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+The Project Gutenberg eBook of The Four Epochs of Woman's Life by Anna M. Galbraith
+
+This eBook is for the use of anyone anywhere in the United States and
+most other parts of the world 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. If you are not located in the United States, you
+will have to check the laws of the country where you are located before
+using this eBook.
+
+Title: The Four Epochs of Woman's Life
+
+Author: Anna M. Galbraith
+
+Release Date: April 7, 2002 [eBook #4986]
+[Most recently updated: February 23, 2021]
+
+Language: English
+
+Character set encoding: UTF-8
+
+Produced by: Jim Weiler, xooqi.com
+
+*** START OF THE PROJECT GUTENBERG EBOOK THE FOUR EPOCHS OF WOMAN'S LIFE ***
+
+
+
+
+                    THE FOUR EPOCHS OF WOMAN'S LIFE
+
+
+                          A Study in Hygiene
+
+ BY
+
+ANNA M. GALBRAITH, M.D.
+
+   Author of "Hygiene and Physical Culture for Women"; Fellow of the New
+   York Academy of Medicine ; Ex-President of the Alumnae Association,
+   Woman's Medical College of Pennsylvania; Attending Physician,
+   Neorological Department, New York Orthopedic Hospstal and Dispensary.
+  _________________________________________________________________
+
+   WITH AN
+
+ INTRODUCTORY NOTE
+
+   by
+
+ JOHN H. MUSSER, M.D.
+
+   Late Professor of Clinical Medicine, University of Pennsylvania.
+
+  "As in a building
+   Stone rests on stone, and wanting the foundation
+   All would be wanting, so in human life
+   Each action rests on the foregoing event
+   That made it possible, but is forgotten
+   And buried in the earth."
+
+                                                        -- LONGFELLOW.
+  _________________________________________________________________
+
+                          INTRODUCTORY NOTE
+                          _________________
+
+IT has been well said that the bulwarks of a nation are the mothers.
+Any contribution to the physical, and hence the mental, perfection of
+woman should be welcomed alike by her own sex, by the thoughtful
+citizen, by the political economist, and by the hygienist. Observation
+of the truths, expressed in a modest, pleasing, and conclusive manner,
+in the essay of Dr. Galbraith contribute to this end. These truths
+should be known by every woman, and I gladly commend the essay to
+their thoughtful consideration.
+
+                        JOHN H. MUSSER, M.D.,
+
+                                   Late Professer of Clinical Medicine
+                                    in the University of Pennsylvania.
+  _________________________________________________________________
+
+  PREFACE TO THE SECOND EDITION.
+                          _________________
+
+THE author takes this opportunity to thank the medical profession and
+the laity for the very cordial reception which has been tendered the
+first edition of this small volume.
+
+The necessity for the use of technical expressions in a book written
+expressly for the laity must always be a matter of regret. And only
+those who have attempted to write a similar work can fully appreciate
+the truth of Herbert Spencer's remark, that "Nothing is so difficult
+as to write an elementary book on scientific subjects."
+
+The author has added to this edition a section on "The Hygiene of
+Puberty," one on "Hemorrhage at the Menopause a Significant Symptom of
+Cancer," and one on "The Hygiene of the Menopause."
+
+                                                    ANNA M. GALBRAITH.
+
+15 WEST NINETY-FIRST STREET, NEW YORK.
+  _________________________________________________________________
+
+  PREFACE.
+                          _________________
+
+  "Ignorance is the curse of God;
+   Knowledge, the wings wherewith we fly to heaven."
+
+                                                       -- "Henry VI."
+
+PERFECT health is essential to perfect happiness. The greater the
+knowledge of the laws of nature, and the more closely these laws are
+lived up to, so much nearer "ideal" will be the health and happiness
+of the individual. Hence the necessity that these same laws should be
+as familiar to the adult man and woman as the alphabet. Further, with
+our present knowledge of the certain suffering, disease, and death
+that are bred by ignorance of all these subjects, it is little less
+than criminal to allow girls to reach the age of puberty without the
+slightest knowledge of the menstrual function; young women to be
+married in total ignorance of the ethics of married life; women to
+become mothers without any conception of the duties of motherhood;
+other women, as the time approaches, to live in dread apprehension of
+"the change of life;" and many women unnecessarily to succumb to
+disease at this time.
+
+The masses of women have at last awakened to a sense of the awful
+penalties which they have paid for their ignorance of all those laws
+of nature which govern their physical being, and to feel keenly the
+necessity for instruction at least in the fundamental principles which
+underlie the various epochs of their lives; and it is in response to a
+widespread demand that this small volume has been written.
+
+This is preeminently the day of preventive medicine; and the physician
+who can prevent the origin of disease is a greater benefactor than the
+one who can lessen the mortality or suffering after the disease has
+occurred.
+
+                                                    ANNA M. GALBRAITH.
+
+15 WEST NINETY-FIRST STREET, NEW YORK.
+  _________________________________________________________________
+
+  CONTENTS
+                          _________________
+
+ INTRODUCTION
+
+ EDUCATION AS THE CONTROLLING FACTOR IN THE PHYSICAL LIFE OF WOMAN
+
+   Huxley's Definition of Education; the Correlation of Mind and Body; the
+   Emotional Nature; Age for Going to School; the Effect of the Study of the
+   Scientific Branches; Industrial Education
+                          _________________
+
+ PART I.-- MAIDENHOOD
+  _________________________________________________________________
+
+ CHAPTER I.
+
+ PUBERTY
+
+   Sexual Development; Age of Puberty; Physical Changes at Puberty; First
+   Onset of Menstruation; Psychic Changes at Puberty
+  _________________________________________________________________
+
+ CHAPTER II.
+
+ HYGIENE OF PUBERTY
+
+   Home Life; Corsets; Shoes; Underwear; Nutrition; Diet; Water;
+   Constipation; School Life; Spinal Curvature; Exercise; Walking; Running
+  _________________________________________________________________
+
+ CHAPTER III.
+
+ ANATOMY OF THE FEMALE GENERATIVE ORGANS
+
+   The Vulva; the Hymen; Condition of the Hymen as a Proof of Virginity; the
+   Bladder; Vagina; Uterus; Respiratory Movements of the Uterus; Fallopian
+   Tubes; Ovaries
+  _________________________________________________________________
+
+ CHAPTER IV.
+
+ PHYSIOLOGY OF THE FEMALE GENERATIVE ORGANS
+
+   Ovulation; Etiology of Menstruation; Uterine Nerve-supply; the Function
+   of the Uterus; Stages of the Menstrual Cycle; Average Duration of the
+   Menstrual Flow; Character of the Flow; Relation of Ovulation to
+   Menstruation; the Menstrual Wave; Definition of Menstruation; Premonitory
+   Symptoms of the Flow; Hygiene of Menstruation
+  _________________________________________________________________
+
+ CHAPTER V.
+
+ THE ANOMALIES OF MENSTRUATION
+
+   Menorrhagia and Metrorrhagia; Dysmenorrhea; Amenorrhea; Leucorrhea;
+   Pruritus Vulva
+  _________________________________________________________________
+
+ CHAPTER VI.
+
+ THE MARRIAGE QUESTION
+
+   Herbert Spencer's Definition of Love; What Constitutes a Suitable
+   Husband; Best Age for Marriage; Shall Cousins Marry? Contraindications to
+   Marriage; Do Reformed Profligates Make Good Husbands? the Proper Length
+   of Time for the Engagement; the Right Time of the Year to Marry; the
+   Selection of the Wedding Day
+                          _________________
+
+  PART II.-- MARRIAGE
+  _________________________________________________________________
+
+ CHAPTER VII.
+
+ THE ETHICS OF MARRIED LIFE
+
+   The Wedding Journey; the Ethics of Married Life; Shall Husband and Wife
+   Occupy the Same Bed? the Consummation of Marriage; the Marital Relation;
+   Times when Marital Relations Should be Suspended
+  _________________________________________________________________
+
+ CHAPTER VIII.
+
+ SEXUAL INSTINCT IN WOMEN
+
+   Sexual Instinct in Women; Excessive Coitus; Causes of Sexual Excitability
+  _________________________________________________________________
+
+ CHAPTER IX.
+
+ STERILITY
+
+   Sterility; the Prevention of Conception and the Limitation of Offspring;
+   the Crime of Abortion; Infidelity in Women
+                          _________________
+
+  PART III.-- MATERNITY
+  _________________________________________________________________
+
+ CHAPTER X.
+
+ PREGNANCY
+
+   Nature of Conception; Pregnancy Defined; Duration of Pregnancy; the Signs
+   of Pregnancy; Quickening; the Determination of Sex at Will; the Influence
+   of the Male Sexual Element on the Fernale Organism; Heredity; Hygiene of
+   Pregnancy; Causes of Miscarriage
+  _________________________________________________________________
+
+ CHAPTER XI.
+
+ THE CONFINMENT
+
+   Preparation for the Confinement; Signs of Approaching Labor; Symptoms of
+   Actual Labor; The Confinement-bed; the Process of Labor
+  _________________________________________________________________
+
+ CHAPTER XII.
+
+ THE LYING-IN
+
+   Management of the Lying-in; Lactation; Nursing
+  _________________________________________________________________
+
+ CHAPTER XIII.
+
+ THE NEW-BORN INFANT
+
+   The Infant's Toilet; the Crib; Feeding of Infants; the Wet-nurse;
+   Artificial Feeding; Characteristics of Healthy Infants; the Stools;
+   Constipation; Urination; Teething
+                          _________________
+
+  PART IV.-- THE MENOPAUSE
+  _________________________________________________________________
+
+ CHAPTER XIV.
+
+ THE MENOPAUSE
+
+   Average Duration of the Menstrual Function; Duration of Menopause; the
+   Menopause; General Phenomena of the Menopause; Prominent Symptoms of
+   Menopause; Pathologic Conditions of Menopause; Hemorrhage at the
+   Menopause a Significant Symptom of Cancer; Causes of Suffering at
+   Menopause
+  _________________________________________________________________
+
+ CHAPTER XV.
+
+ HYGIENE OF THE MENOPAUSE
+
+   Diet; Constipation; Stimulants; the Kidneys; Skin; Turkish Baths;
+   Massage; Exercise; Profuse Menstruation; Hemorrhage; Mental Therapeutics
+  _________________________________________________________________
+
+ CHAPTER XVI.
+
+ HINTS FOR HOME TREATMENT
+
+   Indigestion; Constipation; Enemas; Diarrhea; Vaginal DouchÈ, Baths;
+   Headache; Fainting; Hemorrhage
+                          _________________
+
+ GLOSSARY
+                          _________________
+
+  THE
+
+FOUR EPOCHS
+
+ OF
+
+                              WOMAN'S LIFE
+                          _________________
+
+INTRODUCTION.
+                          _________________
+
+ EDUCATION AS THE CONTROLLING FACTOR IN THE PHYSICAL LIFE OF WOMAN.
+
+   Huxley's Definition of Education; the Correlation of Mind and Body; the
+   Emotional Nature; Age for Going to School; the Effect of the Study of
+   tuse Scientific Branches; Industrial Education.
+
+           "What is man,
+   If his chief good, and market of his time,
+   Be but to sleep and feed? A beast; no more.
+   Sure, He that made us with such large discourse,
+   Looking before and after, gave us not
+   That capability and godlike reason
+   To fust in us unused."
+
+                                                         -- "Hamlet."
+
+THE word education is here used in its broadest sense, and is meant to
+include the physical, mental, intellectual, and industrial. Huxley's
+definition is as follows: "Education is the instruction of the
+intellect in the laws of nature, under which I include not only things
+and their forces, but men and their ways; and the fashioning of their
+affections and of the will into an earnest and living desire to move
+in harmony with these laws. That man, I think, has had a liberal
+education who has been so trained in his youth that his body is the
+ready servant of his will, and does with ease and pleasure all the
+work that, as a mechanism, it is capable of; whose intellect is a
+clear, cold, logic engine, to be turned to any kind of work, to spin
+the gossamers as well as to forge the anchors of the mind; whose mind
+is stored with the great and fundamental truths of nature and the laws
+of her operations; one whose passions are trained to come to heel by a
+vigorous will, the servant of a tender conscience; one who has learned
+to love all beauty, whether of nature or of art, to hate all vileness,
+and to respect others as himself."
+
+The Correlation of Mind and Body.-- It is of the utmost importance
+that the mutual reaction of mind and body upon each other should be
+thoroughly understood. This reaction is so constant, so intricate, and
+so complex that it is at times difficult to say which is cause and
+which effect. Does the depressed state of the mind cause the
+indigestion, or is a torpid liver the real seat of the melancholia?
+
+The brain is the most delicately constructed organ in the entire body.
+In the lower animals the brain is simply the great nerve-center which,
+with its prolongation the spinal cord, presides over all the functions
+of life which differentiate the animal from the vegetable. In the
+human being the brain is much more highly developed and complicated;
+and is, in addition, the seat of the mind, the intellect, and the
+affections. Like all the other tissues of the body, the brain receives
+its nourishment from the blood-vessels which pass through it, and its
+healthy maintenance is in a direct ratio to the condition of its
+blood-supply.
+
+A most interesting psychologic study is found in the case of cerebral
+paralysis of young children, where there is mental defect amounting to
+stupidity or imbecility, accompanied by extensive paralysis of the
+body, so that the child is not able to sit up. With the gradual
+improvement of the physical condition, so that the muscles become firm
+and the child can sit, stand, and even walk, there is a corresponding
+mental development; from being stupid and dull, the expression of the
+face brightens and becomes intelligent; the child talks quite as well
+as other children of its age, and sometimes becomes really
+intellectually precocious. Here we see the development of the brain as
+a direct result of the improved physical condition. In certain cases
+of insanity, on the contrary, we find that the wasting away of the
+body results from the disease of the brain, i. e., the disease of the
+brain has wrought the wreck of the body.
+
+From these pathologic studies, or studies of how the diseased state of
+the brain and body may be overcome by physical development, on the one
+hand, and, on the other hand, how the healthy body may be wrecked by
+disease of the brain, we will turn to a consideration of the effect of
+the development of the mind and intellect upon the physical health.
+
+On a girl's entering Vassar College an exact and detailed physical
+examination is made by the resident physician, a health record is kept
+during her stay there, and at the time of her graduation a final
+physical examination is made. As a result of these statistics Dr.
+Thelberg says: "These statistics, now covering a number of years, show
+that not only can girls profitably take a college education, that is
+accomplished; but will prove that grave physical imperfections can be
+corrected in the period between eighteen and twenty-two years of age,
+coincidently with the development of the mind along the lines of
+college work; the college work, if not excessive in amount, being a
+real and most important factor in the physical development."
+
+But a still more striking proof can be cited of the beneficial result
+of mental and intellectual occupation upon the bodily health. At
+Vassar a great deal of attention is very properly paid to general
+hygiene and the physical development, in addition to the natural
+advantages of outdoor life in the country.
+
+Take, for example, a woman's medical college located in the city: the
+four years' course places the greatest strain on both mind and body;
+practically no time is left for recreation, and very much too little
+time is spent in sleep; the amount of exercise taken is the minimum.
+Yet in spite of all these disadvantages under which the young women
+labor, a great many of them who enter far below par in health, or,
+indeed, on the fair road to become chronic invalids, graduate very
+greatly improved in health.
+
+The Emotional Nature.-- Formerly much more than now, owing to the
+defective methods of her education and mode of life, the emotional
+nature of woman was allowed to run riot. The child was coddled; the
+girl was allowed to grow up without any of the discipline which young
+men receive in their college and business life, and little or no
+attention was paid to her physical development. The woman naturally
+became a bundle of nerves, highly irritable, unreasonable, and
+hysterical. All this reacted in the most detrimental manner upon her
+physical health.
+
+The seed for much of this emotional hyperesthesia is sown in
+childhood. From birth until the end of the eighth year should be one
+grand holiday. During this time the child develops very rapidly,
+especially during the first two years of life. And at the end of the
+eighth year the brain has attained to within a few ounces of its full
+weight. The muscular system has been developed together with the
+coordination of motion. The child has learned to use a language fairly
+well; she has developed an excellent memory and is most inquisitive
+and acquisitive.
+
+Another method for undermining the healthy tone of the nervous system
+is the intricate dances taught very young children and then placing
+them on public exhibition, where they are wrought up to the highest
+pitch. From a purely medical standpoint, children under eight years of
+age should not be allowed to take dancing lessons. After this age a
+moderate amount of dancing in a well-ventilated room is good exercise.
+
+Children's parties belong in the same category, and, on account of the
+injurious effects on the nervous system, should be tabooed. They are
+too exciting, and cause an overstimulation of the nervous system and a
+precocious childhood and puberty.
+
+Instead of rearing an oversensitive hot - house plant that must be
+fragile in the extreme, strive to rear a sturdy plant that can hold
+its own amid the storms. The child should spend as much of its life as
+possible in the open air, and in the warm months live out-of-doors.
+City children should be taken to the seashore or country to spend
+several months every summer. Together with outdoor sports, gymnastics
+adapted to the age of the child should be begun early and continued
+throughout life. Good muscular development is attended with good
+digestion and a well-balanced nervous system.
+
+Until after the twelfth year there should be absolutely no difference
+between the physical, mental, or industrial education of girls and
+boys. And, still further, they should be encouraged to have their
+sports together; this will improve the girls physically and broaden
+them mentally, and will do a great deal to take the rough edges off
+the boys. After this age it will be wise to allow slight barriers to
+grow up, without calling the attention of any one to the fact, that
+will cause the companionship to be less free and unrestrained.
+
+Age for Going to School.-- Although the child may be allowed to go to
+kindergarten long before this time, it should not be allowed to enter
+the school-room before eight years of age. And from eight to twelve
+years, not more than four hours a day should be spent in study. After
+this time it may be put down more closely to intellectual work; but no
+more mental work should be required than will enable the girl to enter
+college at eighteen. And eighteen years of age is as young as any girl
+should be allowed to go to college; after this age the mind is more
+matured and acquires knowledge more easily than before, while the
+development of the body is less rapid. The physical system has become
+more stable. The literature indulged in by girls under eighteen years
+of age should be most carefully selected.
+
+The Effect of the Study of the Scientific Branches.-- A knowledge of
+the laws of nature is essential to health; hence the necessity for the
+study of the natural sciences-- anatomy, physiology, chemistry,
+physics, and zoology. Aside from the intrinsic value of this
+knowledge, it is almost universally conceded that these studies
+develop the judgment; and no one will have the temerity to deny that a
+lack of judgment must undermine the health as well as the success and
+happiness of the individual.
+
+Industrial Education.-- When it is considered how intimate are the
+relations between the physical and the psychic states, and how often
+the psychic condition leads to actual disease, and that often of the
+most incurable type, it needs no demonstration that a mental
+occupation which will take the woman out of herself is a physical
+necessity. Therefore when the girl has reached the subjective limit of
+her intellectual education,-- that is, when she has reached the limit
+of her capacity or taste,-- it is essential to her physical well-being
+that she should turn her attention to some industrial occupation. This
+may be housekeeping or any other occupation for which she has taste or
+talent. A healthy mental occupation is an absolute necessity to
+prevent the individual from becoming self-centered. And to become
+self-centered is the first step on the certain road to chronic
+invalidism.
+
+A most important part of an education is the knowledge of how to
+procure the most perfect development of the body possible, and how to
+maintain the health. This has not been touched upon here, since the
+outlines for the general physical education have already been given in
+"Hygiene and Physical Culture for Women,"* and the present volume
+concerns itself only with the four critical epochs of woman's life.
+
+* By Anna M. Galbraith, M. D.; published by Dodd, Mead & Co.
+
+With this broad view of an education, as a means to procure the best
+physique possible; a mind disciplined to meet to the greatest
+advantage all the vicissitudes of life; an intellect developed along
+the lines of its greatest possibilities; and an occupation chosen in
+accordance with the tastes and talents of the individual; it becomes
+an incontrovertible fact that the education is the controlling factor
+in the physical life of every woman.
+  _________________________________________________________________
+
+             "Be not simply good; be good for something."
+
+                                                              THOREAU.
+                          _________________
+
+  PART I.-- MAIDENHOOD.
+                          _________________
+
+ CHAPTER I.
+
+ PUBERTY.
+
+   Sexual Development; Age of Puberty; Physical Changes at Puberty; First
+   Onset of Menstruation; Psychic Changes at Puberty.
+
+  "Self-reverence, self-knowledge, self-control,
+   These three alone lead life to sovereign power."
+
+                                                         -- "OEnone."
+
+Sexual Development.-- Sexual development goes on during all the years
+of childhood, but is not complete in the female sex until between the
+twenty-second and the twenty-fifth year. If the child has no inherited
+taint, and has been properly educated morally, physically, and
+intellectually, it must follow that the structural development of the
+pelvic organs has been normal; and normal organs always perform their
+functions perfectly.
+
+The commencement of the ovarian function does not cause any more
+profound change in the system and habits than does dentition. The
+various epochs of life are generally spoken of as if they were
+paroxysmal-- as though they were separated by some tremendous chasm,
+which had to be leapt over or fallen into. Nature makes no such
+egregious blunders; preparations for every change in life have been
+going on for a very long time before the evidences of such change
+become manifest.
+
+In a healthy girl the psychic and physical changes incident to puberty
+occur so gradually as to escape the girl's own notice. The first and,
+if the girl has not been properly prepared for it, always startling
+change is the appearance of the menstrual flow. The mother who has not
+told her daughter of this coming change in her life before it is due
+has committed a serious error; it is no uncommon occurrence for girls
+who know nothing of this function to get into a tub of cold water to
+stop the flow; and if they stay in long enough, it generally does
+stop, and the girl's health may be ruined for life.
+
+The opinion of Dr. Ely van de Warker is that "if healthy ovulation is
+the outcome of healthy childhood, the function will obey the law of
+periodicity year by year, and all this time the young woman will be
+able to sustain uninterrupted physical and intellectual work as well
+as the young man. Not that the laws of health may be violated with
+impunity at puberty or any other time of a woman's life; but a law of
+health is no more binding upon a young woman than it is upon a young
+man; and there really is no such thing as one law for women and
+another for men."
+
+Age of Puberty.-- In the temperate regions the age of puberty is
+reached between the ages of twelve and fourteen years. The girl is
+then said to be nubile; that is, as soon as menstruation appears it is
+possible for her to bear children; but she is by no means sufficiently
+developed to do so, as she herself will not be completely developed
+physically or mentally before the age of twenty-two or twenty-five
+years.
+
+Physical Changes at Puberty.-- The physical changes that gradually
+take place, beginning at the time of puberty, are: the breasts,
+pelvis, and neck enlarge; hair develops over the pubis and in the
+arm-pits; the voice alters. As a rule, women continue to grow in
+stature until the twenty-fifth year. It is said that brunettes develop
+sooner than blondes, and that large women develop more slowly than
+women of small stature; city girls develop younger than girls brought
+up in the country. Whatever stimulates the emotions causes a premature
+development of the sexual organs; as children's parties, late hours,
+sensational novels, loose stories, the drama and the ball-room, talk
+of beaux, of love and marriage, and children being surrounded with the
+atmosphere of riper years. It is generally believed that early
+stimulation of the sexual instincts leads to the premature
+establishment of puberty, as do also spiced foods and alcoholic
+beverages.
