ultimate judge of all true +constructive legislation. + +THE EUGENIC PRINCIPLE + +The eugenic principle is, that "the fit only shall live." This does not +mean that the unfit must die, but that only the fit shall be born. +Occasionally, as a product of bad environment, or faulty training, or +eccentricity, a horse gives evidence of vicious traits, but the scientific +breeder never mates him. He is allowed to die out. If he were permitted to +father a race, his progeny would develop murderous characteristics that +would retard the type for generations. + +THE FIT ONLY SHALL BE BORN.--This implies the exclusion of those, as +parents, who are incapable of creating fit children. Fit children are +children who are physically and mentally healthy. Parents who are unfit to +create physically and mentally healthy children are those diseased in body +or mind, especially if the disease is of the type which science has proved +to be transmissible, or which directly affects the vitality of the child. +In such a category we place those who are deaf, dumb, blind, epileptic, +feeble-minded, insane, criminal, consumptive, cancerous, haemophilic, +syphilitic, or drunkards, and those known to be victims of disease of [11] +any other special type. + +It must not be inferred that the above classification is made arbitrarily. +There are many arguments which may be advanced limiting the eugenic +applicability of certain of these diseased conditions. These, however, do +not directly come within the province of the mother. They may be safely +left to special state regulation. We simply make the assertion that no +mother would willingly, or designedly, ally her offspring with any member +of society afflicted with any of the diseases enumerated. + +EUGENICS AND MARRIAGE.--The eugenic idea, practically applied to the +institution of marriage, means that no unfit person will be allowed to +marry. It will be necessary for each applicant to pass a medical +examination as to his, or her, physical and mental fitness. This is +eminently a just decree. It will not only be a competent safeguard against +marriage with those obviously diseased and incompetent, but it will render +impossible marriage with those afflicted with undetected or secret disease. +Inasmuch as the latter type of disease is the foundation for most of the +failures in marriage, and for most of the ills and tragedies in the lives +of women, it is essential to devote special consideration to it in the +interest of the mothers of the race. + +It is estimated that there are more than ten million victims of venereal +disease in the United States to-day. In New York City alone there are two +million men and women--not including boys and girls from six to twelve +years of age--actively suffering from gonorrhea and syphilis. Eight out of +every ten young men, between seventeen and thirty years of age, are +suffering directly or indirectly from the effects of these diseases, and a +very large percentage of these cases will be conveyed to wife and children +and will wreck their lives. No one but a physician can have the faintest +conception of the far-reaching consequences of infection of this character. +The great White Plague is merely an incident compared to it. These diseases +are largely responsible for our blind children, for the feeble-minded, for +the degenerate and criminal, the incompetent and the insane. No other [12] +disease can approximate syphilis in its hideous influence upon parenthood +and the future. The women of the race, and particularly the mothers, should +fully appreciate the real significance of the situation as it applies to +them individually. That they do not appreciate it is well known to every +physician and surgeon. + +It is first necessary to state certain medical facts regarding these +diseases. They exist for years after all symptoms have disappeared; no +evidences exist even to suggest to the patient that he, or she, is not +entirely cured. After the germs have been in the patient for some time they +lose a certain degree of their virility, and a condition of immunity is +established. In other words the tissue ceases to be a favorable medium for +the development, or activity, of the germs. If these germs, however, are +conveyed to another person, who has never had the disease, or whose tissue +is not immune, they will immediately resume their full activity and +virulence, and will establish the disease, frequently in its most violent +form, in the person so infected. The startling deduction which we must draw +from these facts is, that a man may infect his wife, and may thereby be the +direct cause of wrecking her entire life, and may, in addition, as a +consequence of the infection, cause a child to be born blind, without even +remotely suspecting that he is in any way responsible for it. In the light +of this knowledge, what is the percentage risk a young girl takes when she +selects a husband, remembering that eight out of every ten husbands bring +these germs to the marriage bed? Reread the true story of the young woman +on page five, accept my assurance that there are thousands and thousands of +such cases, and ask yourself, who is to blame? We may certainly assure +ourselves that no man living would wilfully desecrate his bride. He did not +know,--did not even suspect that the disease he had years ago was still in +his system. Society is to blame--you and I--the laxity of the law is the +culprit. Had he been compelled to pass a physical examination before +marriage he would have been told the truth. + +It is a notorious fact, that in every civilized city in the world, the +number of operations that are daily performed on women, is increasing [13] +appallingly. Every surgeon knows that nine-tenths of these operations are +caused, directly or indirectly, by these diseases, and in almost every case +in married women, they are obtained innocently from their own husbands. It +is rare to find a married woman who is not suffering from some ovarian or +uterine trouble, or some obscure nervous condition, which is not amenable +to the ordinary remedies, and a very large percentage of these cases are +primarily caused by infection obtained in the same way. + +When a girl marries she does not know what fate has in store for her, nor +is there any possible way of knowing under the present marriage system. If +she begets a sickly, puny child,--assuming she herself has providentially +escaped immediate disease,--she devotes all her mother love and devotion to +it, but she is fighting a hopeless fight, as I previously explained when I +stated that one-half of the total effort of one-third of the race is +expended in combating conditions against which no successful effort is +possible. Even her prayers are futile, because the wrong is implanted in +the constitution of the child, and the remedy is elsewhere. These are the +tragedies of life, which no words can adequately describe, and compared to +which the incidental troubles of the world are as nothing. + +So long as these conditions exist need we not tremble for the future of the +race? Is not this future welfare a personal issue, or can we trust the +future of our daughters to the same indiscriminate fate that has written +the pages of history in the past? + +This problem has been debated from every possible angle without our +reaching any seemingly practical solution. The promise of emancipation, +however, came with the dawn of eugenics. It is the only solution that gives +promise of immediate and reasonable success. For that reason alone it +should receive the active support of every good mother in all lands. + +THE UTILITY OF MARRIAGE CERTIFICATES.--There would seem to be no question +as to the utility of marriage certificates. We must remember, however, that +there is a distinction between marriage and parenthood, and that [14] +eugenics is concerned only with parenthood. It is interested in the +institution of marriage to the extent only that it may, by some system of +regulation, be a positive and fixed factor in the production of exclusively +healthy children. The eugenist demands fit children. If society can ensure +fit children, as a consequence of any marriage system which may or may not +include medical certification, the eugenic aim is fully met. At the present +time the giving of a marriage certificate, which is really a permit to +marry, would seem to be the most practical way promptly to accomplish the +eugenic purpose. We should promptly question the honor of any prospective +husband disposed to evade the examination simply because he was not +compelled to obey by a legislative enactment. + +We believe that when the public is educated to the truth and intent of +eugenics, there need be no compulsory examination. Men and women will, of +their own accord, desire to know if their marriage will jeopardize the +race. There will be questions of heredity to elucidate, questions of +inherited insanity, poison taints, of blindness and deafness, or it may be +of drunkenness. + +Further, marriage certificates, or permits, must be considered in regard to +the future conduct of those to whom we refuse permits to marry. A refusal +of the permission to marry will not change the desire to marry. Many, of +course, to whom a permit is refused, will accept the situation, will be +thankful to be possessed of the knowledge of their incompetency in order +that they may seek medical aid. These individuals will remain under medical +supervision until their ailments are cured and their competency +established. In this way the eugenic aim is materially furthered. Others +may not abide by the decree which forbids marriage. It would wholly defeat +the eugenic idea if the unfit children were to continue to be born +illegitimately. These individuals will comprise the few--probably the +present unfit members of society--and the final solution of the matter must +remain a question of education and evolution. When public opinion is +educated to the degree necessary to establish a system of eugenic +self-protection, we shall be provided with a race of children whose [15] +culture will achieve the ideal of parenthood by a process of education +rather than legislation. + +THE MARRIAGE CERTIFICATE AND VICE.--If a prenuptial examination were made +compulsory there is no doubt of the very prompt and salutory effect it +would have on present-day vice. It has often been said that "You cannot +legislate virtue or sobriety into a people." We are familiar too with the +maxim that "You can lead a horse to the well, but you cannot make him +drink." You can lead a horse to the well, however, and lo! he drinks. If +you lead him at the right time he will always drink. If we legislate at the +psychological moment we can legislate virtue and sobriety into a people. + +A very large percentage of existing vice is the immediate product of +ignorance, and the larger percentage of the remainder is the result of +propinquity and the idea that it will never be found out. Very little of it +is the outcome of innate degeneracy. It is an acquired degeneracy we must +guard against, and that is the special educational motive of eugenics. +Young men will be taught the truth about vice, and if they have been +victims in the past, they will willingly submit themselves to a _competent_ +investigation of their fitness for marriage. If they are still pure, the +desire to remain so, in order to be eligible for parenthood, will guard +them against the risk of contamination. This will not only result in a +distinct improvement of the moral tone, but the potential possibilities to +posterity will be incalculable. Legislation might therefore be the vehicle +through which eugenic education could enlighten and evolve a fit race. + +EUGENICS AND PARENTHOOD + +If the supreme end is a better race we must recognize that the great need +for society to-day is to educate for parenthood. History teaches that a +civilization that dissipates its virility in profligacy or spends its +energy in political and commercial trickery, and gives no thought to the +character of the men and women it produces, is destined to total failure. +Parenthood and birth--in these we have the eugenic instruments of the [16] +future. The only permanent way to cure the ills of the world is to prevent +the multiplication of people below a certain standard. The elevation and +the actual preservation of the race depends upon rendering it impossible +for the unfit coming into existence at all. In other words the unfit or +unworthy must be rejected, not necessarily as individuals, but as parents. + +Eugenics is allied to the principle of heredity,--the principle that +enables us to modify conditions so as to ensure the right children being +born. The propaganda against infant mortality is directed only toward the +provision of a good environment,--so that children, when born, may survive +and attain the maximum of their hereditary promise. The two campaigns are +essentially complementary. The one applies only before birth, the other +after birth. The statistics of infant mortality unfortunately show that it +is not a process that extinguishes the unfit only. The healthy succumb to +unfavorable environment and it was to amend this condition that the +campaign against infant mortality was undertaken. The two campaigns appeal +to the same creed: that parenthood is the supreme function of the race, +that it must not be indifferently undertaken; that it demands the most +careful preparation; that it is a duty which can only be carried out +eugenically by the highest attainable health of body and mind and emotions. + +EUGENICS AND MOTHERHOOD.--Any plan or scheme which has for its object race +regeneration must concern itself with the health, the education, and the +psychology of woman; the environment which shall surround her period of +motherhood, and her selection of the fathers of the future. Society must +safeguard her in all her relations. The race to-morrow are the babies of +to-day. The wealth of a nation therefore is the type of baby that will +constitute its civilization from generation to generation, and absolutely +nothing else counts. We hear much about race suicide, but is it not +monstrous to cry for more babies when we do not know how to keep alive +those we have? It is a fact that everywhere the birth rate of the Caucasian +people is on the decline. Our birth rate as a whole, however, is ample;[17] +it is the death rate that is significant and appalling. When we remember +that one-third of all the babies born die before they reach the age of five +years; and that the deaths of babies under one year of age comprise about +one-fourth of the total death-roll; and that fully one-half of all these +deaths are needless and unnecessary, wherein is the wisdom of working for a +higher birth rate if it is merely that more may die? + +The majority of babies are born physically healthy, but because of our +destructive process, we proceed to annihilate hundreds of thousands of them +yearly, and because of defective environment and education we render +thousands of others, including the fit and unfit, inefficient and +incompetent as propagating factors. It is to remove this disastrous stigma +on our intelligence that we have been forced to study the conditions which +the eugenic idea represents. When these principles are understood and +believed, and when they are acted upon, infant mortality will cease to +exist. + +It was the design of the Creator that human motherhood should be an exalted +occupation. He placed in her care to nurture and to love, the most helpless +living thing. Few have regarded a baby from this viewpoint and fewer still +understand its supreme significance. That it is the most utterly helpless +thing possessing life is a self-evident fact, and that it should be +destined to be King of all mammalian tribes as well as Lord of all the +earth is a superlative paradox. Because of its utter inability to care for +itself it is more in need of care than any other representative of the +animal world. It is not only in need of immediate care, but it demands care +longer than the young of any other species. + +It stands to reason, therefore, that the function of motherhood must be +reckoned with in any scheme of race regeneration; that it must be provided +with the most favorable environment; and that it must be relieved of any +condition which would materially retard the meeting of the obligation to +its fullest possible extent. In an ideal eugenic sense the state must +ensure sustenance to those deprived of ample food and raiment, and [18] +science must continue to solve the problem of a fitter sanitary and +hygienic environment for the congested and densely populated zones of +habitation. Philanthropy must not continue to be wholly misdirected, it +must extend its aid to the deserving healthy and fit, as well as to be +exclusively the protecting agency of the diseased and unfit. If life is the +only wealth, and the preservation of childhood the highest duty of society +and the state,--which it would seem to be, since the continuance and +preservation of the race is obviously essential to the continuance of the +state itself,--the life of every child must be considered an economic as +well as a moral trust. If, therefore, every child is sacred, every mother +is equally sacred. If every child is to be cared for, every mother must be +cared for. If the state cannot afford to provide for what is imperatively +essential to its own continuance, it might as well go out of existence, as +it inevitably will in the end on any other basis, and as all preceding +states have done. + +Mothers must not be dependent upon their children's labor for their +maintenance, because if children are compelled to work, they will not be +able to work in the future,--and adult efficiency is necessary to the +well-being of the individual, the race, and the state. + +No mother should work, because in the care of her children she is already +doing the supreme work. The proper care of children is so continuous and +exacting a task, and of such importance to posterity, that it must be +regarded as the highest and foremost work--and adequate in itself--and its +efficiency must not be hampered by mothers having to do anything else. + +Motherhood must not be financially insecure, because this would defeat its +eugenic purpose. Society, therefore, as a matter of self-preservation, must +ensure to woman her mental and economic security. Civilization's margin is +large enough to provide this. We spend large amounts on luxuries and evils +which are contrary to the genesis of self-preservation, while motherhood is +its basic necessity. When public opinion is educated in the essentials of +eugenics much of this can be, and will be diverted to a nobler purpose. The +total cost necessary to ensure the adequate care of dependent [19] +motherhood would be a mere fraction of the national expenditure, and not a +tithe of what we spend in pension allowances yearly. The latter is regarded +as an honorable debt and is at best the direct product of a decadent ideal, +while motherhood constitutes the very germ of the only altruistic idealism +for all the future. + +We concede, therefore, that the children and the mothers must be provided +for, not only as a product of the true construction of the ethics of +sociology, but in obedience to the fundamental law of a moral system of +eugenics. We must go further and assert that children must be cared for +through the mother. It has been the practice to divorce the improvident +mother from her dependent children. This has been demonstrated to be not +only an altruistic fallacy. It has proved to be an economic blunder. + +There is another type of evil which largely menaces the eugenic ideal of +motherhood. It is those cases where married women who have children are +compelled to be the bread winners of the family as well as its mothers. No +woman can earn support for herself and children outside of her home and +competently assume the responsibilities of motherhood at the same time. +Whatever aid a mother renders to the state, as a result of effort in +factory or shop, is of infinitely less value, from an economic standpoint, +than her contribution as mother in caring for her own children in her own +home. A careful study of infant mortality, and the conditions of child +life, so far as survival value is concerned, condemns in the strongest and +most vital sense this whole practice. The preservation of the race is the +essential requisite, and it is the vital industry of any people. Any +seeming economic necessity which destroys that industry is one that will +contribute largely to the downfall of the people as a race. + +EUGENICS AND THE HUSBAND.--The question of the husband's moral and parental +obligation, as dictated by the marriage institution and constitution, may +be left out of this discussion. We may assert, however, that we do not +believe the eugenic principle intends, in devising ways and means for [20] +the adequate protection, in its completest sense, of motherhood, to relieve +the father of any of his moral or parental obligations. These obligations +will be justly defined, and as previously stated, will be the subject of +special state legislation. No legislation of an economic character can +detract from the performance of a moral obligation, and by no process of +sophistication can modern statesmanship accomplish the dethronement of +motherhood. The duty of the father is to support his children and the +mother of his children, and the duty of the state is to see that this is +done. The fundamental law of the eugenist must be to recognize that +fatherhood is a deliberate and responsible act, for which a fixed +accountability must be maintained. Whatever legislation is undertaken in +this connection must be with the object in view of strengthening the +efforts of the right kind of father and husband, and of rendering more +difficult the path of the irresponsible father and husband. If the supreme +duty of a state is the maintenance of justice, its whole effort in the +future will be to legislate in harmony with the eugenic principle. + + * * * * * + + + [21] +CHAPTER III + + "I hope to live to see the time when the increased efficiency in the + public health service--Federal, State and municipal--will show itself + in a greatly reduced death rate. The Federal Government can give a + powerful impulse to this end by creating a model public health + service." + + EX-PRESIDENT TAFT. + +EUGENICS AND EDUCATION + + THE PRESENT EDUCATIONAL SYSTEM IS INADEQUATE--OPINIONS OF DR. C. W. + SALEEBY, ELLA WHEELER WILCOX, LUTHER BURBANK, WILLIAM D. LEWIS, + ELIZABETH ATWOOD, DR. THOMAS A. STORY, WILLIAM C. WHITE, DR. HELEN C. + PUTNAM--DIFFICULTY IN DEVISING A SATISFACTORY EDUCATIONAL + SYSTEM--EDUCATION AN IMPORTANT FUNCTION--THE FUNCTION OF THE HIGH + SCHOOL--THE HIGH SCHOOL SYSTEM FALLACIOUS--THE TRUE FUNCTION OF + EDUCATION. + +The fundamental law of eugenics demands that all education be exerted for +parenthood. We have proved that the child is not only essential to the life +of the state, but is the state. Consequently any function other than +parenthood is a non-essential so far as organic existence is dependent upon +it. Education can, therefore, have no higher or more righteous motive than +as a contributory agency in the perpetuation of the function upon which all +existence depends. If the only function of education is to make one a +worthy citizen, or to make him, or her, self-supporting, or able to bear +arms in defense of his country, rather than a perfect link in the complete +chain of enduring life, its purpose is being perverted. It is not +sufficient to provide a girl, for instance, with an exclusive environment +which regards her simply as a muscular entity, as is the tendency in some +of the "best" girls' schools to-day; nor to fit her as a domestic or +society ornament; nor must she be regarded simply as an intellectual +machine, as is done under the system styled "the higher education of +women." Any one of these is an example of misdirected excess and is [22] +only part of the whole. None of these systems strives to develop the +emotional side of the complex female character, and any educational system +which ignores the emotions is not only inadequate but reprehensible in the +highest degree. The ideal which will strive for education for ultimate +parenthood will more completely solve the question of complete (eugenic) +living. + +THE PRESENT EDUCATIONAL SYSTEM IS INADEQUATE.--There is no question that +education, as conducted at the present time, is one of the most disastrous +institutional fallacies of modern civilization. In support of this +contention, we are prompted to quote at length from various authorities +bearing on this subject. + +Dr. C. W. Saleeby, an international authority on education, writes as +follows: + +"A simple analogy will show the disastrous character of the present +process, which may be briefly described as 'education' by cram and emetic. +It is as if you filled a child's stomach to repletion with marbles, pieces +of coal and similar material incapable of digestion--the more worthless the +material the more accurate the analogy--then applied an emetic and +estimated your success by the completeness with which everything was +returned, more especially if it was returned 'unchanged,' as the doctors +say. Just so do we cram the child's mental stomach, its memory, with a +selection of dead facts of history and the like (at least when they are not +fictions) and then apply a violent emetic called an examination (which like +most other emetics causes much depression) and estimate our success by the +number of statements which the child vomits onto the examination paper--if +the reader will excuse me. Further, if we are what we usually are, we +prefer that the statements shall come back 'unchanged'--showing no sign of +mental digestion. We call this 'training the memory.' The present type of +education is a curse to modern childhood and a menace to the future. The +teacher who cannot tell whether a child is doing well without formally +examining it, should be heaving bricks, but such a teacher does not exist. +In Berlin they are now learning that the depression caused by these [23] +emetics (examinations) often lead to child suicide--a steadily increasing +phenomenon mainly due to educational overpressure and worry about +examinations. + +"Short of such appalling disasters, however, we have to reckon with the +existence of this enormous amount of stupidity, which those who fortunately +escaped such education in childhood have to drag along with them in the +long struggle towards the stars. This dead weight of inertia lamentably +retards progress. + +"If you have been treated with marbles and emetics long enough, you may +begin to question whether there is such a thing as nourishing food; if you +have been crammed with dead facts, and then compelled to disgorge them, you +may well question whether there are such things as nourishing facts or +ideas." + +The gifted writer, Ella Wheeler Wilcox, in an editorial in the _New York +American_, expressed herself recently in the following terms: + +"A wave of dissatisfaction is sweeping over the country regarding our +school system. And eventually this will cause a change to be made. The +larger understanding of mothers regarding education will result in the +personal element entering into the training of children. + +"When women have a voice in the affairs of the nation there will be more +teachers, larger salaries, fewer pupils in each department, and more +attention will be given to the temperaments and varying dispositions of +children by their instructors. + +"Instead of regarding the little ones who enter public schools as machines +which must be taught to go according to one rule, each child will be +studied as a threefold being, and his mind, body and spirit will be cared +for and developed according to his own peculiar needs. All this will come +slowly, but it will come. + +"Before children enter the public schools there should be a great sifting +process under the direction of a national board of scientific men. The +brain equipment of each child, the tendencies given it at birth, should be +tested; then the nervous, hysterical and erratic minds ought to be [24] +placed in a school by themselves, under the care of men and women who know +the law of mental suggestion. + +"Quiet, loving, wholesome rules, followed day after day and month after +month, would bring these children out into the light of self-control and +concentration. The hurried, crowding, exciting methods of the public +schools are disastrous to fully half of the unformed minds sent into the +intellectual maelstrom which America provides under the name of Public +Schools. + +"For the well-born, normal-minded, healthy-bodied child, who has wise and +careful guardians or parents to assist in his mental guidance, the public +school forms a good basis on which to build an education. For the average +American child of excitable nerves and precocious tendencies, it is like +deep surf swimming for the inexperienced and adventurous bather. + +"The great foundation of education--character--is not taught in the public +schools. There is no systematized process of developing a child's power of +concentration; there is not time for this in the cramming process now in +vogue and with the enormous pressure placed on teachers. No teacher can do +justice to more than fifteen children through the school hours. In many of +our public schools there are fifty and sixty children under one instructor. +This is fatal to the nervous system of the teacher and deprives the pupils +of that personal sympathy which is of such vital importance." + +Luther Burbank, the famous California horticulturist, declares that the +great object and aim of his life is to apply to the training of children +those scientific ideas which he has so successfully employed in working +transformation in plant life. + +In an editorial, entitled, "Teaching Health," the _New York Globe_ states, +"Anatomy and physiology are reasonably exact sciences, and nine-tenths of +the hygienic abuses against which the doctors are preaching would be +prevented if the laity had an elementary knowledge of physiology. Such an +educational reform could be carried out without causing any clash whatever +between the warring medical sects." [Page 25] + +William D. Lewis, Principal of the William Penn School, Philadelphia, in an +article entitled: "The High School and the Girl," in a recent issue of the +_Saturday Evening Post_, wrote in part as follows: + +... "The first thing that society wants of our girl is good health. This is +the first essential for her efficient service and personal happiness in +shop, office, store, school or home. The future of the race so far as she +represents it, depends upon her health. What is the high school doing to +improve the girl's health? In the overwhelming majority of cases absolutely +nothing. On the other hand, it is subjecting her to a regimen planned for +boys, without the slightest consideration of the physical and functional +differences between the sexes. + +"It pays no attention to the curvature of the spine