+
+First Onset of Menstruation.-- Sometimes the first menstrual discharge
+appears suddenly, lasts for a few days, and then stops; it may appear
+after an interval of two or three weeks, or not for several months. If
+for several months the flow appears at the regular time, and the
+quantity is about the same as the first, the menstrual habit may be
+said to be established. The mode of onset varies considerably within
+the limits of health. So long as the general health remains good, no
+anxiety need be felt in regard to the establishment of the menstrual
+function.
+
+In other cases there may be a discharge of blood at the first period,
+and none afterward for several months; in other words, menstruation
+may be established suddenly, intermittently, or gradually. It must be
+remembered that certain pathologic conditions cause many disturbances
+connected with the onset of puberty.
+
+Psychic Changes at Puberty.-- The angular, gawky feeling gradually
+disappears; the girl becomes self-conscious; new impulses arise, and
+she gives up many of the hoydenish ways of childhood. The girl's
+imagination is more lively, and just at this time mathematics form an
+excellent subject for mental occupation. The girl now begins to
+question the whys and wherefores, and demands reasons for the course
+that is laid out for her, and is full of ideas of her own; so that
+while as a child she had accepted almost unquestioningly the commands
+of her parents, she can be managed now only through the power of
+reason. And this is just as it should be, for the girl has reached the
+years of discretion, and now is the time when her reason and judgment
+are capable of rapid cultivation.
+
+  CHAPTER II.
+
+ HYGIENE OF PUBERTY.
+
+   Home Life; Corsets; Shoes; Underwear; Nutrition; Diet; Water;
+   Constipation; School Life; Spinal Curvature; Exercise; Walking; Running.
+
+  "Every man is the architect of his own fortune."
+
+                                                      PSEUDO-SALLUST.
+
+Home Life.-- With beginning menstruation the equilibrium of the body
+is very easily disturbed, so that even in the case of the healthy girl
+some precautions should be taken and a rational regime should be
+adhered to; while in the case of the delicate girl a still more
+careful attention will have to be directed toward her weak points, in
+order that she may develop into a healthy woman.
+
+For every girl at this time of life home is preeminently the place; so
+that she may not only have the benefit of a mother's watchful care,
+but also lead a life as free from conventionalities and as much in the
+open air as possible. No girl should be sent away to school at this
+period of rapid growth and development; nor should girls of the
+working classes, when it can possibly be avoided, be sent out to fill
+positions as clerks in illy ventilated stores, in factories, or as
+domestics. If a girl can be kept at home until she is eighteen years
+old, she will be a much stronger, healthier woman than would otherwise
+be possible.
+
+Corsets.-- At this period of life it is particularly necessary that
+the clothing should be warm and at the same time sufficiently loose to
+prevent the constriction of any part of the body. And whatever the
+adult woman may elect to do in the matter of wearing corsets herself,
+she does her young daughter an irreparable injury by constricting and
+moulding her growing body in these corset-splints. Corsets placed on
+the young girl interfere with the functions of circulation,
+respiration, digestion, and of the pelvic organs, also with muscular
+development. In addition to all this, the girl is handicapped in
+taking all outdoor exercises and athletic sports.
+
+The lungs, heart, and great blood-vessels are placed in and completely
+fill an air-tight, distensiblecage, which is most distensible at its
+base.
+
+The least chest girth of the adult woman-- that is, the under-arm
+girth around the chest-- that is consistent with health is
+twenty-eight inches; and this girth must be enlarged three inches in
+forced inspiration. In ordinary respiration the waist expansion should
+be one-half to one inch, while during great muscular activity it
+should be from one and a half to three or four inches. One-third of
+the lungs lie below the point of beginning corset pressure, so that
+with tight corsets this amount of lung substance must be more or less
+useless.
+
+It is self-evident that any restriction placed about the waist, by
+preventing the full expansion of the ribs and the descent of the
+diaphragm, will further embarrass the heart's action by diminishing
+the amount of room it has to work in, at the same time that it
+diminishes the amount of oxygen which is inspired. Fresh air is by far
+the most important part of the daily food. It is in the lungs that the
+blood throws off its carbonic acid and other impurities; but it is
+able to do this only when the lungs are supplied with an abundance of
+oxygen. Every inch which a woman adds to her chest measure adds to the
+measure of her days.
+
+Great physical injury has followed women playing lawn-tennis while
+tightly corseted. And although dancing is a much milder exercise,
+since it frequently takes place in an overheated and poorly ventilated
+room, fatal results occasionally occur from the same cause.
+
+Standing erect calls into action almost all the muscles of the trunk,
+neck, and lower extremities. So long as the line of gravity falls
+within the area of the feet, the muscular effort required is so slight
+that it is little more than the tonicity contained in all living
+muscle. The greater the displacement of the line of gravity, the
+greater the muscular effort required to maintain the equilibrium of
+the body. Up to a certain extent, exercising the muscle develops the
+strength and size of the muscle. On the other hand, when a muscle
+within the body is unused, it wastes; when used within certain limits,
+it grows. But when the corset splint is applied to the body of the
+young girl, it supplants the functions of the abdominal and back
+muscles, which is to hold the trunk erect, and these muscles gradually
+grow weak and waste. And so the liability to the various spinal
+curvatures is increased.
+
+The original object of the corset was to give greater prominence to
+the hips and abdomen. But fashions change! In "the French figure" or
+straight-front corset now in vogue the pelvis is tilted forward,
+producing a sinking in of the abdomen and a marked prominence of the
+hips and sacrum, necessitating a compensatory curve of the spine which
+increases the curvature forward at the small of the back-- a deformity
+which, a few years ago, women were going to orthopedic surgeons to
+have corrected. In this attitude the line passing through the centre
+of gravity strikes the heels, the knees are hyper-extended, and the
+muscles of the calves and thighs are rendered tense.
+
+By interfering with the muscular development and digestion, the girl
+is very apt to become angular, flat-chested, anemic, and to have a
+muddy complexion. And so the corset really defeats the object for
+which it was put on-- that of giving the girl a good figure and
+enhancing her beauty.
+
+There is no objection to girls wearing any of the various forms of
+hygienic waists now on the market.
+
+Shoes.-- The feet are the part of the body to come in contact with the
+greatest degree of cold, whether on the floor of the house or the
+pavement of the street. Hence it is a matter of prime importance to
+the entire body that the feet should be properly clad.
+
+The thick-soled, flat-heeled shoes which became popular with bicycling
+and golf are most hygienic, and it is highly desirable that this style
+of shoe should be adhered to for outdoor exercise.
+
+Underwear.-- In our cold and changeable climate the most suitable
+undergarment is the "combination" woolen undersuit, which reaches from
+neck to ankles and has long sleeves. Much greater warmth is afforded
+when the undersuit is moderately tight fitting. Such a suit should be
+worn the entire year, the grade of weight being adapted to the season.
+
+Nutrition.-- The nutrition of the body is dependent on the food
+supply, digestion and excretion. The growing girl should eat more than
+the adult woman, because of her more active life and of the fact that
+the food which she takes must not only replace the worn-out material
+of the body, but also provide new material needed for growth.
+Insufficient food and food of defective quality and composition work
+proportionately for more harm during the growing age.
+
+The full adult weight is not attained before the twenty-fifth year.
+When the final growth of the body and development of the vital organs
+is completed, the function of food is simply to replace waste with new
+material and to furnish material for the development of force.
+
+Diet.-- The diet should be a mixed one, consisting of the various
+kinds of fresh meats, fish, milk, eggs, poultry, vegetables, fruit,
+and fat in the shape of cream, butter, and the fat of beef and mutton.
+Animal food improves the condition of the muscles, which are made
+firmer than they would be through a vegetable diet. Meat in general
+has a more stimulating effect upon the system and is more
+strengthening than vegetable food, and it gives rise to a sensation of
+energy and activity. The common estimate is that meat should occupy
+one-fourth and vegetable food three-fourths of a mixed diet.
+
+Common salt in moderate quantity is essential, but all highly spiced
+or seasoned foods should be avoided, also pickles and vinegar. All
+"sweets" are harmful, because they destroy the appetite for other
+things and upset the digestion. Tea and coffee should be tabooed, as
+well as all alcoholic beverages.
+
+Good digestion depends for the most part on serving the meals at the
+same hour every day, eating leisurely, and masticating the food well.
+There is a great tendency on the part of the school girl to sleep late
+in the morning, then "bolt" her breakfast in order to get to school in
+time. Nothing could be more pernicious to the digestion, unless it is
+the eternal nibbling of candy.
+
+A healthy girl needs nothing between meals. A delicate girl will be
+the better for a glass of milk in the middle of the morning and at
+bed-time; or pure beef juice may be given instead.
+
+Water.-- Water is needed to keep the kidneys properly flushed. The
+amount of urine secreted during the twenty-four hours should be three
+pints. Of course it will be less than this if the quantity of water is
+insufficient. In addition to the urine about ten ounces of water are
+lost from the surface of the lungs, and eighteen ounces from the skin,
+making a total of about five pints; and this quantity of water must be
+taken daily in order to maintain the equilibrium of the body. The
+solid food of a mixed diet contains from fifty to sixty per cent. of
+water, so that about twenty-five ounces of water are taken into the
+system daily as an integral part of the food. In addition, three pints
+more should be taken as plain water. The bladder acts as a reservoir
+for the urine, and should be emptied at least three or four times a
+day.
+
+Constipation.-- In order to keep the digestive system in good
+condition, the refuse matter which collects in the lower bowel must be
+evacuated every day. And in order to secure this regular bowel
+movement, regularity in the time of going to the toilet is a prime
+necessity. And now is the time when the habits of a lifetime are being
+formed. If a tendency to constipation exists, it can almost always be
+overcome by increasing the amount of fruit and vegetables eaten, also
+by eating cracked wheat, oatmeal, corn and graham bread; all of which
+increase the peristaltic action of the intestines. The small amount of
+water taken by girls and women is another fertile source of
+constipation.
+
+School Life.-- When it is considered that fully one-half of the girl's
+waking hours are spent in school or in study preparing for school, it
+becomes evident that the girl's attitude at her desk should be the
+correct one. The malpositions at the desk are the most frequent cause
+of lateral curvatures, round shoulders, and flat chests. And these
+deformities are more common in girls than they are in boys.
+
+The common faults of the desk and seat leading to these malpositions
+are unsuitable shape of the back of the seat, too great a distance
+between the seat and the desk, and the incorrect slope of the desk.
+
+The edge of the desk should slightly project over the edge of the
+chair. The top of the desk should incline downward about ten degrees
+toward the student, and be low enough to allow the forearm to rest on
+it without raising the shoulder. The seat should be sufficiently deep
+to support almost the entire thigh, and close enough to the floor to
+allow the soles of the feet to rest firmly on it. The back of the
+chair should be arched so as to support the hollow of the back, and
+should reach just above the lower part of the shoulder-blades, and so
+make it easy and comfortable for even a weakly child to sit upright.
+
+If the seat is too high, the feet do not rest on the floor, and so the
+girl does not get the proper aid from the legs and feet to maintain an
+erect position. If the desk is too high, the elbow can rest on it only
+by curving the spine and raising the shoulder. The work is brought too
+close to the eyes and causes extra strain. If the desk is too low, the
+child stoops over it and becomes round-shouldered, and there is a
+tendency to become short-sighted.
+
+The pupil should sit erect with the weight equally borne by both
+buttocks; the legs should be straight before the trunk, and the feet
+firmly resting on the floor. The book should be held about twelve
+inches from the eyes.
+
+Spinal Curvatures.-- It should be distinctly borne in mind that
+lateral curvature of the spine is a distortion of growth. The
+deformity appears and is developed during the growing years. It is
+more common in girls than in boys, for two reasons: that at the age
+when lateral curvature is first seen, girls grow more rapidly than
+boys; and their muscular system is less well developed.
+
+In most early cases the faulty attitudes are clearly the result of
+muscular weakness. The growth in size has not been accompanied by a
+corresponding development of the muscles. This condition is most
+frequently met with in rapidly growing girls, and it is one of the
+most common causes of lateral curvature. In these cases proper
+gymnastics are indicated, but they should be prescribed and carried
+out with much care.
+
+It is upon the erectness, suppleness, and strength of the spinal
+column that most of the power and grace of the body depend.
+
+Lack of ventilation is a fertile cause of headache, anemia (or an
+impoverished condition of the blood in iron and oxygen), and
+dyspepsia. All these are rare before but common after twelve years of
+age.
+
+Exercise.-- In physical culture the object aimed at should be the
+symmetrical development of all the muscles of the body. Hence the
+necessity for bringing every individual muscle into play, at first for
+its development, and later for its maintenance.
+
+The tendency of almost all forms of exercise is to develop some
+portion of the body at the expense of the rest. The most perfect form
+of exercise is therefore that one which will most nearly call into
+play all the muscles of the body.
+
+Walking.-- Walking is the only form of exercise which may be said to
+be universal. In walking the muscles of the chest get little exercise,
+and those of the spine and abdomen even less. In walking the arms
+should swing easily at the sides, both from a physiological and an
+esthetic point of view. If the girl is weak or is unaccustomed to take
+any exercise, the guide for the amount of exercise taken at any one
+time must be this: At the first sense of fatigue, stop at once and
+rest, otherwise positive harm instead of good may be accomplished. The
+girl who depends on walking for her outdoor exercise should walk at
+least three miles every day, and walk at the rate of three miles an
+hour.
+
+After acquiring as great a walking speed as is consistent with a
+graceful and easy carriage, the running exercise should be begun,
+gradually increasing the distance, but not the rate of speed.
+
+In exercising, all tight clothing about the neck, chest, and waist
+must be removed. Pure air and full breathing are required during and
+after exercise. Full breathing not only promotes the change of air in
+the lungs, but also quickens the functions of the circulation and
+digestion. Eating must be avoided shortly before or shortly after any
+considerable exercise, as it impairs digestion.
+
+Running.-- Running is the best exercise for developing the breathing
+capacity. While brisk walking is allowable, fast running is not. The
+rule for running is to begin slowly, run moderately for perhaps fifty
+feet, then increase the speed gradually; but in running for exercise,
+never speed to the utmost. A five-mile gait is quite sufficient. The
+run should be closed with the same moderation with which it was begun,
+and the girl should never stop short, as this sudden arrest of action
+gives a most undesirable shock to the heart.
+
+In beginning to take any form of exercise the intensity and duration
+of the movements practiced must be increased very gradually, or
+positive harm instead of good will be done. As soon as fatigue is
+appreciable, the exercise should be discontinued and at once be
+followed by complete rest. Rapid respiration, palpitation or
+dizziness, headache, the face becoming pale or pinched or flushing
+suddenly, a feeling of great heat or excessive perspiration, are all
+danger signals showing that the exercise has already been carried too
+far and should cease at once. Continued over-exertion carried to a
+point of exhaustion leads to an obstinate irritability of the heart as
+well as to organic lesions.
+
+Mountain-climbing, rowing, and bicycling call into play almost all the
+muscles of the body. Of all the outdoor exercises for girls, swimming
+is one of the most perfect. It not only calls into vigorous action
+most of the muscles of the body, but spares many of those muscles that
+are so commonly overworked, the most of the work being performed by
+muscles that are so little used as to have become flabby and weak.
+
+Swimming and sea-bathing must be avoided by girls who have weak hearts
+and in whom the reaction after a plunge into cold water is never
+established; also by girls with heart disease or kidney disease.
+
+The principal outdoor games are croquet, archery, golf, tennis,
+cricket, foot-ball, and base-ball. Of these, croquet is the mildest,
+and is for that reason a good beginning exercise. Croquet, archery,
+golf, and tennis are all defective in that they cause a greater
+development of the right than of the left side of the body.
+
+As the greater majority of these outdoor exercises can only be
+indulged in for seven months of the year, they should be supplemented
+by exercises in the gymnasium for the remaining five winter months.
+
+There should be the greatest variety possible in the kinds of exercise
+taken, not only to develop the body symmetrically, so as to obtain
+strength, vigor, grace, celerity, and accuracy of movement, but also
+because there is no such potent cause of fatigue as monotonous
+repetition of the same act, whether physical or mental.
+
+It has been repeatedly proven that physical deterioration can be
+overcome by exercise, and that by so doing the mental capacity is
+greatly increased.
+
+  CHAPTER III.
+
+ ANATOMY OF THE GENERATIVE ORGANS.
+
+   The Vulva; the Hymen; Condition, of the Hymen as a Proof of Virginity;
+   the Bladder; Vagina; Uterus; Respiratory Movements of the Uterus;
+   Fallopian Tubes; Ovaries.
+
+  "He that respects himself is safe from others;
+   He wears a coat of mail that none can pierce."
+
+                                                       -- LONGFELLOW.
+
+The Vulva.-- The female generative organs consist of three groups--
+the external, the intermediate, and the internal. The vulva, or
+external generative organs, comprises all those organs which are
+external to the body.
+
+The vulva is pierced by two openings, the smallest and most anterior
+of which is the external opening of the urethra, or excretory duct of
+the bladder. This opening is surrounded by a slight eminence and has a
+somewhat puckered aspect.
+
+The larger opening is the vaginal orifice. In the virgin this is
+partially closed by the hymen. About one inch back of this is the
+anus, or the external orifice of the large bowel. This part of the
+bowel is known as the rectum.
+
+The Hymen.-- The hymen consists of a thin duplicature of mucous
+membrane strengthened by fibrous tissue, and is stretched across the
+posterior part of the vaginal orifice, which it partly occludes.
+Rupture of the hymen usually, but not always, occurs during the first
+sexual intercourse. In rare cases it is found intact at the time of
+the birth of the first child. In women who have borne children the
+vaginal orifice is surrounded by small irregular elevations; these are
+the remains of the ruptured hymen, but are usually present only after
+labor has taken place, since the torn hymen is converted into
+eminences as the result of the pressure incident to child-bearing, and
+not to coitus.
+
+The Condition of the Hymen as a Proof of Virginity.-- Formerly much
+stress was laid on the condition of the hymen as a proof of virginity.
+The hymen tightly closed, barely admitting the tip of a small
+index-finger, is positive evidence of virginity. But the hymen may
+lose its tone by a local catarrhal condition or by a general muscular
+relaxation; it may then become so relaxed that the only positive
+evidence rendered by the intact hymen is that the woman has not borne
+a child.
+
+In a paper on the preservation of the hymen, Dr. Hannah M. Thompson
+writes: "Further, if the hymen was intended as a guarantee of moral
+character, and for moral protection, either of man or woman, would we
+not have some reason for reflecting on the wisdom and righteousness of
+a Creator who has failed to make equal provision, and to give a like
+guarantee of an uncorrupted manhood? As physicians, we know too well
+that where one woman enters the marriage relation tainted in body
+there are thousands of men reeking with disease; and there is no
+demonstrable test to distinguish these, no proof for the young woman
+of the virginity or virtue of the young man."
+
+The Bladder.-- The female bladder is relatively broad and capacious,
+and is also highly distensible. When the bladder is allowed to become
+overdistended, it is carried backward and tends to cause a backward
+displacement of the uterus. The urethra, or excretory duct of the
+bladder, is about an inch and a half long, and lies firmly imbedded in
+the anterior vaginal wall.
+
+The Vagina.-- The intermediate organ is the vagina. This is a
+musculo-membranous canal which connects the external with the internal
+organs of generation. The vagina lies in relation with the bladder and
+the urethra in front, and with the rectum behind. The vagina is
+sufficiently distensible to allow of the passage of so large a body as
+the child.
+
+The Uterus.-- The internal organs of generation are the uterus, the
+ovaries, and the Fallopian tubes. Of these, the ovaries and the uterus
+are the essential female organs of generation. The virgin uterus is a
+small, hollow, muscular organ, somewhat pear-shaped, whose cavity is
+about one and a half inches deep. The uterus is divided by a natural
+constriction into a body and a neck. The neck, or cervix, is somewhat
+spindle-shaped, and has a canal running through its center which opens
+by a small aperture-- the so-called external orifice,-- into the
+vagina. In the virgin uterus the apposition of the anterior and
+posterior walls reduces the cavity to little more than a longitudinal
+cleft. With the advent of old age the whole organ suffers marked
+atrophy.
+
+The uterus is situated in the middle of the pelvic cavity, between the
+bladder and the lower bowel. It is held in place by broad elastic
+bands which go to different sides of the pelvis; it is also in part
+supported by the structures below and above it. But so loosely is the
+uterus held that it is easily pushed about-- as, for instance, by a
+full bladder or a packed bowel. And persistently allowing the bladder
+to become overfull, and failure to have a daily evacuation of the
+bowels, are prolific sources of displacements of the womb.
+
+Respiratory Movements of the Uterus.-- When no constrictions are
+placed about the waist, the uterus moves freely up and down with every
+respiration. So distinctly and with such regularity do these movements
+take place that an operator by watching the movements of the uterus
+can tell the effect that the anesthetic is having on the patient's
+breathing. These so-called respiratory movements play a very important
+role in the circulation of the uterus, and in the return of the venous
+blood to the heart.
+
+Anything which interferes with these movements, as the use of corsets,
+or of tight bands around the waist, prevents the free return of the
+venous blood. The uterus becomes congested, and through the constant
+abnormal weight of the organ itself, as well as the pressing down upon
+it from above of the superincumbent organs, the uterus is pushed down
+below its normal position, the ligaments whose duty it is to hold it
+up become relaxed, and the unhappy woman suffers all the agonies that
+are attendant on the "falling of the womb." For this reason the
+disorder is frequently met with in women who have never borne children
+as well as in those who have.
+
+The Fallopian Tubes.-- The Fallopian tubes extend from the upper,
+rounded angles of the uterus, within and along the free margin of the
+broad ligaments, for a distance of about two inches, to the vicinity
+of the ovaries, where each one terminates in a funnel-shaped orifice
+surrounded by a series of fringed processes. The lumen of the tube is
+narrowest at its inner end, where it opens into the cavity of the
+uterus by a minute orifice which scarcely admits a bristle; the
+diameter of the canal gradually increases until it reaches its ovarian
+extremity. The mucous lining of the tube is clothed by a single layer
+of hair-like epithelium, whose current sweeps from the ovarian toward
+the uterine end of the tube; and it is these movements which propel
+the ovum from the ovary to the uterus.
+
+The Ovaries.-- The ovaries are two small bodies of an almond shape,
+and lie on either side of the uterus. The bulk of the entire organ
+consists of connective tissue, in which lie imbedded the Graafian
+follicles or ovisacs, in which the ova are contained. These follicles
+or ovisacs are minute cells which are packed immediately beneath the
+surface, where they occur in all stages of development. With the
+increase in size which accompanies their development the follicles
+pass toward the surface, where they form a distinct projection, and at
+this point will occur the final rupture of the sac and the escape of
+the ovum. It is supposed that the ovum is grasped by the fringe-like
+extremity of the Fallopian tube and is carried through it by the
+movements of the ciliary epithelium to the uterus.
+
+The formation of new follicles continues only for a short time after
+birth, when the Graafian follicles are the most numerous; the entire
+number contained within the ovaries of the child being estimated at
+over 70,000. In view of the unquestionably large number of follicles
+in very young ovaries, and the relatively small number of ova which
+reach maturity, the degeneration of many follicles after reaching a
+certain degree of development seems certain.
+
+  CHAPTER IV.
+
+ PHYSIOLOGY OF THE FEMALE GENERATIVE ORGANS.
+
+   Ovulation; Etiology of Menstruation; Uterine Nerve-supply; the Function
+   of the Uterus; Stages of the Menstrual Cycle; Average Duration of the
+   Menstrual Flow; Character of tahe Flow; Relation of Ovulation to
+   Menstruation; the Menstrual Wave; Definition of Menstruation; Premomitory
+   Symptoms of the Flow; Hygiene of Menstruution.
+
+  "Toil and grow strong; by toil the flaccid nerves
+   Grow firm, and gain a more compacted tone."
+
+                                                        -- ARMSTRONG.
+
+Ovulation.-- At birth the formation of the ova is nearly completed;
+the production of' new cells probably ceases after the second year.
+The ovaries of the child of two years contain, therefore, the full
+quota of ova, although the vast majority of these cells always remain
+immature and undeveloped. While it is probable that a variable number
+of the immature ova undergo partial development before puberty, yet
+the advent of sexual maturity at that time marks the establishment of
+the regular development of the Graafian follicles and their contained
+ova, accompanied by the attendant phenomena of menstruation.
+
+During the entire child-bearing period, or from about the age of
+fifteen to forty-five years, the development of the Graafian follicles
+and the discharge of the ova are continually taking place. The
+liberation of the ova usually takes place at definite times, which in
+general coincide with the menstrual epochs, one or more ova being set
+free at each period; but this is by no means invariable.
+
+The ripe human ovum or germ cell is a spheric cell, about 0.2 mm. in
+diameter, consisting of granular protoplasm, in which lies a nucleus
+which contains the germinal spot. The proper cell-wall is a structure
+of great delicacy, outside of which is a secondary envelope.
+
+Menstruation.-- The etiology of menstruation has been variously
+explained at different epochs. The chief theories have been that of
+plethora, and the ovulation, the tubal, and the nerve theories.
+
+First, the Theory of Plethora.-- From the time of Hippocrates to 1835
+the theory prevailed that in the female body the formation of blood is
+sufficiently rich to provide every four weeks for an overflow of the
+same, the evacuation of which becomes a necessity. It was believed
+that this excess of blood depended on an excess of formative power in
+the woman.
+
+Second, the Ovulation Theory.-- This was distinctly formulated about
+1845. It construed the menstrual hemorrhage as a subsidiary
+phenomenon, entirely dependent on the periodic dehiscence of ovules.
+The changes supposed to take place in the Graafian follicles at each
+menstrual period were believed to involve a peculiar expenditure of
+nerve force, which was so much dead loss to the individual life of the
+woman. The growth of the Graafian vesicle and its contained ovum was
+supposed to cause an irritation of the nerves of the ovary, which was
+reflected to the entire nervous system. The gradual accumulation of
+this irritation finally caused a reflex action which determined an
+afflux of blood to the uterus and ovaries, which constitutes the
+catamenial flow.
+
+The ovulation theory was refuted by the following facts: Ovulation may
+and does occur without menstruation; women who have never menstruated
+may conceive; conception may occur during lactation, without the
+menses having returned since the last parturition; children at birth
+have many ovules contained within the ovaries; ovulation may persist
+for a time after the menopause, and even pregnancy has occurred,
+although very rarely after this time; the menses may continue
+regularly after the removal of the ovaries and Fallopian tubes; this
+is exceptional, and, as a rule, the periods only continue for two or
+three years at longest.
+
+Third, the Tubal Theory.-- Lawson Tait thought that thorough removal
+of the tubes was far more essential in determining the menopause, and
+that cases of periodically recurring hemorrhage after the removal of
+the ovaries were to be explained by the fact that the tubes had not
+been sufficiently removed. As an anatomic and surgical fact, the tubes
+can never be wholly excised unless the upper part of the uterus is
+also amputated.
+
+Fourth, the Nerve Theory of Menstruation.-- This is based upon the
+following views:
+
+1. That menstruation is a process directly controlled by a
+nerve-center situated in the lumbar region of the spinal cord.
+
+2. That the menstrual impulses reach the uterus through two sets of
+nerves.
+
+3. That menstruation is the result of nerve irritation, vascular
+congestion, and the subsequent relief of these by hemorrhagic
+discharges.
+
+4. That hemorrhage from the uterus is the result either of a local
+uterine condition, or of influences outside of the uterus acting
+directly on the center.
+
+5. That the removal of the appendages arrests menstruation by
+preventing the propagation of uterine influences to the center.
+
+Uterine Nerve Supply.-- One set of nerves causes contraction of the
+muscular fibers of the uterus, while the other set transmits impulses
+which bring about its vascular engorgement; and they are probably
+concerned in bringing about the determination of blood to the uterus
+and its appendages, which is so marked a feature of the menstrual
+process.
+
+As the result of long-continued investigation, Johnstone has come to
+the conclusion that the lining membrane of the uterus belongs to that
+class of organs whose function it is to replace organic waste.
+"Menstruation is a periodic wasting away of those corpuscles that are
+too old to make a placenta." He has further found that, as compared
+with the uteri of very many of the lower animals, the human uterus is
+very scantily supplied with lymphatics, and the only way to rid the
+uterus of the overripe, and therefore consequently useless, tissue is
+to wash it out through the vagina by a blood-stream. The tough wall of
+the human uterus and the increased blood-pressure caused by the erect
+position cause the difference between menstruation in the human female
+and rut in the lower animals.
+
+The strong light of recent investigations has necessitated the laying
+aside of many time-honored theories; and as the close of the
+nineteenth century has seen the emancipation of the uterus from the
+thralldom of the ovary, so we may believe that the twentieth century
+will find women of such fine physique as to prove the error of the
+popular fallacy that the cause of woman's weakness lies in the
+performance of her functions.
+
+The Function of the Uterus.-- The function of the uterus is to provide
+a favorable place for the reception of the product of conception,
+where it may be protected and nourished during the period of its
+development. The purpose of menstruation is to keep the uterus in
+suitable condition for the reception of this product of conception at
+any time. It is now known that the menstrual flow is not the whole of
+menstruation, and that the changes going on in the uterus are almost
+as continuous as the process of digestion. The whole of the
+reproductive life of woman has been divided into cycles of
+twenty-eight days each; these cycles have been divided into four
+stages.
+
+Stages of the Menstrual Cycle.-- The first or constructive stage is
+one of preparation for the reception of the ovum. During this stage
+the preparing of a decidua takes place, or building a nest for the
+expected egg; there is a swelling of the mucous membrane, an
+enlargement of the uterine glands, and an increase in the connective
+tissue. It is thought that this stage lasts for one week; when
+pregnancy does not occur, it is followed by degenerative changes.
+
+The second or destructive stage is marked by destructive changes which
+give rise to the usual phenomena of the menstrual period; there is a
+discharge of blood, mucus, and disintegrated mucous membrane. The
+actively growing cells of the uterine lining membrane undergo rapid
+destructive changes, the fabric of the half-formed decidua tumbles to
+pieces, the turgid capillaries burst and pour out the menstrual flow,
+which sweeps away all the useless debris. The irritation sets up
+reflex uterine contractions, and so the blood is squeezed out of the
+distended capillaries and washes away the degenerated cells.
+
+The third or reparative stage, as its name indicates, is one of
+repair, in which by constructive changes the epithelial lining which
+was thrown off is replaced by new, which is formed in from three to
+four days.
+
+The fourth or quiescent stage includes the remaining twelve or
+fourteen days of the menstrual cycle, and represents the quiescent
+period prior to the initiative changes which mark the beginning of the
+next period.
+
+Average Duration of the Menstrual Flow.-- The average duration of the
+menstrual flow is five days, although the variations are considerable
+in healthy women. A flow lasting any place from two to six days is
+perfectly consistent with health; but a flow continuing less than two
+or more than six days generally indicates local or general disease.
+
+Character of the Menstrual Flow.-- For the first few hours, or perhaps
+for the first day, the flow is usually slight in quantity and light in
+color; on the second and third days the flow reaches its height, and
+is profuse and dark, but it should never be clotted; after this it
+gradually ceases. The amount of the flow varies from five to ten
+ounces. If less than five or six or more than eighteen napkins are
+pretty well saturated through, the amount may be considered abnormal.
+
+Relation of Ovulation to Menstruation.-- It has not yet been decided
+just in what relation the processes of ovulation and menstruation
+stand to each other. It is supposed that the transit of the ovum to
+the uterus occupies at least one week. It has been thought that the
+decidua of a particular menstrual period is related, not to the ovum
+discharged at that period, but to the ovum discharged at the preceding
+period.
+
+The menstrual wave, or the wave of "supplementary nutrition,"[*] upon
+which the menstrual process ultimately depends, was first established
+by Dr. Mary Putnam Jacobi in the Boylston prize essay for 1876;
+showing that menstrual life is associated with a wave of well-marked
+vital energy, which manifests itself in a monthly fluctuation of the
+tempera ture of the body, in the daily amount of the excretion of urea
+and of carbonic acid, and of the rate and tension of the pulse. The
+wave attains its maximum during the week preceding menstruation, and
+slowly falls to its minimum, which is reached the week after
+menstruation.
+
+* Dr. Goodman and Dr. Stephenson have since written on this subject,
+and the "wave" is often known as the Stephenson wave.
+
+This wave indicates a periodic variation in the bodily metabolism, and
+is probably directly influenced by the rhythmic activity of the
+menstrual center. This observation would seem to be nullified by the
+fact that the phenomena referred to have been found to occur in men as
+well as in women; and that the lower animals also seem to show the
+same periodic variations. "It is therefore evident that the phenomena
+belong not to the function of menstruation, but to a general law of
+vital energy."
+
+Definition of Menstruation.-- Menstruation may, then, be defined as
+the periodic discharge of blood from the uterus, accompanied by the
+shedding of the epithelium of the body, as well as that of the uterine
+glands near their orifices.
+
+The sanguineous discharge is due partly to the oozing of blood from
+the surfaces denuded of epithelium, and partly to active congestion.
+The discharge from the uterus is largely augmented by mucus secreted
+in increased quantity at this period from the enlarged uterine glands.
+
+The tubes take some part in the process of menstruation; their mucous
+membrane is swollen, the epithelium is shed in places, and they are
+filled with a thin bloody fiuid, containing blood-corpuscles and
+cast-off epithelium cells.
+
+The menstrual wave continues from puberty to the menopause; it is a
+nervous phenomenon. Ovulation is a progressive, non-periodic process;
+it begins before birth and continues till the ovarian tissue is
+atrophied or worn out.
+
+Premonitory Symptoms of the Flow.-- The premonitory symptoms of the
+monthly flow should not be so marked as to cause the individual any
+discomfort. The first indication of the return of the period should be
+the appearance of the flow. There is generally a feeling of abdominal
+fulness with some lassitude, and sometimes slight headache. The
+temperature is lower and the pulse is slower than at other times. This
+lowered tone of the system is an additional reason for increased care
+against exposure in wet or cold weather.
+
+Hygiene of Menstruation.-- During the menstrual periods all cold baths
+must be strictly prohibited, whether tub-baths or cold sponges. The
+reason of this is that the application of cold to the surface causes a
+driving in of the blood from the exterior of the body to the internal
+organs; and at the menstrual periods there is already a congested
+condition of the pelvic organs, and it must be remembered that
+congestion is the first stage of inflammation.
+
+Hot or warm sponge-baths may be taken throughout the period; and the
+vulva should be bathed with warm water twice a day through the entire
+period of the flow, as this not only removes the clotted blood before
+it decomposes and becomes the source of irritation, but also removes
+other irritating matters, and prevents the nervousness that is caused
+by a local irritation.
+
+It is strange how women who are scrupulously neat in all other
+respects will allow the smegma to collect in and about the vulva; as a
+matter of fact, for the purpose of cleanliness it is much more
+necessary that the external genitals should be washed twice a day with
+soap and water all through life than that the face should be washed
+that often.
+
+Another question which is still sub judice is the necessity for and
+the frequency with which vaginal douches should be taken; all
+physicians are agreed that a vaginal douche taken immediately after
+the menstrual period is beneficial, as it removes all the debris of
+the flow, which is sometimes very irritating.
+
+Exercise.-- A moderate amount of exercise should be taken every day;
+this is needed now quite as much as at any other time, and only good
+can result from it. And no harm comes of a woman going out in the rain
+or in cold weather; as has been shown, the menstrual process is going
+on for a large part of the time, and the flow is only the external
+appearance, but during the time of the flow the woman must be
+unusually careful not to get her feet wet or to sit down with damp
+clothing on. Violent exercise of all kinds is to be prohibited at this
+time, as dancing, rides on the bicycle, gymnastics, and walks of over
+three miles. The reason for this is very obvious; the uterus has now
+reached the height of its turgescence, and is heavier than at any
+other time, hence the danger that displacements or a very profuse flow
+would be caused by any kind of violent exercise.
+
+Treatment.-- If the woman has been so unfortunate as to get caught out
+in a heavy rain so that her clothes have been wet through, or if in
+the cold weather she should come into the house thoroughly chilled,
+the best thing to do is to take off her wet things as quickly as
+possible, be well rubbed down with hot, rough towels, drink a cup of
+hot tea, go to bed at once and place a hot-water bag over the abdomen.
+She should remain in bed until the next morning, to the end that the
+circulation may regain its equilibrium as quickly as possible by the
+immediate relief of the pelvic congestion. If this exposure should
+have caused the sudden cessation of the flow, a hot mustard foot-bath
+should be taken. One tablespoonful of mustard is used to a gallon of
+water as hot as can be borne; the pail should be made as full as can
+be without running over, and a blanket wrapped around the pail and
+woman, so as to cause a profuse perspiration; this should be kept up
+for ten minutes; if the water cools off, hot water may be added.
+
+  CHAPTER V.
+
+ THE ANOMALIES OF MENSTRUATION.
+
+   Menorrhagia and Metrorrhagia; Dysmenorrhea; Amenorrhea; Leuchorrhea;
+   Pruritus Vulvae.
+
+  "Defer not till to-morrow to be wise,
+   To-morrow's sun on thee may never rise."
+
+                                                          -- CONGREVE
+
+Menorrhagia and Metrorrhagia.-- By menorrhagia is meant an excessive
+or too profuse menstrual flow; by metrorrhagia, a flow of blood
+between the menstrual periods. Neither one constitutes a disease by
+itself, but is a symptom of some pathologic condition.
+
+It has already been stated that the excretory organs, by constantly
+eliminating from the system the worn-out material, keep the machine
+healthy and in good working order. Kept within natural limits, this
+elimination is the source of strength and health; beyond these limits,
+the menstrual flow becomes an actual hemorrhage that, by draining away
+the life, becomes the source of weakness and disease.
+
+No physician would dare to bleed a man or woman once a month, year in
+and year out for thirty years; but, through ignorance or folly, this
+is what many girls do for themselves.
+
+This excessive flow, aside from actual local disease, is brought about
+by excessive muscular exercise during menstruation; by the use of all
+stimulants, whether alcoholic beverages or quinin; as well as by the
+thinness of the blood.
+
+When the flow is excessive, it must be considered a pathologic
+condition, which needs the physician's attention. Rest in the
+recumbent position is the first essential; the diet must be plain and
+unstimulating, and attention must be paid to the condition of the
+blood.
+
+The general diseases which generally cause this condition are anemia,
+Bright's disease, malaria, the early stages of tuberculosis, and heart
+disease.
+
+The local causes may be reflex, as powerful emotions; or due to local
+disease of the uterus and its appendages, as the various inflammations
+and displacements of the uterus, fibroid tumors, polypi, and cancer.
+
+Dysmenorrhea is painful menstruation. The most frequent forms are due
+to uterine congestion; to mechanical causes, as a narrowing of the
+cervical canal, particularly at its internal opening, or to a
+constriction caused by the bending over of the uterus at the junction
+of the body and the neck; or to ovarian irritation.
+
+The pain varies in intensity from slight discomfort to the most
+intense uterine colic, which is experienced in the lower part of the
+abdomen. In severe cases the general health becomes undermined, the
+nervous system gives way, and hysteria and other disorders of the
+nervous system result.
+
+The congestive variety usually occurs in patients who have previously
+menstruated painlessly. The pain comes on suddenly with the flow and
+ceases when the flow stops; it is very severe and is generally
+accompanied by a diminution or a cessation of the flow. There is
+severe headache, marked diminution in the secretion of the kidneys,
+and general restlessness. The patient frequently experiences pain in
+walking, is easily fatigued, has leucorrhea and an irritable bladder.
+
+In ovarian dysmenorrhea the pain precedes the flow for several days
+and ceases when a free flow is established. The pain is of a dull
+aching character, and may be felt on one or both sides of the abdomen,
+according as one or both ovaries are involved.
+
+Amenorrhea.-- In amenorrhea the menstrual flow may not appear for some
+years after it is normally due; or the flow may cease after some
+months or years of continuance; or the flow may be abnormally scanty
+or even absent.
+
+The menstrual flow is much later in appearing in some families than in
+others, so that this may be considered as a family idiosyncrasy; and
+if the girl's health is good, it need cause no anxiety. If, on the
+contrary, the girl has severe headaches, or suffers in any way, the
+physician should be summoned at once, as the absence of menstruation
+may be indicative of some serious pathologic condition,
+
+A scanty flow is often indicative of thinness of the blood; on the
+other hand, serious anemias often lead to profuse menorrhagias or
+metrorrhagias, as has already been stated. The cause of the profound
+anemia itself may be insufficient nutrition, overwork, or lack of
+exercise.
+
+Scanty menstruation is often seen to occur in fevers, in the later
+stages of consumption, in advanced Bright's disease, in malaria, or in
+any other very serious disease. In these cases it seems to be a
+conservative process on the part of nature in the run-down state of
+the system. As consumption progresses menstruation generally ceases
+absolutely, never to return again; and in this case nothing should be
+done to try to induce a return of the flow.
+
+Great shock sometimes causes a sudden cessation of the flow; and
+sometimes a sea-voyage, followed by the change of habitat, will cause
+an obstinate form of amenorrhea.
+
+But it cannot be too well understood that, after the menstrual flow
+has been regularly established, it continues with the greatest
+regularity throughout the child-bearing period, unless the exposure to
+wet or cold has been sufficiently severe to cause great indisposition
+on the part of the woman. In this case it is possible that, if the
+exposure took place just previous to the time of the expected flow,
+one period may remain out. But except in case of serious illness,-- as
+for example, typhoid fever,-- two or more periods do not fail to
+appear except in the case of pregnancy.
+
+Leucorrhea.-- Leuchorrhea, or "whites," is a mucous or mucopurulent
+discharge from the vagina; it may be a symptom of uterine or vaginal
+disease.
+
+Immediately after the menstrual flow there is a well-marked vaginal
+secretion which is whitish in appearance; it may be transparent or of
+a milky color, and is sometimes very acrid. This secretion may also
+precede the flow, and there is nothing abnormal in this. But any
+discharge occurring between the periods sufficient to stain the
+clothing-- the so-called whites or leucorrhea-- is abnormal, and is
+caused by an inflammation of the vagina or the neighboring parts. In
+addition to the discharge there is heat and swelling of the parts,
+more or less local distress, and generally intense nervousness.
+
+If the disease is not cured, it may become chronic. The pain, heat,
+and scalding disappear, but a copious discharge continues, and in this
+stage the disease may be very obstinate and greatly reduces the
+strength. The constant drain breaks down the system, producing pallor,
+debility, pain in the back, palpitation, indigestion, and so forth.
+
+The character of the discharge in leucorrhea varies considerably, from
+a whitish or mucous secretion, to a yellowish or mucopurulent
+secretion, and is debilitating in proportion as it is profuse. It is
+to be remembered that this is not in itself a disease, but indicates a
+disease of some of the pelvic organs; and that all such inflammations
+left to themselves incline to grow worse.
+
+A severe leucorrhea is generally attended with frequent and finally
+painful micturition; pain in walking in the lower part of the abdomen,
+which may become so severe as to compel the patient to go to bed.
+
+Pruritus Vulva.-- This is an intense and persistent itching of the
+vulva, and is a symptom rather than a disease. It is not an infrequent
+result of leucorrhea, the acrid discharge of the latter leading to an
+irritation of the parts; this causes rubbing of the parts until a
+veritable inflammation is produced.
+
+Other causes of pruritus vulvae are: The local congestion, such as
+occurs at the menstrual period, or in certain cases of pelvic
+inflammations, or in early pregnancy; constipation; sedentary habits;
+congestion of the liver; incontinence of urine, and diabetes. When
+dependent on the latter, the malady is most obstinate in yielding to
+treatment. Indigestible foods or drinks, the rubbing of the clothes,
+the friction of walking, and the heat of the bed act as exciting
+causes in those predisposed to it.
+
+The essential treatment here is to at once ascertain and remove the
+cause; aids in the treatment are vaginal douches and cooling lotions.
+
+  CHAPTER VI.
+
+ THE MARRIAGE QUESTION.
+
+   Herbert Spencer's Definition of Love; What Constitutes a Suitable
+   Husband; Best Age for Marriage; Shall Cousins Marry? Contraindications to
+   Marriage; Do Reformed Profligates Make Good Husbands? the Proper Length
+   of Time for the Engagement; the Right Time of the Year to Marry; the
+   Selection of the Wedding Day.
+
+  "Well, Brutus, thou art noble; yet, I see,
+   Thy honourable mettle may be wrought
+   From that it is disposed: Therefore, 'tis meet
+   That noble minds keep ever with their likes.
+   For who so firm that cannot be seduced?"
+
+                                                  -- "Julius Caesar."
+
+Herbert Spencer's Definition of Love.-- "Love is habitually spoken of
+as though it were a simple feeling, whereas it is the most compound,
+and therefore the most powerful, of all the feelings. Added to the
+purely physical elements of it, are first to be noticed those highly
+complex impressions produced by physical beauty; around which are
+aggregated a variety of pleasurable ideas, not themselves amatory, but
+which have an organized relation to the amatory feelings. With this
+there is united the complex sentiment we term affection-- a sentiment
+which, as it can exist between those of the same sex, must be regarded
+as an independent sentiment, but one which is here greatly exalted.