developed by the +exclusively sit-at-a-desk-and-study-a-book type of education bequeathed to +the girlhood of the nation by the medieval monastery: It ignores the +chorea, otherwise known as St. Vitus' dance developed by overstudy and +underexercise; it disregards the malnutrition of hasty breakfasts, and +lunches of pickles, fudge, cream-puffs and other kickshaws, not to mention +the catch penny trash too often provided by the janitor or concessionaire +of the school luncheon, who isn't doing business for his health or for +anybody else's; it neglects eye-strain, unhygienic dress, uncleanly habits, +anemia, periodic headaches, nervousness, adenoids, and wrong habits of +posture and movements.... If you believe that the high school is a social +institution with a mission of public service, regardless of the relation of +that service to Latin or Algebra, then you must agree that it should look +after what everyone recognizes as the foremost need of the adolescent girl. + +"One fact that every educator in both camps knows is that the home is not +attending to the health of the adolescent girl. This problem is pressing +upon us now largely because of the revolutions in living conditions that +has come within the last quarter of a century." + +In a report of a recent Conference on the Conservation of School [26] +Children held at Lehigh University by the American Academy of Medicine, the +following items appear. + +Four great reasons why medical inspection in schools is needed were brought +out by Dr. Thomas A. Story of New York, who spoke from the educator's +standpoint: + +"The first reason is concerned with communicable diseases, and the second +with remediable incapacitating physical defects. It was reported in 1906 +that over twenty per cent. of the children in the schools of New York City +had defective vision, and over fifty per cent. had defective teeth. These +defective conditions are amenable to treatment whereby the functional +efficiency of the pupil is improved. He is capable of better work and the +school efficiency is advanced. + +"The third reason is concerned with irremediable physical defects. The +cripples, the deformed and the delinquents whose incapacitating defects are +permanent should be found and classified. This enables special instruction +and opens up educational possibilities otherwise unattainable, besides +removing retarding factors in the progress of the normal pupil. + +"The fourth reason is concerned with the development of hygienic habits in +the school child, and through the child, of the community. Medical +inspection which influences the health habits of the masses is a matter of +supreme importance. The teacher will have pupils of cleaner habits and +healthier, with fewer interruptions and disturbances from absences. + +"To make medical inspection successful physical examinations should uncover +the anatomic, physiologic, and hygienic conditions. Every piece of advice +given to a pupil that can be followed up should be followed up and the +result recorded. No system of medical inspection in schools can be complete +and permanently successful which does not eventually educate the parent and +child to a sympathetic and cooeperative relationship with the system. +Medical inspection is a force working for a better general education in +personal hygiene and should cooerdinate with the class room instruction. +Hence it must be a system in sympathetic relationship with the general [27] +management of the school, and should be under the same responsible control. +Since it is an educational influence and so directly related to the success +of the school, it ought to be a part of the school organization." + +A paper was read by Dr. Helen C. Putnam of Providence, R. I., on "The +Teaching of Hygiene for Better Parentage." She said: + +"Life is a trust from fathers and mothers beginning before history; to be +guarded and bettered in one's turn, and passed along to children's +children. A definite conception of this trust is essential to right living. +Educators are finding that well directed correlation of human life, with +phenomena of growing things in school gardens and nature studies, develops +a wholesome mental attitude. Since tens of millions of our population have +only fractions of primary schooling, there is where the teaching must +begin. These primary years are the time to lay foundations before a wrong +bias is established. + +"Education for parenthood cannot be completed at this early age. The +strategic years for making it most effective are from sixteen to +twenty-four, when home-making instincts are waking and strongest. We have +15,000,000 young people of these ages in no schools, and eligible for such +instruction. All state boards of education were recently petitioned by the +American Association for Study and Prevention of Infant Mortality to urge +the appointment of commissions on continuation schools of home-making, to +investigate conditions and needs in their respective states and to report +plans for meeting them effectively through such continuation schools or +classes." + +DIFFICULTY IN DEVISING A SATISFACTORY EDUCATIONAL SYSTEM.--It will be +observed that each of these authoritative writers criticises the system of +education now in vogue. The criticism is not, nor could it justly be, +specialized. It is simply an expression, from different viewpoints, of the +feeling that we are not doing ourselves justice as yet, we are groping +after something better. It may be, as I have previously stated, that no[28] +satisfactory system of education will be evolved until the laws of kindred +sciences, which have organic relationship to what we understand as +education, are fixed and better understood. We are just beginning to +appreciate the true meaning of environment. We know little about heredity, +but enough to appreciate its vital importance. Psychology is a realm of +much hope, but we have only tasted of its surface promise and know little +of the mysteries it may unfold. Eugenics, the infant giant of science, +promises to establish the race on an enduring foundation. These sciences +have laws which we do not yet understand; they relate to that part of human +evolution which mind dominates. The quality of the mind's dominion depends +upon the mind's education and environment, and since the laws of these +sciences, upon which a perfect system of education depends, have not been +revealed, it is quite evident that all past systems of education have been +more or less deficient. It is further evident that evolution has suffered +as a result of the mind's imperfect education,--a condition that is +manifest all around us. + +It must be appreciated, however, that we are discussing a large subject. If +we understood all there is to know about environment; if we knew the laws +of heredity, and psychology, and eugenics, and then could apply them, and +educate the product of this combination of forces, we would be very near to +the super-man. One must have a sober mental horizon to evolve the picture +which would be the product of the above solution and then to estimate its +meaning on human happiness and progress. We are approaching the ethics of +right living,--of justice and truth,--the divine in man. At no time in the +history of man has civilization been so near a solution of life's supreme +problem as at the present moment. + +Education is an important function in life's scheme, and while we may +regret that it is not possible to formulate a system that would be perfect +and capable of immediate application, we can continue to work patiently and +hopefully, with assurance that in the near future the problem will be +satisfactorily solved. When heredity, psychology, and eugenics combine [29] +to dictate the system, we shall doubtless find, that, in the beginning, it +will be a system of individualization. In the interest of health and of +justice, and consequently of efficiency, this would seem to be the natural +and the logical lead. + +So long as human nature is as it is, we must meet conditions as they exist. +We know as parents, and some of us know as physicians, that a task easily +performed by one individual, without any apparent harmful results, will tax +the capacity of another individual to the very utmost. Any educational +system which does not recognize this law, is vicious. Yet such is the +system in vogue to-day in America. We must adapt the burden to the +endurance of the pupil. The administration of an educational machinery must +solve this problem from the individual standpoint. + +In the departmental work in our public schools there seems to be no system. +Each teacher prescribes home work without any knowledge of what others of +the same grade do, and without any apparent consideration in favor of the +individual pupil. The result is that the total amount for each night is +absurdly in excess of the capacity of the ordinary, or for that matter the +extraordinary, pupil. This engenders nervousness and irritability, and is +contrary to the ethics of education,--the fundamental law of which should +be the preservation of good health. We must have regard for the physical +and mental health of each pupil, and as the capacity of each pupil is +different, the system is committing an egregious wrong by sacrificing the +weaker instead of adapting the burden according to the strength and +endurance of the bearer. + +THE HIGH SCHOOL SYSTEM FALLACIOUS.--Even the high schools do not seem to be +wisely availing themselves of their opportunity from the eugenic or +economic standpoint. According to the report of the Commissioner of +Education of the United States the percentage of pupils studying some of +the more important subjects in the year 1909-1910 is stated as follows:[30] + +Latin, French and German 83 per cent. +Algebra and Geometry 88 " " +English Literature 57 " " +Rhetoric 57 " " +History 55 " " +Domestic Economy,--including + sewing, cooking and household + economies 4 " " +If only barely four per cent. of the girls in our high schools are studying +subjects which directly contribute to their efficiency as home-makers, what +are the prospects for worthy parenthood in the light of the fact that +seventy-five per cent. of all women between the ages of twenty and +twenty-four are married? + +The function of the high school, so far as girls are concerned, is to +conserve health, to train for domestic efficiency and motherhood, and if +necessary for economic independence. It must also furnish the stimulus for +mental culture and direct a proper aspiration for social enlightenment. The +curriculum should include biology, hygiene, psychology, home beautifying, +the story-telling side of literature, music and a few other studies tending +to make woman more like woman than she is to-day. When we have this, +teaching for mothercraft will be more nearly realized. + +From the eugenic standpoint the present system of education is not +satisfactory. To attain our end it is essential to devise other means of +education. It must be remembered, however, that no system of education +alone can ever enable us to achieve our end, no matter how perfect the +system may be. Education can only draw out what is in the child; it cannot +draw out what is not there. What the child is, depends upon its heredity. +The pedagogic ability of the school-master will never make a genius. + +A child's mind may be likened to a block puzzle, each block representing a +part of a picture, which can only be completed when they are all arranged +in their correct places. Each block is an ancestral legacy,--the child's +heritage--and to find its proper place in order to complete the [31] +character picture--to solve the riddle of the jumbled blocks,--is the duty +of the educator. He can only manipulate what is there, and the test of his +system will depend upon his ability to solve the puzzle of the ancestral +blocks. We must divorce ourselves from the idea that a child's mind, at the +beginning, is an empty space, to be filled in with knowledge according to +the ability of the teacher; or that it is like a sheet of paper, to be +written upon. Education, and the educator, is absolutely limited to +"drawing out" what heredity put there. Education frequently is given credit +which rightly belongs to nature. A child cannot do certain things until +nature intends that it should. A baby cannot possibly walk until the +nervous mechanism which controls the function of walking is developed. Many +children walk at the first attempt, simply because they did not make the +first attempt until after nature had perfected the mechanism and the innate +ability to walk was already there. Suppose we tried to teach that baby to +walk a month before nature was ready; each day we patiently coax it to +"step out," we guide it from support to support, and we protect it from +stumbling. Some day it walks, and we congratulate ourselves on the victory, +when as a matter of fact, we not only had nothing to do with it but were +impertinent meddlers, not instructors. Nature was the teacher and she was +quite capable of completing the task without our aid. It is reasonable also +to assume that any effort to force a natural function is quite likely to do +much harm. We have found this to be so in various departments of education +when the system was wrongly conceived. In physical culture this principle +has been demonstrated over and over again. + +If our ancestral legacy is a good one, our picture blocks will be numerous +and it will be possible for the proper system of education, aided by a +suitable environment, to arrange them into many designs. If, on the other +hand, our heredity did not endow us abundantly the number of our picture +blocks may be limited to three or four, and they will be easily arranged so +as to form a simple picture. The one represents a child whom heredity has +richly endowed, the other one whom it has meagerly supplied with innate[32] +possibilities. Heredity therefore dictates the function of education; and +the school-master can only fashion the picture put there. If the ancestral +blocks are not there with which to make an elaborate picture he must +content himself with what is there,--he or his art cannot create others. +When he congratulates himself on achieving a wonderful result in graduating +a particularly brilliant student, he is taking to himself unmerited honors. +If his individual ability is responsible in one instance, why not apply the +same system to all pupils? If this system is responsible for the brilliancy +of one pupil, why does not the same system make all brilliant? The reader +knows the answer,--because heredity did not endow them equally. Men are not +born equal, despite the Declaration of Independence. + +The school-master is not responsible for the apt and the inapt pupil. He is +responsible for his system which dictates how he will differentiate between +the apt and the inapt pupil, in order to achieve the best results without +injustice to either. + +The inefficient teacher is a dangerous equation in the school system. I +mean by inefficiency, the quality of being temperamentally unsuited to the +profession. There are a large number of anemic, hysterical young women +teaching in the public schools of our cities who should not be there. They +should not be there in justice to themselves, nor should they be there in +justice to their pupils. A strict, yearly medical examination should be +made of the teachers to decide their physical and psychical fitness to fill +their positions adequately. One teacher, physically or psychically +inefficient, can do an inconceivable amount of harm in one school term. We +cannot afford to experiment along this line. It means too much, and even at +the price of one unhappy child it is too much to pay. The teacher who feels +that she is not suited to the work; who has constantly to hold herself and +her temper under control; whose nerves are such that she cannot do justice +to herself, whose sense of justice is capable of perversion on purely +sentimental grounds; or who has lost--or never possessed--the gift of +maintaining discipline, should promptly find another position. She is [33] +earning her salary under false pretenses, and that alone condemns her. I +believe, that a large percentage of the inefficiency of the New York +Schools is due, not to the academic or scholastic inability of the average +teacher, but to the average female teacher's physical, and especially her +psychical unfitness to teach. We must concede, however, that in many +instances the teacher's unfitness is a direct product of the pernicious +system itself. + +[Illustration: _From "The Village of a Thousand Souls," Gesell, American +Magazine_ + +Evidence of a Feeble Mind + +A dirty shack in a mud hole in the country is merely another reflection of +the same condition that causes the slums of the city. In our glowing spirit +of humanity we cry out to raise up "the submerged tenth." Rather, should we +not stamp them out of existence--treat them as a menace, and not as a thing +of pity? + +Men, in general, rise; their minds are subjectively or objectively educated +to their mental limit. They cannot go beyond it. "The submerged tenth" +exists because its mental limit is low--often close to the upper margins of +feeble-mindedness--and because it is mentally incapable of rising to +anything else.] + +[Illustration: _From "The Village of a Thousand Souls," Gesell, American +Magazine_ + +Evidence of a Vigorous Mind + +The family that is vigorous, healthy in mind and body, "up and coming," +reflects itself in a hundred different ways. Small matter whether or not it +is "an old family," has wealth, social position, a college education. A +daughter's or a son's happiness, the real, deep-down-inside happiness that +is worth while, may be more certainly insured by marrying with an eye to +mentality and stock than by a marriage into a so-called "first family." + +Eugenics hath its reward.] + +Under an ideal system of education the child would be left absolutely free +until the age of seven. We do not believe that the physical apparatus of +the mind is prepared for educational interference before that age, and we +know that the growth of the brain, physiologically and anatomically, is not +complete until after the seventh year. + +The greater portion of a child's education necessarily depends upon its +environment. Heredity and environment, therefore, are the two factors which +determine the characters of any living thing. Heredity gives to the child +its potential greatness,--its promise of greatness. Whether these potential +qualities ever become real depends upon environment. A child may have the +hereditary (innate) ability to become a Shakespeare, but if his environment +is not suitable to the development of this potential greatness, he will +never realize his hereditary promise. In other words, the innate qualities +which he has, and which will make of him a Shakespeare are never "drawn +out" or educated. Hence he can never become great until environment +furnishes the means to him. + +Environment, including education, does not add to the potential qualities +of inheritance. Education can only educate what heredity gives; it can give +or add nothing itself; it simply educates what is there already. There is +plenty of material, but it is not the right material. What educators want +is the right kind of material--the material which the eugenists will +eventually supply. Or as Mr. Havelock Ellis has expressed it: + +"Education has been put at the beginning, when it ought to have been put at +the end. It matters comparatively little what sort of education we give[34] +children; the primary matter is what sort of children we have to educate. +That is the most fundamental of questions. It lies deeper even than the +great question of Socialism versus Individualism, and indeed touches a +foundation that is common to both. The best organized social system is only +a house of cards if it cannot be constructed with sound individuals; and no +individualism worth the name is possible unless a sound social organization +permits the breeding of individuals who count. On this plane Socialism and +Individualism move in the same circle." + +Education, then, as an exclusive factor, cannot achieve our ideal of +race-culture. In order that education may achieve a large measure of +success, it must have the proper material, and the right material can only +come as a result of the working out of the eugenic principle. Then--in the +aftertime--our educational efforts will not be wasted and misdirected, as +they are almost wholly to-day. + +If we could transmit our acquired characteristics, education would have a +relatively smaller, and a much more fixed function in the "general scheme," +but we cannot. We can only transmit what was inherent in us when created. +This simply means that, at the moment of conception, the child is +created,--it is a completed whole,--what it is to be is fixed at that +moment, its inherent capacities are formed. Nothing can affect it, in this +sense, after that moment. No act of either parent can have any influence on +it. Whatever ability the father or mother possessed of an innate character +is transmitted to the child at the instant of conception and that innate +legacy constitutes the working instrument of the child for all time. It +cannot be added to by education, or by environment, but both of these may +have a large influence in deciding whether it will be developed to its +highest possible limit of attainment. + +Education, mental, moral and physical, is limited by this inability to +transmit acquired character to the persons educated. Each generation must, +therefore, begin, not where their parents left off, but at the point [35] +where they began. The same difficulties and the same problems must be met +at the beginning of each generation. + +THE TRUE PROVINCE OF EDUCATION.--Education may justly be the instrument, +however, which will educate public opinion to a true appreciation of the +function of race culture. In this way the cause of the eugenist will +greatly prosper, and the race will profit through the effort which will +further the conservation of the best and most fit specimens for parenthood. +So also may education, through the molding of public opinion, create sound +opinion,--when each individual will be a center of eugenic enthusiasm. +Especially does this responsibility fall upon parents and those who are in +charge of childhood. The young must be taught the supreme sanctity of +parenthood. They must be instructed in eugenic principles in a way that +will impart to them the definite knowledge that it is the highest and +holiest science. The eugenic education of children is the real beginning at +the beginning, the indispensable necessity, if race culture is to assume +its transcendent role in modern civilization. It is urgently necessary for +both sexes but more especially for girls. "Urgently necessary," because, +though Herbert Spencer wrote the following criticism nearly fifty years +ago, the conditions are much the same to-day:-- + +... "But though some care is taken to fit youth of both sexes for society +and citizenship, no care whatever is taken to fit them for the position of +parents. While it is seen that, for the purpose of gaining a livelihood, an +elaborate preparation is needed, it appears to be thought that for the +bringing up of children, no preparation whatever is needed. While many +years are spent by a boy in gaining knowledge of which the chief value is +that it constitutes 'the education of a gentleman'; and while many years +are spent by a girl in those decorative acquirements which fit her for +evening parties; not an hour is spent by either in preparation for that +gravest of all responsibilities--the management of a family. Is it that +this responsibility is but a remote contingency? On the contrary, it is +sure to develop on nine out of ten. Is it that the discharge of it is easy? +Certainly not. Of all functions which the adult has to fulfill, this is the +most difficult. Is it that each may be trusted by self-instruction to [36] +fit himself, or herself, for the office of parent? No; not only is the need +for such self-instruction unrecognized, but the complexity of the subject +renders it the one of all others in which self-instruction is least likely +to succeed." + +It must be our highest educational aim to cultivate or create the eugenic +sense. In this way, and in this way only, may we feel satisfied that the +foundation, upon which shall be erected the generations that are yet to +come, will be of an enduring character. + + * * * * * + + + [37] +CHAPTER IV + + "It is only because we are accustomed to this waste of life and are + prone to think it is one of the dispensations of Providence that we go + on about our business, little thinking of the preventive measures that + are possible." + + CHARLES E. HUGHES. + +EUGENICS AND THE UNFIT + + THE DEAF AND DUMB--THE FEEBLE-MINDED--A NEW YORK MAGISTRATE'S + REPORT--REPORT OF THE CHILDREN'S SOCIETY--THE SEGREGATION AND TREATMENT + OF THE FEEBLE-MINDED--WHAT THE CARE OF THE INSANE COSTS--THE + ALCOHOLIC--DRUNKENNESS. + +In order to achieve success in eugenics we must strive to encourage the +parenthood of the worthy or fit, and to discourage the parenthood of the +unworthy or unfit. The unfit are those, as previously explained, who, +because of mental or physical disability, are unable to create fit or +healthy children. + +THE DEAF AND DUMB.--The condition known as deaf-mutism is due to innate +defect in about half of all cases. Deaf children have one or two deaf +parents or grandparents. There may be two or three such children in a +family. That the deaf should not marry is generally conceded by those who +work amongst them. It should be our aim to discourage the intimate +association of the adolescent deaf and dumb in institutions. It has been +found that such intimate association frequently results in marriage. They +should be educated and instructed in the knowledge that they cannot marry. +When they understand the eugenic principle upon which this social law is +constructed they will be amenable to reason. No process of suasion will be +necessary, however, if their intimate association is prevented. + +THE FEEBLE-MINDED.--This includes the criminal, the imbecile, the insane, +and the epileptic. The feeble-minded, technically speaking, belong to the +degenerate class. They enter life mentally deficient, not necessarily [38] +diseased. They should, therefore, be regarded as fit subjects for +educational modification rather than for penal correction or punishment. It +is conservatively estimated that there are five million feeble-minded +people in the United States to-day and not one-eighth of them are receiving +adequate treatment or education. Recent statistics, from various countries, +show that the percentage of deficient or feeble-minded children is +decidedly on the increase. According to a bulletin issued by the United +States Bureau of Education (August, 1912) there are 15,000,000 school +children suffering from physical defects which need immediate attention and +which are prejudicial to health. It would seem as though the time had +passed for anything other than radical measures in the interest of the +race. + +Apart from the eugenic fact that these feeble-minded children are not fit +subjects for parenthood, they are a constantly contaminating influence on +society morally, and are a detriment and a hindrance to social and economic +advancement. One illustration of this contaminating process, which is of +serious eugenic import, is the presence of these deficient children in our +public schools. By reason of their lack of attention and concentration, +their mental or psychic insufficiency, their moral delinquency, and +uncontrollable instincts and impulses, they are a menace to the well-being +and to the progress of the normal or fit pupils; they retard and undermine +the discipline of the schoolroom, and they affect the efficiency of the +teachers. They are allowed to stay in school because of the indifference of +the authorities, or because of the influence and social standing, or +political "pull" of the parents, despite the recognition of the injustice +done. Many of the parents of these children seek medical advice but, +because of absurdly inadequate civic or state provision for such cases, the +physician is practically helpless. Most of these irresponsible children are +allowed to wander through the years unrestrained and unprotected. They +easily become the victims of vice and crime, and eventually they become +degenerates and end their lives in insane institutions. Because of the +stigma of degeneration these feeble-minded individuals fall into the [39] +hands of the law and are thereby robbed of the medical assistance which +society should afford them in the early years when improvement is yet +possible. + +The following report which recently appeared in one of the daily papers is +interesting and suggestive in this connection. One of the New York City +Magistrates, in his annual report, said: "There is growing up in this city +a menacing army of boys and young men who are the most troublesome element +we have to deal with.... From the ranks of these rowdies that are organized +in bands, or bound up with chums or pals, come most of the crop of +burglars, truck thieves, holdup men, gun-bearers, so-called 'bad men' and +other criminals and dangerous characters. Without reverence for anything, +subject to no parental control, cynical, viciously wise beyond their years, +utterly regardless of the rights of others, firmly determined not to work +for a living, terrorizing the occupants of public vehicles and disturbing +the peace of the neighborhoods, they have no regard for common decency." + +But it is to the records of the Children's Society that one must go for +reliable statistics of the potential criminal, as there the only systematic +study of their conditions is made and recorded by one of the greatest +neurologists in the country, Dr. Max Schlapp, of New York. As a specialist +in nervous diseases he has been connected with the Children's Society and +the Children's Court, where he has had wide opportunities for observing the +relation between delinquence and mental defectiveness. In cases of +viciousness or feeble-mindedness exhaustive studies have been made by Dr. +Schlapp. And the extent to which society is daily at the mercy of +uncontrolled potential criminality is alarming. + +"Feeble-minded children and feeble-minded men," says Dr. Schlapp, "are +roaming about the streets of New York to-day as free agents. Parents are +not compelled by law to put a feeble-minded child in custody. Yet that +feeble-minded child unsuspected as such, amiable and care-free as he +usually is, is potentially a criminal, and at any moment may commit a +crime. That child is permitted to grow up without restraint, except [40] +such as the parents exercise, and this has no effect whatever in these +cases. The child is allowed to marry and bring forth children of his own +kind, more feeble-minded and more dangerous. There is no system designed to +pick out from the community persons so afflicted, and no