+Then there is the sentiment of admiration, respect, reverence, in
+itself one of considerable power, and which in this relation becomes
+in a high degree active. There comes next the feeling called the love
+of approbation. To be preferred above all the world, and that by the
+one admired above all others, is to have the love of approbation
+gratified in a degree passing every other experience, especially as
+there is added that indirect gratification of it which results from
+the preference being witnessed by others. Further, the allied emotion
+of self-esteem comes into play. To have succeeded in gaining such
+attachment from and sway over another is a proof of power which cannot
+fail to agreeably excite amour propre. Yet again, the proprietary
+feeling has its share in the general activity. There is the pleasure
+of possession, the two belonging to each other. Once more, the
+relation allows of an extended liberty of action. Toward each other a
+strained behavior is requisite. Around each there is a suitable
+boundary that may not be crossed; an individuality on which none may
+trespass. But in this case the barriers are thrown down, and the love
+of unrestrained activity is gratified. Finally, there is an exaltation
+of sympathies, egotistic pleasures of all kinds are doubled by
+another's sympathetic participation, and the pleasures of another are
+added to the egotistic pleasures. Thus around the physical feeling
+forming the nucleus of the whole, are gathered the feelings produced
+by personal beauty that constitutes simple attachments, of
+self-esteem, of property, of love of freedom, of sympathy. These, all
+greatly exalted and severally tending to reflect their excitements on
+one another, unite to form the mental state we call love. And as each
+of them is comprehensive of multidinous states of consciousness, we
+may say that this passion fans into immense aggregate most of the
+elementary excitations of which we are capable; and that hence results
+its irresistible power."
+
+What Constitutes a Suitable Husband.-- It is desirable that the
+husband shall be a few years older than the wife. Man is later in
+coming to maturity, and also retains his sexual powers considerably
+longer than woman; so that for these functions to cease about the same
+time, the wife must be younger than the husband. A difference of from
+two to five years is best; if the parties are young, it is not
+essential that the husband should be much the wife's senior, as it is
+later in life. The husband may be ten years older, but a greater
+disparity of age than this is rarely compatible with congeniality of
+tastes and dispositions, so essential to a happy married life. The
+woman who risks her happiness with a man many years younger than
+herself violates a precept of nature.
+
+The average stature of the man is about three inches greater than that
+of the woman, and in the physiologic marriage any great deviation from
+this should be avoided.
+
+The essentials for a happy marriage may be summed up as follows: that
+the parties shall be of suitable age; that they shall be physically
+well mated and in full sympathy with each other's views of life, of
+the same social position, and of equal education.
+
+The Best Age for Marriage.-- The reproductive life begins with
+puberty, but maturity is not reached before the age of twenty-one. It
+is only then that the standard of development is reached that is most
+compatible with the successful bearing of the grave responsibilities
+of wifehood and motherhood. The too early exercise of the reproductive
+functions leads to increased suffering on the part of the mother,
+depresses her vitality, and increases her liability to disease.
+Statistics show that the mortality is very much greater where girls
+marry under twenty years of age.
+
+The offspring are apt to be small and ill developed, and die in large
+numbers in early life; only a small percentage live long and robust
+lives. In France it has been observed that where the fear of
+conscription has caused many young people to marry the offspring were
+lacking in vigor. Among the offspring of immature parents there is a
+larger proportion of idiots, cripples, criminals, scrofulous, insane,
+and tubercular than among the children of nubile parents.
+
+In our climate women are best fitted to become wives and mothers
+between the ages of twenty-four and twenty-eight years. Before this
+age neither their self-knowledge, their knowledge of the world, nor
+their experience is sufficiently mature to fit them to wisely make the
+choice of a companion for life, or to become mothers. After forty,
+most women cannot hope for children. Men had better wait until between
+the ages of twenty-seven and thirty years, before they undertake the
+responsibilities of parenthood.
+
+Shall Cousins Marry?-- They might if both families were perfectly
+healthy; but as few families are without some lurking predisposition
+to disease, it is not well, as a rule, to run the risk of developing
+this by too repeated unions.
+
+Contraindications to Marriage.-- Young women in whose family there is
+a distinct history of such hereditary diseases as cancer,
+tuberculosis, or insanity for two generations back, should not marry
+at all. Not only is this a fearful legacy to hand down to their
+children, but pregnancy and child-bearing very decidedly favor the
+development of these diseases.
+
+Syphilis in either sex is a distinct bar to marriage; first, the party
+married is sure to contract the disease, even though it may have been
+supposed to have been cured. Fortunately, the children of such
+marriages are generally still-born; still, they do sometimes live, and
+are most pitiable and sickly objects. For any one to marry under these
+conditions is a crime against society, against the State, and against
+posterity.
+
+Women who have serious forms of heart disease, tuberculosis, or
+Bright's disease would, by becoming pregnant, run a serious risk of
+losing their lives toward the close of the pregnancy or at the time of
+their confinement. In case of heart disease, the pulmonary congestion
+that accompanies pregnancy, together with the encroachment of the
+pregnant uterus on the cavity of the chest, would greatly add to the
+embarrassment of the heart's action.
+
+In normal pregnancy there is some congestion of the kidneys; where
+there is actual disease of the kidneys prior to the pregnancy, this
+congestion is apt to become so severe as to threaten the woman's life.
+These organic diseases are not to be confounded with functional
+diseases which are dependent on some other cause; as palpitation of
+the heart due to indigestion, or heart murmurs dependent on the thin
+state of the blood, or congestion of the kidneys due to exposure to
+cold;-- all of which may be cured by proper treatment.
+
+Should a woman with a fibroid tumor marry, she would run a great risk
+to her life; she should have the tumor removed, or, if this is not
+possible, she should give up all thoughts of marriage, since the
+increased irritation and congestion consequent upon the marital
+relations would tend to favor its growth. Should pregnancy ensue,
+delivery might be attended with serious complications, as very
+difficult labor, postpartum hemorrhage, or, as these tumors have but
+little vitality, and the pressure to which they are subjected during
+labor is liable to cause their death, disorganization, sloughing, and,
+as a result, puerperal septicemia.
+
+Sometimes there is such a lack of development of the genital organs as
+to prevent the woman from having children.
+
+Two persons with even a slight tendency to the same disease, either
+inherited or acquired, should not intermarry, even if they are in
+comparatively good health at the time. Their offspring would be quite
+sure to inherit their diseased tendencies.
+
+Persons whose constitutions have been somewhat injured, but who are
+not tainted with actual disease, may rear children much healthier than
+themselves, provided their own lives are wisely regulated. If they are
+growing better all the time, and are not too much broken in
+constitution, it may be safe for them to marry.
+
+Among the Jews the physician is frequently consulted before
+matrimonial alliances are contracted. This custom could not but be of
+universal benefit; many local or general diseases would be eradicated
+before marriage, and in this way much suffering and unhappiness would
+be spared; or, in other cases, the patient would be advised of the
+inadvisability of marriage.
+
+Do Reformed Profligates Make Good Husbands?-- The manner of life that
+has been led by this class of men is such as to undermine their
+health, if not to have rendered them physical wrecks. There is the
+overindulgence in alcoholic beverages, and perhaps, added to this,
+some drug habit. In addition to this, these men early in their career
+are apt to become infected with some of the venereal diseases, or
+perhaps with all of them-- gonorrhea, syphilis, and so forth; and
+these diseases have the horrible characteristics of becoming latent. A
+man who contracts this kind of a disease can never be really sure that
+he is cured. All venereal diseases are highly contagious.
+
+It is now a well-established fact that gonnorrheal infection is not
+only one of the most common causes of pelvic inflammations in women,
+but that these same inflammations are of the most virulent types,
+unless they are recognized and treated in the early stages. It is also
+a well-known fact that a large percentage of married women suffer from
+this disease. Sterility almost always results.
+
+In the case of a syphilitic parent, one or two children may be born,
+but the offspring is generally sickly and diseased. Inebriety as well
+as sexual excesses are both well recognized as distinct forms of
+disease accompanied by degeneracy of brain tissue. It is nothing less
+than criminal for such men to have children, since these children
+would at least inherit the tendency to the same diseases, if they did
+not actually have them; there is also a strong probability of such
+children being born idiots or imbeciles.
+
+It is therefore self-evident that, instead of a reformed profligate
+making a good husband, he must make a very diseased one. It has
+therefore been suggested that the parents of the prospective bride
+should demand from the intended groom a certificate of freedom from
+all venereal diseases by a physician of their own selection. Also that
+there should be legislation upon the subject, and that before a man is
+granted a license of marriage, he should have a certificate from the
+health officer of freedom from syphilis, gonorrhea, and tuberculosis.
+
+The Proper Length of Time for the Engagement.-- A period not shorter
+than three months, nor longer than one year, should elapse between the
+engagement and the marriage.
+
+There are strong physiologic reasons against long engagements: they
+keep the affections and the passions in an excited and unnatural
+condition, which after a time tends to weaken the nervous system and
+undermine the health. These evil consequences are common to both
+sexes. It is far better that the subject of marriage should not be
+entertained at all unless the circumstances are such that the union
+might with propriety be effected at once.
+
+The Right Time of the Year to Marry.-- When woman marries she enters
+upon a new life, and a very trying one. Extreme heat and extreme cold
+are both very taxing to the human economy. Midsummer and midwinter are
+therefore both objectionable, but especially the former.
+
+The Selection of the Wedding-day.-- This is by common consent left to
+the bride. She should select a time about ten or fifteen days after
+the end of one of her menstrual periods, as this is the time of
+comparative sterility, and it is most desirable that the first sexual
+relations should be fruitless.
+                          _________________
+
+  PART II.-- MARRIAGE.
+                          _________________
+
+ CHAPTER VII.
+
+ THE ETHICS OF MARRIED LIFE.
+
+   The Wedding Journey; the Ethics of Married Life; Shall Husband and Wife
+   Occupy the Same Bed? the Comsummation of Marriage; the Marital Relation;
+   Times when Marital Relations Should be Suspended.
+
+  "If it is possible to perfect mankind, the means of doing so will
+  be found in the medical sciences."-- DESCARTES.
+
+The Wedding-journey.-- The wedding-journey, which was formerly the
+cause of so much discomfort to both husband and wife, has fortunately
+gone out of vogue; and in its place has come the retirement to a quiet
+country or seaside spot, away from the prying eyes of friends. Thus
+the nervous strain incident to sight-seeing and travel is avoided.
+
+The Ethics of Married Life.-- It has been said that God set men and
+women in pairs in order that they might perfect each other and
+complete each other's happiness. The secret of all true happiness in
+life lies in the spirit of altruism; one must be able to wholly forget
+herself and to find her happiness in the welfare of others.
+
+The woman who exhausts herself physically and financially on the
+preparation of her trousseau and her wedding does her husband a wrong
+by bringing him a wife who is on the verge of nervous prostration.
+
+The secret of a happy married life depends to no small extent on the
+very beginning: the relation is so entirely new, and much lies hidden
+in the character of each that was never suspected by the other.
+
+Between husband and wife there must always be mutual concessions,
+forbearance, and sympathy; a mutual helpfulness to attain all that is
+best. This, of course, implies that the life of each is an open book
+for the other to read; that there is an unreserved exchange of
+thought; and that no privilege is claimed by the one that would not
+willingly be accorded to the other.
+
+"How many men," says Balzac, "proceed with women as the monkey of
+Cassan with the violin; they have broken the heart without knowing it,
+as they have tarnished and disdained the jewel whose secret they never
+understood. Almost all men are married in ignorance of women and of
+love. They have commenced by forcing open the doors of a strange house
+and have wished to be well received in its salon. But the most
+ordinary artist knows that there exists between him and his
+instrument-- his instrument which is made of wood or ivory-- a sort of
+indefinable friendship. He knows by experience that it has taken years
+to establish this mysterious rapport between an inert material and
+himself. He could not have divined at the first stroke all its
+resources and caprices, its faults and its virtues. His instrument
+only became a soul for him and a source of melody after long study; he
+only came to understand it as two friends after the most learned
+interrogation.
+
+"So the world is full of young women who grow pale and feeble, sick
+and suffering. The ones are a prey to inflammations more or less
+severe; the others remain under the dominion of nervous attacks more
+or less violent. All these husbands have caused their own unhappiness
+and ruin. Never begin married life with a rape. To demand of a young
+girl whom one has seen forty times in fifteen days to love you because
+of the law, the king, and justice is an absurdity.
+
+"Love is the union of necessity and of sentiment. Happiness in
+marriage is the result of perfect understanding between the spirits of
+husband and wife. From this it happens that in order to be happy, a
+man is obliged to bind himself to certain rules of delicacy and honor.
+After taking advantage of the social laws which consecrate the
+necessity, it is necessary to obey the secret laws of nature, in order
+to make the sentiments flourish. If a man places his happiness on
+being loved, it is necessary that he should love sincerely; nothing
+resists a veritable passion."
+
+Shall Husband and Wife Occupy the Same Bed?-- Among civilized nations
+custom differs in this regard; in Germany, for instance, the husband
+and wife occupy separate beds in the same room; formerly in this
+country it was almost the universal custom for husband and wife to
+occupy the same bed. The current of opinion has changed in this
+respect, and it is now considered in the highest interests of both
+that they shall occupy not only separate beds, but separate rooms;
+these rooms communicating through a door which connects their
+respective dressing-rooms. This is unquestionably the best arrangement
+from the hygienic as well as from the ethical point of view. Health
+requires that one-third of the time shall be spent in sleep; the bed
+was made for sleep; and the most refreshing sleep can only be obtained
+by occupying the bed alone. If two persons occupy the same bed and one
+is restless, the sleep of the other is necessarily disturbed. Again,
+two persons occupying the same bed necessitates the same hour for
+rising and retiring, which is not always convenient or agreeable.
+Balzac writes on this subject: "To put the system of separate
+bed-rooms into practice is to attain to the highest degree of
+intellectual power and of virility. By what syllogism man arrived at
+establishing as a custom that of man and wife sleeping together, a
+practice so fatal to happiness, to health, to pleasure, and even to
+self-love, would be curious to seek out." If for financial reasons it
+is not possible to have separate bed-rooms, the German custom of
+having separate beds should be adopted.
+
+The Consummation of Marriage.-- The consummation of marriage is often
+attended with difficulty owing to the rigidity of the hymen; this, if
+present, must usually be ruptured before connection takes place. Great
+gentleness and care must be exercised by the husband if it does not
+readily yield, the use of hot vaginal injections should be kept up for
+several weeks before the trial is repeated. These usually relax the
+parts very considerably; but if coitus is still found impossible, it
+is better to consult a physician at once, when a simple operation will
+generally remove the trouble and the woman is spared much suffering.
+In no case is any violence on the part of the husband allowable, as it
+might produce irreparable injuries.
+
+There is always more or less suffering on the part of the wife at
+first, partly due to the rupture of the hymen, and partly to the
+forcible dilatation of the vagina and she should be allowed a
+sufficient time for nature to repair these injuries. By so doing, the
+constitutional disturbances and the nervous disorders which are so
+very prevalent may be prevented. Too frequent indulgence at this
+period is a prolific source of inflammatory diseases, and often
+occasions sterility and ill-health.
+
+The first nuptial relations should be fruitless, in order that any
+indisposition arising therefrom should have had time to disappear
+before the woman becomes pregnant.
+
+The Marital Relation.-- It is most important for the interest of both
+parties that there should be chastity in the marriage relation as well
+as out of it. Many young couples have had their lives ruined by
+excessive sexual indulgence. The effect is usually most severe upon
+the husband, yet the wife becomes weak, nervous, and excitable. Sexual
+excess is also the grave of domestic affection. The general rule given
+is that coitus should never take place oftener than every seven or ten
+days. When coitus is succeeded by langour, depression, or malaise, it
+has been indulged in too frequently.
+
+Among civilized people there are three widely diferent views as to the
+proper course to be pursued:
+
+First, those who maintain that sexual intercourse should not take
+place except for the propagation of the species.
+
+Second, those who believe that the act is a love relation, mutually
+demanded and enjoyed by both sexes, and serving other purposes besides
+that of procreation.
+
+Third, those who hold that sexual intercourse is a physical necessity
+for the man, but not for the woman.
+
+The first theory, "that the sexual relations should never be sustained
+save for the purpose of procreation," has many advocates. They teach
+that there are other uses for the procreative element than the
+generation of offspring, and far better uses than its waste in
+pleasures. They claim that a life of total chastity increases the
+physical and mental vigor; and there will result a procreation on the
+mental and spiritual planes, instead of on the physical ones.
+
+They also claim that to woman belongs the creative power; that she
+must choose when a new life shall be evolved; and that only by
+adhering to this law can she be protected in the highest function of
+her being-- the function of maternity.
+
+The adherents of the second theory, "that the act is a love relation,
+mutually demanded and enjoyed by both sexes, and that it serves other
+purposes besides that of procreation," claim that the female sexual
+life indicates that the healthy woman is neither indifferent nor
+passive in the generative act. It has much the same effect as in man--
+a powerful increase in her sensations, whole groups of muscles are set
+in motion, and the uterus as well as the entire nervous system are in
+an excited condition and activity. And that it is the province of the
+mother to decide when a new life should begin.
+
+The third theory, "that sexual intercourse is a physical necessity for
+the man, but not for the woman," is by far the most widely accepted.
+We will consider, first, the practical results of this last theory;
+and, second, the scientific basis on which it rests.
+
+It is generally acknowledged that this practice has done more to cause
+domestic misery, sickness, and death than that dreadful scourge of the
+human race, tuberculosis.
+
+This man, accustomed all his life to gratify his sexual passions
+promisculously, marries a virtuous young girl. In her menstrual
+periods she has had to do only with the secondary phenomena; with the
+expulsion of the ova not at all. She has had no instruction in the
+corresponding physiologic life of the man, and is astonished at the
+male sexual indications, and is led to believe in their physiologic
+necessities. The result is that she not only suffers physically, but
+feels outraged and disgraced. She is liable to the chance of maternity
+at any time; and such offspring will probably be sickly.
+
+Passion is presented to the young wife in so hideous a guise that it
+will take the utmost consideration of her husband afterward to enable
+her to completely overcome her repugnance. If she be worn and weary of
+excesses in the early days of her married life, the husband will have
+only himself to blame if he is bound all his life to an apathetic and
+irresponsive wife. Husbands place great strains upon the affections of
+their wives, and lower themselves almost past reinstatement in their
+respect and esteem.
+
+Lastly, on what scientific basis does this "physilogic necessity" for
+sexual gratification on the part of the male rest? Analogy with the
+lower animals does not bear it out. Among animals, except in rare
+instances under domestication, the female admits the male in sexual
+embrace only for procreation. Among many savage tribes this same rule
+has but few exceptions. The analogies between the male and the female
+sexual organs; between seminal emissions and menstruation; between the
+sexual life of the male and of the female, only go to accentuate the
+fact that this so-called physiologic necessity on the part of the male
+has arisen chiefly through the difference of education; so that it has
+come to be that the woman is chaste and the man is degraded; that the
+woman is too sentimental and the man too passionate. From a purely
+medical standpoint, the most eminent physicians and physiologists of
+the day all unite in advocating a chaste and continent life, simply
+for the sake of the man's own health, independently of all other
+considerations.
+
+Times when Marital Relations Should be Suspended.-- The marital
+relations should always be suspended during the menstrual period.
+During pregnancy intercourse should never, or at least very rarely, be
+indulged in. At this time the mother needs to conserve all her
+strength and energies for herself and child; and any sexual relations
+during this time increase the sufferings of the mother and impair the
+vitality of the child. It has been even suggested that much of the
+pain during parturition would be avoided by entire continence during
+pregnancy. Intercourse during the early months of pregnancy is a
+frequent cause of abortion. Women who have supposed that they have
+never been pregnant have in reality been having abortions every second
+or third month.
+
+A woman should never be subjected to coitus until three months after
+delivery. During lactation intercourse should never, or at least very
+rarely, be indulged in; as the function of lactation makes a heavy
+drain on the strength of the mother, and anything which would further
+weaken her would tend to impoverish the quality of the milk and thus
+the child would suffer.
+
+  CHAPTER VIII.
+
+ SEXUAL INSINCT IN WOMEN.
+
+   Sexual Instinct in Women; Excessive Coitus; Causes of Sexual
+   Excitability.
+
+  "Virtue, the strength and beauty of the soul,
+   Is the best gift of heaven."
+
+                                                        -- ARMSTRONG.
+
+Sexual Instinct in Women.-- After careful observation of the sexes in
+the married state, it is found that the sexual appetence is less in
+women than it is in men. Much of this difference in sexual appetence
+is doubtless due to the chastity of their lives, coupled with and
+resulting from the difference of education. The girl is taught
+repression, and the boy expression; that girls must be chaste; that
+chastity for boys is impossible.
+
+According to the intensity of the sexual instinct women have been
+divided into three classes: A larger number than is supposed have
+little or no sexual feeling. Second, those who are subject to strong
+passion; this class is larger than the first, but small as compared
+with the whole of their sex. Third, those in whom the sexual appetite
+is moderate; this class comprises the vast majority of women.
+
+And, even granting to woman more pleasure in sexual indulgence than
+usually comes to her by largest allowance, it is safe to say that in
+nine cases out of ten maternity, with its early pains and later cares,
+greatly lessens her power of enjoyment; and that for the larger part
+of her married life she is either positively distressed by the
+apparently necessary demands of her husband upon her, and irresponsive
+to them, or kept to a cheerful response by a self-abnegation and
+regard for his comfort, not to say fear of his moral aberration, which
+is a positive drain upon her health and strength.
+
+Excessive Coitus.-- Those who are most frequently found to suffer from
+venereal excesses are the newly married; especially if they have weak
+constitutions and excitable temperaments. A great deal of mischief is
+done by two persons of unequal constitutions being matched together;
+the husband may exhaust the wife or vice versa, the weaker party being
+constantly tempted to exceed their strength. In all sexual matters
+there must be a consideration for others. It is not so much from
+selfishness as from ignorance that such a mistake is made. The
+ignorance comes from a lamentable morbid delicacy which prevails on
+all sexual matters, and which prevents all open and rational
+conversation on them, even between those who have the most intimate
+knowledge of each other.
+
+When the conjugal act is repeated too often, the man will become
+gradually conscious of diminished strength, diminished nerve force,
+and diminished mental powers. Excess weakens a man's energies, and
+enervates and effeminates him. Moreover, it renders him liable to an
+infinity of diseases and a readier victim to death.
+
+Not only is the strength of the constitution lowered by the excessive
+expenditure of force and matter requisite for the perpetuation of the
+species, but this lowered standard of vitality is transmitted to
+children. There can be but little doubt that this is one of the
+reasons why so many healthy parents beget sickly children, who die
+early. They have exhausted themselves of the material from which a new
+life is created, and so it is not properly started at the beginning
+and never reaches its highest development. To the truth of this
+statement attests the mental imbecility, the pallid and attenuated
+forms, of the children who are the earlier products of marriage. The
+effect of excessive coitus in women is seen by the confirmed ill
+health of so many women after marriage and repeated child-bearing. A
+large number of these cases are dependent upon alteration and diseases
+of the genitalia; but a considerable number are unconnected with local
+disease, and in many other cases the health is never regained after
+all local phenomena have disappeared.
+
+Sexual excitement in the woman causes certain congestion of the
+genital organs; and at the time of the orgasm there is a reflex
+movement which corresponds to erection, and which consists of a
+peristaltic movement of the tubes and uterus; to the uterus also is
+ascribed an act of suction by which the spermatozoa are drawn up into
+its interior. Even when pregnancy does not follow, the too frequent
+excitation and activity of the uterus in weak constitutions causes
+illness, first of the genital organs and then of the nervous system.
+
+Local diseases caused in women by excessive coitus are: vaginal
+catarrh, acute catarrh of the vulva, acute inflammation of the lining
+membrane of the uterus as well as of the uterus itself, inflammation
+of the ovaries, and even peritonitis. It is also known to be an
+important factor in the origin of blood-tumors and of cancer of the
+uterus. Especially is coitus at a time of great physical fatigue
+liable to be provocative of uterine inflammations. Aside from ethical
+considerations, coitus during the menstrual period may be the cause of
+rupture of the impaired blood-vessels, thus causing blood-tumors.
+Excessive coitus is a well-known cause of chronic inflammation of the
+uterus; that is, a habitual congestion of the uterus is induced by
+excessive sexual intercourse. This has been frequently mentioned by
+authors as leading to enlargement of the uterus in the non-pregnant
+condition; and it is a still more potent factor in the recently
+impregnated organ, whose tissues are succulent and the vessels
+enlarged, a condition inviting congestion and enhancing the
+susceptibility to engorgement.
+
+The general manifestations of impaired health in women due to
+excessive coitus are: chronic anemia, with malnutrition; impaired and
+altered functions in all the organs, especially those of the nervous
+system. Menorrhagia is apt to be induced by overstimulation of the
+ovaries, together with exhaustion and sexual apathy.
+
+The source of so much misery is the increasing physical weakness of
+the female and the increasing nervous weakness of the male, with an
+increasing sexual excitability, two factors of tragic effect for the
+wife. Here is seen the unfortunate result of teaching two kinds of
+morals, one for men and another for women.
+
+Causes of Sexual Excitability.-- Too frequent genital irritation,
+onanism, too frequent intercourse, alcohol, too rich and too highly
+seasoned foods, lack of exercise.
+
+Treatment of Sexual Excitability.-- Avoid alcohol and precocious
+puberty. Strictest attention must be paid to the diet; everything is
+to be avoided which is difficult of digestion or which retards it. The
+following articles of diet must all be avoided: cheese, foods seasoned
+with pepper and curry, highly salted and acid foods, and all rich
+foods; and meat must be eaten only in moderate quantities.
+Constipation irritates the genitalia directly and increases the
+inflammation. The close relation of Venus and Bacchus is known not
+only in mythology. Carbonated waters are to be especially avoided,
+such as soda, seltzers, Preblauer, Geisshubler, and acid waters; also
+champagne and beer, heavy Italian, Spanish, and English wines. All
+alcoholic drinks must be forbidden.
+
+As heavy gymnastics as the strength of the individual will admit, and
+plenty of exercise out-of-doors must be taken. There must also be
+constant mental and physical employment. In women sexual excitability
+is often caused by local diseases, and passes off with their cure; if
+not, she must use her will-power, and take the various forms of cold
+baths. Sexual intercourse not oftener than once in two or three weeks,
+and avoid all intimate approaches; if this is not sufficient, she will
+have to leave her husband for a few months.
+
+  CHAPTER IX.
+
+ STERILITY.
+
+   Sterility; the Prevention of Conception and the Limitation of Offspring;
+   the Crime of Abortion; Infidelity in Women.
+
+  "Never let yourselves do evil that good may come. If you do, you
+  hinder the coming of the real, the perfect good in its due time."
+
+                                                  -- PHILLIPS BROOKS.
+
+Sterility.-- Conception is least apt to take place from the tenth day
+after one period until the third day before the next; but there is
+practically no time during a woman's sexual life when she may not be
+impregnated; in this connection it must be remembered that the
+spermatozoa stay alive in her for more than a week.
+
+During lactation women are generally sterile, especially in the first
+months which follow the accouchement, because the vital forces are
+then concentrated on the secretion of milk.
+
+The age of the wife at the time of marriage has much to do with the
+expectation of children. As the age increases over twenty-five years
+the interval between the marriage and the birth of the first child is
+lengthened. For it has been ascertained that not only are women most
+fecund between twenty and twenty-five years, but that they begin their
+career of child-bearing sooner after marriage than either their
+younger or older sisters.
+
+A wife who has had children and ceases to conceive for three years
+will probably bear no more.
+
+When marriages are fruitless, the wife is almost always blamed; but it
+is by no means the wife that is always at fault; many husbands are
+absolutely sterile. Every man is not prolific who enjoys good health
+and is vigorous. Gross states that in one case out of six the
+sterility was due to the male. Kehrer, after a series of carefully
+conducted experiments, has arrived at the conclusion that in at least
+a third of the cases of sterile marriages the husband was the party at
+fault, and that gonorrhea was the cause of the barrenness.
+
+Venereal diseases have their share of influence, and the gonorrheal
+infection is a potent cause of sterility. It is by no means proved
+that syphilis has any unfavorable influence on conception, though
+abortions due to this are frequent.
+
+Gonorrhea often prevents conception by the inflammation traveling up
+the womb, and along the Fallopian tubes to the ovaries, whose covering
+is rendered thick and dense, so that the ovum cannot escape, or if it
+does, the fimbriated end of the tube is so agglutinated that it cannot
+grasp the ovum.
+
+Alcoholism is considered a cause of sterility. It evidently does
+diminish the sexual potency in the male, and for this the female is
+often blamed.
+
+It does not follow because a woman has not given birth to a child that
+she has not conceived. The life of an infant for a long time after
+birth is a frail one, and before birth its existence is extremely
+precarious; it often perishes a few days after conception. A period
+coming on a few days late, and at the same time one which is unusually
+profuse, is the only evidence which the young wife may have of an
+abortion. Among prostitutes, the frequent delay of menstruation, then
+abundant hemorrhage, is in many cases only habitual abortion, and
+leads to changes in the generative organs which must result in
+sterility. A tendency to miscarriage may therefore be all that stands
+in the way of having a family; this can frequently be remedied.
+
+Sexual incompatibility is well known to exist; prominent examples
+being Augustus and Livia; Napoleon and Josephine. It is also a
+well-known fact that frigidity is a cause of barrenness. A short
+separation of husband and wife is often salutary in its influence upon
+fertility.
+
+It is a well-established fact that the time immediately before the
+period, but still more that immediately following the period, are the
+most favorable times for conception to take place; the remaining quiet
+in bed of the woman after the generative act is also favorable to
+conception.
+
+The most frequent causes of sterility in women are inflammation of the
+lining membrane of the uterus, or of the neck of the uterus, or of
+both. The source of this condition in women who have had children is
+most frequently due to parturition or abortion. In the newly married
+it may be due to a previously existing slight uterine catarrh in a
+displaced uterus, or it may be a manifestation of a run-down state of
+the system. In a majority of the newly married, however, the
+inflammation of the endometrium is probably due to the first efforts
+at conjugal approach. Many young women as the result of the
+preparation of the trosseau, augmented by a round of gaities at the
+time of marriage, enter the married state in a condition bordering on
+physical and nervous exhaustion; and then begin engorgements and
+inflammations which lead to future suffering and to sterility.
+Displacements and flexions of the uterus also cause sterility. Such
+displacements of the neck of the uterus may occur that, instead of
+lying in a pool of semen, as it should, it is above, in front of, or
+away from it, and this may prevent conception.
+
+Vulvar and vaginal hyperesthesia, inflammations of the vulva, undue
+shortness of the vagina, unless great care is exercised by the
+husband, will induce painful coitus, and may bring about sterility by
+favoring the formation of a copulation sac outside of the axis of the
+uterine canal, and consequently misdirection of the semen.
+
+Scrofula, probably by its effects on the general condition, leading to
+deficient development of the whole body, the genital organs included,
+may be productive of sterility.
+
+The female being less passionate than the male, the orgasm comes on
+later with her, or the male orgasm occurs so soon that she may not
+reach that stage at all. If both were simultaneous, it is reasonable
+to suppose that conception would be more likely to occur.
+
+Ovulation is doubtless more frequently performed in some women than in
+others. Some women conceive with more or less regularity every fifteen
+or eighteen months, and others at intervals of several years.
+
+The effect of repeated coition, provided that impregnation does not
+take place at once, is to engorge the uterine vessels, to alter the
+nature of the glandular secretions, to cause profound reflex
+disturbances, and thus to produce such changes in the endometrium as
+to lead to local inflammation and to general nervous exhaustion.
+Backache, leucorrhea, and irritable bladder are the first symptoms of
+this disorder; but frequently there are added to these, headache,
+indigestion, rectal tenesmus, painful and profuse menstruation. In
+many cases the disease continues in a mild catarrhal form, giving the
+woman little inconvenience besides the slight leucorrheal discharge
+which stains her clothing; but often this is indicative of such a
+change of the lining membrane of the uterus as to render it unfit for
+the fixation and development of the ovum, even should impregnation
+take place.
+
+Under normal conditions, during the intermenstrual period, a plug of
+clear viscid mucus, which is secreted by the glands of the cervical
+canal, blocks up that passage, but is washed away each month by the
+menstrual discharge. Under ordinary conditions this obstruction must
+seriously interfere with the entrance of the spermatozoa into the
+cavity of the uterus, and renders the former theory, recently revived
+by Bossi, quite tenable, that impregnation is most likely to occur
+just after the menstrual epoch.
+
+The vaginal secretion under certain pathologic conditions may become
+so acid that it induces sterility. Women who suffer m severe vaginal
+catarrh are frequently sterile, the spermatozoa being found dead in
+the vagina some hours after copulation, although an examination a
+shorter time afterward revealed them still alive. In cases where
+conception takes place in spite of a very acid condition of the
+vaginal secretion, it is probable that some of the spermatozoa enter
+the uterus before the secretion has had time to act on them, or
+possibly the spermatozoa being injected in a mass, the acid secretion
+is unable to penetrate and kill them all.
+
+The reaction of the normal vaginal mucus is always acid, that of the
+cervix alkaline; but as the result of the inflammatory condition, the
+reaction of each is often intensified, especially that of the vagina,
+which has an exceedingly sour and penetrating odor. This acid
+discharge, bathing the neck of the uterus, penetrates more or less
+into the cervical plug and causes coagulation of the alkaline mucus.
+
+The chief constituent of the semen is albumin; agents which affect
+albuminous substances influence the functional activity of the
+spermatozoa-- heat, concentrated acids, and probably concentrated
+alkalies. In normal conditions the alkalinity of the seminal fiuid
+seems to be sufficient to neutralize the acidity of the vaginal
+secretions, so that the spermatozoa may remain seventeen days or more
+(Bossi) within the vaginal canal, even during a menstrual period,
+without having their vitality destroyed.
+
+When hyperacidity of the vaginal secretion is present, it is probable
+that the fertilizing element is at once rendered inert; but should
+some of the spermatozoa succeed in reaching the interior of the
+cervical canal, the increased alkalinity of the secretion there would
+in all probability put an end to all further progress.
+
+The conditions, then, which appear to prevent fecundation are: First,
+the absence of the proper nidus for the ovum; second, the obstruction
+of the cervical canal by a mucus plug; third, increased alkalinity of
+the cervical secretion, often accompanied by the increased acidity of
+the vaginal secretion. Three conditions must, then, be determined:
+First, are there spermatozoa in the semen? Second, do they get into
+the uterocervical canal? Third, do the secretions in the canal poison
+the spermatozoa?
+
+"For those who are very anxious for offspring," wrote Marion Sims, "I
+usually order sexual intercourse on the third, fifth, and seventh days
+after the flow has ceased; and on the fifth and third days before its
+return. For the most obvious reasons this would always be before going
+to bed at night, instead of just before rising in the morning. The
+horizontal position favors the retention of semen; the erect its
+expulsion. I am satisfied that too frequent sexual indulgence is
+fraught with mischief to both parties. It weakens the semen; in other
+words, that this is not so rich in spermatozoa after too frequent
+indulgence; and when carried to the extent of a debauch, the fiuid
+ejaculated may be wholly destitute of spermatozoa. Thus it will be
+seen that it will be much better to husband the resources of both man
+and wife."
+
+The Prevention of Conception and the Limitation of Offspring.-- Some
+of the contraindications to procreation are when either parent suffers
+from a disease which is transmissible, and such diseases frequently
+manifest themselves only after marriage; when the pregnancy would
+endanger the mother's life, or even where the pregnancy is a nine
+months' torture to her; where either parent is suffering from ill
+health; or where for economical reasons no more children are desired.
+
+If there exists no condition in either parent or in their
+circumstances why they should not have children, the next
+consideration due to their children, is how the same may be procreated
+under the most favorable conditions possible; this condition can only
+be secured by making the circumtsances such that the mother shall be
+able to choose the time for their conception when both parents are in
+the best physical condition. That children should be brought into the
+world haphazard, as the result of accident, is to degrade the human
+race below that of the lower animals, where the female admits the male
+only at the time of the rut, which in the majority of cases occurs
+only once a year.
+
+Another requisite to bearing healthy children is that the pregnancies
+shall not follow each other too rapidly. Aside from the consideration
+for the health of the mother herself, she must be in good physical
+condition to bear the healthiest children she is capable of giving
+birth to; and for this there must be from two and a half to three
+years between the successive pregnancies. The results of
+overproduction on the children are frequently, that they are sickly,
+short-lived, or suffer from rickets, cerebral paralysis, idiocy, or
+imbecility.
+
+And last, but certainly not least, many women become chronic invalids,
+or are hastened to premature graves, by having children as fast as
+they possibly can.
+
+The most natural and moral way for the artificial prevention of
+conception, when on account of ill health or for economic reasons no
+more children are desired, is to abstain from sexual intercourse. But
+in the majority of cases the husband will not agree to this, and so
+the greatest number of methods have come to be used to prevent
+conception.
+
+Perhaps the most frequent method use to prevent conception is
+withdrawal before the ejaculation of semen. While this is most
+injurious to the husband-- debility, nervous prostration, and even
+paralysis are said to ensue-- the health of the wife also suffers. If,
+this interrupted sexual congress is continued for years, there develop
+gradual nervous disturbances on both sides, and a serious disease of
+the uterus makes itself felt. The generative organs become engorged
+with blood, but are not permitted to enjoy relaxation consequent upon
+the full completion of the act. This engorgement may lead to undue
+local nutrition, and diffuse growth and proliferation of the
+connective tissue may take place. Hence the uterine walls become dense
+and thickened and the nerves compressed. Of course, pain and
+tenderness and a sense of bearing down will be the result. Flexions
+and versions may be consequent upon the engorgement. The nerves become
+shattered, and the woman will be fortunate if she contracts no serious
+womb trouble.
+
+"It is strange," says John Stuart Mill, "that intemperance in drink or
+any other appetite, should be condemned so readily, but that
+incontinence in this respect should always meet not only with
+indulgence, but with praise. Little improvement can be expected in
+morality until the producing of too large families is regarded with
+the same feeling as drunkenness, or any other physical excess."
+
+Sismondi writes: "When our true duties toward those whom we give life
+are not obscured in the name of a sacred authority, no man will have
+more children than he can properly bring up. If a woman has a right to
+decide any question it is how many children she should bear. Whenever
+it becomes unwise that the family should be increased, justice and
+humanity require that the husband should impose on himself the same
+restraint which is submitted to by the unmarried."
+
+In the opinion of Dr. Edward Reich, it is very much to be wished that
+the function of conception should be placed under the domain of the
+will. But the strongest appeal has been made for the sake of morality
+itself; namely, to prevent the crime of abortion. Dr. Raciborski, of
+Paris, took the position that the prevention of offspring to a certain
+extent is not only legitimate, but it is to be recommended as a means
+of public good.
+
+Continence, self-control, and a willingness to deny himself-- that is
+what is required of the husband. But suffering women assure us that
+this will not suffice; that men refuse to restrain themselves; that it
+leads to loss of domestic happiness, to illegitimate amours; or that
+it is injurious physically and mentally; that, in short, such advice
+is useless because it is impracticable.
+
+Dr. Napheys writes: "Is it amiss to hope that science will find
+resources, simple and certain, which will enable a woman to let reason
+and sound judgment, not blind passions, control the increase of her
+family?"
+
+The Crime of Abortion.-- From the moment of conception a new life
+begins, a new individual exists; another child is added to the family.
+The mother who deliberately sets about to destroy this life by want of
+care, or by taking drugs, or by the use of instruments, commits a
+great crime, and is just as guilty as if she strangled her new-born
+infant. The crime she commits is child-murder. Women in their frenzy
+at finding themselves in this condition, and with no slightest idea of
+the sin that they are committing, are constantly guilty of committing
+abortions on themselves, or going to professional abortionists to have
+this crime of child-murder committed. This is another of the sins due
+to the ignorance of the sex in all matters pertaining to reproduction;
+and it is a fearfully prevalent one.
+
+Infidelity in Women.-- "We have now reached the last infernal circle
+of the divine comedy of marriage; we are at the depths of the inferno.
+There is something, I do not know what, terrible in the situation in
+which a married woman finds herself when an illegitimate love has
+ruined her for the duties of a wife and mother. As has been so well
+and strongly expressed by Diderot, infidelity in woman is like
+incredulity in a priest; it is the last step in human forfeitures; it
+is for her the great social crime, for it implies all the others.
+
+"Weigh the sufferings of the future, the agonies of years by the
+ecstasy of half an hour. If this conservative sentiment of the
+creature, the fear of death, does not stop her, what could be expected
+of laws? Oh, sublime infamy!"-- (Balzac).
+                          _________________
+
+  PART III.-- MATERNITY.
+                          _________________
+
+ CHAPTER X.
+
+ PREGNANCY.
+
+   Nature of Conception; Pregnancy Defined; Duration of Pregnancy; the Signs
+   of Pregnancy; Quickening; the Determination of Sex at Will; the Influence
+   of the Male Sexual Element on the Female Organism; Heredity; Hygiene of
+   Pregnancy; Causes of Miscarriage.
+
+                  "Happy he
+  With such a mother, faith in womankind
+  Beats with his bood, and trust in all things high
+  Comes easy to him, and though he trip and fall,
+  He shall not bind his soul with clay."
+
+                                                         -- TENNYSON.
+
+Nature of Conception.-- Conception, or impregnation, is the union of
+the germ and the sperm cell, the result of which is a new being. On
+coition, the semen being received into the female organs, which are at
+that time in a state of turgescence, the spermatozoa, by means of
+their own vibratile activity, find their way into the Fallopian tubes,
+and here come in contact with the ovule.
+
+The ovule is a minute cell with a transparent membrane, within which
+is the yolk containing the germinal vesicle. The spermatozoon
+penetrates into the ovule and becomes fused with it. The processes of
+development begin at once to occur. There is congestion of the uterine
+mucous membrane out of proportion to the rest of the uterus; the ovum
+finds lodging here, and becomes surrounded by a membrane which
+incloses it in a separate sac.
+
+Pregnancy Defined.-- Pregnancy begins with conception and ends with
+parturition; it provides for the nutrition and the expulsion of the
+embryo and for its nutrition for a short time after birth.
+
+The average duration of pregnancy is ten lunar months, or two hundred
+and eighty days. The date of the confinement is calculated by
+reckoning from the date of the last menstrual flow; count backward
+three months from the date of the first appearance of the last menses;
+to this add twelve months and seven days, five days being for the
+average menstrual duration and two days for the possibility of
+fecundation.
+
+Duration of Pregnancy.-- Many difficulties are experienced in
+determining the date of the expected confinement. As most pregnancies
+occur in married women, we cannot base any calculations on a single
+act of coitus. And even if there was but one, all physiologists agree
+that there is a variable period in different women, and in the same
+woman at different times, between insemination and the fertilization
+of the ovum. It is the moment of fecundation, or the union of the germ
+and sperm cells, which marks the beginning of pregnancy. The
+uncertainty becomes still greater owing to our inadequate knowledge as
+to the length of time during which the sexual elements, the ova and
+the spermatozoa, retain their vitality after liberation from their
+respective sources. While it is not certainly known, it is probable
+that the ovum is capable of impregnation any time during its sojourn
+within the oviduct and before reaching the uterus, or probably for a
+period of about one week from the time of its escape from the Graafian
+follicle. The remarkable vitality of the spermatozoa even under less
+favorable circumstances-- direct observation shows that these elements
+retain their movements for over nine days outside of the body--
+renders it almost certain that their powers of fertilization are
+maintained for a long time after they are deposited within the healthy
+female genital tract; it is believed that the spermatozoa are capable
+of fertilization after a sojourn of three or more weeks within the
+oviduct.
+
+Consideration of these facts renders apparent the impossibility of
+fixing with certainty the date of the beginning of pregnancy, since
+conception may result from the union of the ovum liberated at the
+beginning of the period with the spermatozoon introduced at the end of
+that time; or it may result from the meeting of the male elements
+already within the oviduct with an ovum discharged a day or two before
+the occurrence of the menstrual period.
+
+The Signs of Pregnancy.-- The cessation of the menstrual period is the
+sign of the greatest value in women who have been regular; but it must
+always be remembered that there may be an irregularity of menstruation
+for the first few months after marriage. The appetite is capricious;
+morning sickness or nausea in the morning on first getting up is a
+very common symptom in the early months of pregnancy; enlargement of
+the abdomen; in the first two months of pregnancy the abdomen is
+flattened and the umbilicus is depressed; after this the abdomen
+begins to enlarge. There is also an increase in the size of the
+breasts, with a deepened color of their areolae and later a watery
+secretion. The external genitals become swollen and of a bluish color.
+Feeling of the fetal movements-- that is, the movements of the small
+parts of the child in the womb-- by the mother is not always reliable,
+since gas in the intestines has sometimes been mistaken for this.
+These signs are more valuable when several exist together.
+
+The nausea and vomiting of pregnancy, the so-called morning sickness,
+consists of nausea accompanied often by vomiting or retching of a
+glairy fiuid, showing itself most frequently on rising in the morning,
+but sometimes appearing after breakfast. It is aggravated by the
+assumption of the erect position. It may begin within a few days, but
+as a rule it does not show itself until the fourth week of pregnancy;
+and it generally ceases about the fourth month, rarely persisting
+throughout the entire time. In the majority of cases it does not
+sensibly impair the health. It is a sympathetic disorder reflected
+from the uterus; it is aggravated by indigestible food, by sexual
+excitement, and by emotional disturbances; it is most marked in first
+pregnancies and in women of highly emotional natures. It is not
+infrequently due to some inflammation of the uterus or erosion about
+the external orifice, and disappears on the removal of the cause.
+
+Mammary Changes.-- During pregnancy the mammary glands are in
+immediate sympathy with the growing reproductive organs of the pelvis;
+consequently a genuine physiologic enlargement commences in these
+organs from the beginning of gestation. Their glandular structure
+becomes larger, fuller, and firmer; a sensation of weight or pricking
+is felt by the patient; the veins become more prominent. The nipples
+also become enlarged, more elongated, and somewhat erect. Surrounding
+the nipple is the areola; this becomes darker in color.
+
+In most women a drop of watery fiuid, the so-called colostrum, may be
+squeezed out from the nipple at the end of the third month of
+pregnancy.
+
+The signs of pregnancy are divided into the presumptive, the probable,
+and the positive. The presumptive signs are: menstrual suppression,
+morning sickness, irritable bladder, mental and emotional phenomena.