law whatever to +prevent their untrammelled movements. + +"The city street is a recruiting ground for the gangster because it is full +of defective children, mental and moral, who are potential criminals. This +question has never been seriously considered. When brought under corrective +restraint it has hitherto long been the custom to herd all the cases +together while serving time. But in 1894 the German Government woke up to +the fact that 3 to 7 per cent. of city children and those of isolated rural +communities contain the 'moron,' or intellectually defective type, together +with the moral imbecile." + +Investigation showed recently that in a reformatory near Berlin 63 per +cent. of the inmates were abnormal, while over 50 per cent. were seriously +defective or menaces to society. This has since been shown to exist in all +the leading nations--England, France, Italy, where, by the way, the +Camorrist type is the equivalent for our New York gangster. In the Elmira +Reformatory 38 per cent. are, as a rule, feeble-minded and consist of types +that repeat their offense against society or commit some other crime. + +There is only one way to prevent these types from becoming a menace. +Restrain them while they are still developing; keep them from becoming free +agents in the community they menace. Types continually come up in the +Children's Society and the Children's Court. They are carefully studied. +From the actions of the child, from his parents and family history, from +the frequency with which he repeats some offense particularly pleasing to +him, and by virtue of psychological tests and careful medical examinations +the examiners are able to pick out children who should receive scientific +care and treatment. + +"The characteristics of the feeble-minded are usually deceiving. One +expects to find them with low brows and furtive looks and more or less +vicious in appearance after they develop criminal tendencies. One would[41] +expect them to show stupidity at a glance. On the contrary, they are +sometimes bright on the surface, amiable, good-tempered under trying +conditions, and almost likeable for their external social side. This is +particularly true of the high grade defectives. The lower order may be +taciturn, gloomy and retiring, and these traits may be noticed almost from +infancy. But as they grow up their social nature may be developed, and they +too may give the appearance of amiableness. One notable thing about them is +their pose of frank innocence. In this they are engaging, and almost +convincing. + +"The street type that makes a gangster is practically the same if cruder in +development. These children usually exhibit absolutely no sign of affection +for their parents, no sympathy, and are notably cruel toward animals. One +boy we had in the Children's Society persistently killed all the dogs and +cats his family kept. Finally, when they ceased keeping the animals he got +at the canary cage and killed the bird by pulling the feathers out singly. +He had no compunction about lying, and looked you right in the eye when he +lied. Otherwise he was charming and natural." + +While moral insanity is hereditary, yet it can be produced in one +generation. An alcoholic man with clean antecedents may leave tainted +descendants. The only way to combat these conditions in the city is to have +strict registration of all feeble-minded and insane. The state should +discover them, examine them through public officials, and segregate them. +Not only physicians, but school teachers and officials in public +institutions should detect them. There should be in each state an +institution for feeble-minded delinquents. + +The history of the average "gangster" shows a taint of alcoholism. This is +further aggravated by living under immoral surroundings, where petty crimes +like stealing and lying are considered "smart." This is the starting point +of the New York "gangster." He is handicapped, and under ancestral +disabilities and the disadvantages of environment that is pernicious, he +cannot get very far. A boy usually qualifies with a gang on his own [42] +personality and tastes. He will often wander from one gang to another until +he has found his particular atmosphere. The best will never find any one +gang congenial enough to hold him, and he finally emerges a decent citizen. +It is all a process of finding himself. The aim of the police should be to +discount as much as possible any swaggering and false hero worship. + +The time has come when this great nation should take national cognizance of +this problem. There should be a national institution on some isolated +island. Civilization is coming to recognize such a necessity. With a close +eye on the tide of immigration and a careful segregation of these defective +types, we should soon rid ourselves of what is now growing to be a serious +menace to the home and the nation. + +THE SEGREGATION AND TREATMENT OF THE FEEBLE-MINDED.--Dr. John Punton, of +Kansas City, Mo., in an able and exhaustive article on "The Segregation and +Treatment of the Feeble-Minded," writes as follows: + +"Your attention is directed to a recent report issued by Wentworth E. +Griffin, Chief of Police of Kansas City, Mo., in which he claims that +recently within six months' time no less than 2,480 juveniles were arrested +charged with crimes ranging from vagrancy to murder and that the majority +of these boys and girls were not normal children, but degenerates who +required medical rather than penal treatment. 'Boys and girls,' says he, +'should not receive correction in the city jails, the work house or +reformatories. These should be the last resort. To correct a boy you must +have an idea of his mental processes. It is natural that the parents +understand something of the child and use that knowledge to make a good boy +out of him. Certainly it cannot be done in the reformatories, for although +the authorities there are competent, they are hardly medical psychologists. +In my opinion, if any progress is to be made it is the parent and the +doctor that must do the work, not the police and the courts.' + +"That our Chief of Police deserves credit for not only publishing this +report, but also for the advanced position he takes in recognizing the +appropriate care and treatment of the juvenile offender, is certain, [43] +for he understands the fact that the parents are often the chief culprits +in the child's delinquency and that medical rather than penal treatment is +more often indicated than is at present allowed or practiced. + +"When we come to inquire into the cause of feeble-mindedness, alcoholic +heredity, syphilitic heredity, and consanguineous marriages are found to be +the chief etiological factors. Bourneville claims that 48 per cent. of the +idiots and imbeciles are the offspring of alcoholic parents.... Acute and +chronic diseases in the parents, fright, shock, injuries, parental neglect, +faulty education, poverty, malnutrition, social dissipation and lack of +proper control are all well-known factors in the production of +feeble-mindedness. + +"Segregation of the feeble-minded is advocated by medical authority the +world over, and when this is done they can be made under appropriate +medico-pedagogic treatment to become largely self-supporting. + +"As an economical as well as a humane measure, the various States can well +afford to make such provision, more especially for the large body of +feeble-minded who are now without any medical care whatever. Moreover, +where it is possible, laws prohibiting the marriage of such as well as all +other defectives should be passed and enforced." + +WHAT THE CARE OF THE INSANE COSTS.--The total cost of the care of the +insane, in this country, has been estimated to be $165,000,000 a year. In +estimating the cost of the insane we must take into account the value or +worth of each adult to the State. This value has been computed to be $700 a +year. If, upon this basis, we count the adult membership of the insane +class between the ages of eighteen and forty-five, we find that their worth +is roughly about $132,000,000. + +The cost of maintenance in the various insane institutions is about +thirty-three millions of dollars a year. It would be quite possible to +justly increase this total by estimating the worth of the help whose whole +time is devoted to the care of the insane. If these individuals worked at +some other trade or profession, their time would. be of value to the [44] +state in general--not to a class who should be non-existent. The cost to +the state of the potential criminal is not included in this estimate. + +From the above figures it may be observed that it costs more to simply +maintain the insane each year than it costs to work the Panama Canal; or to +pay for the total cost of the Executive, Legislative and Judicial +departments of our government. The total cost is more than the entire value +of the wheat, corn, tobacco, and dairy and beef products exported each year +from this country. + +ALCOHOLIC DRUNKENNESS.--Alcoholism is a sign and a symptom of degeneracy +and is a distinct indication of unfitness for parenthood. The only cure for +alcoholism is to prohibit parenthood. It has been proved that alcohol taken +into the stomach can be demonstrated in the testicle or ovary within a few +minutes, and, like any other poison, may injure the sperm or the germ +element therein contained. As a result of this intoxication of the primary +elements, children may be conceived and born who become idiots, epileptics +or feeble-minded. It is asserted that 48 per cent. of all the idiots and +imbeciles are the offspring of alcoholic parents. + +Recent experiments show that parental alcoholism alone can determine +degeneration. Mr. Galton quoted the case of a man who, "after begetting +several normal children became a drunkard and had imbecile offspring"; and +another case has been recorded of a healthy woman who, when married to a +drunkard, had five sickly children, dying in infancy, but in a later union +with a healthy man bore normal and vigorous children. + +Dr. Sullivan found on inquiry that: + +.... "Of 600 children born of 120 drunken mothers 335 died in infancy or +were still-born, and that several of the survivors were mentally defective, +and as many as 4.1 per cent. were epileptic. Many of these women had female +relatives, sisters or daughters, of sober habits and married to sober +husbands. On comparing the death rate amongst the children of the sober +mothers with that amongst the children of the drunken women of the same +stock, the former was found to be 23.9 per cent., the latter 55.2 per +cent., or nearly two and a half times as much. It was further observed [45] +that in the drunken families there was a progressive rise in the death rate +from the earlier to the later born children." + +Dr. Sullivan cites as a typical alcoholic family one in which the first +three children were healthy, the fourth was of defective intelligence, the +fifth was an epileptic idiot, the sixth was dead born, and finally the +productive career ended with an abortion. + +The nervous systems of many children of alcoholic parents are wrecked for +life; many die in convulsions as infants. Many, however, who do not die, +live as epileptics. This action of alcohol on the health and vitality of +the race is the most serious of the evils that intemperance brings on the +community. The tendency of all children of alcoholics is toward nervous +disorders of a grave type. + +Statistics show a very high rate of still-births and abortions among the +children of drunken mothers, show that drunken women must not be permitted +to become mothers. + +Dr. Branthwaite in a lecture stated: "In my judgment, habitual drunkenness, +so far as women are concerned, has materially increased, during the last +twenty-five years, which I have spent entirely amongst drunkards and +drunkenness. These people are not in the least affected by orthodox +temperance efforts; they continue to propagate drunkenness, and thereby +nullify the good results of temperance energy. Their children, born of +defective parents, and educated by their surroundings grow up without a +chance of decent life, and constitute the reserve from which the strength +of our present army of habitual drunkards is maintained. Truly we have +neglected in the past, and are still neglecting, the main source of +drunkard supply--the drunkard himself; crippled that and we should soon see +some good results from our work." + +Dr. Fleck, another authority, says: "It is my strong conviction that a +large percentage of our mentally defective children, including idiots, +imbeciles and epileptics, are the descendants of drunkards." + +Therefore the chronic inebriate must not become a parent. + + * * * * * + + + [47] +CHAPTER V + + "The real undermining of health is not seen. It is done in an insidious + way. It has to be carefully ferreted out." + + DR. HARVEY W. WILEY. + +WHAT EVERY MOTHER SHOULD KNOW ABOUT EUGENICS + +In the preceding pages we have written about eugenics as a science; it is +our intention now to point out briefly in just what way eugenics directly +concerns the mothers of to-day. In the first place let us try to appreciate +what it will mean to the race if "the fit only are born." "Fit" children, +it will be recalled, means children born healthy of healthy, selected +parents, parents with a good ancestral history, conveying to their +offspring a reasonably adequate legacy. If the "fit only are born" we start +with a healthy stock. What a significant and tremendous advantage this is. +At once we rid the world of the potential inefficients--the feeble-minded, +the insane, the criminal, the deaf-mute, the drunkard. If we are correct in +assuming that the reason why all former civilizations have failed and +passed away, was because they bred a race of people physically and mentally +unfit to survive, the demand of the eugenist that only "fit children shall +be born" will strike at the very root of this evil. If we uproot the cause +of racial degeneration we begin the building of a race that should not +degenerate. If we establish a race that will not degenerate, it must gain +strength and virility with each generation. + +This assumption is logically correct, but we must do more than breed "fit" +children. We must take care of them after they are born. We must furnish +them with a good environment (see page 3). Heredity without favorable +environment counts for very little,--we must never forget that. Heredity +and environment are the two important determining factors in the life of +every child born. If eugenics furnishes the heredity by ensuring the [48] +birth of the "fit" only, it depends upon the mothers of the race to provide +the environment. Every mother must know how to take the best care of +herself and of her child. This book is devoted to instructing her in the +details of this duty. + +We cannot hope, however, to reach this high altruistic plane by simply +taking the first step in the right direction. We who are alive to-day must +begin the work, and leave it to posterity to carry forward. We must do our +part. Every mother must become an enthusiastic eugenist. If she begins to +teach, and preach, and practise its principles now, she will contribute to +the heredity of unborn generations. To those of us who are alive to-day, +environment is the vastly more important consideration, for our heredity is +fixed and beyond the power of control. The question of eugenics for the +present generation, therefore, is a question of environment. + +All our efforts must be directly in developing what heredity gives our +children. We are wholly responsible for that. We must feed and clothe them +properly; we must provide air spaces and playgrounds for exercise; we must +educate them, and protect them from disease; and we must safeguard the +birth of future generations by keeping our race stream pure. This is no +small task, and the only way it will ever be satisfactorily accomplished is +for each mother to realize her individual trust. The average individual +does not realize the actual conditions that prevail. When recently the +question of the public health was investigated by competent authorities, +and the report furnished to the United States Senate, it caused a +tremendous sensation. If that is possible in a body composed of men who are +supposed to be intelligent and wide-awake to existing conditions, how much +more significant and appalling it should be to the average mother whose +interest is centered in her own home. + +According to the statistics and statements given in that document the +annual financial loss from needless deaths and accidents alone amounted to +$3,000,000,000. [Page 49] + +Acute diseases are held responsible for a large part of the loss. Chronic +diseases are responsible for the greatest part of the waste of life, and +they are believed to be increasing in their ravages. Minor ailments, +believed to be nine-tenths preventable, are now costing the nation many +dollars through incapacitation of persons and through leading to serious +illness. Industrial accidents, largely preventable, are also exacting a +heavy toll annually. + +That this great waste of life and health and the national economic loss +that results can be modified by national action is asserted. Here are to be +found the reasons advanced for a great national department of health. The +work of this department would be varied. It would include direct work in +promoting health on the part of the government, such as administering the +food and drug act; aiding the healing and educational agencies, both city +and State; obtaining information concerning the cause and prevention of +diseases, and disseminating scientifically proved information on all health +subjects. + +It is maintained that the movement for the conservation of health is the +most momentous of the conservation movements in this country, and that of +all the national wastes which are to be condemned, this waste of health is +the gravest. + +Many startling statements are set forth in the document. Dr. Charles +Wardell Stiles, of the United States Public Health and Marine Hospital +Services, declares that "The United States is seven times dirtier than +Germany and ten times as unclean as Switzerland." He declares that: "Lack +of interest in preventive measures against diseases is slaughtering the +human race." He takes the position that the real trouble is not so much +race suicide as race slaughter, and that it is rather that too many +children are allowed to die than that not enough children are born. + +It is estimated that tuberculosis, a preventable disease, costs the nations +$1,000,000,000 annually. Typhoid fever is estimated by Dr. George M. Kober, +dean of the medical department of Georgetown University, to cost over +$300,000,000 annually. [Page 50] + +In connection with acute diseases this statement is made: "The loss from +tuberculosis has been reduced to half of what it was thirty years ago. +Nevertheless, of the 90,000,000 people now living in the United States at +least 5,000,000 will be lost through this disease because adequate effort +is not made to prevent it. Besides the economic waste through deaths from +any disease, the waste through sickness from the same disease is also +colossal." + +Great as are the reductions in the rates of infant mortality by improved +milk and water supplies and by educational campaigns, the present rate is +still enormous. + +"If some witch or wizard could conjure up the unnecessary babies' funerals +annually occurring in this country it would be found that the little +hearses would reach from New York to Chicago. If we should add the mourning +mothers and friends, it would make a cortege extending across the +continent." + +While the death rates from acute diseases have been greatly reduced, the +rates from chronic diseases have been steadily increasing. Cancer is one of +the chronic diseases apparently on the increase. + +That the annual death toll and the 3,000,000 constant sick beds could be +reduced from one-fourth to one-half by proper measures is asserted. In +other words, there might be saved every day, as many lives as perished on +the _Titanic_, with the consequent enormous economic saving. + +These are surely impressive statements. It would seem as though it should +be a simple task to pass a Public Health Bill, establishing a bureau in +Washington, with a representative in the cabinet, whose sole duty it would +be to preserve the public health. It has proved rather the reverse, +however. We have been able to inaugurate various species of +conservation,--of lands, of forests, of water,--but the conservation of +human life is not important enough. Even though states and empires depend +upon their people for their very existence, our statesmen feel that human +life is too cheap, too common, to take immediate steps in this direction. + +If women--especially mothers--would devote themselves to the eugenic [51] +end of legislation, men would soon obey. The application of eugenics to the +human species, coming, almost in the spirit of an inspiration, at the time +when women are about to be enfranchised, is significant. It may be that +destiny has decreed that the one shall be the complement of the other; it +is certainly beyond contradiction that in eugenics the women of the earth +have a divine weapon with which to wage a righteous and an awaking +propaganda of truth. + +A mother should be interested in every phase of the subject. Her daughter's +success in marriage should intimately concern her. Her health and her +happiness in that sphere should elicit her deepest maternal consideration. +She may rightly hope to be proud of her daughter's offspring, and to find +pleasure in the society of her grandchildren. She should, therefore, devote +all her efforts to ascertain the truth, with reference to the physical and +mental equipment of her future son-in-law; his ability adequately to +support a family; his sobriety, his disposition, associates, etc., should +all be carefully considered and pondered over. This is not going far +enough, however; we must know positively that he is not diseased,--that he +is not a victim of gonorrhoea or syphilis. + +When parents weigh in the balance the possibility of a wrecked life, of +destroying the right to have children, or of bringing them into the world +blind or diseased; of permanently destroying the hope of happiness, peace, +and success, no combination of advantages in a son-in-law is deserving of +the slightest consideration. We are treating of the sacred things of +life--of life itself. If parents combine to crucify and betray their +daughters--to sell them body and soul into bondage for social or other +advantages; if they preserve silence when they should speak and thereby +take all the sunshine, for all eternity, out of one existence; then, if on +their death-beds these daughters should accuse them, the guilty knowledge +that they were responsible will be the sting that will blast their hope of +peace and forgiveness here and in the worlds to come. + +When mothers realize that, every day, in every large hospital in every city +in the civilized world some woman (a daughter of some mother) is being [52] +unsexed because of these unjustly obtained diseases, surely their voices +shall speak in no uncertain way. + +Another eugenic suggestion that should deeply concern every good mother is, +that the mother's milk is the private property of the babe, and whoever +deprives the babe of this, the sole right it possesses, is not only a thief +but a scoundrel. A curious and significant fact was discovered by +investigators when studying the question of infant mortality a few years +ago. It was found from a mass of statistics that there were two recent +instances when the death rate of infants decreased suddenly and quite +decidedly. The first instance was when the Civil War in this country caused +a cotton famine in England. As a result of the famine the factories of +Lancashire were all closed and the employees being then without work +remained at home. As a large percentage of the workers were married women +with children they had the time and the opportunity to nurse their children +regularly. Despite the fact that these women were starved and badly clad +and deprived of the comforts of home, the death rate of the infants dropped +steadily to an unprecedently low mark. + +A number of years later, when the German army surrounded Paris during the +Franco-Prussian War the besieged inhabitants of the capital suffered from +hunger and disease. The death rate of the adult population increased +enormously while the death rate of the infants dropped markedly. + +The explanation of this curious phenomenon was simply that while times were +normal the women labored outside of their homes and as a consequence the +babies were not fed regularly and when fed were not fed mothers' milk. It +demonstrated a truth that we are apt to lose sight of, that mothers' milk, +even the milk from badly-nourished, poverty-stricken mothers is infinitely +better than an abundant supply of artificial food combined with neglect. In +view of the fact that there is a distinct tendency to evade this maternal +duty these facts should be suggestive and important. It is the duty of the +mother with any eugenic sense to preach and to practise this gospel. [53] +Paris learned the lesson of the siege because though she has the smallest +birth-rate to-day, she nevertheless has the smallest infant death-rate of +any large city in Europe. + +The writer believes that in eugenics the women of the race have the +instrument wherewith to save the world. He is assured that it is the +supreme potential agency for the betterment of the race, and that mankind +will never be inspired with a holier cause. He believes that through all +the ages the human race has been growing better, coming nearer the truth, +and that as a result of this patient progress, there has been evolved the +eugenic idea that is to solve the problems of the human family. If the "fit +only are born" think of the possibilities of education and of environment. +Each child is born with a great potential promise, and endowed with a +reasonably good heredity, the whole effort of that child will be toward a +higher moral attainment. If the effort of the individuals of the race is to +achieve a high moral success, the quality of the civilization of future +generations will be far superior to the type with which we are familiar. + +Eugenics gives to women the supreme civilizing instrument of the future. It +places the burden of the morality of the home and of the race on their +shoulders. If we deny the writing on the wall it does not render the +warning negative. The signs of the times are epochal. The great political +parties are realizing, for the first time in history, that new and +important issues concerning the family, the home, and the children, in +other words the nation's manhood and womanhood, must be considered and +included in their platforms. They know that the time has gone when +statesmen will exclusively decide what shall be done with the sons and +daughters which women bring into the world. They know that the mothers of +the race must have a voice in deciding for peace or war since they create +every soldier that will lie dead when war is over. Women will help decide +the question of taxation by government and by trusts, because they know +that it comes out of their incomes and they need it all for their children. +Women know that their cause is the cause of freedom, and freedom is the[54] +cause of the eugenist. They know that the function of government should be +justice and no code of justice can have higher ethics than the ethics of +eugenism. + +MOTHERS' EUGENIC CLUBS.