+The probable signs are: mammary changes, abdominal enlargement,
+changes in the neck of the womb, and certain changes which are felt on
+bimanual examination. The positive signs are: feeling the various
+parts of the fetus, active movements of the fetus, and hearing the
+fetal heart sounds.
+
+Functional disturbances of the bladder are quite often noticeable in
+the early part of the pregnancy. In the first part of the pregnancy
+the bladder is dragged upon, and later it is pressed upon by the
+enlarged uterus so that the bladder capacity is lessened and frequency
+of urination is the result. In the fourth month, when the uterus
+ascends into the abdominal cavity, these bladder symptoms subside,
+until the very close of the pregnancy, when by the descent of the now
+greatly enlarged uterus there may be even incontinence of urine.
+
+Changes in the Abdomen.-- During the first two months of the pregnancy
+there is a flattening of the abdominal surface, due to the descent of
+the uterus into the pelvic cavity, thus slightly dragging the bladder
+downward and drawing the umbilicus inward. In the latter part of the
+fourth month there is noticeable a slight abdominal enlargement, and
+the umbilicus is no longer sunken. By the end of the fourth month the
+base of the uterus has risen two inches above the symphysis, and at
+the end of the thirty-eighth week it touches the lower extremity of
+the breast-bone; the umbilicus has been for many weeks protruding;
+during the last two weeks of pregnancy the uterus again descends and
+the woman feels more comfortable.
+
+On the inspection of the abdomen of a pregnant woman there will be
+noticed a brown line which extends from the umbilicus to the pubes,
+and all over the surface the presence of striae, or long purple
+grooves, due to the distention of the abdomen; on the sides of the
+abdomen and down the thighs, red, blue, or white markings, like
+cicatrices, may be seen.
+
+Quickening.-- Quickening is the sensation experienced by the mother as
+the result of the active fetal movements of the child in the womb.
+These movements are first felt between the eighteenth and the
+twentieth week; the common rule is that quickening occurs at the
+middle of pregnancy; that is, at four and a half months. As pregnancy
+advances these active motions increase in frequency and become more
+marked. When felt or seen by the physician, as can be done in the
+sixth month, fetal movements constitute a positive sign of pregnancy.
+
+The Determination of Sex at Will.-- Although this has always been a
+question of great interest, and the subject of much experimentation,
+no rule can as yet be given by which the parents can know in advance
+of the birth of the child what the sex will be. Dr. Schenck's theory
+is that the ruling factor in determining the sex is the food partaken
+of by the mother.
+
+Furst believes that the differentiation may occur before, during, and
+a little while after the impregnation; that the chances of the
+development of one or another sex in one and the same woman may vary
+before final differentiation occurs. It is impossible to determine the
+sex of the embryo before the tenth week of fetal life. The cause of
+the differentiation, he believes, lies largely in the good or bad
+state of the health of the parents; in the first instance there being
+an excess of females, and in the latter an excess of males, relatively
+speaking. He believes that there is an excess of male children when
+conception takes place during the post-menstrual anemia. He has
+investigated one hundred and ninety-three cases carefully in regard to
+the probable date of conception after menstruation, and there is a
+notable increase of male births over female in the cases where
+conception occurred in the first five days after menstruation; that is
+to say, where the woman is not so well nourished as later.
+
+Dr. J. Griffith Davis gives as the result of her experiments in this
+direction, that when conception takes place three days before the
+menstrual period or within forty-eight hours afterward, the child will
+be a girl; when conception takes place ten days after the period, the
+child will be a boy.
+
+Although there are a greater number of the female than the male sex in
+all parts of the world where reliable statistics have been taken, in
+all civilized countries the proportion of male births is greater than
+that of females. There is a greater tendency of the male offspring to
+die earlier, and this is seen even before birth, in the proportion of
+three to two. For this reason the stronger sex as applied to men has
+been regarded by some authors as a misnomer. They are physically
+weaker in early life and succumb more readily to noxious influences.
+
+The relative age of the parents is said to be another factor in
+determining the sex of the children. Seniority on the father's side
+gives an excess of male children; equality in the age of the parents
+gives a slight preponderance of females; seniority on the mother's
+side gives an excess of females. Men, and especially scholars, who
+pass a sedentary life and who exhaust their nervous force to a great
+extent, beget more girls than boys; so, also, a very advanced age on
+the part of the man diminishes the number of male offspring.
+
+The Influence of the Male Sexual Element on the Female Organism.-- Dr.
+Alexander Harvey, of Aberdeen, has adopted the theory of fetal
+inoculation. He believes that the effect is first due to the influence
+of the male element upon the ovum, which, in consequence of the
+subsequent close attachment and freely inter-communicating
+blood-vessels between the modified embryo and the mother, inoculates
+the condition of the mother with the qualities of the male; and so, on
+the subsequent impregnation by another male, the offspring resembles
+the first male and not its real parent. He even goes further, and says
+that it is conceivable, by successive impregnations effected by him,
+that the influence may be increased, and if so the younger children
+begotten by him, rather than the elder, might be expected, ceteris
+paribus, to bear their father's image. And as regards the mother, he
+suggests the question, whether there is not something in the popular
+notion that in the course of years the wife comes to resemble the
+husband; and that not merely in respect of temper, disposition, or
+habits of thought, but in bodily appearance, which may be referable to
+this influence exerted by the husband on her constitution, through the
+medium of the fetuses in utero.
+
+  "Yet it shall be; thou shalt lower to his level day by day,
+   What is fine within thee growing coarse to sympathize with clay.
+   As the husband is the wife is; thou art mated with a clown,
+   And the grossness of his nature will have weight to drag thee
+  down.
+   He will hold thee, when his passion shall have spent its novel
+  force,
+   Something better than his dog, a little dearer than his horse."
+
+Darwin, on the other hand, considers it a most improbable hypothesis
+that the mere blood of one individual should affect the reproductive
+organs of another individual in such a manner as to affect the
+subsequent offspring. The analogy, he says, from the direct action of
+the foreign pollen on the ovaries and seed coats of the mother plant
+strongly supports the belief that the male element acts directly on
+the reproductive organs of the female, and not through the
+intervention of the crossed embryo.
+
+Dr. John Brown, in reviewing the subject, says it must be conceded
+that the male element has an influence on the female, over and above
+its fertilizing influence upon the ovum. The limit of this influence
+is at present unknown.
+
+Heredity.-- Girls are more apt to resemble their fathers in mental
+traits, disposition, and constitution; while boys take after their
+mothers. Boys procreated by intelligent mothers will be intelligent;
+while it does not always follow that the sons of intelligent fathers
+are intelligent. The poets Burns, Ben Johnson, Goethe, Walter Scott,
+Byron, and Lamartine were all born of women remarkable for vivacity
+and brilliance of language.
+
+Hygiene of Pregnancy.-- The health and perfection of the child depend
+largely upon the health and perfection of the parents at the time of
+its conception, as well as upon the condition of the mother during the
+pregnancy. Even when both parents possess a strong constitution, but
+one or both of them is suffering from a temporary exhaustion or
+malaise, the child will be born below the standard of health it ought
+to possess. Children born during the first year of married life seldom
+equal in health the children born of the same parents later; they are
+not only apt to be sickly, but the liability to premature death is
+greatly increased. For this reason it is better that the first year of
+married life should be allowed to pass without conception taking
+place. A child begotten in an intoxicated or depraved condition of a
+parent may be depraved itself in the same way, and is apt to be
+feeble-minded or idiotic.
+
+It must be borne in mind that prenatal culture of some sort begins at
+the time of conception; and that on the mental as well as on the
+physical state of the mother, the health as well as the disposition of
+the child will depend to no slight extent. The prospective mother who
+constantly gives way to her feelings does a wrong to her unborn child.
+The mother is at this time more impressionable, more nervous, and more
+irritable than is natural to her; and while her family should make a
+certain allowance for her condition, she, on her part, should not
+allow herself to give way to her morbid feelings. The prospective
+mother should not lead a life of self-indulgence, on the one hand, or,
+on the other, should not be weighed down with cares; she should
+interest herself in her usual duties, and be relieved of all anxiety
+possible.
+
+Dress.-- The clothing must be loose, and all compression about the
+waist and abdomen must be especially avoided. If the woman wears
+corsets, she must take them off at once, and substitute a Ferris or
+some similar hygienic waist. The corset prevents the proper
+development of the abdominal muscles, which play so important a role
+in the expulsion of the child from the womb, as well as in the proper
+growth and development of the fetus itself. If the woman has already
+borne children, and toward the end of the pregnancy the abdomen
+becomes pendulous, she will very materially add to her comfort by
+swearing a muslin abdominal bandage.
+
+A woolen undersuit, or undervest and drawers, with high neck and long
+sleeves, must be worn winter and summer; the grade of the wool to be
+adapted to the season of the year. The especial necessity for wearing
+wool next the skin during the pregnancy is because of the intimate
+relation between the skin and the kidneys. Any chilling of the body at
+this time is apt to lead to the congestion of the kidneys. If there is
+already any congestion of the kidneys present, or any abdominal pain,
+in addition to the undersuit an abdominal bandage should be worn.
+These bandages come woven in ribbed woolen, and fit the body snugly.
+This bandage is to be constantly worn, and, of course, changed at
+night. During the cold weather the stockings should also be of wool.
+Under no circumstances are garters allowed to be worn, as they form a
+constriction around the leg and interfere with the return of the
+venous blood to the heart, and so increase the tendency to the
+formation of the varicose veins. It is better not to use any means to
+hold the stockings up; they will be kept sufficiently well in place by
+the under-drawers. Low shoes should never be worn except in the
+hottest weather. It is of the greatest importance that the woman
+should be impressed with the necessity of the avoidance of taking
+cold, since any lung or kidney trouble is a serious complication of
+pregnancy.
+
+Diet.-- The diet is the same as that at any other time, only it is
+more necessary to guard against anything which is likely to cause
+indigestion. In other words, the diet should be plain, simple, and
+easy of digestion; nutritious and partaken of at regular intervals. In
+the latter part of pregnancy owing to the pressure of the enlarged
+uterus on the stomach, the food may have to be partaken of in smaller
+quantities and at shorter intervals. At this time also the appetite is
+abnormally large. Where it does not disagree with the patient, milk is
+the best adjuvant possible to the diet.
+
+Constipation.-- Constipation is the rule of pregnancy. This is due to
+the great pressure that the enlarged uterus makes on the bowel; and as
+important as it is at all times to keep the bowels regular, it is at
+this time more necessary than ever that the woman should have the
+bowels well evacuated every day. A retention of fecal matter in the
+body causes the reabsorption into the blood of the toxic matters, with
+the resulting headaches, dizziness, loss of appetite, and intense
+nervousness. To obviate this tendency to constipation, plenty of fruit
+and vegetables should be eaten, as well as cereals if the woman is
+taking a good deal of outdoor exercise, otherwise the latter had
+better be omitted. The woman should drink plenty of water-- at least
+three pints a day; this acts as a laxative as well as to flush out the
+kidneys. If, in spite of all these measures, constipation still
+persists, as it probably will, a seidlitz powder can be taken the
+first thing on rising in the morning; or from one teaspoonful to one
+tablespoonful of the effervescing granules of the phosphate of soda in
+a glass of water, also to be taken on rising in the morning; or
+one-half grain of the solid extract of cascara sagrada night and
+morning. The object of these is to keep the bowels open, but purgation
+must always be avoided.
+
+Bladder Symptoms.-- If there is any irritability of the bladder, any
+scalding on urination, or a very great frequency of emptying the
+bladder in the early months of pregnancy, a physician should be
+consulted at once; in the last months of pregnancy there is a desire
+to evacuate the bladder frequently, and sometimes at the last there is
+an incontinence of urine, which is due to the descent of the uterus
+and the great pressure on the bladder; this condition disappears with
+the confinement.
+
+Leucorrhea.-- If this is present to any marked degree, the vaginal
+douche should be continued throughout the pregnancy; the temperature
+of the douche should be from 110∞ to 112∞ F.; it must never be taken
+very hot or very cold. The fountain syringe should be used, and the
+bag should not be hung more than three feet above the bed, so that
+there shall not be too much force to the stream of water.
+
+Baths.-- Warm tub-baths may be taken throughout the pregnancy, but
+never oftener than twice a week, and the woman should never stay in
+the tub longer than is absolutely necessary for the bath, as otherwise
+the bath is too enervating. A daily sponge-bath of cool or cold salt
+water at a temperature of from 80∞ to 70∞ F., and in the proportion of
+a pint of rock or sea salt to a gallon of water is most invigorating,
+and counteracts many of the nervous symptoms and promotes sleep and
+good digestion. The temperature of the room in which this bath is
+taken should be 72∞ F. Shower-baths cause too great a shock to the
+nervous system, and they as well as foot-baths must be prohibited.
+Sitz-baths at a temperature from 110∞ to 90∞ F. may be taken just
+before retiring throughout the pregnancy. The frequency and duration
+of the bath as well as the temperature should be regulated by the
+attending physician. In cases of intense nervousness and insomnia
+these baths have an excellent sedative effect. A pregnant woman must
+never under any circumstances take ocean baths, since there is always
+great danger that the shock of the waves will cause an abortion.
+Sea-voyages should be avoided because of the severe nausea and
+vomiting, as well as the danger that the lurching of the vessel may
+cause miscarriage.
+
+The sewing-machine is a tabooed thing for the pregnant woman, because
+of the jarring of the pelvis which it produces. Sweeping of heavy
+carpets is also injurious. There must be no lifting of heavy pieces of
+furniture, and especially no lifting from the floor, as it interferes
+with the circulation in the uterus and is apt to produce miscarriage.
+
+Driving in an easy carriage over smooth roads is permissible;
+dogcarts, or any conveyance which produces much jolting, must be
+avoided; and while driving is good, the woman should not do her own
+driving, on account of the danger of the jars that would be caused by
+the sudden pulling of the horse upon the lines. Horseback-riding and
+bicycling are, of course, forbidden, as are also golf, tennis, and
+dancing.
+
+Exercise.-- Exercise in the open air should be taken every day, when
+the weather is suitable, and walking is the best form of exercise. The
+amount will be regulated to some extent by what the woman has been
+accustomed to taking, and it should always stop short of fatigue. The
+woman should live as much as possible in the open air, and she should
+attend to her ordinary duties about the house. Long railway journeys
+are always objectionable.
+
+Hemorrhoids or piles are very often troublesome toward the close of
+the pregnancy. To overcome this, the patient should lie down
+immediately after the bowel movement, and remain in the recumbent
+position for ten or fifteen minutes. In addition, care should be taken
+to secure a loose movement of the bowels. Should the piles come down,
+applications of cloths wrung out of hot water, and held well pressed
+against the bowel, should be made; the piles should then be pressed
+back until the finger feels that the mass has been pushed above the
+second constriction of the bowel, which is felt to exist at about two
+inches above the sphincter ani muscle. Should these means not suffice,
+the physician must be consulted at once.
+
+Swelling and pain of the external genitals and of the lower limbs are
+best relieved by the recumbent position. Should the veins of the legs
+be much enlarged or the feet swollen, the patient should have
+compression made by the wearing of elastic stockings. Or in some cases
+a bandage is sufficient; in this case the bandage may be made of
+muslin; it should be three inches wide, and, beginning at the toes,
+should extend up as high as the enlargement of the veins continues.
+This bandage should be freshly applied every morning before rising.
+
+Pain caused by the stretching of the skin may be relieved by the
+inunction of the skin with cottonseed or cocoanut oil. For severe pain
+in the small of the back, rubbing with soap liniment or alcohol will
+be found useful.
+
+Mental Occupation.-- Important as this always is, it is doubly so now.
+The mind should be constantly and pleasantly occupied, but no severe
+study should be indulged in. The emotional susceptibility is generally
+somewhat increased. The pregnant woman, quite excitable and irritable,
+readily responds to influences by which in the non-gravid condition
+she could not be affected. Sometimes she feels unusually well, is
+intellectually brightened and more active, and says she is positively
+happier. At other times she is despondent and morose.
+
+Physiologists admit and observation proves that maternal emotions do
+affect the development and the exterior of the fetus; likewise the
+mental organization of the fetus may be affected. All unpleasant news,
+frights, and physical shocks, also scenes of suffering and distress,
+must be avoided, as the mind is particularly impressionable at this
+time. Around the patient should be thrown a gentle and protective
+care, and she should be treated with the considerate kindness which
+her condition demands. Theatres and all places where there will be a
+large assemblage of people should be avoided, as the close air and
+general bad ventilation are apt to produce vertigo and sometimes
+attacks of fainting.
+
+Sleep.-- During pregnancy a large amount of sleep is required; there
+should be eight hours spent in sleep at night, and one hour every
+afternoon. Pregnant women should never do any night watching. There is
+unusual necessity for good ventilation during sleep at this time.
+
+The Marital Relation.-- Coitus is, as a rule, distasteful to pregnant
+women. It is for the best interest of the wife as well as for that of
+the child that all marital relation should be suspended at this time.
+Even uncivilized nations have condemned the privilege of sexual
+intercourse during pregnancy, and have visited punishment on the
+offender. If these relations are not wholly suspended, they must at
+least be at those periods which correspond to the time at which the
+woman would have been unwell had she not been pregnant. To the
+continuance of these relations throughout the pregnancy is due much of
+the suffering of the wife, not only then, but at the time of the labor
+as well; and the nourishment of the child is interfered with.
+
+Causes of Miscarriage.-- Hemorrhoids; straining at stool; excessive
+intercourse in the newly married; nursing; ocean-bathing;
+overexertion; overexcitement; a fall; any violent emotion; anger;
+sudden or excessive joy; a fright; running; dancing; horseback-riding;
+riding in a heavily built carriage over rough roads; great fatigue;
+lifting heavy weights; the abuse of purgative medicines; disease or
+displacements of the womb; and a general condition of ill health.
+
+The danger of miscarriage is greatest during the first three months of
+pregnancy. Miscarriage is a fruitful source of disease and often of
+danger to wives; it is said that thirty-seven out of every hundred
+pregnant women miscarry. Miscarriage is most apt to occur during the
+first pregnancy; and great care should be taken to prevent this, as
+the habit is easily established, and after one miscarriage has
+occurred, another is likely to follow, so that it is sometimes with
+the greatest difficulty that the woman can be made to carry the fetus
+to full term. Artificially produced abortions are not an infrequent
+cause of sterility; the young wife becomes pregnant, and has an
+abortion produced because she is not yet ready to give up all her
+pleasures; and eventually when she does become very anxious to have a
+child such an extent of uterine disease has been produced by the
+abortions that she cannot conceive.
+
+To Prevent Miscarriage.-- The life must be free from all excitement,
+and must be as quiet as possible without becoming monotonous; especial
+care must be exercised at the return of the dates for the menstrual
+periods.
+
+The symptoms of miscarriage are a show of blood, more or less profuse,
+with intense abdominal pain; on the slightest show of blood the
+patient should go to bed at once and the physician should be sent for.
+
+  CHAPTER XI.
+
+ THE CONFINEMENT.
+
+   Preparation for the Confinement; Signs of Approaching Labor; Symptoms of
+   Actual Labor; the Confinement-bed; the Process of Labor.
+
+  "To my conception one generation of educated mothers would do more
+  for the regeneration of the race than all other human agencies
+  combined; and it is an instruction of the head they need, and not
+  of the heart. The doctrine of responsibility has been ground into
+  Christian mothers above what they are able to bear."
+
+                                          -- ISABELLE BEECHER HOOKER.
+
+Preparations for the Confinement.-- The right time to engage the
+physician who is to take charge of the woman at her confinement is
+just so soon as the woman knows that she is pregnant. It used to be
+argued that, since giving birth to children was a physiologic process,
+there was no necessity for the woman to consult the physician until he
+was sent for when the labor pains began. Take the case of the woman
+who is for the first time pregnant; she is absolutely at sea; she has
+not the least idea how she ought to feel, what she ought to do or to
+leave undone; the result is that she often has a miscarriage which is
+the source of the greatest disappointment to her husband and herself,
+or she suffers very unnecessarily throughout the entire pregnancy, has
+a difficult labor, and perhaps gives birth to a sickly child.
+
+The educated physician will explain to her what symptoms are normal
+and what are pathologic, and often he will be able to entirely cure
+the latter. It is now a well-established fact that the most serious
+complications of the pregnancy, and of the labor itself are caused by
+severe congestion or disease of the kidneys. The condition of the
+kidneys can only be determined by frequent examinations of the urine;
+during the early months of pregnancy these examinations are made once
+a month, and during the last month they are made every week. The
+amount of urine passed in the normal condition is three pints a day.
+
+Nowhere, perhaps, is the constant vigilance of the physician so well
+rewarded as in the careful oversight of the pregnant woman. She goes
+through her entire pregnancy feeling well, and often the greatest
+discomfort that she suffers is due to her size; her labor and her
+lying-in are normal, and she gives birth to a healthy child.
+
+Engagement of the Nurse.-- This is generally left to the physician in
+charge of the case, since he is responsible for the safe delivery of
+the woman; but if the patient has any decided choice in the matter, it
+is acceded to unless there should be some very valid objections, and
+the physician always sends the nurse in view for that case to see the
+patient in order to ascertain if she is personally agreeable to the
+patient.
+
+Choice of Room for the Confinement and Lying-in.-- The room should be
+light, sunny, and well ventilated; it should not be too near a
+water-closet. In the city as quiet a room as possible should be
+selected, and one that is well removed from the rest of the house, so
+that if necessary perfect quiet can be maintained. The room should be
+as cheery as possible.
+
+The dress of the mother during the lying-in consists of a merino
+undervest, with high neck and long sleeves, and a nightgown, which
+shall be open all the way down the front. The gowns should be made of
+light muslin or of cambric; and there should be a sufficient number so
+that they may be changed every day.
+
+Six abdominal bandages should be provided. These are made of light
+muslin, and they should be eighteen inches wide and long enough to go
+once and a third around the patient's hips at the sixth month of
+pregnancy, or about one yard and a quarter long; they may be made
+straight or to fit the patient at the sixth month. This bandage is
+fastened down the front; it is applied directly after the labor, and
+adds greatly to the patient's comfort during the lying-in.
+
+The vulvar pads used during the lying-in are the antiseptic absorbent
+pads which can be obtained at any place where surgical dressings are
+sold; they are made of absorbent cotton, covered with cheesecloth, and
+sterilized.
+
+There must be a sufficiently generous supply of sheets so that they
+can be changed every day, and the drawsheet as often as may be
+required. Nothing is so important to a good lying-in as to have a
+clean, well-ventilated room, and plenty of fresh bed-linen.
+Cleanliness is the first requisite to antisepsis, and this is the
+secret of avoiding puerperal fever.
+
+Articles to be provided for the confinement are:
+ 1. An oblong douche-pan of agate-ware.
+ 2. An agate bed-pan.
+ 3. A bath thermometer.
+ 4. Two pieces of rubber sheeting; one, one yard square, and the other
+    two yards square.
+ 5. Two sterilized bed-pads, 30 inches square by 3 to 4 inches thick.
+ 6. Three dozen antiseptic absorbent pads.
+ 7. One pound of sterilized absorbent cotton; twelve yards of
+    cheese-cloth.