--There should be established in every community a +mothers' eugenic club. The object of the club should be to further the +eugenic idea. Papers should be prepared, read, and discussed on subjects +having a eugenic interest. + +One of the main aims of these clubs should be to interest the local +Congressman and the member of the State Legislature in eugenics. In all +probability they will know nothing specific about race-culture--unless they +are exceptional men--in which case it will be the duty of the members of +the club to educate them. The object of such education of course would be +to ensure that they will act intelligently when any legislative proposal is +made having a eugenic interest. Find out what they know about the public +health as contained in the report on page 48, and if they will vote in +favor of a Public Health Bureau. You should know how your representatives +stand on the Pure Food and Drugs Act; if they really appreciate the +significance of the measure; if they would be in favor of pensioning +mothers and widows who have children depending upon them; what their views +are regarding compulsory marriage licenses; the reporting of venereal +diseases to the local health authorities; if they would favor the +segregation of the feeble-minded and their maintenance and treatment by the +state; if they endorse the eugenic principle that "the fit only shall be +born," and if they really understand just what that means. + +If the mothers in every community would take this step, they could control +the legislation affecting such subjects in a comparatively short time. If +the various States concede to women the right to vote--as they will sooner +or later--such mothers' clubs would have a large and intelligent share in +educating the women's votes on questions which directly concern their own +immediate and remote welfare. + +The question of education would concern these clubs and much could be done +by mothers to direct the authorities as to just what is needed to educate +for [Page 55] parenthood, along the lines suggested elsewhere in this book. + +A mothers' eugenic club would rightly become an instrument for good in all +local sociological interests. It could maintain a trained nurse to care for +the sick and helpless, to teach the people how to live, and how to care for +their homes and their children. The members themselves could visit the +poor, the needy, and the sick. + +There are so many people in the world who are near the brink of +failure,--so many who need a little hope infused into their lives,--and so +many who are really deserving of help and sympathy and inspiration. The +women who do this work for the work's sake are amply repaid by the good +they find to do. The doing of such work is a consecration and an education. +Life means more, and the whole temperament reflects a truer sympathy and a +stronger purpose. + +There are many mothers, for example, who are willing to do what is +essential in the interest of their children, but they do not know what +should be done. These people cannot afford a physician or a nurse to teach +them, nor do they even know that their methods are wrong or that they need +any instruction. We must carry the information and the explanation to them. +We must show them the need for a change of methods. This is the work for +those charitably disposed women who desire some worthy purpose in life, who +really wish to do some genuine good. All the equipment they need is good +common sense. They will explain why it is essential to pasteurize the milk +before feeding it to the baby because most of the milk used by the poor is +unfit for use as a baby food. They will show how to keep the nipples and +the bottles clean, and they will give them lessons on how to prepare the +food to the best advantage. They will instruct them how to dress the baby +in hot weather, and they will explain why it is necessary to provide the +baby with all the fresh air possible. They will gain the confidence of +these mothers and they will tell them all they know, in tactful and +diplomatic and common-sense language so that they may appreciate the +eugenic reasons for everything they do regarding the care and well-being of +the baby. In every city in the country this work is needed and is [56] +waiting for the missionaries who will volunteer. To teach mothers the need +for boiled water as a necessary drink for baby and older children is alone +a worthy avocation. To impress upon one of these willing but ignorant +mothers the absolute necessity for washing her hands before preparing +baby's food, that she must keep a covered vessel in which the soiled +napkins are placed until washed, that she should frequently sponge her baby +in hot weather,--and explain thoroughly why these are important +details,--is a work of true religious charity. They should be taught to rid +their houses of flies, and especially to keep them from the baby and from +its food, bottles, and nipples. They should be instructed to discontinue +milk at the first sign of intestinal trouble, to give a suitable dose of +castor oil, and to put the child on barley water as a food until the danger +is passed. They should be taught to know the serious significance of a +green watery stool, that it is the one danger signal in the summer time +that no mother can ignore without wilfully risking the life of her baby. +They should be shown how to prepare special articles of diet when they are +needed. If every mother were educated to the extent as indicated in the +above outline the appalling infant mortality would fall into +insignificance. It is not a difficult task, nor would it take a long time +to carry out; it is the work for willing women who have time and who +perhaps spend that time in less desirable but more dramatic ways. It is +education that is needed, and it is education that is willingly received, +as all mothers are ready to devote their time in the acquirement of +knowledge that will help them save their offspring. This is the eugenic +opportunity and it is an opportunity that should devolve upon the women of +the race. + +Such a mothers' club would receive the willing financial support of the men +of the community. It should be placed upon a sound financial basis because, +to be successful, it would have to bestow much material aid. I know of +clubs that are self-supporting, however. Each club needs a leader to begin +it; will the reader be that one in her Community? + +A Mothers' Eugenic Club would of course discuss the practical side of [57] +the eugenic question: the proper feeding and clothing of children; hygiene, +sanitation, housekeeping and homemaking, and the efficiency and health of +each member of the home, and all other topics of interest to every wife and +mother. The writer believes that in the very near future we shall have a +Mothers' Eugenic Club in every community in the United States; that these +clubs will be guided by, and be an instrument of, a National Eugenic +Bureau, composed of women, that will cooeperate and harmonize the work as a +whole, so that the conservation of human life will be effected to its +maximum extent; that the excessive infant mortality will be overcome, +because ignorant and incompetent mothers--the greatest cause of infant +mortality--will be educated and instructed in the rudiments of eugenics and +will consequently, to a large extent, cease to be ignorant and incompetent; +that the desecration of young wives will stop, and stop forever, because +vice and disease will be branded and exposed; that the feeble-minded, the +deaf-mute, the imbecile, and the insane, will no longer be allowed to +propagate their kind, to the permanent detriment of the race. + +When such clubs are established, and when all mothers do their individual +duty in the interest of the race, we shall begin to see the dawn of a +promise that will achieve its supreme success in the generations that will +people the earth in the eugenic aftertime. + + * * * * * + + + [61] +CHILD-BIRTH + +CHAPTER VI + + "Solicitude for children is one of the signs of a growing civilization. + To cure is the voice of the past; to prevent, the divine whisper of + to-day." + + KATE DOUGLAS WIGGIN. + +PREPARATIONS FOR THE CONFINEMENT + + THE BIRTH CHAMBER--WHAT TO PROVIDE FOR A CONFINEMENT--READY TO PURCHASE + OBSTETRICAL OUTFITS--POSITION AND ARRANGEMENT OF THE BED--HOW TO + PROPERLY PREPARE THE ACCOUCHMENT BED--THE KELLY PAD--THE ADVANTAGES OF + THE KELLY PAD--SHOULD A BINDER BE USED?--SANITARY NAPKINS--HOW TO + CALCULATE THE PROBABLE DATE OF THE CONFINEMENT--OBSTETRICAL TABLE--WHEN + SHOULD A PREGNANT WOMAN FIRST CALL UPON HER PHYSICIAN--REGARDING THE + CHOICE OF A PHYSICIAN--HOW TO KNOW THE RIGHT KIND OF A PHYSICIAN FOR A + CONFINEMENT--THE SELECTION OF A NURSE--THE DIFFERENCE BETWEEN A TRAINED + AND A MATERNITY NURSE--DUTIES OF A CONFINEMENT NURSE--THE REQUISITES OF + A GOOD CONFINEMENT NURSE--THE PERSONAL RIGHTS OF A CONFINEMENT + NURSE--CRITICIZING AND GOSSIPING ABOUT PHYSICIANS. + +THE BIRTH CHAMBER + +The room in which the confinement is to take place should be selected with +care. In many cases there will be no choice for the reason that there will +be only one suitable bedroom available. Where practicable however a room +having the following accessories, or as many of them as is possible, should +be given the preference. + + 1.--Good light, and a southern exposure. + + 2.--Capable of being well ventilated and well heated if necessary. + + 3.--Running water if plumbing is modern. + + 4.--Fairly large size (not a hallroom). + + 5.--A quiet room, free from street noises. + +If the house is a private one the room should be on the second floor. If +the home is in an apartment house the confinement chamber should be as [62] +far removed from the living-room as circumstances will permit,--especially +if there are other children who will make more or less continuous noise. + +All unnecessary furniture, pictures and draperies should be taken out of +the room a few days before the confinement is due; the room itself, and +everything left in it, should be thoroughly cleaned and aired. A small +table for holding instruments, sterilizing basins, etc., should be provided +and in readiness. + +WHAT TO PROVIDE FOR A CONFINEMENT.--The following articles should be in +readiness at all confinements:-- + + 1.--Douche pan. + + 2.--Bed pan. + + 3.--Douche bag (fountain syringe) with glass douche tube. + + 4.--One rubber sheet 11/2 yards square. + + 5.--Two bed pads, one yard square, made of absorbent cotton or old + clean cloths, covered with washed cheese cloth and stitched here and + there to hold in place. + + 6.--One dozen clean towels. + + 7.--One-half dozen clean sheets. + + 8.--A hot water bottle. + + 9.--One pound absorbent cotton (good quality). + + 10.--Five yards sterile gauze. + + 11.--Four quarts of hot, and as much cold water, that has been boiled. + + 12.--One-half dozen papers assorted safety pins. + + 13.--One box sanitary pads. + + 14.--Four pieces of unbleached cotton or muslin, one and one-quarter + yards long. + + 15.--Four ounces powdered boracic acid. + + 16.--Four ounces of brandy or whisky. + + 17.--One jar of white vaseline (unopened). + + 18.--One cake of castile soap. + + 19.--Two or three agate or china hand basins. + + 20.--One slop jar. + + 21.--One pan under bed for after birth. + +The physician will direct that certain additional articles be provided +according to his individual taste and custom. These will include an [63] +antiseptic and ergot; any other requisite found necessary can be sent for, +or the physician can supply it, as he invariably has in his bag whatever +may be required in complicated cases or in an emergency. All the items +enumerated in the above list are absolutely essential, they may not all be +used but it would not be safe to undertake a confinement without providing +the essential requisites. Many maternity outfits are prepared ready for use +and can be obtained at the larger drug stores, costing from $10 to $25. The +articles in the above list can be bought for about $6, not including those +articles which the patient is assumed to have. The following are samples of +the ready-to-purchase outfits: + +READY-TO-PURCHASE OBSTETRICAL OUTFITS + + OUTFIT NO. 1 + 1 Sterilized Bed Pad (30 inches square). + 2 dozen Sterilized Vulva Pads. + 2 Sterilized Mull Binders (18 inches wide). + 5 yards Sterilized Gauze. + 1 pound Sterilized Absorbent Cotton (1/2 pound). + Rubber Sheet, 11/2 yards by 2 yards, Sterilized. + Douche Pan, Sterilized. + 1 Tube K-Y Lubricating Jelly. + Sterilized Nail Brush. + Boric Acid, Powdered. + Tinct. Green Soap. + Bichloride Tablets. + Lysol. + Tube Sterilized Tape. + PRICE $10.00. + + OUTFIT NO. 2. + 2 Sterilized Bed Pads (30 inches square). + 2 dozen Sterilized Vulva Pads. + 2 Sterilized Mull Binders (18 inches wide). + 6 Sterilized Towels. + 10 yards Sterilized Gauze. + [Page 64] + 1 pound Sterilized Absorbent Cotton (1/2 pound). + Rubber Sheet, 1 yard by 11/2 yards, Sterilized. + Rubber Sheet, 11/2 yards by 2 yards, Sterilized. + 4 quart Sterilized Douche Bag with glass nozzle. + Douche Pan, Sterilized. + Sterilized Nail Brush. + 2 Agate Basins, Sterilized. + Safety Pins. + 2 Tubes Sterilized Petrolatum. + 1 Tube K-Y Lubricating Jelly. + Boric Acid, Powdered. + 100 grms. Chloroform (Squibb's). + Fl. Ext. Ergot. + Tinct. Green Soap. + Bichloride Tablets. + Lysol. + Tube Sterilized Tape. + Sterilized Soft Rubber Catheter. + Sterilized Glass Catheter. + Stocking Drawers, Sterilized. + Talcum Powder. + Bath Thermometer. + PRICE $19.50. + +These materials, being cleansed and sterilized, are ready for use at any +time. + +These complete outfits are packed in neat boxes, thus enabling the contents +to be kept intact until needed. + +THE POSITION AND ARRANGEMENT OF THE BED.--The bed should be a substantial +single bed. If a double one is used, prepare the side for the confinement +which will permit the physician to use his right hand,--that will be the +right side of the patient as she lies in bed. One objection to a double bed +is its tendency to sag. This tendency can be obviated however by placing an +ironing board under the spring from side to side, or by using shelves from +a book case. This expedient will support the mattress, thereby rendering +the bed firm and free from any sagging tendency. The position of the bed in +the room should be such that the patient will not directly face the window +light, nor be in a direct draught between the window and the door. It [65] +should be so arranged that the nurse can get easily to either side, +consequently it must not be pushed against the wall. + +HOW TO PREPARE THE ACCOUCHMENT BED.--Over the mattress place the rubber +sheet so that its center will be exactly under the hips of the patient. Pin +with large safety pins each corner of the rubber sheet to the mattress; now +put the sheet on exactly as you do when making an ordinary bed. On top of +the sheet, and in the middle of the bed (again where the patient's hips +will rest), place a draw sheet. A draw sheet is a sheet folded once, placed +across the bed, and pinned tightly with large safety pins to the mattress +at each side. The advantage of this sheet is, that it can be removed when +necessary, leaving the original clean sheet on the bed, without disturbing +the patient. Be particular not to have the top of the draw sheet higher +than the middle of the patient's back. Place the pad,--previously prepared +for the purpose,--on the draw sheet and level with the top of the draw +sheet. + +Most physicians carry with them to all confinements a _Kelly pad_. A Kelly +pad is a rubber pad with inflated sides, which is put under the patient's +hips, and which retains all the discharges incident to a confinement so +that when it is removed the bed is clean and fresh. The advantage of the +Kelly pad is twofold; first, it ensures a clean, compact, systematic +confinement; second, its use subjects the patient to the least necessary +movement at a time when movement is distressing, painful, and frequently +dangerous. If a Kelly pad is not used, it is desirable to place under the +pad (between the pad and the draw sheet) a piece of oil cloth or rubber +sheeting, or a number of newspapers will do. This will prevent, to a +considerable degree, the discharges from soaking through the pad on to the +draw sheet and sheet and mattress below. + +After the confinement is over and the patient is clean, remove the Kelly +pad, and the pad below if necessary, or the pad and newspapers if these are +used,--place a clean pad under the patient and you are ready to place the +binder on if a binder is to be used. [Page 66] + +SHOULD A BINDER BE USED?--Medically a binder is not necessary, neither is +it objectionable from a medical standpoint. It is supposed to hold the +flaccid, empty womb in place. This it does not do and we are of the +opinion, that it, in many instances, according to how it is put on, +compresses the womb out of place. The binder is certainly appreciated by +most patients because of its snug, comfortable feeling; and in cases when +the abdominal wall is fat and the muscles soft, it holds them together in a +way that is impossible by the use of any other device. To claim that the +binder prevents hemorrhages is absurd. Our personal rule is to put one on +if the patient wants one, or if she has previously had one. To be +effective, in any sense, the binder should extend from the waist line down +to halfway between the hips and knees and should be snugly, but not too +tightly pinned. + +SANITARY NAPKINS.--These can be purchased already prepared in most drug +stores, or they can be made in the following manner: Take an ordinary grade +of cheese cloth, wash it, and when dry, cut it into half yard squares. In +the center of each square place a strip, six or eight inches long, of +absorbent cotton and fold the gauze lengthwise over it so as to make a pad. +These can be used as napkins, and after they are soiled can be burned. It +is absolutely wrong to use rags or any old cloths for napkins, as the +patient can be infected and made seriously sick by this procedure. + +HOW TO CALCULATE THE PROBABLE DATE OF THE CONFINEMENT.--The duration of +pregnancy extends for 280 days from the end of the last menstruation. Add +seven days to the date of the last menstruation, and from that date count +ahead nine months, or backward three months and you may have the probable +date of the confinement. Should you pass this time you will probably go on +for two additional weeks. The reason for this is that the most susceptible +time for conception to occur is either during the week following +menstruation or a few days before menstruation. If, therefore, you pass the +above probable date which was calculated from the end of the last +menstruation, it shows that conception did not take place during the [67] +week following that menstruation; and the assumption will be that it took +place a few days before the next menstruation, which will be about two +weeks later than the date as calculated above. + +If, for example, a pregnant woman was last sick from January 1st to 5th we +add seven days to the 5th, which is the 12th, to which we add nine months, +which will give us, as the probable date of confinement, October 12th. +Should she go a few days over the 12th, the probability is that the +confinement will take place on October 26th. + + TABLE FOR CALCULATING THE DATE OF CONFINEMENT + ----------------------------------------------------------------- + JAN. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 + OCT. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 + ----------------------------------------------------------------- + JAN. 21 22 23 24 25 26 27 28 29 30 31 + OCT. 28 29 30 31 1 2 3 4 5 6 7 NOV. + ----------------------------------------------------------------- + FEB. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 + NOV. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 + ----------------------------------------------------------------- + FEB. 21 22 23 24 25 26 27 28 + NOV. 28 29 30 1 2 3 4 5 DEC. + ----------------------------------------------------------------- + MAR. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 + DEC. 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 + ----------------------------------------------------------------- + MAR. 21 22 23 24 25 26 27 28 29 30 31 + DEC. 26 27 28 29 30 31 1 2 3 4 5 JAN. + ----------------------------------------------------------------- + APR. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 + JAN. 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 + ----------------------------------------------------------------- + APR. 21 22 23 24 25 26 27 28 29 30 + JAN. 26 27 28 29 30 31 1 2 3 4 FEB. + ----------------------------------------------------------------- + MAY. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 + FEB. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 + ----------------------------------------------------------------- + MAY. 21 22 23 24 25 26 27 28 29 30 31 + FEB. 25 26 27 28 1 2 3 4 5 6 7 MAR. + ----------------------------------------------------------------- + JUNE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 + MAR. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 + ----------------------------------------------------------------- + JUNE 21 22 23 24 25 26 27 28 29 30 + MAR. 28 29 30 31 1 2 3 4 5 6 APR. + ----------------------------------------------------------------- + JULY 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 + APR. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 + ----------------------------------------------------------------- + JULY 21 22 23 24 25 26 27 28 29 30 31 + APR. 27 28 29 30 1 2 3 4 5 6 7 MAY + ----------------------------------------------------------------- + AUG. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 + MAY 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 + ----------------------------------------------------------------- + AUG. 21 22 23 24 25 26 27 28 29 30 31 + MAY 28 29 30 31 1 2 3 4 5 6 7 JUNE + ----------------------------------------------------------------- + SEPT. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 + JUNE 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 + ----------------------------------------------------------------- + SEPT. 21 22 23 24 25 26 27 28 29 30 + JUNE 28 29 30 1 2 3 4 5 6 7 JULY + ----------------------------------------------------------------- + OCT. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 + JULY 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 + ----------------------------------------------------------------- + OCT. 21 22 23 24 25 26 27 28 29 30 31 + JULY 28 29 30 31 1 2 3 4 5 6 7 AUG. + ----------------------------------------------------------------- + NOV. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 + AUG. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 + ----------------------------------------------------------------- + NOV. 21 22 23 24 25 26 27 28 29 30 + AUG. 28 29 30 31 1 2 3 4 5 6 SEPT. + ----------------------------------------------------------------- + DEC. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 + SEPT. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 + ----------------------------------------------------------------- + DEC. 21 22 23 24 25 26 27 28 29 30 31 + SEPT. 27 28 29 30 1 2 3 4 5 6 7 OCT. + ----------------------------------------------------------------- + + [68] +The foregoing table affords us a handy means of finding the probable date +of confinement at a glance. + +Find the date of the last day of the last menstrual period in the upper +row; the date immediately below it is the probable date of confinement. + +For example if the last menstrual period was from Jan. 1st to 5th, we find +January 5th and below it we note October 12th as the probable date of +confinement. + +WHEN SHOULD A PREGNANT WOMAN FIRST CALL UPON HER PHYSICIAN?--The earliest +indication of pregnancy is the interruption of menstruation. When +menstruation fails to appear at its regular time in a young married woman +whose past menstrual history is good,--i.e., she has been sick every month +regularly and without pain since she began menstruating as a girl,--the +assumption would naturally be that she was pregnant. Menstruation may +however "miss" one month for other reasons than pregnancy just at this +time, as is explained elsewhere, so it is wise to defer a positive +assumption on such an important matter. When the second menstruation does +not appear, and there are no specific reasons for its failure to appear, it +may be safely assumed that pregnancy has taken place. A visit to the family +physician one week after the second menstruation should have appeared, or +at least long enough to feel absolutely certain that the sickness is not +coming around, is not only necessary, but is the essential and correct step +to take for a number of very good reasons. If a woman for example has not +had a baby, how does she know she can have one? It is quite possible to +become pregnant and yet it may be wholly impossible to give birth to a +child. It is necessary to be constructed normally, or as near what is +regarded as normal as is possible, in order safely to assume the +responsibility of carrying a pregnancy to a successful completion. No one +but a physician, who is skilled and familiar in the knowledge of what +constitutes the proper size, and shape, and quality, and relations, one +with another, of your bones, and ligaments, and muscles, can tell [69] +whether you can safely be permitted to carry a pregnancy to term or not. If +the anatomical conditions are not just right; if circumstances from a +medical standpoint are not favorable; if your personal risk is too +hazardous; if, in other words, medical science should decide that you are +one of the very few women who cannot have a baby, is it not of very great +importance that you should know this as soon as possible? Does not that +fact alone render your early call upon your physician imperative? A +physician can bring out facts, relating to the personal and family history, +and habits, of the prospective mother, which will enable him to formulate +advice which will prove of the highest value from the very beginning of +pregnancy. Instructions carried into effect at this early date, as to +personal conduct, exercise, diet, etc., will have a distinctly beneficial +influence, not only on the patient's health and the character of her +confinement, but on the physical vitality of the coming baby. + +REGARDING THE CHOICE OF A PHYSICIAN.--This is a matter that should receive +the most careful consideration. While it is just to admit that every +physician is capable of successfully conducting maternity cases, there are +certain characteristics in the individual temperament that would seem to +indicate that some physicians are better adapted to this special work. + +Trustworthiness is an imperative essential in a physician who assumes the +responsibility of confinement engagements. He must be clean in his personal +habits as well as morally. He should possess the virtue of patience and be +tactful, and above all he should be made to feel that he has your implicit +confidence. If you will analyze these qualifications you will understand +just what they imply. The physician who has the reputation of having the +largest practice is not necessarily the man you want, nor does it imply +that he is the best fitted to conduct your case to your satisfaction. The +fact that he is a very busy man may be distinctly detrimental to your best +interests. If the physician has the reputation of being an excellent +doctor, but, "You can't always depend on him,--he may be out of town, or he +may send his assistant, or substitute," you don't want him; it is too [70] +important an event to you to take a chance with. Rely rather upon the man +who, though his charge may be a little higher, is known to be trustworthy; +who will take a personal interest in you, and is known to be patient and +capable. + +THE SELECTION OF A NURSE.--A choice must be made between having a trained +nurse and what is known as a maternity, or monthly, nurse. The choice may +be dictated by the financial means of the patient. A trained nurse is paid +from $25 to $30 per week, while a maternity nurse usually gets $15 per +week. + +A trained nurse is a graduate from a hospital where she has successfully +completed a course of training. She is to be preferred, if she can be +afforded, for the reason that she has been trained to obey absolutely the +orders of a physician, and because she has the requisite knowledge to +detect emergencies, and the necessary skill and experience to enable her to +act intelligently of her own initiative in any emergency. + +The maternity nurse, on the other hand, has not had an adequate training +and is absolutely helpless, so far as medical knowledge is concerned, in a +real emergency. Her experience is limited to what she has picked up in the +various cases she has had. She, as a rule, has chosen this means of +obtaining a living as a result of some domestic financial affliction. She +does not understand the laws of sterilization and has not been trained to +obey, without question, the instructions of a physician. The maternity +nurse follows a routine which she is incapable of modifying to suit the +particular case. She has old-fashioned ideas and notions which she carries +out as a matter of course, and she overestimates the great importance of +her experience to the extent of wholly disregarding the advice of the +physician. She assumes the care of the patient and baby, and regards this +as her right, and as a result she is frequently responsible for much injury +to the mother and child. Despite these objections we have worked with many +of these nurses who were to be preferred to trained nurses. It is the +individual after all that counts, and if a maternity nurse, though +technically untrained, is adaptable, tactful, and will consent to be [71] +instructed to the extent of obeying without argument, she can become +invaluable, and her skill and experience will carry her creditably over +many trying incidents. The objection of the medical profession to an +untrained nurse is based, not so much on her lack of ability, as upon her +propensity to indiscriminate and indiscreet talk,--they have not been +trained to know the value of professional silence, nor have they had the +necessary education which would have enabled them to acquire through their +experience the knowledge that "silence is golden" at all times. A trained +nurse possesses the requisite knowledge, but may have an objectionable +individuality. An untrained nurse may have sufficient knowledge, and what +she lacks she may make up for in being congenial and adaptable. While the +trained nurse strictly attends exclusively to the mother and the baby, a +maternity nurse as a rule attends to the household duties in addition. She +cooks the meals of the entire family, and dresses and cares for the other +children if there is no one else to do it. The duties of a maternity nurse +can be specified and agreed upon, and the terms arranged when she is +engaged. The duties of a trained nurse are fixed by nursing laws and +medical rules and cannot be changed or modified by private agreement. These +laws and rules, however, are not sufficiently arbitrary to make it +impossible for the nurse to be obliging, courteous, and +sincere,--qualifications which every patient has a right to expect, and a +right to insist upon from every graduate nurse. + +The selection of a nurse should receive careful consideration. She should +be known to be honest, honorable, competent, healthy, and personally clean +in habits and dress, and she should be tactful, obliging, and she should +attend to her own affairs strictly. She should not be a gossip; she should +not shirk her work or pry into family affairs that do not concern her; and +she should not drag into the conversation her own personal or family +secrets. + +The nurse has certain rights which the patient should willingly recognize. +She is entitled to a comfortable bed, sufficient sleep, good food, and +exercise in the open air every day. These are essential in order that [72] +she maintain her own health, as well as keep at the highest point of +efficiency. + +When you select your physician consult with him regarding your nurse. If +you know personally a capable nurse, there is no objection to selecting +her, and no physician will oppose this procedure if you assume the +responsibility of her capability. + +There are many advantages, however, in permitting the physician to provide +a nurse. He assumes the responsibility of the nurse's capability, and it is +safe to assume he will not recommend one whom he knows to be personally +objectionable, or professionally incapable. Every physician acquires +certain individual methods in the conduct of maternity cases, which +experience has taught him to be successful. A competent knowledge of these +methods by the nurse greatly facilitates the details and ensures a +harmonious conduct of the entire case,--facts which accrue to the comfort +and the well-being of the patient. + +It is not out of place here to warn a young wife against being advised by a +neighbor or a busybody, as to whom she should select as physician or nurse. +You must not depend upon the gossip of the neighborhood. The physician or +nurse whom you are told by one of these irresponsible individuals not to +take, may be the one above all others whom you should take. When you hear a +gossiping woman decry a physician, depend upon it, she owes him +something,--most often it is a bill, but it may only be a grudge. There is +no class of men in any community who are maligned and abused so much as are +physicians. They seem to be the choice victims of the enmity and spite of +every malicious feminine tongue. A woman should think twice before she +utters a criticism regarding the work of a physician. She would, if she but +knew how quickly she brands and advertises herself as irresponsible and +lacking in ordinary courtesy and good breeding, as she is not qualified to +criticise the professional capability of a physician, nor is she qualified +to estimate the extent of the wrong she perpetrates. There is no class of +men who do more conscientious work, day after day, than do physicians, [73] +and there is no class of men who are more deserving of the commendation of +the entire community than the thousands of self-sacrificing, underpaid +members of the medical profession. Be suspicious therefore when you hear a +criticism, and be very, very sure before you utter one,--rather give him +the benefit of the doubt and you will do no wrong, and it may be at some +future date you will be thankful you did not criticise. + + * * * * * + + + [75] +CHAPTER VII + +THE HYGIENE OF PREGNANCY. + + DAILY CONDUCT OF THE PREGNANT WOMAN--INSTRUCTIONS REGARDING HOUSEHOLD + WORK--INSTRUCTIONS REGARDING WASHING AND SWEEPING--INSTRUCTIONS + REGARDING EXERCISE--INSTRUCTIONS REGARDING PASSIVE + EXERCISE--INSTRUCTIONS REGARDING TOILET PRIVILEGES---INSTRUCTIONS + REGARDING BATHING--INSTRUCTIONS REGARDING SEXUAL INTERCOURSE--CLOTHING + DURING PREGNANCY--DIET OF PREGNANT WOMEN--ALCOHOLIC DRINKS DURING + PREGNANCY--THE MENTAL STATE OF THE PREGNANT WOMAN--THE SOCIAL SIDE OF + PREGNANCY--MINOR AILMENTS OF PREGNANCY--MORNING NAUSEA, OR + SICKNESS--TREATMENT OF MORNING NAUSEA, OR SICKNESS--NAUSEA OCCURRING AT + THE END OF PREGNANCY--UNDUE NERVOUSNESS DURING PREGNANCY--THE 100 PER + CENT. BABY--HEADACHE--ACIDITY OF THE STOMACH, OR + HEARTBURN--CONSTIPATION--VARICOSE VEINS, CRAMPS, + NEURALGIAS--INSOMNIA--TREATMENT OF INSOMNIA--PTYALISM, OR EXCESSIVE + FLOW OF SALIVA--VAGINAL DISCHARGE, OR LEUCORRHEA--IMPORTANCE OF TESTING + URINE DURING PREGNANCY--ATTENTION TO NIPPLES AND BREASTS--THE VAGARIES + OF PREGNANCY--CONTACT WITH INFECTIOUS DISEASES--AVOIDANCE OF DRUGS--THE + DANGER SIGNALS OF PREGNANCY. + +CONDUCT OF THE PREGNANT WOMAN + +The young wife will arrange her daily routine according to the physician's +instructions, which, by the way, she should faithfully carry out. If you +are one of the fortunate many who enjoy reasonably good health, you have +doubtless been told to follow a plan very similar to the one we shall now +briefly outline. + +For the first six months she can safely continue to do her household work. +It is to her advantage to do so for many reasons, but especially because it +helps to keep her physically in good condition, and because it keeps her +mind engaged, thus avoiding a tendency to nervous worry. After the sixth +month it is desirable to give up the heavier part of the work. Washing and +sweeping should be absolutely prohibited. Moving furniture or heavy trunks +must not be done by the prospective mother, but all light work can and [76] +should be indulged in to the very end. Find time to spend at least one hour +and a half in the open air every day. Unless there is a medical reason +against active exercise there is nothing so beneficial to the pregnant +woman as walking, nor is there any substitute for it. A drive or motor ride +into the country, or a car ride around town, is an excellent device against +ennui and is highly desirable during this time, but not as a substitute for +the daily long walk. A pregnant woman must keep her muscles strong and in +good tone if she hopes to do her share toward having a short and easy +confinement. She must keep active to ensure perfect action of all her +organs--the stomach must digest; the bowels and kidneys must act perfectly; +the heart, and lungs, and nerves must be supplied with good blood and fresh +air; the appetite must be keen, and the sleep sound. Walking in the open +air will do all this and nothing else can, to the same satisfactory degree. + +Light passive exercise at home is desirable to those very few who cannot +walk in the open air, but at best it is a poor substitute. It is necessary +to avoid any exercise or any labor of the following character from the very +beginning of pregnancy: stretching, lifting, jarring, jumping, the use of +the sewing machine, bicycling, riding, and dancing. + +She should continue to employ the same toilet privileges she has been +accustomed to except the use of the vaginal douche, which must be stopped +from the date of the first missed menstrual period. This is the only safe +rule to follow and no exception should be made to it except upon the advice +of a physician. + +Bathing during the entire course of pregnancy is a highly necessary duty. +It is particularly advantageous during the later months because it relieves +the kidneys at a time when they are called upon to perform an excess of +work. The temperature of the bath should be warm and rapidly cooled at the +finish. Brisk rubbing with a course towel will ensure the proper reaction. + +Sexual intercourse must be restricted during pregnancy; and it should be +wholly abstained from during what would have been the regular menstrual +periods, if pregnancy had not occurred, for the reason that abortion is[77] +apt to take place. It is most harmful during the early and late months of +pregnancy. Sexual intercourse is distasteful to most and harmful to every +pregnant woman. + +CLOTHING DURING PREGNANCY.--The clothing should be so constructed as to +relieve any undue pressure on the breasts or abdomen. For this reason it +should be suspended from the shoulder. When it is appreciated that clothing +supported by the waist crowds the growing womb, and exerts pressure upon +the kidneys, and is responsible for many of the kidney complications that +occur during pregnancy, no further reason need be given for discarding all +clothing, except very light garments, that are not held by some device +whose support is from the shoulders. A specially constructed linen waist is +made and sold for this purpose. It is fashioned so that all the lower +garments and the garters can be fastened to, and supported by it. Corsets +should be absolutely discarded from the very first day of pregnancy. + +In a large woman with a lax abdomen, a properly made abdominal support will +not only be a great comfort but of real advantage. It should exert a +support upward by lifting the abdomen, not by constricting it. It should +therefore be obtained from a reliable dealer and be made and applied to +effect the above object,--otherwise it may do more harm than good. + +DIET OF PREGNANT WOMEN.--Some degree of digestive disturbance and loss of +appetite is the rule early in pregnancy. By the fourth month these +conditions invariably cease, and the appetite and the ability to digest +will greatly improve. The diet from the very beginning of pregnancy should +be plain and easily digested. It is not possible to formulate an absolute +table of what or what not to eat, as the same foods do not agree equally +well with all patients. The individual taste should be catered to within, +reason, and the meals should be taken at regular intervals. Articles of +diet that experience shows do not agree with the patient should be rigidly +excluded from the menu. A varied diet of nutritious character is essential +during pregnancy in order to ensure good blood, health, and strength. A +monotonous diet, or a diet composed largely of stale tea, coffee, and [78] +cake, is not permissible, and may do untold harm. Pastries and desserts of +all kinds should be excluded. In the later weeks of pregnancy, because of +the large size of the womb, the diet should be cut down as the stomach is +interfered with in the process of digestion. Should the patient at any time +during pregnancy experience a loss of appetite, or an actual disgust for +food as sometimes occurs, it is preferable to suggest a change of scene and +surroundings rather than the use of medicine. A short vacation, a change of +table, new scenery, will promptly effect a cure. This condition is mental +rather than physical; the patient allows herself to become introspective; +the daily routine becomes monotonous and stale; hence a change of a few +days will be all that is necessary. If it is not possible for the patient +to obtain a change of scene, a complete change of diet for a few days will +often tide over the difficulty. We have known patients to take kindly to an +exclusive diet of kumyss, or matzoon, or predigested foods, with stale +toast or zwieback, to which can be added stewed fruits. Alcoholic drinks +should be left out entirely. + +THE MENTAL STATE OF THE PREGNANT WOMAN.--The coming baby should be the text +of many interesting, spontaneous talks between the young couple from the +time when it is first known that a new member of the family is on its way. +The husband should feel that he is a party to the successful consummation +of the little one's journey. He can contribute enormously to this end. It +should be his duty, born of a sincere affection and love, to formulate the +programme of events which has for its main object the wife's entire mental +environment. He should encourage her to live up to the physician's +instructions, and arrange details so that she will obtain the proper +exercise daily. He should read to her in the evening, and arrange his own +business affairs so that he will be with her as much as is possible. In +many little ways he can impress upon her the fact that they both owe +something to the unborn babe and that each must sacrifice self in its +behalf. His principal aim, of course, will be that she will not worry or +have cause to worry. He will so direct her mental attitude that she will +dwell only upon the bright side of the picture; she will thus strive to[79] +realize the hope that the baby will be strong and healthy, and she will, +prompted by his encouragement and devotion, try to do her duty faithfully. +Working together in this way, much can be done that means far more than we +know of, and in the end the little one comes into the world a welcome baby, +created in love and born into the joy of a happy, harmonious, contented +home. + +THE SOCIAL SIDE OF PREGNANCY.--The social side of the question should not +be overlooked or neglected at this time. Here again the imperative +necessity arises to warn the young wife against certain individuals who +seem to have a predilection toward recounting all the terrible experiences +they have heard regarding confinements. It is astonishing to learn how +diversified a knowledge some women burden themselves with in this +connection. They can recount case after case, with the harrowing details of +a well-told tale, and seem to delight in so doing. Every physician has met +these women. The young wife must not permit or encourage any reference to +her condition. Simply refusing to discuss the question is the only sure +method of preventing its discussion. She will find among her friends a few +who have her best interests at heart, and these few will strive sincerely +to be of real usefulness to her. If she will keep in mind that the most +important element in the success of the whole period, and consequently the +degree of her own health, happiness, and comfort, as well as that of her +unborn baby, is the character of her own thoughts from day to day, and +month to month, she will be complete master of the situation. By constantly +dwelling on happy thoughts, reading encouraging and inspiring books, +admiring and studying good pictures, working with cheerful colors in sunny +rooms, exercising, dieting, and sleeping in a well-aired room, she will +have no cause to regret her share in the task before her, or the kind of +baby she will bring into the world. + +MINOR AILMENTS OF PREGNANCY.--There are certain minor ailments which it +would be well to be familiar with lest a little worry should creep into the +picture. + +Maternity is not only a natural physiological function, but it is a [80] +desirable experience for every woman to go through. The parts which +participate in this duty have been for years preparing themselves for it. +Each month a train of congestive symptoms have taxed their working +strength; pregnancy is therefore a period of rest and recuperation,--a +physiological episode in the life history of these parts. If any ailment +arises during pregnancy it is a consequence of neglect, or injury, for +which the woman herself is responsible,--it is not a natural accompaniment +of, or a physiological sequence to pregnancy. Find out, therefore, wherein +you are at fault, rectify it, and it will promptly disappear. + +MORNING NAUSEA OR SICKNESS.--So-called morning nausea or sickness is very +frequently an annoying symptom. It is present as a rule during the first +two or three months of pregnancy. How is it produced and how can it be +remedied? + +It is produced most frequently by errors in diet. It may be caused by an +unnatural position of the womb or uterus, by nervousness, constipation, or +by too much exercise or too little exercise. The physician should be +consulted as soon as it is observed to be a regular occurrence. He will +eliminate by examination any anatomical condition which might cause it; or +will successfully correct any defect found. When the cause is defined his +instructions will help you to avoid any error of diet, constipation, or +exercise. Many cases will respond to a simple remedy,--a cup of coffee, +without milk, taken in bed as soon as awake will often cure the nausea. The +coffee must be taken while still lying down,--before you sit up in bed. If +coffee is not agreeable any hot liquid, tea, beef tea, clam bouillon, or +chicken broth, or hot water may answer the purpose, though black coffee, +made fresh, seems to be the most successful. Ten drops of adrenalin three +times daily is a very certain remedy in some cases, though this should be +taken with your physician's permission only. If the nausea occurs during +the day and is accompanied with a feeling of faintness, take twenty drops +of aromatic spirits of ammonia in a half glass of plain water or Vichy +water. Sometimes the nausea is caused by the gradual increase of the [81] +womb itself. This is not usually of a persistent character and disappears +as soon as the womb rises in the abdominal cavity at the end of the second +month. + +Nausea frequently does not occur until toward the end of pregnancy. In +these cases the cause is quite different. Because of the size of the womb +at this time the element of compression becomes an important consideration. +The function of the kidneys, bowels, bladder, and respiration may be more +or less interfered with, and it may be desirable to use a properly +constructed abdominal support, or maternity corset. These devices support +and distribute the weight, and prevent the womb from resting on or +compressing, and hence interfering with, the function of any one organ. If +the womb sags to one side, thereby retarding the return circulation of the +blood in the veins from the leg, it may cause cramps in the leg, especially +at night, or it may cause varicose veins, or a temporary dropsy. The +correct support will prevent these troublesome annoyances; a properly +constructed maternity corset is often quite effective. The diet should +receive some special attention when these conditions exist. Any article of +diet which favors fermentation (collection of gas) in the stomach or bowel +should be excluded. These articles are the sugars, starches, and fats. It +can readily be understood that if the bowels should be more or less filled +with gas, or if they should be constipated, it will cause, not only great +distress, but actual pain. Regulation of the diet, therefore, and exercise +(walking best of all) will contribute greatly to the avoidance of these +unnecessary sequelae. + +It must be kept in mind that the entire apparatus of the body is +accommodating a changed condition, and though that condition is a natural +one, it requires perfect health for its successful accomplishment. This +means a perfect physical and mental condition,--a condition that is +dependent upon good digestion, good muscles, healthy nerves, clean bowels, +and so on. The slightest deviation from absolute health tends to change the +character of the body excretions, the quality of the blood, etc. If the +excretions are not properly eliminated, the blood becomes impure, and so we +sometimes get itching of the body surfaces, especially of the abdomen [82] +and genitals; neuralgias, especially of the exposed nerves of the face and +head; insomnia and nervousness. These are all amenable to cure, which again +means, as a rule, correct diet and proper exercise as the principal +remedial agencies. + +UNDUE NERVOUSNESS DURING PREGNANCY.--This is very largely a matter of will +power. Some women simply will not exert any effort in their own behalf. +They are perverse, obstinate, and unreasonable. The measures which +ordinarily effect a cure, they refuse to employ. It is useless to argue +with them; drugs should never be employed; censure and affection are +apparently wasted on them; they cannot even be shamed into obedience. The +maternal duty they owe to the unborn child does not seem to appeal to them. +We do not know of any way to handle these women and to our mind they are +wholly unfit to bring children into the world. Fortunately these women are +few in number. The maternal instinct will, and does, guide most women into +making sincere efforts to restrain any undue nervous tendency, and to be +obedient and willing to follow instructions. There is nothing so beneficial +in these cases as an absolutely regulated, congenial, daily routine, so +diversified as to occupy their whole time and thought to the exclusion of +any introspective possibility. Frequent short changes to the country or +seashore to break the monotony, give good results in most of these cases. +The domestic atmosphere must also be congenial and the husband should +appreciate his responsibility in this respect. + +Women of this type should have their attention drawn to the following facts +in this connection: While the most recent investigations of heredity prove +that a woman cannot affect the potential possibilities of her child, she +can seriously affect its physical vitality. The following illustration may +render our meaning clear: suppose your child had the inborn qualities +necessary to attain a 100 per cent. record of achievement in the struggle +of life; anything you may or may not do cannot affect these qualities--the +child will still have the ability to achieve 100 per cent. Inasmuch, +however, as a mother can affect the health or physical qualities of her[83] +child she is directly responsible, through her conduct, as to whether her +child will ever attain the 100 per cent. record, or if it does, she is +responsible for the character of its comfort, its health, its enjoyment, +all through its life's struggle toward the 100 per cent. achievement +record. She may so compromise its physical efficiency that it will succumb +to disease as a consequence of the ill health with which its mother +unjustly endowed it, even though it possess the ability to attain the 100 +per cent. if it lived. + +We often see brilliant children who are nervous and physically unfit, and +we see others of more ordinary mental achievement who are healthy and +robust animals. The one is the offspring of parents possessing unusual +mental qualities but who are physically unable or unwilling to render +justice to their progeny; the other parents may be less gifted mentally, +but they are healthy and they are willing to give their best in conduct and +in blood to their babies. Many of these brilliant children never achieve +their potential greatness because they fall by the wayside owing to +physical inability, while the healthy little animals achieve a greater +degree of success because of the physical vitality which carries them +through. To achieve a moderate success and enjoy good health is a better +eugenic ideal than the promise of a possible genius never attained because +of continuous physical inefficiency. + +The nervous and willful mother should therefore consider how much depends +upon her conduct. It cannot be too frequently reiterated and emphasized +that every mother should do her utmost to guard and retain her good health. +Good health means blood of the best quality and this is essential to the +nourishment of the child. To keep in good health does not mean to obey in +one respect and fail in other essentials. It means that you must obey every +rule laid down by your physician, willingly and freely in your own interest +and in the interest of your unborn babe. In no other way may you hope to +creditably carry out the eugenic ideal that "the fit only shall be born." + +HEADACHE.--This is a symptom of great importance. If it occurs [84] +frequently, without apparent cause, the physician should be consulted at +once, as it may indicate a diseased condition of the kidneys, and +necessitate immediate treatment. Headaches may, of course, be caused in +many ways and most frequently they do not have any serious significance, +but they must always be brought to the attention of the physician. As a +rule they are caused by errors of diet,--too much sugar, candy, for +instance, late and indigestible suppers, indiscriminate eating of rich +edibles, etc.,--or they may be products of nervous excitement (too little +rest), as shopping expeditions, strenuous social engagements, late hours, +etc. + +ACIDITY OF THE STOMACH, AND SO-CALLED HEARTBURN.--These are sometimes in +the early months of pregnancy annoying troubles. The following simple means +will relieve temporarily: A half-teaspoonful of bicarbonate of soda or +baking soda in a glass of water or Vichy water; or a half teaspoonful of +aromatic spirits of ammonia in Vichy, or plain water; or a tablespoonful of +pure glycerine. The best remedy is one tablespoonful of Philip's Milk of +Magnesia taken every night for some time just before retiring. + +Heartburn is the result of eating improper food, or a failure to digest the +food taken. Starchy foods should be avoided. Meats and fats should be taken +sparingly. Avoid also the et ceteras of the table, as pickles, sauces, +relishes, gravies, mustard, vinegar, etc. Good results follow dry +meals,--meals taken without liquids of any kind. Live on a simple, easily +digested, properly cooked diet. Chew the food thoroughly, take plenty of +time and be cheerful. + +CONSTIPATION DURING PREGNANCY.--Most women are as a rule more or less +constipated during pregnancy. It is caused by failure to take the proper +amount of outdoor exercise, to take enough water daily, to live on the +proper diet, to live hygienically, or because of wrong methods of dress. It +is most important that the bowels should move thoroughly every day. +Pregnancy no doubt aggravates constipation by diminishing intestinal +activity. Consequently there is a greater need for activity on the part of +the woman, and open air exercise is the best way to accomplish this. [85] +She should eat fruits, fresh vegetables, brown or Graham bread, or bran +muffins, figs, stewed prunes, and any article of diet which she knows from +experience works upon her bowel. She should drink water freely; a glass of +hot water sipped slowly on arising every morning or one-half hour before +meals, is good. Mineral waters, Pluto, Apenta, Hunyadi, or one teaspoonful +of sodium phosphate, or the same quantity of imported Carlsbad salts in a +glass of hot water one-half hour before breakfast, answers admirably. If +the salts cannot be taken a three- or five-grain, chocolate-coated, cascara +sagrada tablet, may be taken before retiring, but other cathartics should +not be taken unless the physician prescribes them. Rectal injections should +be avoided as a cure of constipation during pregnancy. They are very apt to +irritate the womb and if taken at a time when the child is active, they may +annoy it enough to cause violent movement on its part, and these movements +may cause a miscarriage. See article on "Constipation in Women." + +VARICOSE VEINS, CRAMPS, AND NEURALGIA OF THE LIMBS.--When cramps or painful +neuralgia occur repeatedly in one or both legs, some remedial measures +should be tried. Inasmuch as the cause of this condition is a mechanical +one, it would suggest a mechanical remedy. The baby habitually seeks for +the most comfortable position, and having found it stays there until +conditions render it uncomfortable. He does not consult you in the matter, +but he may be subjecting you to untold misery and pain. The child may rest +on the mother's nerves or blood-vessels as they enter her body from her +lower limbs. If the pressure is sufficient, it can interfere quite +seriously with the return blood supply, because veins which carry back to +the heart the venous or used blood, are vessels with thin, soft, +compressible walls, while arteries which carry blood away from the heart +cannot be compressed easily, because their walls are hard and tense. The +condition therefore is that more blood is being sent into the limb than is +being allowed to return; in this way are produced varicose veins. If these +varicose veins burst or rupture we have ulcers, which may quickly heal,[86] +or they may refuse to heal, and become chronic. A dropsical condition of +the leg may follow, and because of interference with the circulation of the +blood we get cramps and neuralgias. How can we remedy this painful +condition? + +Sometimes we don't succeed, but at least we can try. So long as the cause +exists, it is self-evident that rubbing the limb with any external +application, will not give any permanent relief, though it is well to try. +When rubbing, to relieve cramps at night, always rub upward. It is not a +condition that calls for medicine of any kind, while hot baths and hot +applications will only make the trouble worse. The remedy that promises the +quickest and longest relief is for the patient to assume the knee-chest +position for fifteen minutes, three times a day, till relief is permanently +established. The patient rests on her knees in bed, and bends forward until +her chest rests on the bed also. The incline of the body in this position +is reversed; hips are highest, the head lowest. The baby will seek a more +comfortable position and this new position may relieve the pressure and +cure the condition. Doing this three times daily for fifteen minutes gives +relief to the leg by reestablishing a normal blood circulation, and very +soon the baby finds a new position that does not interfere with its +mother's blood supply, and the cramps, and neuralgia and dropsy, and maybe +the varicose veins will soon show improvement. Wearing the proper kind of +abdominal support may help, as explained on page 77. If the varicose veins +are bad, it is desirable to wear silk rubber stockings or to bandage the +limbs. + +INSOMNIA DURING PREGNANCY.--Insomnia or sleeplessness is sometimes a +vexatious complication during pregnancy. It seldom if ever becomes of +sufficient importance or seriousness to interfere with the pregnancy or the +health of the patient. Nevertheless, a period of sleeplessness lasting for +two or three weeks is not a pleasant experience to a pregnant woman. It is +most often met with during the latter half of pregnancy. + +There can be no question that every case of insomnia has definite cause, +and can be relieved if we can find the cause. The only way to find it [87] +is to systematically take up the consideration of each case, and this is +best done by the physician. He must have patience and tact; you must answer +each question truthfully and fully. Your diet, personal conduct, exercise, +condition of bowels, mental environment, domestic atmosphere, everything, +in fact, which has any relation to you or your nerves, must be inspected +with a magnifying glass. Some little circumstance, easily overlooked, of +seemingly no importance, may be the cause of the trouble. You may need more +outdoor exercise, or you may need less outdoor exercise. You may need more +diversion, more variety, or you may need less. You may need a sincere, +honest, tactful, patient confidant and friend, or you may need to be saved +from your friends. You may be exhausting your vitality and fraying your +nerves by social exigencies,--those empty occupations which fill the lives +of so many fussy, loquacious females,--echoless, wasted, babbling moments, +of supreme important to the social bubbles who ceaselessly chase them but +of no more interest to humanity than the wasted evening zephyrs that play +tag with the sand eddies on the surface of the dead and silent desert. You +may have wandered from the narrow limitations of the diet allowable in +pregnancy, or you may be the victim of an objectionably sincere relation +who pesters you with solicitous inquiries of a needless character. Whatever +it is, rectify it. A good plan to follow on general principles is to take a +brisk evening walk with your husband just before bedtime, and at least two +hours after the evening meal. Follow this with a sitz bath as soon as you +return from the walk. + +A sitz bath is a bath taken in the sitting position with the water reaching +to the waist line. It should last about fifteen minutes and the water +should be comfortably hot. It is sometimes found that this form of bath +creates too much activity on the part of the child and defeats the purpose +in view. This is apt to be the case in very thin women when the abdomen is +not covered by a sufficient layer of fatty tissue. These women will find it +advisable to take, in place of the sitz bath, a sponge bath in a warm room, +using the water rather cool than hot but in a warm room. Rub your skin [88] +briskly but waste no time in getting into bed. A glass of hot milk, before +going to bed, or when wakeful during the night, may serve as a preventive. +When these measures fail the physician should be called upon to advise and +prescribe. + +PTYALISM, OR AN EXCESSIVE FLOW OF SALIVA.--This is a common condition in +pregnancy, but cannot be prevented. It is of no importance other than that +it is a temporary annoyance. + +Itching of the abdomen can usually be allayed by a warm alcohol rub, +followed by gently kneading the surface of the abdomen with warm melted +cocoa butter, just before retiring. + +A VAGINAL DISCHARGE.--Soon after pregnancy has taken place the woman may +notice a discharge. It may be very slight or it may be quite profuse. In +some cases it does not exist at all during the entire period. As a rule the +discharge is more frequent and more profuse toward the end of pregnancy. + +If the discharge exists at any time,--and it is no cause for worry or alarm +if it does exist,--inform your physician. He will advise you what to do, +because it is not wise for you to begin taking vaginal douches or +injections without his knowledge, and at a time when they may do you +serious harm. Should itching occur as a result of any vaginal discharge the +following remedial measures may be employed: + +A solution of one teaspoonful of baking soda to a douche bag of tepid water +may be allowed to flow over the parts, or cloths saturated with this +mixture may be laid on the itching part. A solution of carbolic acid in hot +water (one teaspoonful to one pint of hot water), is also useful, or a wash +followed by smearing carbolic vaseline over the itching parts. If your +physician should suggest a mild douche for itching of the vagina as the +result of a discharge, it may be promptly relieved by using Borolyptol in +the water. Buy a bottle and follow directions on the label. + +TESTING URINE IN PREGNANCY--IMPORTANCE OF.