+ 8. Six abdominal bandages, eighteen inches wide, preferably made to
+    fit the figure at the sixth month of gestation.
+ 9. Two hand-scrubs.
+10. Four ounces of the tincture of green soap.
+11. Bottle of corrosive sublimate tablets.
+12. Four ounces of powdered boric acid.
+13. Half a pint of good whisky.
+14. Two ounces of aromatic spirits of ammonia.
+15. Two ounces of aqua ammonia.
+16. One pint of alcohol.
+17. Two tubes sterilized white vaselin.
+18. Plenty of large and small safety-pins.
+19. Hot-water bag.
+20. New fountain syringe, to hold four quarts; with glass nozle.
+21. One small basin for vomited matter.
+22. Two very large agate basins or wash-bowls for washing doctor's
+    hands and for antiseptic solutions.
+23. Vessel for after-birth.
+24. Three large pitchers; one for boiling water, one for cold boiled
+    water, and one for antiseptic solution.
+25. Tumbler for boric acid solution for washing baby's eyes, with fine
+    old linen sterilized.
+26. One dozen freshly laundered sheets, and two dozen towels.
+27. Stocking-drawers, muslin.
+28. Change of night-clothing warmed for the mother.
+29. A warm blanket to receive the baby.
+30. An infant bath-tub.
+31. A large piece of oil-cloth to protect the floor.*
+
+* Van Horn & Co., Park Avenue and 41st Street, New York, keep an
+obstetric outfit, containing many of the above articles, cleansed,
+sterilized, and packed in a box ready for use, so that they remain
+intact until needed. The price of this outfit is $16.50.
+
+Baby's Outfit.-- Four flannel bandages, to be made of fine, soft
+flannel, four inches wide, to go once and a third around the body. The
+edges may be pinked or whipped, but should never be hemmed; a tape is
+sewed on double, the ends passing around the body, and so the bandage
+is fastened without pinning.
+
+Six merino shirts, with high neck and long sleeves, made to button
+down the front.
+
+Cotton diaper napkins, not too large; old soft ones are preferable.
+
+Long merino stockings which can be pinned to the napkin.
+
+Flannel petticoats, not too long; these may be made on muslin bands,
+which are held up on the shoulders by means of straps. The essential
+in all the clothing is that it should be sufficiently loose.
+
+Dress-slips should not be so elaborate that they cannot be washed and
+changed with sufficient frequency; and not so long that the baby's
+feet will be hampered in their movements by them. All of baby's
+clothes but the dress should be fastened by safety-pins.
+
+Baby's basket should contain:
+ 1. One outfit of clothes.
+ 2. One tube of sterilized tape.
+ 3. A pair of blunt-pointed scissors.
+ 4. Large and small safety-pins.
+ 5. Pieces of fine old linen; old handkerchiefs are the best.
+ 6. A soft hair-brush.
+ 7. A powder box and puff, with talcum powder.
+ 8. Two tubes of sterilized white vaselin.
+ 9. Two soft towels.
+10. Castile soap.
+11. Single-bulb syringe; so-called "eye and ear syringe."
+12. A woolen shawl or wrap.
+
+If there is no nurse available before the labor sets in, and it is
+necessary for the patient to see to the sterilizing of the above
+articles, she should first scrub off all pitchers, basins, and other
+utensils, as well as the douche-pan, fountain syringe, and rubber
+sheeting, with a brush and hot soap-suds; the hand-scrubs are to be
+well washed; then each article should be pinned separately in coarse
+towels, and put to boil for half an hour in an ordinary wash-boiler.
+The articles so boiled are then dried without removing the towels, put
+away, and not opened till the time of the labor.
+
+The abdominal bandages must be laundried and pinned up in separate
+towels until they are needed. The cheese-cloth must be laundried and
+then sterilized.
+
+The vulvar pads should be pinned in an old napkin, in packages of half
+a dozen each; and one package is sterilized at a time by placing it in
+the oven until the outer covering is scorched. The linen for the
+baby's eyes and the cheese-cloth are treated in the same way; they are
+to be cut up into small pieces and sterilized as needed.
+
+Signs of Approaching Labor.-- About two weeks before labor there is a
+sinking of the womb. At the beginning of the ninth lunar month this
+was at the end of the breast-bone; it now descends to a point midway
+between this and the navel; the abdomen becomes smaller, the pressure
+on the lungs is relieved, and the woman breathes more freely. But at
+the same time that the woman is relieved of the pressure on the chest,
+she experiences increase of the troubles in the lower extremities.
+There is an increase of the bladder symptoms, with a desire for
+frequent unrination. Constipation becomes more troublesome, and there
+may be hemorrhoids; the veins of the lower extremities may become
+greatly enlarged.
+
+There is an increased fullness of the external genitals and a greatly
+augmented amount of mucous discharge. There is a feeling of anxiety
+and nervousness, with depression of spirits.
+
+During the last two weeks of pregnancy patients are apt to have
+cramp-like pains in the lower part of the abdomen. These are often
+mistaken for labor pains. True labor pains are characterized by
+starting in the back, extending around the abdomen and toward the
+pubes and down the thighs; they come at more or less regular intervals
+of half to three-quarters of an hour, and increase in intensity with a
+decrease in the intervals. A strong pain is apt to be followed by two
+weaker ones. The so-called false pains are irregular in their
+occurrence.
+
+Symptoms of Actual Labor.-- First is generally the show; this is a
+discharge of mucous tinged with blood; at the same time the true labor
+pains set in. When the patient or nurse is in any doubt as to the
+character of the pains, or when the show appears, the physician should
+be summoned at once. Other symptoms are frequent desire to empty the
+bladder and bowels, and a sensation of shivering.
+
+The Confinement-Bed.-- A single bed is much more convenient, but it is
+rarely found in a private house. The double bed is arranged as
+follows: The hair mattress is covered with a large rubber sheet, which
+is pinned with safety-pins at the corners and tucked well under the
+mattress; the rubber sheet must not be drawn too tightly for fear of
+tearing. Over this comes the sheet, and over the upper half of the
+bed, the draw-sheet; this is a sheet folded four double, which goes
+across the bed so as to come under the hips of the patient, and is
+tucked under the mattress at both sides. The object of this is so that
+it may be frequently and easily changed without disturbing the
+patient. The sheet, blanket, and spread which are to serve as a
+covering after delivery are folded back and placed on the left side of
+the bed.
+
+The lower right-hand corner of the bed-- the right side of the bed is
+that side which is toward the right hand as one stands facing the
+foot-board-- is arranged for the confinement; on this is fastened the
+smaller rubber sheet, and over this the sheet is folded, and both are
+fastened down with safety-pins. The pillow for the patient should be
+placed at the upper and inner corner of the square. After the delivery
+the patient is lifted to the upper part of the bed and the temporary
+dressing is removed. A sheet and blanket are used for a covering
+during the confinement.
+
+Before the labor begins it is well to fasten up the vest and gown, so
+that they will not be soiled, as it is important that the patient
+shall be moved as little as possible after the labor, as all movements
+tend to increase the bleeding.
+
+The floor oilcloth must be spread at the side of the bed which is made
+up for the confinement, and should extend slightly under the bed.
+
+A bureau in the room should contain the mother's and baby's clothing,
+bed-linen, towels, and any other articles which will be needed, all
+properly arranged.
+
+The clothing for the mother and baby will be placed where it will keep
+warm, and the infant bathtub will be in readiness in case of sudden
+need for it.
+
+All water used about the confinement must have been carefully
+sterilized in advance. The best way to sterilize the water is by
+boiling it in a large wash-boiler; whatever vessel is used must be
+scrupulously clean, and ought to be new. The vessel is covered over,
+and the water is allowed to boil for half an hour; it is then, still
+covered, set aside to cool. There should be three gallons each of
+sterilized hot and cold water; since in case of an emergency there
+must be plenty of water ready for use.
+
+The various articles ordered in the confinement outfit will be at hand
+ready for use. It is the duty of the nurse to have everything ready
+for the doctor before his arrival. The patient should have a full warm
+tub-bath, fresh night-clothes put on, and an enema should be at once
+given to unload the bowels, and this even though there may have been a
+bowel movement only a few hours previously. The patient should remain
+in bed until the arrival of the doctor. After an examination has
+assured the latter that all is right, she may be allowed to go around
+the room, with a wrapper thrown on over the night-gown.
+
+Conveniently near the bed should be a small table, covered with one or
+two freshly laundried towels. This table should have on it a
+wash-basin, a hand-brush, soap and hot water, an antiseptic solution,
+scissors, a ligature for the navel, and a suitable aseptic lubricant
+for the hands.
+
+The Process of Labor.-- The process of labor is divided into three
+stages. The first stage is that of dilatation; by which is meant the
+stretching of the mouth of the womb so that the child may pass
+through. At the first confinement this stage lasts about fifteen
+hours; at subsequent labors the length of this stage is much shorter,
+the average time being eight hours. The pains during this stage are
+sharp and cutting, and they are accompanied by a slight show of blood.
+The patient is fretful and nervous
+
+The second stage of labor is called that of expulsion, because in this
+stage the uterus contracts down together with the abdominal muscles to
+expel the child from the womb and the vagina into the world. The
+duration of this stage in the first confinement is about an hour and a
+half.
+
+The third stage of labor includes the time from the expulsion of the
+child till the coming away of the after-birth; the average length of
+this stage is from twenty minutes to half an hour.
+
+The average length of time for the first labor is seventeen hours; and
+for subsequent labors from eight to eleven hours.
+
+The bag of waters is the sac of membranes in which the child is
+inclosed. It contains a liquid in which the child floats; the object
+of the water is to protect the child from sudden shocks or any kind of
+injury during pregnancy. During labor this membrane with its contained
+water serves as a dilating wedge to assist in the opening of the womb,
+and it also protects the child from the direct contraction of the
+uterus upon it. When the waters break prematurely, the labor is much
+longer and more tedious; normally this should not occur before the
+mouth of the womb is fully dilated.
+
+The pains of the second stage of labor are of a bearing down
+character, and constantly increase in force and frequency; the climax
+being reached as the head passes through the vulvar orifice.
+
+A child usually lies in the womb with the head downward; the reason of
+this is that there is more room in the upper part of the uterus, and
+as the small parts of the child as it is folded upon itself take up
+the most space, they occupy this position, while the head lies just
+above the pubes. The normal position of the child is: the head is
+flexed on the chest, the legs on the thighs and the thighs on the
+abdomen, and the hands are folded across the chest. And so the child
+is usually born head first.
+
+During the stage of expulsion the head of the child is forced down
+slightly during each pain, to recede a little during the intervals
+between the pains; in this way the vagina and its external orifice are
+gradually stretched so that the head of the child may pass through
+without tearing the parts. If the head is allowed to pass through
+suddenly, or where the labors are rapid, as in the case of women who
+have given birth to several children, much mischief may be done by
+tearing the soft parts.
+
+After the birth of the head there is a short interval of rest, when
+the shoulders are born; the rest of the body easily slips out; and
+with the expulsion of the after-birth the labor is over.
+
+At the very beginning of labor the patient should be given a full warm
+tub-bath, and make an entire change of linen. She will usually prefer
+to be dressed in her night-clothing, over which during the first stage
+she may wear a loose wrapper; a sterilized napkin should be worn over
+the vulva during this stage. During the first stage, as a rule, the
+patient should not be confined to bed until the dilatation is well
+advanced; she is generally more comfortable if she is allowed to move
+around the room, and the pains are thereby advanced.
+
+The only way in which the physician can determine whether labor has
+begun is by making an internal examination; and this will enable him
+to decide as to whether it is necessary to remain or not.
+
+The nurse should always wear a wash dress in the confinement and
+lying-in room.
+
+If the labor is long, nourishment in the form of beef-tea, broths, and
+milk may be given. No stimulants should be given without the direction
+of the physician. The frequent taking of cold water is permissible.
+
+At the beginning of the labor the family and friends must be excluded
+from the room, and it must be kept as quiet and as cheerful as
+possible.
+
+Toilet of the Patient.-- The newly born child is received in a small
+blanket, is well wrapped, and laid in a warm place. The nurse then
+turns her attention to the mother; the external genitals and soiled
+parts of the body are cleansed with sterilized cheese-cloth wrung out
+of an antiseptic solution; if the body-linen has become soiled, it is
+also changed, and all blood-stained articles are removed from the bed.
+The patient is then carefully lifted up on the permanent bed, and the
+vulvar pad and the abdominal bandage are applied; after which the
+patient is allowed to rest.
+
+  CHAPTER XII.
+
+ LYING-IN.
+
+   Management of the Lying-in; Lactation; Nursing.
+
+  "'Tis is ourselves that we are thus or thus. Our bodies are our
+  gardens; to the which, our wills are gardeners."-- "Othello."
+
+Management of the Lying-in.-- Immediately after the delivery the first
+essential for the patient is absolute quiet and rest; the room must be
+kept quiet and darkened, and ordinarily the patient is allowed to fall
+into a light sleep. During the first few hours after labor the best
+position for the mother is flat on the back, with only a small pillow
+under the head. After the first twenty-four hours the patient may be
+allowed to turn on the side as she prefers. Since absolute rest is the
+first requisite for the patient, she must be left alone with the
+nurse, who must see that she does not fall into too deep a sleep. If
+the child's cries disturb the mother, it must be taken into another
+room.
+
+The lying-in room must be kept free from all odors, all soiled
+clothing must be at once removed from the room, and good ventilation
+must be insured, being careful to prevent any drafts.
+
+While the patient is asleep, and after the baby has been attended to,
+the nurse should place all blood-stained articles in cold water to
+soak. If in the city, the after-birth may be burned in the furnace or
+range; it should be well covered with coal. In the country the
+after-birth can be buried in a deep hole.
+
+During the first two or three days the vulvar dressings should be
+changed from every three to six hours, and at all times as often as
+they are soiled. Each time that the dressing is renewed the external
+genitals and their immediate surroundings are to be carefully cleansed
+with sterilized water, and finally washed with a solution of boric
+acid, in the proportion of one tablespoonful of boric acid to one
+quart of water. It is convenient to keep this solution mixed and on
+hand, as it takes some little time to prepare it; it should be kept in
+a strength double that which is desired, so that it may be diluted
+with warm water to give the desired temperature. This solution may be
+poured over the parts from a small pitcher, the douche-pan having been
+placed under the patient before the washing began. After labor the
+vulva is very sensitive, so that while the greatest care must be used
+to remove all clots of blood and the discharge, there must be no brisk
+rubbing of the parts. No blood-stained linen should be permitted to
+remain about the patient or the bed.
+
+Since the lying-in woman perspires freely, her skin ought to be
+frequently cleansed by sponging with a weak solution of alcohol in
+tepid water; this should be followed by friction with a towel until
+the skin is in a glow. Cleanliness of the bed is promoted by the use
+of a draw-sheet, which is a sheet folded to four thicknesses and
+placed beneath the patient's hips in such a way that the upper edge of
+the sheet shall come under the lower part of the pillows. Air and
+light must be freely admitted at all times in order that the room may
+be bright and cheerful. For the first few weeks the eyes of the
+new-born infant should be shielded from all strong light.
+
+Visitors.-- For the first week after the confinement the patient
+should see no visitors. Even the husband or mother should not remain
+in the room long at a time. Nothing of a disagreeable nature should be
+told to the patient; and whoever goes into the sick-room should always
+carry the most cheerful manner, as it is highly necessary that the
+patient should be kept mentally as well as physically quiet at this
+time.
+
+Diet.-- For the first twenty-four hours the diet must be restricted to
+liquids, and in most cases nothing is given until the patient has had
+a few hours' rest. The first thing that is given to the patient should
+be a cup of warm milk or tea. Milk is the best diet; this may be
+varied with beef-tea, bouillon, mutton or chicken broth; any of these
+broths may be made with rice or barley to vary the flavor, but these
+must not be given to the patient. The patient should have six ounces
+of the liquid every two hours during the day and every three hours
+during the night.
+
+On the second day bread well toasted through may be added to any of
+the liquids. On the third day stewed or baked apples should be added
+to the diet. On the fourth day, and from this on, the patient will
+have regular meals, but the diet must be a plain one. For breakfast,
+stale bread, a soft-boiled egg, fruit, and a cup of tea, not too
+strong. For dinner, which should always be given in the middle of the
+day, an oyster-stew or clam broth, a lamb chop, or a very small piece
+of beefsteak or chicken; but with these there must be no gravies or
+dressings; a potato baked in the skin; raw tomatoes, if in season;
+apple sauce or cranberry; celery; junket, plain corn-starch, lemon
+jelly, plain cup-custard. From this list the diet must be arranged so
+as to give as much variety as possible from day to day. Midway between
+breakfast and dinner, and again in the middle of the afternoon, the
+patient should have a glass of milk. The diet should be generous, but
+simple.
+
+Urination.-- The feeble condition of the bladder in the first few
+hours after delivery frequently leads to the retention of urine. Owing
+to the copious secretion of urine which is so common at this time,
+painful and injurious distention of the bladder may result. The
+patient should therefore endeavor to pass her urine in at least six
+hours after labor, whether she feels any inclination to do so or not;
+the sound of running water or warm fomentations over the bladder, warm
+water in the douche-pan, and moderate pressure applied by the hand
+over the suprapubic region, are often effective in accomplishing the
+desired result. If all these means fail, the catheter must be used as
+the last resort. During the entire lying-in the bladder should be
+emptied every six hours.
+
+Evacuation of the Bowels.-- There should be an evacuation of the
+bowels in from twenty-four to thirty-six hours after the labor. For
+this purpose a seidlitz powder may be given, or the liquid citrate of
+magnesia. If this does not suffice, an enema of warm water, to which a
+little soap or two teaspoonfuls of glycerin have been added, may be
+given. Two pints of water should be prepared; the patient will retain
+as much as she comfortably can, and as long as she can. The bowels
+should be opened daily after the first day.
+
+After-pains are caused by the same physiologic process that causes
+labor pains-- namely, by the contractions of the uterus. After the
+first confinement the after-pains are, as a rule, not severe;
+attention to the regular emptying of the bladder and bowels also
+lessens the severity of the after-pains; these pains seldom last after
+the second day.
+
+The Lochia.-- The discharges of the mother continue for about two
+weeks, and are called lochia. For the first twenty-four hours they are
+pure blood; the second and the third day they are of the character of
+bloody water; from the fourth to the sixth day they have a,
+greenish-yellow color, and from the tenth to the twelfth day they
+become pure white. Soiled napkins and dressings should never be
+allowed to remain in the patient's room.
+
+Duration of the Lying-in.-- This lasts for six weeks. During this time
+the organs of generation are returning to their normal size and
+condition. In order that the woman may be in the best condition
+possible at the end of this time, it is essential that for the first
+two weeks she should remain in bed; and so long as there is any blood
+in the discharge the woman should not be allowed to sit up. The first
+sitting up should be in bed, the patient being supported by a
+bed-rest. During the second two weeks the patient may be allowed to
+divide her time between the bed and the couch; in the latter part of
+this time she may be allowed to go around her room a very little; and
+for two weeks more she should remain on the same floor. The first
+sitting up should not last more than half an hour. Getting up and
+going around too soon after the confinement, "being too smart," is one
+of the most prolific sources of falling of the womb, and all manner of
+uterine trouble, by which the general health of the woman is greatly
+impaired.
+
+Lactation.-- If it is at all possible, every mother should nurse her
+own child; in the interests of both the mother and the child. So far
+as the mother is concerned, the process of lactation is beneficial
+because it hastens the return of the uterus to its normal size.
+Wet-nurses are known tyrants, and if the quality of the milk has
+anything to do with the disposition of the child, as is believed to be
+the case, the idea is distasteful of having a woman who belongs to the
+lower classes provide nourishment for your child; and artificial
+feeding is one unmitigated trouble.
+
+A deficiency of the quantity or the quality of the mother's milk can
+generally be remedied by the diet and attention to the health of the
+mother; if the deficiency in quantity persists, the mother's milk can
+be supplemented by artificial feeding.
+
+There may exist certain conditions of the mother in which nursing her
+own infant would be inadvisable or even impossible. Syphilis
+contracted late in the pregnancy, and tuberculosis, are
+contraindications, owing to the danger of the mother infecting the
+child. Inversion of the nipples, their excoriation, or persistent
+sensitiveness may make it impossible. In marked general debility of
+the mother from any cause whatever, it would be injurious to the
+mother and the child.
+
+After the mother and the new-born infant have had some hours of rest
+and sleep, it is advisable to apply the child to the breast, to
+receive by this first effort the small quantity of milk which is an
+especial provision to act as a natural purge and to start the bowels
+of the child into a healthy activity; this also excites the milk
+glands to secretion. The mother's milk in full supply may be expected
+in from forty to sixty hours after delivery.
+
+Nursing.-- When the mother's nipples are of the normal size and well
+formed, the healthy infant instinctively suckles at once when placed
+at the breast, but sometimes it has to be taught; by squeezing out a
+few drops of milk to wet the nipple, the child will usually take hold,
+or a little sugar and water may be put on the nipple; a little
+patience and tact are all that is necessary to insure success. But the
+infant must be taught to nurse at once before the breasts become
+engorged with milk.
+
+Under ordinary circumstances the child is to be kept at the breast for
+one year. But if within this time the menstrual period should recur
+and be profuse, or should the woman again become pregnant, the quality
+of the milk becomes poor, and necessitates the immediate weaning of
+the child; the character of the milk is also altered, and even its
+secretion may be checked. Nervous agitation may so alter the quality
+of the milk as to make it poisonous. A fretful temper, fits of anger,
+grief, and sudden terror not only lessen the quantity of the milk, but
+render it thin and unhealthful, inducing disturbances of the child's
+bowels, diarrhea, and so forth.
+
+Position of the Mother When Nursing.-- When in bed in the recumbent
+position, the mother should lie on that side from which the infant is
+going to nurse; when up, the mother should sit erect.
+
+Care of the Nipples.-- Immediately after each nursing the nipples
+should be washed off in a saturated solution of boric acid in cold
+water, and dried with a soft cloth. If they are disposed to crack,
+anoint them with cocoa-butter immediately after each cleansing. If the
+skin of the nipple is very sensitive, a nipple-shield should be used
+for the first few days; or should the nipple become sore at any time,
+the shield can be resorted to. The nipple-shield must fit tightly; the
+best ones are made of glass with a rubber tip. In the intervals of
+nursing the nipple-shield should be kept in cold water after it has
+been thoroughly cleansed by being brushed on both sides.
+
+The breasts are sometimes distended from an over-secretion of milk;
+this is relieved by saline cathartics, by abstinence from liquids, and
+by the use of a compression breast bandage. This is made of a straight
+piece of muslin, with a shallow notch cut in one edge for the neck,
+and, a deep one for each arm; the bandage is closely applied over the
+breasts, and the ends pinned in front; it is also pinned over the
+shoulders.
+
+In debilitated women the supply of milk may be insufficient; the most
+reliable evidence of this is the fact that the infant ceases to gain
+in weight.
+
+  CHAPTER XIII.
+
+ THE NEW-BORN INFANT.