--One of the most important +duties, if not the most important, of both the physician and the patient is +to have the urine of the pregnant woman examined every month during the[89] +first seven months and every two weeks during the last two months. The +urine examined during the first seven months should be the first urine +passed on the day it is sent for examination. During the last two months of +pregnancy the patient should pass all her water into a chamber for an +entire day, and take about three ounces of this mixed water for +examination. She should measure the total quantity passed during these days +and mark it with her name on the label of the bottle. The physician will +thus have an absolute record and guide of just how the kidneys are acting, +and as they are the most important organs to watch carefully during every +pregnancy, the greatest care should be taken to see that failure to note +the first symptom of trouble does not take place. + +ATTENTION TO NIPPLES AND BREAST.--The physician should inspect the breasts +and nipples of every pregnant woman when she first visits his office. +Frequently the nipples are found to have been neglected, probably subjected +to pressure by badly fitting corsets or too tight clothing. Instructions +gently to pull depressed nipples out once daily, if begun early, will +result in marked improvement by the end of pregnancy. During the latter +part of pregnancy the breasts should be carefully and thoroughly bathed +daily in addition to the daily bath. This special bath should be with a +solution of boric acid (one teaspoonful to one pint of water). After the +bath apply a thin coating of white vaseline to the nipples. It may be +necessary to resort to the following mixture to harden the nipples and to +make them stand out so that the child can get them in its mouth: Alcohol +and water, equal parts into which put a pinch of powdered alum; this +mixture should be put in a saucer and the nipples gently massaged with it +twice daily. A depressed nipple may also be drawn out by means of a breast +pump. If the nipples are not pulled out the child will be unable to nurse. +It may then be necessary to put the child on the bottle and when the +nipples are ready he may not take them after being used to the rubber +nipple. The breasts may become caked and as a caked breast is a very +painful and serious ailment it is wise to attend to this matter in [90] +time. + +THE VAGARIES OF PREGNANCY.--Certain foolish, old-fashioned ideas, have +crept into the minds of impressionable people regarding pregnancy, which +are aptly termed vagaries. It is believed by some that if the pregnant +woman is the victim of fright, or is badly scared, or witnesses a +terrifying or tragic sight, her child will be, in some way, affected by it. +If the incident is not of sufficient gravity to cause an abortion or a +miscarriage it will not, in any way mark, or affect the shape of the child +in the womb. + +It is believed by some that a child can be marked by reason of some event +occurring to the mother while carrying it. This is not so; a child cannot +be marked by any experience or mental impression of the mother. Some +believe that the actual character of a child can be changed by influences +surrounding the mother while carrying it. The character of a child cannot +be changed one particle after conception takes place, no matter how the +mother spends her time in the interim. + +It should be carefully understood that the character of the baby is +entirely different from the physical characteristics of the baby. Were this +not so it would be futile on the part of the mother to discipline or +sacrifice herself in the interest of her baby. The baby's character will +reflect the qualities of the combined union of mother and father. The +baby's physical characteristics will largely depend upon the treatment +accorded it by the mother during its intro-uterine life. Hence we lay down +rules of conduct, diet and exercise in order to produce a good, sturdy +animal, while the character or mind of the animal is a part of the +fundamental species already created. In other words, no matter how much +care you bestow upon a rose bush, its flower will still be a rose,--it may +be a better rose, a stronger, sturdier rose, a better smelling and a more +beautiful rose, but it is still a rose. + +CONTACT WITH INFECTIOUS DISEASES.--The pregnant woman should be warned +against the danger of coming in contact with any person suffering from any +infectious or contagious diseases. To become the victim of one of these[91] +diseases near the time of labor would be a dangerous complication not only +to the mother, but to the child. A woman is more liable to catch one of +these diseases during the last month of pregnancy than at any other time. +The most dangerous diseases at this period are Scarlet Fever, Diphtheria, +Erysipelas, and all diseased conditions where pus is present. + +AVOIDANCE OF DRUGS.--It is a safe rule during pregnancy to avoid absolutely +the taking of all medicines unless prescribed by a physician. + +THE DANGER SIGNALS OF PREGNANCY.--The following conditions may be of very +great importance and may be the danger signals of serious coming trouble. +They must not therefore be neglected or lightly considered. When any of +them make their appearance send for the physician who has charge of your +case, at once, and follow his advice whatever it may be. + + 1. Any escape of blood from the vagina, whether in the form of a sudden + hemorrhage or a constant leaking, like a menstrual period. + + 2. Headache, constant and severe. + + 3. Severe pain in the stomach. + + 4. Vertigo or dizziness. + + 5. Severe sudden nausea and vomiting. + + 6. A fever, with or without a chill. + + * * * * * + + + [93] +CHAPTER VIII + +THE MANAGEMENT OF LABOR + + WHEN TO SEND FOR THE PHYSICIAN IN CONFINEMENT CASES--THE PREPARATION OF + THE PATIENT--THE BEGINNING OF LABOR--THE FIRST PAINS--THE MEANING OF + THE TERM "LABOR"--LENGTH OF THE FIRST STAGE OF LABOR--WHAT THE FIRST + STAGE OF LABOR MEANS--WHAT THE SECOND STAGE OF LABOR MEANS--LENGTH OF + THE SECOND STAGE--DURATION OF THE FIRST CONFINEMENT--DURATION OF + SUBSEQUENT CONFINEMENTS--CONDUCT OF PATIENT DURING SECOND STAGE OF + LABOR--WHAT A LABOR PAIN MEANS--HOW A WILLFUL WOMAN CAN PROLONG + LABOR--MANAGEMENT OF ACTUAL BIRTH OF CHILD--POSITION OF WOMAN DURING + BIRTH OF CHILD--DUTY OF NURSE IMMEDIATELY FOLLOWING BIRTH OF + CHILD--EXPULSION OF AFTER-BIRTH--HOW TO EXPEL AFTER-BIRTH--CUTTING THE + CORD--WASHING THE BABY'S EYES IMMEDIATELY AFTER BIRTH--WHAT TO DO WITH + BABY IMMEDIATELY AFTER BIRTH--CONDUCT IMMEDIATELY AFTER LABOR--AFTER + PAINS--REST AND QUIET AFTER LABOR--POSITION OF PATIENT AFTER LABOR--THE + LOCHIA--THE EVENTS OF THE FOLLOWING DAY--THE FIRST BREAKFAST AFTER + CONFINEMENT--THE IMPORTANCE OF EMPTYING THE BLADDER AFTER LABOR--HOW TO + EFFECT A MOVEMENT OF THE BOWELS AFTER LABOR--INSTRUCTING THE NURSE IN + DETAILS--DOUCHING AFTER LABOR--HOW TO GIVE A DOUCHE--"COLOSTRUM," ITS + USES--ADVANTAGES OF PUTTING BABY TO BREAST EARLY AFTER LABOR--THE FIRST + LUNCH--THE FIRST DINNER--DIET AFTER THIRD DAY. + +WHEN TO SEND FOR THE PHYSICIAN IN CONFINEMENT CASES.--The physician should +be notified just as soon as it is known that labor has begun. The adoption +of this course is necessary for a number of reasons. It is only just that +he should have an opportunity to arrange his work so that he may be at +liberty to give his whole time to your case when he is wanted. He may not +be at home at the moment, but can be notified, and can arrange to be on +hand when your case progresses far enough to need his personal attention. +It will relieve your mind to be assured that he will be with you in plenty +of time. [Page 94] + +Don't worry unnecessarily if he does not come immediately when you notify +him, provided you notify him at the beginning of labor. There is plenty of +time. You have a lot of work to do before he can be of any help. Many women +entertain the idea that a physician can immediately perform some kind of +miracle to relieve them of all pains at any stage in labor. This is a +mistaken idea. No physician can hasten, or would if he could, a natural +confinement. He waits until nature accomplishes her work, and he simply +watches to see that nature is not being interfered with. If something goes +wrong, as it does now and again; or if the pains become too weak, or if the +proper progress is not being made, he may help nature or take the case out +of her hands and complete the confinement. If it is thought best to do +this, there will be plenty of time. + +THE PREPARATION OF THE PATIENT AND THE CONDUCT OF ACTUAL LABOR.--It is +assumed that the patient has adhered to the instructions of the physician +given during the early days of her pregnancy. These instructions included +directions as to exercise, diet, bathing, etc. + +Having calculated the probable date of the confinement, it is the better +wisdom to curtail all out-of-door visiting, shopping, social engagements, +etc.,--everything in fact out-of-doors except actual exercise, for two +weeks previous to the confinement date. The usual walk in the open air +should be continued up to the actual confinement day. The daily bath may be +taken, and it is desirable that it should be taken, up to and on the +confinement day. + +THE MEANING OF THE TERM "LABOR."--By labor is meant, the task or work +involved in the progress by means of which a woman expels from her womb the +matured ovum or child. After the child has been carried in the womb for a +certain time (estimated to be 280 days) it is ripe, or fully matured, and +is ready to be born. The womb itself becomes irritable because it has +reached the limit of its growth and is becoming overstretched. Any slight +jar, or physical effort on the part of the patient, or the taking of a +cathartic, is apt to set up, or begin the contractions which nature has +devised as the process of "labor" by which the womb empties itself. [95] + +THE BEGINNING OF LABOR.--When the first so-called pains of actual labor +begin they are not always recognized as such. The explanation of this +seeming paradox is that the "pains" are not always painful. A woman will +experience certain undefined sensations in her abdomen; to some, the +feeling is as if gas were rumbling around in their bowels; to others, the +feeling is as if they were having an attack of not very painful abdominal +colic; while others complain of actual pain. The fact that these sensations +continue, and that they grow a little worse; and that the day of the +confinement is due, or actually here, impresses them that something unusual +is taking place; then, and not till then, does the knowledge that labor is +really approaching dawn upon them. + +In due time one of these new sensations, which constitute the first stage +of labor, will be more emphatic; there will be a little actual pain so that +she will feel like standing still, holding her breath and bearing down. +That is the first real labor pain and marks the beginning of the second +stage of labor, and may be the first absolute sign that will leave no doubt +in her mind that labor has begun. + +The nurse will now inquire into the condition of the patient's bowels. If +they have not already moved freely that day, she will give the patient a +rectal injection of one pint of warm soap suds into which one teaspoonful +of turpentine is put. After the bowels have been thoroughly cleansed, the +patient will be made ready for the confinement. The clothing necessary +consists of dressing gown, night gown, stockings and slippers. These are +worn as long as the patient is out of bed, when all but the night gown will +be discarded. The entire body of the patient, from the waist line to the +knees, should be thoroughly cleansed, paying particular attention to the +private parts; first with warm water and castile soap, and then rendered +aseptic by washing with four quarts warm boiled water into which has been +put one teaspoonful of Pearson's Creolin. A soft napkin is then wrung out +of water that has been boiled and cooled to a suitable temperature, and +laid over the genital region, and held in place by a dry clean napkin, [96] +and allowed to remain there until the physician takes personal charge of +the case. + +LENGTH OF THE FIRST STAGE OF LABOR.--There is no definite or even +approximate length of time for the first stage of labor,--that, you may +recall, was the more or less painless stage, or as it has been termed, the +"getting-ready" stage. Inasmuch as it is an unimportant and practically +painless stage, most patients do not mind it. They continue to be up and +around and work as usual. + +The first stage of labor is utilized by nature in opening the mouth of the +womb. + +The second stage of labor is utilized by nature in expelling the child into +the outer world. + +LENGTH OF THE SECOND STAGE OF LABOR.--After the second stage has begun, the +length of time necessary to end the labor, assuming everything is normal, +depends upon the strength and frequency of the pains. The stronger and more +frequent the pains, the quicker it will be over. First confinements +necessarily take longer, because the parts take more time to open up, or +dilate, to a degree sufficient to allow the child to be born. In subsequent +confinements, these parts having once been dilated yield much easier, thus +shortening the time and the pains of this, the most painful, stage of +labor. The average duration of labor is eighteen hours in the case of the +first child, and about twelve hours with women who have already borne +children. The time, however, is subject to considerable variation, in +individual cases, as has been pointed out. + +CONDUCT OF THE PATIENT DURING THE SECOND STAGE OF LABOR.--She should remain +up, out of bed, as long as she possibly can. The object of this is because +experience shows that the labor pains are stronger, and more frequent, when +in the upright position. Even though this procedure would seem to invite +more constant suffering, it must be remember that labor is a physiological, +natural process, that there is nothing to fear or dread; and if the patient +is in good health, it is to her advantage to have it over soon, rather than +to encourage a long drawn out, exhausting labor. When the pains come [97] +she should be told to hold on to something, to hold her breath as long as +possible, and to bear down. A good plan is to roll up a sheet lengthwise, +and throw it over the top of an open door and let her grasp both ends +tightly and bear down; or she can put her arms over the shoulders of the +nurse and bear down. Instruct her to hold her breath as long as she can, +bearing down all the time, and when she can't hold it any longer, tell her +to let up, and then take a quick deep breath and bear down again, repeating +this programme until the pain ceases. Tell her specifically to be sure to +keep bearing down till the end of the pain, because the most important +time, and the few seconds during which each pain does most of its work +during the second stage of labor, is at the very end of each pain. When a +woman understands that these instructions are for her good, and that they +are given with the one purpose of saving her pain, and shortening the +length of labor, she will try to obey. Each pain is intended by nature to +do a certain amount of work, and each pain will accomplish that work if the +woman does not prevent it; and if she does prevent it, she is only fooling +herself, because the next pain will have to do what she would not allow the +former to do, and so on according to how she acts. + +THE CARRIERS OF HERITAGE + +[Illustration: Here is the actual bridge from this generation to the next. + +Into these two little bodies--the larger not over one-twenty-fifth of an +inch in diameter--is condensed the multitude of characteristics transmitted +from one generation to another. + +The vital part of the _Ovum_ is the _Nucleus_, which contains the actual +bodies that carry heritage--the little grains that are the mother's +characteristics--_Chromosomes_. This nucleus is nourished by oils, salts +and other inclusions, known as _Cytoplasm_. Floating in the cytoplasm may +be found a tiny body known as the _Centrosome_, which acts as a magnet in +certain phases of cell development. Around this whole mass is a _Cell +Wall_, more or less resisting and protective. + +The _Spermatozoan_ is structurally much different from the ovum, but it +also has its nucleus and chromosomes, which carry to the child the +transmittable characteristics of the father. + +The ovum is usually comparatively large and stationary, and whatever motion +is therefore necessary to bring it into contact with the male cell devolves +upon the latter, which possesses what is known as a _locomotor tail_. In +addition there are usually many sperms to one ovum, so that the chances are +that at least one male cell will reach the egg and effect fertilization, +and the beginning of a new life. + +The diagrams on the opposite page show the actual steps by which the +spermatozoan unites with the ovum. It is the very first stage of the +process of cell multiplication that results in the offspring.] + +THE FORMATION OF A NEW LIFE + +[Illustration: _Reproduced by permission from "Genetics," Walters, The +Macmillan Co._] + +HOW A WILLFUL WOMAN CAN PROLONG LABOR.--For a certain time, during the +second stage of labor, a willful, unreasonable woman, can work against +nature and save herself a little pain by prolonging the issue; but there +will come a time when, the head having reached a certain position, the +expulsive pains will be so great that she won't be able to control them and +nature then seems to take her revenge. So if a woman holds back, and begins +to cry, and scream, when she feels a pain coming, she renders the pain to a +large degree negative, she prolongs her labor, adds to the total number of +pains, exhausts herself, and endangers the life of her child. It must, +however, be remembered in all justice that this is a time when it is much +easier to preach than to practice. + +Every confinement is a new experience; no matter how many a physician may +have seen, there are no two alike. It is one of the interesting [98] +psychological problems in medicine to observe the conduct of women during +their first confinement. + +Some are calm, exhibiting a degree of self-control that is admirable. They +are willing to be instructed, and they recognize that the advice is given +for their benefit. They conscientiously try to obey suggestions, and they +make praiseworthy efforts to keep themselves under control. They are +stoics. + +Others collapse at once; they go to pieces under the slightest excuse, and +frequently without as much as an excuse. As soon as the pain begins, they +willfully ignore all the instructions given and desperately and foolishly +try to escape what they cannot escape. In this unreasonable selfishness +they resent advice, and at the same time they implore you to "do something" +for them. There is absolutely no excuse for this kind of conduct; and any +prospective mother who, because of a willful trait in her disposition, +refuses to profit by the kindly professional advice of her physician or +nurse, should at least have some consideration for her unborn babe. It may +seem unkind to criticise the conduct of any woman at such a time. It is not +prompted by a lack of patience or justice however. These women permit, in +spite of every assurance to the contrary, an unreasonable fear to overwhelm +them; and because of this fear they refuse to be guided into a path of +conduct that will save them suffering and shorten the pains which they +complain of. It is our conviction that if a woman would try to follow the +advice of the physician at this time, at least half of all the seeming +suffering would be avoided. We are glad to be able to truthfully state that +this type of woman is vastly in the minority. + +When the second stage has advanced far enough, the patient will decide to +go to bed. It may be necessary to put her in bed earlier, if her pains are +very strong, as there is always a possibility of suddenly expelling the +child under the influence of a strong pain. She will, as previously stated, +discard all clothing, except her night gown, which can be folded up to her +waist line and let down as far as necessary after the confinement is over. +The obvious advantage of this arrangement is that the gown remains [99] +unsoiled, and saves what would be needless trouble if it proved necessary +to change the night gown at a time when the tired-out patient needs rest. +Much aid may be afforded the woman at this stage by twisting an ordinary +bed sheet and putting it around one of the posts or bars of the foot of the +bed. The patient may then pull on the ends during the pain; she may also +find much comfort and aid by bracing her feet on the foot of the bed while +pulling. It is desirable to instruct the nurse to press on the small of the +back during these pains. Some women appreciate a hot water bottle in this +region. If the pains are hard the patient may perspire freely; it is always +refreshing occasionally to wipe the face and brow off with a cloth wrung +out of cold water. Cramps of the limbs may be relieved by forcibly +stretching the leg and pulling the foot up toward the knee. From this time +until the child and after-birth are born the physician will take active +charge of the case. + +THE MANAGEMENT OF THE ACTUAL BIRTH OF THE CHILD.--Near the end of the +second stage of labor it will be observed that the pains have grown strong, +expulsive, and more frequent. Very soon the advancing head will begin to +push outward the space between the front and back passage; the rectum is +pushed outward and the lips of the vagina open. If an anesthetic is to be +used these are the pains that call for it. A few drops may be dropped +singly on a small clean handkerchief held up by the middle over the nose, +its ends falling over the face. A few drops will just take the edge off the +pains, and render them quite bearable. As soon as the pain is over the +patient should rest, relax completely, and not fret and exhaust herself +worrying about the pains to come. It is astonishing how much actual rest a +woman can get between pains if she will only try; and it is astonishing how +much concentrated mischief a willful, unreasonable woman can do in the same +time. She will not try to rest, but cries and moans and pleads for +chloroform, until she succeeds in giving everyone except the physician and +nurse the impression that she is suffering unnecessarily. Her husband or +her mother, whichever is present, gets nervous; they begin to wonder [100] +if the physician is really trying to help; assume a long, sad, serious +face! forget their promise to look cheerful, and mayhap offer sympathy to +the woman. It is a trying moment and needs infinite patience and tact. The +physician attends strictly to his duty, which will now be to guard the +woman against exerting too great a force during the last few pains. About +this time, or before it in many instances, the "waters will break." This +means simply that the bag or membrane in the contents of which the child +floated burst because of the pressure of a pain. This is a perfectly +natural procedure and should not cause any worry: simply ignore it as if it +had no bearing on the labor in any way. As soon as the oncoming head has +dilated the passage sufficiently, so that the edges of the entrance to the +vagina will slip over the head without tearing, the physician allows the +head to be born. It takes some time to do this, and he must hold the head +back until just the right moment. It is best not to let the head slip +through at the height of a pain, or rupture is sure to occur. Wait till it +will slip through as a pain is dying out, and if you have waited long +enough and handled the head skillfully, the conditions will be just right +at a certain moment to permit this without tearing the parts. There are +some cases where a tear, and a good tear, is impossible to guard against. +It is not a question of patience, or tact, or skill; it is a combination of +conditions which patience, tact, and skill are powerless against. + +POSITION OF WOMAN DURING BIRTH OF CHILD.--The position of the woman is a +matter of choice and is not contributory to the results at all. She can lie +on her back, which is the ordinary way, or on her side, as the physician or +the patient prefer. As soon as the head is born the physician should see +that the cord is not round the child's neck; if it is, release it. The +shoulders will most likely be born with the next or succeeding pain. The +physician will permit the lower shoulder to slip over the soft parts first; +this is done by retarding the upper shoulder by pushing it gently behind +the pubic bone of the mother. When the shoulders are through, the rest[101] +of the body of the child slips out without effort. + +DUTY OF NURSE IMMEDIATELY FOLLOWING BIRTH OF CHILD.--As soon as the child +is born the nurse should sit by the side of the mother and hold the womb +until the after-birth is expelled. The womb can be easily felt in the lower +part of the woman's abdomen as a hard mass. It feels about the size of an +extra large orange. The object of holding it is to prevent the possibility +of an internal hemorrhage. It can be readily appreciated that the interior +of a womb, immediately after a child is born, is simply a large bleeding +wound. So long as the womb remains firmly contracted there is very little +chance for an extensive bleeding to take place. As a rule the womb remains +sufficiently contracted to preclude a hemorrhage until the after-birth is +out. After the after-birth is expelled, the womb usually closes down firmly +and the liability to bleed is very much reduced. Because there is a +distinct chance or tendency for the womb to bleed freely during the time +the after-birth remains in, it is customary, as stated above, to watch it +closely and to hold it securely. It is best held with the right hand. The +fingers should surround the top of the womb and exert a slight downward +pressure. Should it show any tendency to dilate or fill with blood, get it +between the fingers and the thumb and squeeze it, pushing downward at the +same time. + +EXPULSION OF AFTER-BIRTH.--The after-birth is usually expelled in about +twenty minutes after the child is born. Great care should be experienced in +its expulsion. It should not be pulled at any stage of its expulsion. If it +does not come easily give it a longer time,--it takes time for the womb to +detach itself from the after-birth; and some after-births are very firmly +attached. Eventually it will come out with a little encouragement in the +way of frictional massage of the womb through the abdominal walls. If the +membranes remain in the womb after the body of the after-birth is out, do +not pull on them. Take the after-birth up in the palm of your hand and turn +or twist it around, and keep turning it around gently, thereby loosening +the membranes from the womb instead of pulling them, which would surely +break them, leaving the broken ends in the womb, and, as a result, the[102] +chance of developing serious trouble. + +The patient should now be given one teaspoonful of the fluid extract of +ergot, which should be repeated in an hour. Should there be an excessive +flow of blood after this period it may be again repeated at the third hour. + +CUTTING THE CORD.--As soon as the child is born, and of course long before +the after-birth is expelled, the physician will tie the cord. This is best +done at two places, one about two inches from the child, and the other two +or three inches nearer the mother. Cut the cord about one-half inch beyond +the first ligature, which will be between the two ligatures. The cord +should be tied with sterile tape made for the purpose, or heavy twisted +ligature silk, or a narrow, ordinary, strong tape, previously boiled. It +should be tied firmly and inspected a number of times within one hour of +its birth. It is possible for a baby to lose enough blood from a cord badly +tied to cause its death. A very good way to ensure against such an accident +is to cut the cord one inch from the ligature nearest the baby, then turn +this inch backward and retie with the same ligature, thus making a double +tie at the same spot. Cut the cord with scissors that have been boiled and +reserved for this purpose. + +WASHING BABY'S EYES AND MOUTH IMMEDIATELY AFTER BIRTH.--As soon after birth +as is practicable, wash the baby's eyes with a saturated solution of +boracic acid. + +Immediately after the eyes have been washed the physician will drop into +them a solution of silver nitrate, three drops of a two per cent. solution +in each eye, or argyrol, three drops 20 per cent. solution. This precaution +is taken against possible infection during labor and, as explained +elsewhere, it is a preventive against certain diseased conditions which, if +present, would result in blindness. + +The physician should then wind a little sterile cotton round his moistened +little finger, dip it in the boracic solution, and holding the baby up by +the feet head down, insert this finger into the throat, thus clearing it of +mucus. The tongue and mouth may be gently washed with the same [103] +solution. + +After the baby has cried lustily as an evidence of life and strength, he +should be wrapped up in a warm blanket quickly, and immediately put in a +cozy basket in a warm place, and left there undisturbed, with his eyes +shaded from the light until the nurse is ready to attend to him. The baby +should be laid on his right side. + +CONDUCT IMMEDIATELY FOLLOWING LABOR.--As soon as the physician is satisfied +that the patient is well enough to be left in care of the nurse or +attendant, every effort should be made to favor a long, refreshing sleep. +Nothing will contribute to the patient's well-being so much as a quiet, +restful sleep after labor. The nurse will therefore take the baby into +another room, fix the mother comfortably, and give her a glass of warm +milk,--draw the shades or lower the light and tell the tired-out mother to +go to sleep. As a rule she will sleep easily, as she is sore and exhausted. + +AFTER-PAINS.--In women who have had children the womb does not as a rule +contract down as firmly as after the first confinement. This condition +permits of slight relaxation of the muscular wall, at which times there is +a slight oozing of blood. This blood collects and forms clots in the +uterine cavity which acts as irritants, exciting contractions in the effort +to expel them. These contractions cause what are commonly known as +"after-pains." These pains last until the womb is free from blood-clots. +They may be severe the first twenty-four hours and then gradually die out +during the following two or three days. Ordinarily in uncomplicated +confinements they rarely annoy the patient longer than a few hours. It is a +rare exception to observe them after the first confinement. + +REST AND QUIET AFTER LABOR.--Sometimes the birth chamber is the rendezvous +for all the inquisitive ladies in the neighborhood. No one should be +permitted in the lying-in chamber until the patient is sitting up, except +the husband and the mother. This should be made an absolute rule in every +confinement. This is a period that demands the maximum of uninterrupted +rest and repose. The world and all its concerns should remain a blank to a +woman during the whole period of her confinement. This is the only +successful means of obtaining mental rest. The husband and mother [104] +should be instructed to present themselves just often enough to demonstrate +their interest in the welfare of the patient and the baby. + +POSITION OF THE PATIENT AFTER LABOR.--After delivery a woman should be +instructed to lie on her back, without a pillow, for the first night. On +the following morning she may have a pillow, but she must remain on her +back for the first week. Sometimes an exception may be made to this rule by +letting the patient move around on the side, with a pillow supporting the +back, on the fourth day. These exceptional cases are those whose womb has +contracted firmly, as shown by the quick change in the amount and color of +the lochia. Women should be told why they must remain on their backs as +explained in the chapter: "How long should a woman remain in bed?" + +THE LOCHIA.--The discharge which occurs after every labor is called the +lochia. Its color is red for the first four or five days; for the +succeeding two or three days it is yellow; for the remainder of its +existence it is of a whitish color. It lasts from ten days to three weeks. + +The odor of the lochia is at first that of fresh blood; later it has the +odor peculiar to these parts. If at any time the odor should become foul or +putrid it is a danger signal to which the nurse should immediately draw the +physician's attention. + +If the amount of the lochia should be excessive it should be investigated. + +THE EVENTS OF THE DAY FOLLOWING LABOR.--We will assume that the patient +enjoyed a long sleep and wakes up refreshed, and with a thankful feeling +that all is over and that baby is safely here. She will want to see and +caress baby, of course. Lay the baby down in bed beside her and let her +love and mother it. Tell her not to lift it, for the strain might injure +her, then quietly steal away for ten or fifteen minutes, for these are +precious, sacred moments. Motherhood--that angel spirit, whose influence +every human heart has felt--that guards and guides the world in its +sheltering arms--is born in its divine sense, into the heart of every woman +for the first time, as she gazes in ecstasy and wonder at her [105] +first-born. She feels that she has begotten a trust,--a trust direct from +her Creator, and she makes a silent resolve, as she gently and timidly +feels the softness of baby's cheek, that she will watch over it, and guide +it, and do all a mother can for it, with God's help. It is good for the +race that mothers do feel this way: and it is good for all concerned that +they be given the opportunity to be so inspired. + +Just as gently take the baby away at the expiration of the allotted time. +Take it with a cheerful, smiling word, and do not comment upon mother's +happy, thoughtful face, she will quickly collect herself and enter into the +spirit of quiet congratulation that should now permeate the home. + +THE FIRST BREAKFAST AFTER LABOR.--If the patient has passed a comfortable +night, feels well, and is free from temperature, and has a normal pulse, +breakfast will consist of a cup of warm milk, or a cup of cocoa made with +milk, a piece of toasted bread, and a light boiled egg; or if preferred a +cereal with milk and toasted bread. This will be the breakfast for the two +following days also. The milk, or the cocoa (whichever is taken), must be +sipped, while the attendant supports the patient's head. The cereal, or the +egg (whichever is taken), must be fed to the patient out of a spoon. The +patient must not make any physical effort to help herself; she must remain +relaxed. Even when she sips her milk, or cocoa, she must not make any +effort to raise her head; the nurse must support its entire weight. This +will be the absolute routine of every meal until the physician gives +permission to change the procedure. It is a waste of time to formulate +rules only to disobey them. + +Shortly after breakfast the patient's toilet should be attended to. She +should have her hair combed, and her face and hands washed. The hair on the +right half of her head should be combed while the head rests on the left +side, and vice versa. The water used for washing the hands and face should +be slightly warmed. It is best to keep the hair braided and to consult the +wishes of the patient as to the frequency of combing it. [Page 106] + +THE IMPORTANCE OF EMPTYING THE BLADDER AFTER LABOR.--An effort should be +made now to have the patient urinate. This is very important at this time, +as it is not an uncommon experience to find that the abdominal muscles are +so worn out and overstrained with the fatigue of labor that they refuse to +act when an effort is made to urinate. As a consequence the bladder becomes +distended and may have to be emptied by other means. This condition is a +temporary and a painless one, and will rectify itself in a day or two; +meantime, if this accident has occurred, it is essential that the bladder +should be emptied from time to time until the patient can do it herself. To +test this function place the patient on the bed pan into which a pint of +hot water has been put, and give her a reasonable time to make the effort +to pass her water. Should she fail, take an ordinary small bath towel and +wring it out of very hot water, just as hot as she can tolerate, and spread +it over the region of the bladder and genitals: if there is running water +in the room, turn it on full and let it run while the towel is in position +as above. If the bladder is full, there is a peculiar, irresistible desire +to urinate when one hears running water. If this effort fails, report the +fact to the physician when he makes his daily call; he will draw the urine +and it will be part of his daily duty to give specific instructions +regarding this function until nature reestablishes it. + +No particular attention need be paid to the bowels for the first two days. +On the morning of the third day, if they have not acted of their own +accord, the physician will give the necessary instructions to move them. +The means necessary to accomplish the first movement after a confinement is +a matter of choice. The old-time idea was to use castor oil, and while +other remedies are now more or less fashionable, castor oil is still an +excellent agent. Enemas are frequently used, but their use is questionable +in this instance, inasmuch as a movement has not taken place for three +days, the object is to clean out the whole length of the intestinal tract, +and an enema is limited to part of the large intestine only,--according to +how it is given. If the small intestines are not thoroughly emptied, [107] +particles of food may remain there, and if so, they will putrify and the +patient runs the risk of developing gas,--sometimes to an enormous extent. +This affliction is painful, and dangerous, and nearly always unnecessary. +It is always, therefore, more safe, and more desirable, to use some agent +by the mouth, and we know of no better one than castor oil; and as castor +oil can be so masked as to be practically tasteless at any drug-store soda +fountain there can be small objection to it. My custom is to send the nurse +or husband with an empty glass to the drug store to have the mixture made +there and brought back ready for use. We have frequently obtained it in +this way and given it to the patient without her knowing what it was. The +best time to give castor oil is two hours after a meal, and two hours +before the next meal--i.e., on an empty stomach. It works quicker and does +not nauseate when the stomach is empty. + +INSTRUCTING THE NURSE IN DETAILS.--The nurse will attend to the patient's +discharges by changing the napkins frequently. The bruised parts should be +washed twice daily, for the first three or four days. If the nurse is a +trained graduate nurse a few directions will suffice. If she is not a +trained nurse the physician should be explicit in his instructions. It +would be better if he actually showed her just how he wanted this work +done. The best way to cleanse the vulvae or privates is to take an ordinary +douche bag at the proper height (about three feet) and allow the solution +(1 to 2,000 bichlorid) to run over the parts into the douche pan, but do +not touch any part of the patient with the nozzle of the douche bag. While +she is directing the water with the left hand she should have a piece of +sterile cotton in the right hand with which she will gently mop the parts. +This method ensures disengaging any clotted blood and is aseptic. Dry the +parts afterwards with a soft sterile piece of gauze and apply a clean +sterile napkin. + +DOUCHING AFTER LABOR.--A nurse should never give a vaginal douche without +instructions from the physician. Douches are not necessary in the +convalescence of ordinary uncomplicated confinement cases. When it is [108] +necessary to give vaginal douches after a confinement, there are good +reasons why they should be given, and it is therefore absolutely essential +that they should be given properly, and with the highest degree of aseptic +precautions. If these rules are not observed, the danger of causing serious +trouble is very great, and as the physician is directly responsible for the +conduct of the case, he should in justice to himself and his patient, do +the douching himself. + +HOW TO GIVE A DOUCHE.--The proper way to give a vaginal douche after a +confinement, when the parts are bruised and lacerated, and when, as a +consequence, the possibility of infection is very great, is as follows: + +Instruct the nurse to boil and cool about two quarts of water and have +another kettle of water boiling. Boil the douche bag and its rubber tubing +and the glass douche tube (do not use the hard rubber nozzle that comes +with the ordinary douche bag). Drain off the water after it has boiled for +ten minutes, but instruct the nurse not to touch the bag or tube, to leave +them in the pan, covered, till the physician uses them. When the physician +calls, place the patient on a clean warm douche pan while he is sterilizing +his hands and making the solution ready. While he is douching the patient +the nurse will hold the bag. The bag should not be held higher than two +feet above the level of the patient. + +ADVANTAGES OF PUTTING BABY TO THE BREAST EARLY AFTER BIRTH.--The patient +can now take, and will likely be ready for, an hour's nap. After the rest +it is desirable to put the baby to the nipple, first carefully cleaning the +nipple with a soft piece of sterile gauze dipped in a saturated solution of +boracic acid. The reasons for this are as follows: + +1st. There is in the breasts of every woman after confinement a secretion +known as "colostrum" which has the property of acting as a laxative to the +child, in addition to being a food. + +2nd. It is advisable that the child's bowels should move during the first +twenty-four hours and the colostrum was put there partly for that purpose. + +3rd. The act of suckling has a well-known influence on the womb, in [109] +that it distinctly aids in contracting it, and thereby expelling +blood-clots and small shreds of the after-birth which might cause trouble +if left in. + +4th. By nursing the colostrum out of the breasts, it will favor and hasten +the secretion of milk. + +5th. It is frequently easier for the baby to get the nipple before the +breast is full of milk, and having once had the nipple it will be easier to +induce him to take it again when it is more difficult to get. + +THE FIRST LUNCH AFTER LABOR.--Lunch will be next in order, and that should +consist of a clear soup,--chicken broth, mutton broth, beef broth with a +few Graham wafers or biscuits, and a cup of custard or rice pudding. This +will be the lunch for the two following days also. The same precautions are +to be observed in giving this as were observed with breakfast and as will +be observed with all other meals as clearly stated before, and repeated +again, so that no mistake may be made. In the middle of the afternoon the +patient can take a cup of beef tea or a cup of warm milk. + +THE FIRST DINNER AFTER LABOR.--Dinner will consist of more broth, or a +plate of clear consomme with a dropped egg, or a cereal, a little boiled +rice with milk, and stewed prunes, or a baked apple. + +After the bowels have moved, on the third day, and provided the temperature +and pulse have been normal since the confinement, the patient can be put on +an ordinary mixed diet, particulars regarding which are given on page 121 +under the heading "Diet for the nursing mother." + + * * * * * + + + [111] +CHAPTER IX + +CONFINEMENT INCIDENTS + + REGARDING THE DREAD AND FEAR OF CHILDBIRTH--THE WOMAN WHO DREADS + CHILDBIRTH--REGARDING THE USE OF ANESTHETICS IN CONFINEMENTS--THE + PRESENCE OF FRIENDS AND RELATIVES IN THE CONFINEMENT CHAMBER--HOW LONG + SHOULD A WOMAN STAY IN BED AFTER A CONFINEMENT?--WHY DO PHYSICIANS + PERMIT WOMEN TO GET OUT OF BED BEFORE THE WOMB IS BACK IN ITS PROPER + PLACE?--LACERATIONS, THEIR MEANING AND THEIR SIGNIFICANCE--THE + ADVANTAGE OF AN EXAMINATION SIX WEEKS AFTER THE CONFINEMENT--THE + PHYSICIAN WHO DOES NOT TELL ALL OF THE TRUTH + +REGARDING THE MORE OR LESS PREVALENT DREAD OR FEAR OF CHILDBIRTH.--Much has +been written, and much more could be written upon this subject. Inasmuch as +this book is largely intended for prospective mothers to read and profit +thereby, and is not for physicians and nurses whose actual acquaintance +with confinement work would render such comments superfluous, it will not +be out of place to consider this phase of the subject briefly, from a +medical standpoint. When one considers that "a child is born every minute" +as the saying goes, and which is approximately true, and at the same time +remembers that statistics prove, as near as can be estimated, that there is +only one death of a mother in twenty thousand confinements, it would really +seem as though we were "looking for trouble" to even regard the subject as +worthy of the smallest consideration. It is much more dangerous to ride +five miles on a railroad, or on a street car, or even take a two-mile +walk,--the percentage possibility of accident is decidedly in your favor to +stay at home and have a baby. Almost any disease you can mention has a +higher, a much higher fatality percentage than the risks run by a [112] +pregnant woman. The real justification for actual fear of serious trouble +is so small that it barely exists. These are facts that cannot be argued +away by any specious if or and. Why, therefore, should there be any real +fear? + +Did you ever hear of the remarks made by a famous philosopher who was given +a dinner by his friends in celebration of his 85th birthday? In replying to +the eulogisms of his friends he said in part: + +"As I look back into those blessed years that have faded away, I can recall +a lot of troubles and many worries as well as much happiness and pleasure, +and thinking of it all this evening I can truthfully say my worst troubles +and worries never happened." + +So it is with the woman who for weeks or months has made her own life +wretched, and possibly the life of her husband and friends, the same in +imagining all kinds of dreadful things that never take place. It is +undoubtedly an exhibition of weakness, an evidence of failure in the +development of self-control. Childbirth is a natural process,--there is +nothing mysterious about it. If you do your part you have no cause to +fear,--the very fact, however, that you entertain a dread of it, shows that +you are not doing your part. One of the saddest parts of life, one of the +real tragedies of living, is the fact that most of us have to live so long +before we really begin to profit by our experiences. Could we only be +taught to learn the lesson of experience earlier, when life is younger and +hope stronger, we would have so much more to live for and so many more +satisfied moments to profit by. One of the most valuable lessons experience +can teach any human being is not to worry and fret about the future. You +can plant ahead of yourself a path of roses and be cheerful, or you can +plant a bed of thorns and reap a thorny reward. Cultivate the spirit of +contentment, devote all your energy to making the actual present +comfortable. Don't fret about what is going to bother you next week, +because, as the philosopher said, most of the troubles we anticipate and +worry about never occur, but the worry kills. + +REGARDING THE USE OF ANESTHETICS IN CONFINEMENTS.--Anesthetics are as a +rule given in all confinements that are not normal. To make this [113] +statement more plain it may be said, that, when it is necessary to use +instruments, or to perform any operation of a painful character, it is the +invariable rule to give anesthetics. As to the wisdom of giving an +anesthetic when labor is progressing in a normal and satisfactory manner, +there is a difference of opinion. Much depends upon the disposition of the +patient and the viewpoint of the physician in charge of the case. It is a +fact that a large number of confinements are easy and are admitted to be +so, by the patients themselves, and in which it would be medically wrong to +give an anesthetic. In a normal confinement, however, when the pains are +particularly severe and the progress slow, there is no medical reason why +an anesthetic could not be given to ease the pain. In these cases it is not +necessary to render the patient completely unconscious. Sufficient +anesthetic to dull each pain is all that is necessary, and as this can be +accomplished with absolute safety by the use of an anesthetic mixture of +alcohol, ether and chloroform, there can be no possible objection to it. +The use of an anesthetic, however, is a matter that must be left entirely +to the judgment of the physician as there are frequently good reasons why +it should not be given under any circumstances. + +THE PRESENCE OF FRIENDS AND RELATIVES IN THE CONFINEMENT CHAMBER.--It is a +safe rule to exclude every one from the confinement room during the later +stages of labor. Sometimes it is desirable to make an exception to this +rule in the interest of the patient, by permitting the mother or husband to +remain. If this exception is made, however, they must be told to conduct +themselves in a way that will tend to keep the patient in cheerful spirits. +They must not sympathize, or go around with solemn, gloomy faces. +Cheerfulness and an encouraging word will tide over a trying moment when +the reverse might prove disastrous. + +Practically the same rule applies to the entire period of convalescence +during which time the patient is confined to bed. This is a very important +episode in a woman's life and the consequences may be serious if it is +misused in any way. Friends and relatives do not appreciate the [114] +absolute necessity of guarding the patient from small talk and gossip, and +an unwitting remark may cause grave mental distress, which may retard the +patient's convalescence and disastrously affect the quality and quantity of +her milk, thereby injuring the child. + +HOW LONG SHOULD A WOMAN STAY IN BED AFTER A CONFINEMENT?--To answer this +question by stating a specific number of days would be wrong, because, few +women understand the need for staying in bed after they feel well enough to +get up. If any answer was given, it should be at least fourteen days, and +it would be nearer the truth medically to double that time. Let us consider +what is going on at this period. The natural size of the unimpregnated womb +is three by one and three-quarter inches, and its weight is one to two +ounces. The average size of the pregnant womb just previous to labor is +twenty by fourteen inches, and its weight about sixteen ounces. We have, +therefore, an increase of about 600% to be got rid of before it assumes +again its normal condition. This decrease cannot be accomplished quickly by +any known medical miracle. Nature takes time and she will not be hurried: +she will do it in an orderly, perfect manner if she is allowed to. The womb +will again find its proper location and will resume its work, in a +painless, natural way, in due time, if all goes well. The uterus or womb is +held in its place by two bands or ligaments, one on either side, and is +supported in front and back by the structures next to it. These bands keep +the womb in place in much the same way as a clothes pin sits on a clothes +line, and it will retain its proper place provided everything is just +right. After labor, it is large and top heavy. If you put a weight on the +top of a clothes pin as it sits on a clothes line, what will take place? It +will tilt one way or the other, and if the weight is heavy, it will turn +completely over. So long as the woman lies in bed the womb will gradually +shrink back to its proper size and place; if she sits up or gets out of bed +too soon, the weight of the womb, being top heavy, will cause it to tilt +and sag out of its true position. As soon as it does this the weight of the +bowels and other structures above will push and crowd it further out [115] +of place. This crowding and tilting interferes with the circulation in the +womb and its proper contraction is interfered with, and thus is laid the +foundation for the multitude of womb troubles that exist. + +It is a mechanical as well as a medical problem. Being partly mechanical, +it is subject to the rules that govern mechanical problems. The importance +of this dual process will be appreciated by considering the following fact. +Many medical conditions tend to cure or rectify themselves because nature +is always working in our behalf if we give her a chance. Take for example +an ordinary cold. You can have a very severe cold and you can neglect it, +and in spite of your neglect you will get well. It is not wise to neglect +colds, nevertheless, it is true that nature will cure, unaided, a great +many diseased conditions, if she has half a chance. This, to a very large +extent, is the secret of Christian Science, yet the principle is known to +everyone. A mechanical condition, on the other hand, has absolutely no +tendency to get well of its own accord, or without mechanical aid. This is +why Christian Science cannot cure a broken leg. It is this principle that +makes diseases of the womb so persistent, and so stubborn of cure. When a +womb once becomes slightly displaced, the tendency always is for it to grow +worse and never to cure itself. The longer it lasts the worse it gets. Its +cure depends upon mechanically putting it back in place and holding it long +enough there to permit nature to reestablish its circulation, and by toning +and strengthening it so that when the mechanical support is taken away it +will retain its position. There is no other possible way of doing it. Now +since it has been proved that nature takes many days to contract a pregnant +womb, a woman is taking a risk, and inviting trouble by getting out of bed +before that time. + +WHY DO PHYSICIANS PERMIT WOMEN TO GET UP BEFORE THE WOMB IS BACK IN ITS +PROPER PLACE?--Without offering the excuse that a woman will not stay in +bed as long as a physician knows she should, there is, however, a large +degree of truth in this excuse. And we are of the opinion that, if a +physician made it a rule to keep all his confinement cases in bed for one +month, [Page 116] he would very soon find himself without these patients. + +Experience has taught us, however, that it is safe, under proper +restrictions, and in uncomplicated confinements, to allow patients to sit +up in bed on the 12th and in certain cases on the 10th day, and to get out +of bed on the 12th or 14th day. When the patient is allowed to sit up, out +of bed, it should not be for longer than one or two hours, and during that +time she should sit in a comfortable rocking or Morris chair, which should +be placed by the side of the bed. Each day the time can be lengthened, and +the distance of the chair from the bed increased. This procedure gives her +the opportunity to walk a little further each day, thereby to test her +strength and ability to use her limbs. On the fourth day, if all has gone +well, she may stay up all day and she may walk more freely about the room. +She should be just to herself, however. As soon as she is fatigued she +should not make any effort to try to "work it off." When a feeling of +fatigue appears she should rest completely. If she has any pain or distress +she should acquaint the physician with it at once. She should not try to +hide anything on the mistaken idea that "it isn't much." She does not know, +and she is not supposed to know what the pain may mean; it may be +exceedingly significant. Many women have saved themselves needless +suffering, and their husbands unnecessary expenditure of money, by calling +the physician's attention to conditions, which in time would have been +serious, and would have necessitated long, expensive treatment. + +LACERATIONS DURING CONFINEMENT, THEIR MEANING AND THEIR SIGNIFICANCE.--The +only interest a laceration or a tear has to a physician, is whether the +laceration or tear is of sufficient importance to need surgical +interference. The laceration can take place at the mouth of the womb, or on +the outside, between the vagina and rectum. + +Those of the mouth of the womb always take place, in every confinement, to +some degree. They are never given any attention at the time of the +confinement, unless under extraordinary circumstances, such as a more or +less complete rupture of the womb, and this is such a rare accident [117] +that most physicians practice a lifetime and never see or hear of one +single case. Those on the outside are always attended to immediately after +labor, or should be, unless they are very extensive and the patient is not +in condition to permit of any immediate operative work. In such a case it +is best to leave it alone until the patient is in condition to have it +operated on at a later date. + +It is distinctly preferable to have it attended to immediately after labor +when it is possible, and it is possible in a very large percentage of the +cases. The explanation of this is because it is practically painless then, +owing to the parts having been so stretched and bruised that they have +little or no feeling. If it is left for a day or two and then repaired, it +will be more painful, because the parts will have regained their +sensitiveness. Another good reason in favor of immediate repair is that a +much better and quicker union will take place than if postponed. + +When a patient is torn, but not to the degree necessary to stitch, it is to +her advantage to be told to lie on her back and keep her knees together for +twelve hours, thus keeping the torn edges together and at rest, thereby +favoring quick and healthy repair of the tear. Some physicians go as far as +to bind the patient's knees together so she cannot separate them during +sleep. + +It is the custom of every conscientious physician to request every woman he +confines to report at his office six or eight weeks after labor. The reason +for this is to find out by examination the character and extent of the +lacerations of the mouth of the womb. No physician can tell at the time of +labor just how much damage has been done, because the mouth of the womb, at +the time of labor, is so stretched and thinned out, that it is impossible +to tell. After the womb has contracted to about its normal size, it is a +very simple matter for any physician to tell exactly the character and +extent of the lacerations. Most of these tears need absolutely no +attention; there are a few however that do. This is a very important matter +for two very good reasons. + +1st. Every woman should know, and is entitled to know, just what [118] +condition she is in, because if she has been torn to an extent that needs +attention, and is left in ignorance of it, her physical health may be +slowly and seriously undermined and the cause of it may not be understood +or even guessed at. A woman who becomes nervous and irritable, loses vim +and vitality, has headaches, backaches and anemia, and no symptoms, or few, +that point to disease of the womb, will suffer a long time before she seeks +relief of the right kind, and will be astonished and outraged when she is +told that it all results from a bad tear of her womb that she knew nothing +about. + +2nd. A physician should in justice to himself insist on this late +examination, because if a woman is told, at some subsequent time, by +another physician that she is badly torn, and she was not told of it by the +physician who confined her, she is very apt to form an unjust opinion of +his work and to entertain an unfriendly feeling toward him as a man. + +Some physicians also, to their discredit, are not slow in permitting an +unjust opinion of a colleague to be spread around, by preserving a silence, +when an explanation would result in an entirely different opinion by the +patient. They permit it to be inferred that the physician was responsible +for the tear, when such is not the case. No physician on earth can prevent +a tear of the mouth of the womb and this should be explained to the +patient. Where the physician is at fault is in the failure to examine his +patients when it is possible to tell that a tear of any consequence exists. +If such an examination is made, he is in a position to state that a tear +exists of sufficient extent to justify careful attention. Immediate +operation is seldom necessary, and if the patient is comparatively young, +it may not be wise to operate, because if pregnancy takes place within a +reasonable time the womb will again tear. She should be told, however, that +should she not become pregnant during the next three years she should be +examined from time to time, and if the condition of her womb, or her health +suggest it, she should have the tear attended to. If after this explanation +she neglects herself she must blame herself, she will at least have no[119] +cause to harbor any resentment against her physician who has done all any +physician is called upon to do under the circumstances. Another important +reason for finding out the character of the laceration is because these +lacerations of the mouth of the womb frequently cause sterility. + + * * * * * + + + [121] +CHAPTER X + +NURSING MOTHERS + + THE DIET OF NURSING MOTHERS--CARE OF THE NIPPLES--CRACKED + NIPPLES--TENDER NIPPLES--MASTITIS IN NURSING MOTHERS--INFLAMMATION OF + THE BREASTS--WHEN SHOULD A CHILD BE WEANED?--METHOD OF WEANING--NURSING + WHILE MENSTRUATING--CARE OF BREASTS WHILE WEANING CHILD--NERVOUS + NURSING MOTHERS--BIRTH MARKS--QUALIFICATIONS OF A NURSERY MAID. + +THE DIET OF NURSING MOTHERS.--A nursing mother should eat exactly the same +diet as she has always been accustomed to before she became pregnant. If +any article of diet disagrees with her she should give up that particular +article. She should not experiment; simply adhere to what she knows agreed +with her in the past. More, rather than less, should be taken, especially +more liquids as they favor milk-making. It is sometimes advisable to drink +an extra glass of milk in the mid-afternoon and before retiring. If milk +disagrees, or is not liked, she may take clear soup or beef tea in place of +it. In a general way milk in quantities not over one quart daily, eggs, +meat, fish, poultry, cereals, green vegetables, and stewed fruit constitute +a varied and ample dietary to select from. + +Every nursing mother should have one daily movement of the bowels; she +should get three or four hours' exercise in the open air every day; and she +should nurse her child regularly. + +The diet of the nursing mother during the period immediately after +confinement is given elsewhere. + +Alcohol, of all kinds, should be absolutely avoided during the entire +period of nursing. + +Drugs of every variety, or for any purpose, should never be taken unless by +special permission of her physician. + +CARE OF THE NIPPLES.--As soon as the mother has had a good sleep after the +confinement the nipples should be washed with a saturated solution of [122] +boracic acid, and the child allowed to nurse. The milk does not come into +the breast for two or three days, but the child should nurse every four +hours during that time. There is secreted at this time a substance called +colostrum. This is a laxative agent which nature intends the child should +have as it tends to move the bowels and at the same time it appeases the +hunger of the infant. It also accustoms the child to nursing and gradually +prepares the nipples for the work ahead of them. + +After each nursing the nipples should be carefully washed with the same +solution and thoroughly dried. + +CRACKED NIPPLES.--Cracked nipples often result from lack of care and +cleanliness. If they are not cared for as described above they are very apt +during the first few days to crack. They should never be left moist. They +should be washed and dried after every feeding. If the breasts are full +enough to leak they should be covered with a pad of sterile absorbent +gauze. + +Nursing mothers should guard against cracked nipples, as they are +exceedingly painful; frequently necessitating a discontinuance of nursing; +and may produce abscess of the breast. + +TREATMENT OF CRACKED NIPPLES.--In addition to washing the nipples, drying +them thoroughly, and placing a pad of dry gauze over them after each +feeding, they should be painted with an 8 per cent. solution of nitrate of +silver twice daily. Before the next feeding, after the silver has been +used, they should be washed with cooled boiled water. If the cracks are +very bad it may be necessary to use a nipple-shield over them while nursing +for a few days. + +TENDER NIPPLES.--Many women complain of the pain caused by the baby when it +is first put to the breast. These nipples are not cracked, they are simple +hypersensitive. They should be thoroughly cleansed and dried as above and +painted with the compound tincture of benzoin. They should be washed off +with the boracic acid solution before each feeding. After a few days under +this treatment the tenderness will leave them. + +MASTITIS IN NURSING MOTHERS.--When inflammation of the breast takes [123] +place in a nursing mother it is the result of exposure to cold, or it may +result from injury. If infection occurs and an abscess develops, it results +from the entrance, through the nipples, or cracks, or fissures in the +nipple, of bacteria into the breast. There is fever, with chills and +prostration, and very soon it is impossible to nurse the child because of +the pain. Nursing should be immediately discontinued, the breast supported +by a bandage and the milk drawn, with a breast pump, at the regular nursing +intervals. An ice-bag should be constantly applied to the painful area and +the bowels kept freely open with a saline laxative. When the fever and the +pain subside nursing may be resumed. + +If the gland suppurates in spite of treatment it must be freely opened and +freely drained. + +WEANING + +WHEN TO WEAN THE BABY.--Medically there is no exact time at which the baby +should be weaned. Certain conditions indicate when it should be undertaken. +It is desirable to wean the baby between the tenth and twelfth months. A +month or two one way or another will not make much difference if the mother +and child are in good condition. It should be weaned between the periods of +dentition rather than when it is actively teething. The time of year is +important. It would be better to wean it before the hot weather if it is +strong and has been accustomed to taking other food than the breast milk. +On the other hand it would be decidedly better to defer the weaning until +the fall, rather than risk weaning at the tenth or twelfth months if these +fall during the height of the hot weather. + +METHODS OF WEANING.--The best way to wean is to do it gradually. It is not +desirable to take the mother's milk away suddenly unless there is a very +good reason for it. The child should be fed small portions of suitable +other food at the beginning of the tenth month. By the end of the tenth +month he should be taking a feeding two or three times a day of food other +than the breast milk. This feeding may be given in a bottle. In some [124] +cases the mother may be able to feed the child with a spoon instead of the +bottle. The substitute feedings allowable at this age are given in another +chapter. + +TIMES WHEN RAPID WEANING IS NECESSARY.--There are times when the child must +be weaned suddenly, as, for example, at the death of the mother, serious +sickness of the mother, or in cases where for any cause the mother suddenly +loses her milk. In these cases it is best to wean at once. If an infant +refuses to take the bottle under such circumstances, the best plan to +adopt, and the wisest one in the long run, is to starve the child into +submission. If he gets absolutely nothing but the bottle he will shortly +take it without protest. If a meddling individual attempts to feed the +child some other food and tries to coax it to take the bottle in the +meantime, much harm may result; it is safe only to fight it out for a day +or two and win than to half starve the child and lose in the end. + +The child should be weaned if it is not gaining in weight. This may +indicate a deficient quality of the mother's milk, or it may indicate a +lack of proportion between the child and mother. If a robust child is +depending upon the nourishment furnished by a mother who is not in good +physical condition the milk may not be adequate in quality and quantity. +The child will not therefore develop normally and it may be necessary to +wean it. + +If the mother becomes pregnant it will be necessary to wean, because +pregnancy invariably affects the quality of the milk. It is a very good +habit to accustom the child to take its daily supply of water from a bottle +from a very early age. This procedure will make it easier to wean at any +time. + +Menstruation is not an indication for weaning as has been explained. If, +however, the return of menstruation affects the milk so that it disagrees +with, or fails to satisfactorily nourish the child, it may be necessary to +wean, but not unless. + +The best reason for weaning a child at the twelfth month is that a mother's +milk after that time is not adequate in quality for a child of that age. A +child at one year of age has grown beyond the capability of its mother[125] +to nurse it: nature demands a stronger and a more substantial food than any +mother can supply. A mother who nurses her child beyond that period is not +only injuring herself, but she is cheating her child. The exception to this +rule is, as has been explained, the second summer. + +The child will evidence its dissatisfaction with the breast supply if it is +not enough; it will not gain in weight, it will be irritable and fretful, +it will tug long and tenaciously at the nipple, it will be unwilling to +cease nursing after it should have finished, and it will drop the nipple +frequently with a dissatisfied cry. These are all signs of insufficient +nourishment, and to the observant mother they will at once indicate that +the child must be weaned and fed upon a mixed diet. + +CARE OF BREASTS WHILE WEANING CHILD.--The process of weaning should cause +little or no discomfort. If the weaning is gradual it is necessary to press +out enough milk to relieve the tension from time to time. It usually takes +three or four days. + +If it is necessary to wean abruptly, as it is occasionally, there may be +considerable distress. In these cases it is necessary to massage the +breasts completely,--until all the milk is out, or as much as it is +possible to get out,--then rub the breasts with warm camphorated oil, and +bind them firmly. When the breasts are massaged for any reason, the rubbing +should be toward the nipple and it should be done gently. If there are any +hard lumps, or caked milk, in the breasts, they must be massaged until +soft, and the binding renewed. It may be necessary to repeat this process +for a number of days. In binding the breasts use a large wad of absorbent +cotton at the sides, under the arms, to support the breasts, and another +wad between the breasts. This renders the binding more effective; permits +the binder to be put on tighter; and prevents it from cutting into the +skin. When weaning has to be done quickly the patient should absolutely +abstain from all liquids. A large dose of any saline, Pluto, Apenta, or +Hunyadi Water, or Rochelle salts, or Magnesium Citrate, should be given +every morning for four or five days. [Page 126] + +If the weaning is gradually undertaken the child should be allowed to nurse +less frequently. One less nursing every second day until two nursings daily +are given. Keep the two daily nursings up for one week and then discontinue +them, after which the above measures may be adopted. To dry the milk up, +the breasts may be anointed with the following mixture: Ext. Belladonna, 2 +drams; Glycerine, 2 ounces; Oil of Wintergreen, 10 drops. + +NERVOUS NURSING MOTHERS.--Nervousness, considered not as the product of a +diseased condition, but as a temperamental quality, is an unfortunate +affliction in some nursing mothers. Let us illustrate just how this +characteristic is detrimental to the helpless baby. A mother was instructed +to give her baby a half teaspoonful of medicine one-half hour after each +feeding. She was told how to give it, and how to hold the baby when giving +it. She was also told that the baby would not like it, and would try to +eject it from its mouth rather than swallow it, and that when it did +swallow it, it would make a little choking noise in its throat, but not to +mind these, to go ahead and give it, as the baby could not strangle or +choke. It was essential to give the baby this medicine, and hence the +physician explicitly instructed her in these details. What was the result? +On the following day when the physician called, and found the baby much +worse, the mother said: "Oh, doctor! I couldn't give the medicine, the baby +wouldn't take it, she nearly strangled to death when I tried to give it." +The physician asked for the medicine and placing the baby over his knee, +gave it without the slightest trouble, much to the mother's amazement. The +servant girl who was a hard-headed, cool, Scotch girl, was instructed and +shown how to give the medicine, which she did successfully. The mother was +temperamentally nervous, was easily excited and became helpless the moment +the baby objected, though she was a strong, robust, healthy woman. + +Another mother was carefully instructed to drop into the eye of her baby +two drops of medicine every four hours. She was told and apparently +appreciated the urgent necessity of the medication as her baby's eye [127] +was badly infected. She was further told that if she did exactly as shown, +the eye would be better in two or three days, and if she did not, the other +eye would become infected, and blindness might result. She undertook to +carry out the directions faithfully. She absolutely failed, however, to +carry out the instructions. Her husband informed the physician on the +following day that she became so nervous and excited that she utterly +failed to treat the eye once, and when he and a sister offered their +assistance she became so unreasonable in her fear that "they might hurt the +baby" that it was impossible to do anything with her. Her sister was +finally shown how to do it and carried the case through quite successfully. + +Inasmuch as this book is intended to convey helpful instruction to every +mother, the author would suggest to those of this type the necessity of +resisting this tendency. It is a matter of will power, just make up your +mind not to be silly and if you find that you cannot trust yourself to +follow instructions, let someone else do it. When the physician tells you a +certain thing must be done, and that no harm can result, do it, and don't +imagine all kinds of impossible happenings. + +So much anguish and annoyance is caused in this world by imagining and +anticipating trouble, that half the pleasure of life is denied us. You +cannot do your whole duty by a helpless baby if you do not reason and act +upon sound judgment. Many babies are lost by mothers being afraid to do +what should be done, and what they know should be done. It is not what the +doctor does that brings a baby through a dangerous sickness; it is the +faithfulness of the nurse in carrying out his instructions that is +responsible for the outcome. A timid, halting, doubting nurse can quickly +undo all a physician hopes to accomplish; while a prompt, faithful nurse, +with initiative, and good judgment, can save a little life in a crisis, +even in the absence of the physician. Follow instructions implicitly, even +though the carrying out of the instructions seem to cause the baby pain and +suffering,--it is for the baby's best interest. + + [128] +BIRTH MARKS.--Much has been written on this subject which a later study of +biology and eugenics have shown to be utterly false. Let us consider the +actual facts. The baby is already a baby, floating in a fluid of its own +manufacture. It has absolutely no connection with its mother except by +means of its umbilical cord,--which is composed of blood vessels. The blood +in these vessels is the child's blood and never at any time does it even +mix with the blood of the mother. It is sent along these vessels into the +placenta, or after-birth, in which it circulates in small thin vessels, so +close to the mother's blood that their contents can be interchanged. Yet +the two streams never actually mix. The carbonic acid and waste products, +in the child's blood, are taken up by the mother's blood, and given in +exchange oxygen and food, which is returned to nourish the child. There is +absolutely no nervous connection between the mother and the child. How then +is it possible for the mother to affect her child in any way except insofar +as the quality of its nourishment is concerned? Nor can a mother affect her +child in any other sense. If the intermingling of blood could affect a +child's education we would frequently resort to surgery. In the article on +Eugenics, under the heading, "Education and Eugenics," it is explained that +the child is "created" at the moment of conception; that absolutely nothing +can affect it after it is created; that no influence of the mother or +father can in any way affect it for better or worse. A mother cannot create +in her child any quality which she may desire no matter how she conducts +herself. It was formerly thought that a mother could for example create a +musical genius by devoting all her time to the study of music while she +carried the unborn child; or that she could make a historian of it if she +studied history; or an artist if she studied paintings. We now know this to +be wholly wrong and for very excellent reasons. + +The mother must realize that the only aid she can bestow upon her unborn +child is to give it the best possible nourishment. She must provide good +blood because the quality of the maternal blood stream bespeaks a healthy +or unhealthy, a fit or unfit, child. Whatever the child is to be is [129] +already fixed, its innate characteristics art part of itself. Whether it +will have the vitality to develop its inherent possibilities depends, to a +great degree, upon its intra-uterine environment,--and its intra-uterine +environment depends upon the health of its mother and the quality of the +blood she is feeding it upon. After birth its health, its success, its +efficiency, depends upon the care it gets and the quality of its mother's +milk. A mother therefore must be in good physical and mental health if she +hopes to do her full duty as a mother. + +QUALIFICATIONS OF A NURSERY MAID.--When a helper, or maid, is employed to +aid in caring for the baby, much precaution should be exercised in +selecting her. The association of the nursery maid and the child, is +necessarity an intimate one, and she should be willing to submit to a +medical examination to prove her physical fitness. Her lungs should be +examined thoroughly, so also should the condition of her mouth, throat and +nose be known. An observant and tactful mother will also find out if there +are any other objectionable conditions existing, which would render her +unfit for the position. A nursery maid should be naturally fond of +children, she should be industrious, and sensible; of quiet tastes and good +disposition. Her work should be a pleasure not a task. + + * * * * * + + + [131] +CHAPTER XI + +CONVALESCING AFTER CONFINEMENT + + THE SECOND CRITICAL PERIOD IN THE YOUNG WIFE'S LIFE--THE DOMESTIC + PROBLEM FOLLOWING THE FIRST CONFINEMENT. + +The first three or four months following the first confinement is the +second important period in the young wife's life. In one sense it is the +most critical period. The first important period you will remember we +stated to be the first few months after marriage. During these months the +young wife passed through the period of adaptation. She found out that +matrimony was not all sunshine and happiness. She learned that her husband +was not the paragon she had idealized. She discovered his human side. She +met daily trials and annoyances incident to domestic life. She found her +level, and, in finding it, she discovered herself. She is not very safely +anchored yet but she is trying to succeed and the future promises well. +Some day she awakes to the knowledge that she is pregnant and a multitude +of new speculations enter into the situation. She finds she must go on +striving and hoping and praying that she may have the strength and courage +to do her part. Time passes, and if she is an ordinary woman she scarcely +does justice to herself. Her duties are exacting, and her physical +condition is not given the study and care which she ought to give it. She +does not understand the importance of the hygiene of pregnancy, and the day +of the confinement finds her more or less exhausted, and worn out. She +passes through the crisis of maternity, however, and spends the customary +ten days in bed. At the end of that period the nurse and physician leave +her to face the most important problem of life alone. She is a mother, and +has in her exclusive charge a human life. + +Let us exactly understand what the real situation is. It would not further +the object of this book or help in the solution of the problem the author +has in mind to depict a false situation. We must concede the following[132] +facts to be true, if we understand the subject: + +1. That the mothers of the human race are, in the vast majority, the poor. + +2. That they are uneducated in the sense that they are not versed in the +science of hygiene and sanitation, and consequently health preservation. + +3. That even the fairly well educated are innocently ignorant of the +science of heredity, environment, hygiene, sanitation and health +preservation. + +4. That to benefit the majority we must depict conditions as they exist +among the poor, and reason from that standard. + +Such books as have been written on this subject have based their facts upon +too high a plane. Their remedies are beyond the means and the understanding +of the average poor mother. Their analogies are based upon conditions that +exist among the better class. The average poor housewife gets no practical +assistance or help from their deductions, because her environment precludes +any utilization of the data furnished; the data is not practical in her +particular case. + +Our young mother is in all probability a physically and mentally immature +girl. She most likely entered the marriage relationship without a real +understanding of its true meaning, or even a serious thought regarding its +duties or its responsibilities. She was not taught the true meaning of +motherhood before actual maternity was thrust upon her. She has probably +innocently acquired habits which are detrimental to her health and her +morals; and she has no conception of the fundamental duties of a homemaker. +Yet into the keeping of this woman a human life has been given. + +Her home surroundings are not such as to inspire confidence or from which +to elicit encouragement. It has been a struggle to make ends meet; to keep +the peace; to be hopeful and cheerful. If she has succeeded in keeping her +home neat and clean and comfortable, it has been at the expense of her not +too robust constitution. If she has made efforts to observe the amenities +of life, to be true as wife, companion and confidant, it has taxed her[133] +nerves, her courage and her vitality. She has frequently been at the +breaking point but she has kept up because she felt it was her duty, and +because there was nothing else to do. + +As she rests from her weary labor during the first long days after getting +out of bed, the loneliness of it all crushes her. She is weak, nervous, and +discouraged, and her white, wan face, with its tired, appealing eyes, +bespeaks her anemic and hopeless condition. She is only a child herself, +yet fate has crowned her with the holy diadem of motherhood. There are +thousands of such mothers and yet posterity need not despair. This is just +the beginning, and from such beginnings have sprung the heroes of the race. +If the reader has carefully read the chapter on Heredity she will +understand that the temporary condition of this mother is not important so +far as the destiny of the child is concerned. The really important question +is, How will this mother develop? The environment of the child depends upon +the conditions with which its mother surrounds it. If she is a failure, the +child's environmental influences will be unfavorable; if she proves worthy +of her trust, if she progresses and masters her difficulties; if she is a +good mother and a good homemaker the child's surroundings and influences +will be favorable to the full development of its hereditary endowment. But +it must be remembered that even an unfavorable environment need not prevent +the hereditary promise from dominating the life of the individual. + +To return to our girl mother, upon whose slender shoulders the weight of a +great responsibility rests,--we wish to concede that her burden is great. +Her home duties are rendered more onerous because of her physical weakness +and disability. The strain of nursing her fretful child is taxing her +vitality and her nerves to the limit. Her disposition is imposed upon by +the exactions of an uncomprehending husband. She is inclined to fretfulness +and melancholia by the seeming uncharitableness of fate and fortune. Her +moments of introspection are almost bitter. It is a critical period,--she +has reached the breaking point. [Page 134] + +Such moments are apt to be epochal. The turning of the wheel of fortune +will decide the destiny of a human soul. + +It may be a friend who will supply the needed inspiration that will +revitalize hope, and courage, and the determination to succeed. Or it may +be a prayer, breathed in the silence of despair that will inspire the +courage to fight on, and change the complexion of life. + +Once again we would advise such a young wife to calmly think matters over; +to find out "what she is working for"; to assemble her ideals and to "know +what she wants." There is nothing organically wrong. It is a condition, not +a disease. She is discouraged, despondent, nervous and weak. The +discouragement, despondency, and nervousness is a result of reduced +physical vitality and lack of system. She is not efficient because she is +not a trained worker. She is easily discouraged because anemia or +bloodlessness fails to supply the oxygen necessary to a fight. There is no +period in a woman's life when she is more apt to fall into a rut than at +this time. Every element, spiritual and physical, which is necessary to +stagnation and indifference is present, and it will take a bold and brave +effort to resist the temptation to failure which has encompassed her. + +How can we suggest a remedy? She must first regain her health. She has +simply a condition to combat, not a disease, and a definite system, a well +laid out plan strictly adhered to will effect the result. She must regain +her health, because, without health, she cannot hope to be efficient in +work or agreeable in disposition, and she owes both to herself, to her +husband and to her child. She must get out of doors. She must walk in the +open air. There is absolutely nothing in life that will effect so +miraculous a transformation in a discouraged, tired, weary and sick woman, +as systematic daily walks in the open air. She must walk briskly, however, +and she must desire to get well. We cannot get well if we do not wish to +get well. One who walks with a purpose will walk erect, firmly and briskly; +she will hold her chest up, and will breathe deeply, and she will drink in +hope, and health, and happiness. It takes time to regain strength [135] +after the strain of pregnancy and labor. Many women complain that they feel +weak and do not regain strength quickly, but they make no effort. They must +make a beginning. Sitting around waiting for it to come will not bring it. +If they cannot walk a mile, they must walk half that distance to begin +with; the five mile walk will follow in time. Many young mothers get into +the habit of taking baby out in his carriage for an airing, and regard this +as exercise for themselves. They join the baby brigade and parade up and +down the block, or select a sunny spot where there are others on a like +quest, and sit around exchanging confidences. These outings usually +degenerate into gossiping parties and are a dangerous and questionable +practice. They are no doubt good for the baby, but they are morally and +physically bad for the young mother. This daily habit is called exercise, +but it is in no sense physical exercise. The young mother should select a +certain time each day, immediately after a nursing when baby is likely to +sleep, and devote this period to walking. One hour each day will accomplish +much in regaining and establishing health and strength, and appetite for +the mother. No indoor work can take the place of a walk out of doors. It is +a duty on the part of the nursing mother to do this. It will enable her to +supply better milk; it will banish her tendency to nervousness; it will +ensure a good appetite, good spirits, and sound sleep. It will make her a +better mother and a better wife. Many young wives sow the first seeds of +discontent, and ultimate failure during the natural depression that follows +maternity. + +She must adopt system in the performance of her household duties. A good +plan is to set aside a certain definite time for meals, when to begin +cooking and when to end washing the dishes. Then arrange regarding the +general household duties. Make a schedule for a week devoting each day to a +certain task so that at the end of the week all the essential work will +have been completed. By systematizing work in this way a great deal of +ground can be covered and as time passes it will become easier, as many +helpful ways will suggest themselves whereby time will be economized. [136] + +Adopt a system with the baby. Many mothers are worn-out, nervous wrecks for +no other reason than a lack of system in the management of the daily life +of their offspring. If system is not adopted in feeding and caring for an +infant it becomes irritable. To a sick, tired, weary mother an irritable +child is an unspeakable torture. Begin right. Give it adequate, but no +unnecessary attention. Nurse it every two hours, and at no other time. Wake +it to nurse at its regular time. It will in a few days acquire the habit of +feeding regularly and will sleep between feedings. Do not overfeed it. +Remember babies never die from starvation, but many do by overkindness, and +overfeeding is the most prolific cause of infant mortality known. Read the +article on "How long should a baby nurse?" Keep the baby clean, comfortable +and happy and you will not have a fretful child, but one that will be a +constant inspiration and incentive to you. + +Find time to rest, take a mid-day nap. Get off occasionally to the country +or the sea shore for a day or two. Keep up your interest in your personal +appearance, be neat and clean, and invite the attention of your husband +during the evening hour. Don't let him grow away from you. Be cheerful, +encourage him to tell of his hopes and plans, and show an interest in his +health and in his work. Do not forget the dominating influence on your +efficiency, and on your happiness which the study habit possesses. Interest +yourself in some art, cultivate your mind, and soon, sooner than you think, +you will have forgotten your troubles and you will have regained your +health. + +There is no other way to do it. There is no royal way in which it can be +done which is not open to the poorest mother. + +An ocean voyage, a trip to Europe, a society Doctor, a professional +masseur, beauty experts and miracle workers cannot accomplish more than you +can in your poor apartment, if you "go about it in the right way and in the +right spirit." Keep in mind always, that: "failure exists only in +acknowledging it." Every task that is worth while is won by self-sacrifice, +by self-abnegation, by patient, persistent, enthusiastic effort, and in no +other way. The joy of consummation is reward enough for all human +sacrifice. + + * * * * * + + +Corrections made to printed original. + +Index: Constipation, in breast-fed infants: 'in-infants' (line-break) in +original + +Ibid.: Gleet; Mucous patches; Pox; Vol II: Vol I. in original + +Ibid.: Sanitary napkins; I, 66: I, 63 in original + +Ibid.: Sexual intercourse; I, 76: I, 78 in original + +Page 23: whether there is such a thing: 'think' (hand-corrected) in +original + +Page 40: recruiting ground for the gangster: 'ganster' in original + +Page 65: incident to a confinement: 'confiement' in original + +Ibid.: The advantage of the Kelly pad: 'paid' in original + +Page 89: the patient should pass: 'pateint' in original + +Page 93: Advantages of Putting Baby to Breast: 'Adantages' in original + +Page 127: anguish and annoyance: 'anoyance' in original + + + + + + +End of the Project Gutenberg EBook of The Eugenic Marriage, Volume I. (of +IV.), by W. 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