+
+   The Infant's Toilet; the Crib; Feeding of Infants; Artificial Feeding;
+   the Wet-nurse; Characteristics of Healthy Infants; the Stools;
+   Constipation; Urination; Dentition.
+
+  "O thou child of many prayers,
+   Life hath quicksands; life hath snares."
+
+                                                       -- LONGFELLOW.
+
+The Infant's Toilet.-- So soon as the mother has been made
+comfortable, the toilet of the infant is attended to. This should be
+made near the register or stove; and the lap of the nurse should be
+covered with a small flannel blanket. The baby's body will be found to
+be covered over with a white, greasy, somewhat cheesy substance; some
+sort of grease is needed for its removal; rendered lard, sweet oil,
+and lanolin are the best; vaselin is less effective. All of this
+cheesy substance must be at once removed; the most difficult parts
+will be in the folds and creases. The nurse should grease the palms of
+her hands, then take the head of the child between them, and
+thoroughly grease it; particular attention must be given to the ears;
+then come the neck, shoulders, arms, chest and back, groins, external
+genital organs, and lower extremities. After the child has been
+thoroughly gone over, the grease should be rubbed off with a soft
+towel.
+
+A rectal injection of one tablespoonful of warm water is given at once
+to unload the bowels of the meconium; this generally acts before the
+baby's toilet is completed. The meconium is the first discharge from
+the infant's bowels after birth, and that which had collected in the
+intestines during the pregnancy.
+
+The Baby's Bath.-- The baby's bath-tub is filled about one-third full
+of water at a temperature of 100∞ F., tested by the thermometer. The
+baby is then gradually immersed in the water, with the exception of
+the head; this is supported on the left wrist of the nurse, which
+passes under the infant's neck, while her hand grasps the left
+shoulder; with the right hand the nurse quickly rubs over the child's
+head and body; the entire bath should not occupy over five minutes.
+The infant is then lifted out into the lap of the nurse, on which is
+spread a soft, warm towel, with which it is carefully dried. One of
+the important points in giving the infant its bath is to be sure that
+the groins, arm-pits, and genitals are thoroughly well dried;
+otherwise excoriation at these parts is sure to occur.
+
+After this a daily tub-bath is given in the same way; soap is rarely
+needed; when it is, castile soap should be used; its constant use is
+not necessary and would only irritate the skin. These daily baths
+strengthen the nervous system and prevent coughs and colds. The bath
+should be given during the morning, one hour after feeding, and should
+not last more than five minutes. The mother herself, just as soon as
+she is able to go around, should superintend the bath; in this way she
+is assured that if properly given, and will also recognize any
+incipient affection of the child. These daily baths should be
+continued till the child is four years old. Powder is not essential;
+but if it is desired, a plain talcum powder may be used.
+
+The Dressing of the Cord.-- After the bath the ligature which was tied
+around the cord at the birth of the child will be found slightly
+loosened; this should first be made tight, and then the cord, doubled
+back on itself, should be tied by the ends of the same ligature. A
+square of soft sterilized linen or gauze is slit up to its center; the
+cord is allowed to pass through this slit, which looks toward the
+child's right; the stump of cord is laid on the left and the ends of
+gauze are folded over this; the whole is kept in place by the
+abdominal bandage. As there is some exudation from the cord, it is
+necessary to change these dressings twice a day; as this exudation is
+of a somewhat gluey nature, it will be found that the dressings stick
+to the cord. In removing the gauze great care must be used not to make
+any traction on the cord; when the infant is placed in the bath, the
+water loosens the dressing and it falls off in the water; at other
+times it must be removed with the greatest care. There should never be
+any odor about the cord; it usually drops off about the fifth day.
+
+The process of ulceration by which the cord falls off leaves an open
+surface on the child's body which offers an avenue for septic
+infection. Great care must therefore be taken that the nurse's hands
+or anything which comes in contact with this surface should be
+perfectly clean. The dressings used must be thoroughly antiseptic.
+
+Care should be used not to fasten the abdominal bandage too tightly;
+the bath is given on an empty stomach, and allowance should be made
+for this; the binder should be loose enough to allow two or three
+fingers to easily slip under it.
+
+The Meconium.-- The First discharge that comes from the bowels is of a
+dark, greenish color, and should come away during the first
+twenty-four hours; if it does not, the baby may suffer a good deal of
+pain, and an enema of warm water must be given. As this substance is
+very difficult to be washed out of napkins, the first ones used should
+be old and afterward be burned.
+
+Cleansing.-- Every time the napkin needs to be changed, even if it is
+only wet, the baby should be washed with warm water. A napkin should
+never be used twice without washing; it chafes the child, and it is an
+unsafe as well as a filthy practice; the napkin must always be removed
+as soon as it is wet.
+
+The Infant's Toilet.-- After the application of the binder and napkin,
+comes the undervest; the fingers of the nurse are passed up through
+the sleeve to seize the infant's hand and pull it through; as soon as
+it gets a little older the child will grasp a finger laid in its palm,
+which greatly facilitates this part of the toilet. The stockings are
+next put on and pinned with safety-pins to the napkin; then comes the
+petticoat, the band of which is also loosely fastened with
+safety-pins, and with the slip the toilet is complete. All the
+clothing should be changed night and morning.
+
+The eyes and mouth should be washed out with separate pieces of gauze
+or old linen. For the mouth, a small piece of cloth wet in warm water
+is wrapped around the little finger of the right hand, going into the
+left angle of the baby's mouth and coming out at the right, going
+between the gums and cheeks as well as over the tongue. This procedure
+should be gone through with every time preceding and following the
+nursing, and in this way the milk is prevented from souring in the
+mouth, and the digestion is kept in good condition. A sore mouth in a
+baby indicates carelessness on the part of the nurse.
+
+A soft hair-brush may be used, but the scalp is too tender to permit
+the use of a comb.
+
+After the toilet has been completed, the baby is laid in its crib, on
+the right side of the body, and warmly covered. The weaker the baby,
+the more attention must be paid to the external warmth. It may be
+necessary to place a warm-water bottle in the crib, but this must
+never touch the infant.
+
+The Crib.-- The infant must have its own crib, without rockers, and it
+must on no account be put to sleep in the same bed with its mother. In
+its early life it should never be taken out of its crib except to be
+fed, to have its clothing changed, or to be bathed. There should be no
+holding on the lap, no dangling, no carrying or fussing over the
+new-born infant; and the more the baby is let alone, the better and
+healthier it will be. If baby cries, look at once to see if it needs a
+fresh napkin; if not, if any pins are sticking into it, if the
+clothing is possibly too tight; if none of these things are wrong,
+give it a sup of water and turn it over on the other side. The baby
+often becomes restless by sleeping for several hours in the same
+position. But on no account take the infant up out of its crib simply
+because it cries.
+
+Cheerfulness and good nature on the part of the infant are dependent
+on its general good health. A healthy infant should not have colic,
+but if such is the case, there is a peculiar look of distress on the
+face, which indicates that the child is in pain; what is needed is
+warmth or medication according to the severity of the case, but never
+floor walking. Begin the latter procedure, and you may hope to keep it
+up for several years.
+
+Ventilation.-- The air is sometimes vitiated for children's uses in
+various ways; their nervous susceptibilities are greater than those of
+older people. A very little odor of tobacco may cause nausea and
+discomfort to an infant in arms. The atmosphere of the room should be
+sweet and pure and unscented. All scents and perfumes affect the
+nervous system, and by constant excitation do it damage. A bouquet of
+flowers renders the air of a closed room too heavy.
+
+Feeding of Infants.-- During the day the infant should be put to the
+breast once every two hours, and once every three hours during the
+night. This interval of time between the feeding is necessary in order
+that there may be sufficient time given for digestion to take place.
+Regurgitation of milk soon after feeding is a sign that the stomach
+has been overfilled. As the infant usually falls asleep after nursing,
+it is necessary to waken it up at the time for the next nursing, as
+good digestion depends upon regularity of feeding.
+
+For the first nursing the infant may be put to the breast in from two
+to six hours after the labor if the mother is sufficiently rested;
+from ten to twenty minutes is long enough for each nursing. Before
+each nursing the nipples should be carefully washed off with a
+solution of boric acid. The first secretion of the breasts is
+laxative; that is, it acts on the bowels, and makes is unnecessary to
+give the infant anything to take for this purpose. The breasts should
+be used alternately in feeding the infant, as this allows a longer
+time for the accumulation of the milk. For the first few days the
+infant needs very little food, and the mother's milk is generally
+sufficient.
+
+The infant should be given a teaspoonful of cool water to drink two or
+three times a day, as the milk does not quench the thirst. The water
+should be sterilized by boiling, and be kept in an air-tight flask.
+
+At the end of the third month the intervals of nursing for the daytime
+should be three hours, and the last nursing at night should be at
+eleven o'clock, and the first nursing in the morning at five o'clock;
+thus allowing the mother an interval of six hours of unbroken sleep.
+
+The best evidence of the proper nutrition of the child is a
+progressive gain in weight. The child should be weighed every week. A
+loss of a few ounces usually takes place during the first few days
+after birth, so that the child does well if at the end of the first
+week it weighs as much as it did at birth. After the first week the
+weekly gain should not fall below five ounces.
+
+The Wet-nurse.-- When the mother for any reason whatever is not able
+to nurse her child, the best substitute is a wet-nurse. Before she is
+employed the wet-nurse should always be carefully examined by a
+physician to insure her freedom from disease. The best age is between
+twenty and thirty years, and the age of the child of the nurse should
+be at least within a month of that of the child to be nursed. The best
+sign of the good health of the nurse and of the condition of her milk
+is furnished by the health of her own child. The breasts should be
+well formed and the nipple of good shape. It is well, if possible, to
+get a woman who has borne several children, as she will understand the
+care of the child better. No woman who is not perfectly healthy is fit
+to be a wet-nurse; and even after she has been engaged her health and
+her habits must be watched over.
+
+Artificia1 Feeding.-- The first requisite in artificial feeding is
+that the milk shall be made to correspond as nearly as possible to
+that of the mother. For this purpose the following formula, prepared
+by Rotch, of modified cow's milk is considered the best:
+
+                       Milk            2 ounces
+                       Cream           3 ounces
+                       Water           10 drams
+                       Milk-sugar   6 3/4 drams
+                       Lime-water       1 ounce
+
+To make one pint of the mixture for use in the twenty-four hours, take
+the milk and cream as soon as it comes in the morning, and mix as
+above directed.
+
+No less important than the correct proportions of the ingredients, is
+freedom from disease germs and bacteria of putrefaction. Complete
+sterilization is possible by prolonged boiling; but experience has
+proved that under prolonged exposure to a temperature near the
+boiling-point certain changes take place in the albuminoids of the
+milk which greatly impair its digestibility. Full sterilization of
+milk for infant feeding has therefore practically been abandoned. It
+has been found that milk heated to 167∞ F. for twenty minutes, and
+promptly chilled by placing on ice, remains practically sterile for
+twenty-four hours, and it is spared the injurious changes which take
+place at a higher temperature. This process is known as
+Pasteurization. The Arnold steam sterilizer affords a convenient
+method of sterilizing; if used with the cover removed, the steam
+chamber being open, the temperature of the steam chamber does not
+exceed 170∞ F.
+
+It is claimed that in the Arnold steam sterilizer, with the use of a
+suitable gas stove, the water begins to boil at the end of two minutes
+after the gas is lighted. A four-ounce bottle of milk at an initial
+temperature of 70∞ F. in the open steam chamber attains a temperature
+of 170∞ in just one hour. An exposure of about one hour and twenty
+minutes in the steam chamber is therefore necessary for the
+Pasteurization.
+
+The rules for sterilizing are as follows:
+
+First, clean the bottles thoroughly; then place them in cold water,
+which is allowed to come to boil and boiled for ten minutes.
+
+Second, fill each with the milk you wish to use; put in the rubber
+cork without the glass plug; this leaves a small opening in the rubber
+cork; set the bottle in the basket, then in the boiler.
+
+Third, set in the refrigerator until needed for use.
+
+Fourth, when wanted for use, place a bottle of the milk so prepared in
+the tin mug which accompanies the sterilizer; fill the mug with hot
+water to the height of the milk in the bottle, heat the milk to the
+temperature of 99∞ F., remove the rubber cork and put on the nipple,
+when it is ready for use.
+
+Fifth, cleanse the bottle immediately after using; throw away any milk
+that has not been used.
+
+Sixth, if the steaming process is preferred, place the basket without
+the bottles in the boiler, fill the water up to, but not above, the
+bottom of the basket, place the bottles in the basket, and proceed as
+before.
+
+It is important that the milk should be sterilized or Pasteurized as
+soon as it is served in the morning. Each bottle must be thoroughly
+washed as soon as it is emptied. Milk sterilized in this way will keep
+for days without spoiling, as it is hermetically sealed and all the
+unhealthy germs have been removed.
+
+The most exact method for the artificial feeding of infants, and that
+which most nearly approaches the mother's milk, is that used by the
+"Walker-Gordon Laboratory," branches of which are to be found in many
+of the large cities.
+
+Not only is the greatest care taken that the milk used shall be pure
+and sterilized ready for use, but these laboratories are equipped by
+special machinery which separates the important elements of the milk--
+namely, the fat, the milk-sugar, and the proteids. So that the
+physician can modify the proportions of these various ingredients of
+the milk to meet the necessity of the age and requirements of the
+infant.
+
+When the milk contains too little sugar, the infant does not gain as
+rapidly in weight as it would otherwise do. Too much sugar in the milk
+is indicated by colic, thin, green, or acid stools, or eructations of
+gas from the stomach.
+
+An excess of fat in the milk is indicated by vomiting; too little fat
+causes constipation with dry hard stools. Proteids in excess are a
+prolific cause of colic and also of diarrhea.
+
+Prescription blanks are furnished the physician, who fills out the
+percentages of fat, milk-sugar, proteids, and alkalinity, to suit the
+age, weight, and general condition of the child. He orders also the
+amount to be given at each feeding, and the number of feedings to be
+given in the twenty-four hours. Each bottle contains just the amount
+to be given at one feeding. All that the mother needs to do is to
+place the bottle in a receptacle containing warm water, until the milk
+has attained a temperature of 99∞ F., remove the cotton stopper, and
+put on the nipple, when it is ready for use.
+
+The Nursing Bottle.-- This should be of clear glass, with a rounded
+bottom, and of such a shape as is easy to clean; so that no particles
+will cling around a corner which cannot be reached. The graduated
+bottle is the most convenient, as it enables the quantities of each of
+the materials used in the preparation of the feeding to be mixed in
+the bottle, doing away with the trouble of measuring before putting
+into the bottle.
+
+Rubber Nipples.-- Two nipples should be kept for alternate use, and no
+nipple should be used longer than two weeks. A soft rubber of conical
+shape is best, with an opening at the top which is not too large, so
+that the milk will not flow through, as it is desirable that the child
+should obtain the milk by suction. So soon as the feeding is over, the
+nipple should be removed from the bottle, and brushed on both sides
+with a stiff brush. It should then be put in cold water, where it is
+kept until it is again wanted.
+
+The baby should be fed slowly, from ten to twenty minutes being taken
+for each feeding. Sucking from an empty bottle or with a nipple in the
+mouth should never be permitted, as in this way the baby draws air
+into its stomach, which will result in colic. Each flask should
+contain only enough for one feeding.
+
+In lieu of the regular sterilizing apparatus, milk may be similarly
+prepared by placing the milk in an ordinary glass fruit-jar with a
+screw lid. This is placed in a colander over a pot of boiling water;
+the milk should be allowed to boil in the open jar for two minutes;
+the jar-lid is then screwed on, and it should steam for twenty minutes
+longer.
+
+The capacity of the infant stomach at birth is about one ounce, which
+is the average quantity of food that should be taken at one meal. The
+average rate of increase in the amount of food is one and a half drams
+a week for the first six months; subsequently somewhat less. The
+intervals of feeding should be two hours at birth, and increased to
+three hours at the end of the third month. The food should be given at
+a temperature of 99∞ F. and fed directly from the sterilizing bottle.
+
+Fresh Air.-- In warm weather the baby is taken out-of-doors in from
+three to four weeks after birth; in cold weather not before two to
+three months. In the latter case it is prepared for the change by
+being first dressed as for the street, with wrap and cap; the windows
+of the room are then opened, and the infant is carried about here. In
+the winter months when the baby is first taken out, it is better to
+carry it in the arms, as it will be kept warmer in this way, and if it
+does become chilled it will be more quickly noticed.
+
+Characteristics of the Healthy Infant.-- The average weight of an
+infant at birth is about seven pounds, and its length is about twenty
+inches; the extremes are four pounds or a little less up to eleven
+pounds. The head and trunk of the child are developed out of
+proportion to the limbs.
+
+The skin of the new-born infant varies from pinkish to red; about the
+fourth day the color becomes somewhat yellowish; this tinge should
+disappear about the end of the second week, and at the same time the
+skin begins to peel off.This process lasts about two weeks longer,
+when the baby's skin takes on its normal color.
+
+The shape of the head varies greatly, much being due to the amount of
+pressure during labor; but this disappears in a few days. As a rule,
+the large bones of the head are felt to be separated by membranous
+ridges called sutures; there is one on the median line on the top of
+the head, and at either end of the suture is a large open space,
+called a fontanel. The largest one is at the front of the head, and is
+called the anterior fontanel; it is about large enough to be covered
+by the tips of two fingers, and is of a lozenge shape; this opening
+does not close till the child is about eighteen months old. In a
+healthy baby this fontanel should be on a level with the bones of the
+head; a slight pulsation may be noticed in it, due to the pulsations
+of the vessels of the brain. There is a much smaller three-cornered
+fontanel at the back of the suture, and one behind either ear; these
+soon close up with bone.
+
+A new-born baby cannot probably do any more than distinguish light
+from darkness. Up to the sixth week there is an inability at
+coordination of the ocular muscles; after this time the eyes begin to
+move in an orderly manner, and they will follow a bright object moved
+slowly in front of them. At about the end of the second month rapid
+movements are perceived, as is evinced by the child's closing its eyes
+quickly on an object suddenly approaching it. At three months the
+child begins to recognize colors; the first recognized are yellow,
+red, pure white, gray, and black. But the faculty of distinguishing
+between colors is not perfected till the third year. The mother is
+recognized about the third month. Hearing and a sense of smell develop
+rapidly after birth; loud noises in its vicinity will cause a child to
+start during the first day after birth. By the time the child has
+reached three months of age it shows signs of having a mind of its
+own, and is capable of exercising thought. It grasps for objects, and
+indicates its likes and dislikes. At from eight to ten months it can
+utter several syllables, and at the age of one year should be able to
+say mama and papa; at two years it should be able to frame short
+sentences.
+
+Weight of the Baby.-- By the end of the sixth month the child's weight
+should be double what it was at birth; that is, about fourteen pounds;
+at the end of the twelfth month be three times as much as at birth, or
+about twenty pounds.
+
+Muscular Action.-- Muscular action in the new-born infant is entirely
+involuntary, there being no voluntary acts until about the end of the
+third month. Sucking and licking are largely instinctive. The
+movements of the arms and legs are impulsive acts, and occur during
+sleep, just as they did in the intra-uterine life. The act of raising
+the head, which is attempted about the fourth month in healthy
+children, is volitional, requiring not so much added strength of
+muscle as power of coordination. As volition develops the power of
+coordination gradually increases, and the child learns to perform
+voluntary or purposeful acts. Voluntary grasping is done after the
+fourth month. As the child learns to balance its head, it attempts to
+sit up. This act is not successfully accomplished until about the
+fortieth week; the child sits firmly alone when ten or eleven months
+old. Before this time it is necessary to support the head and spine of
+the child with the hand. By the third or fourth month the infant
+should be able to grasp things. The child begins to creep about the
+ninth month. The clothing should be so arranged as to allow entire
+freedom of motion.
+
+It should be able to stand up by a chair by the tenth month, and be
+able to walk alone at the end of the first year. It is important that
+parents should know this, since not knowing what a normal baby ought
+to be able to do, cases of birth palsy, or even an attack of paralysis
+due to teething, are not infrequently overlooked, not only by the
+mother, but even by the doctor, who attributes the inability of the
+child to do what other children can do at this age simply to weakness,
+which the child will outgrow; and thus the time passes in which the
+most could be done to cure the child and to prevent the subsequent
+deformity.
+
+A baby should not be forced to stand or walk; a very stout baby, on
+account of its weight, will stand up and walk much later than a slight
+one, the two being equally healthy. Or if a baby has been sick, it
+will feel no inclination to stand up. Naturally, a child creeps before
+it walks, and this develops the muscles of the lower limbs, so that
+they will support the weight of the child in standing. By prematurely
+forcing a child to stand up and walk, there is danger of causing
+bow-legs, as the bones of the legs are still weak; the child should be
+discouraged from standing up too much rather than encouraged to stand
+up more.
+
+Sleep.-- A large proportion of the time of early infancy is spent in
+sleep; for the first few weeks the infant only wakens up to be fed.
+During sleep the eyelids should be tightly closed; a partial opening
+of the lids, showing the whites of the eyes, is an indication of ill
+health. Up to the age of six, children require twelve hours of sleep
+at night, besides an hour or more in the middle of the day; the child
+should be permitted to sleep as long in the morning as it will.
+
+Respiration.-- The healthy infant breathes on an average forty-four
+times a minute; the only time the respirations can be satisfactorily
+counted is during sleep. When the child is awake, the respirations are
+hurried by slight movements of the body, crying, and so forth. The
+average pulse of a newborn baby is one hundred and forty; this is
+hurried by the same causes that hastens respirations; the pulse is
+most easily counted at the anterior fontanel. The average temperature
+of the infant is 99∞ F. When the tip of the nose and the extremities
+are cold, it indicates a lowered vitality.
+
+The nature of the child's cry indicates, variously, hunger, temper, or
+pain; the mother will soon learn to distinguish these varieties. If
+the child cries because it is hungry, the cry ceases so soon as it is
+fed. But a child is never to be fed simply because it cries; it must
+be fed on the hour by the clock. If this rule is not strictly adhered
+to, it will suffer all the forms of indigestion and colic that babies
+are heir to. If it cries because of colic, there is a drawn look on
+the face, and at the same time the legs are sharply flexed on the
+thighs and the thighs on the abdomen. If the cries are due to earache,
+the head will be rolled about from one side to the other. In either
+case nothing will stop the cries until the pain is relieved. A baby
+does not shed tears until the third month.
+
+The Stools.-- The stools of a very young baby fed on breast-milk
+should be of a yellow or orange color. There should be three or four
+evacuations daily; they should contain no curds. Stools of bottle-fed
+babies are lighter in color and more offensive.
+
+Constipation.-- Constipation is not uncommon in infancy; it may be
+overcome by the use of a soap suppository, or by an injection of warm
+soap-suds into the bowel, or by an injection of oil and water, or by
+gentle friction over the bowel, following the course of the large
+intestine.
+
+To make the soap suppository, take a piece of castile soap about an
+inch long, give it the shape of a cone not any larger than the end of
+the little finger, and make it perfectly smooth. This is inserted to
+about half of its length into the rectum and held there until it
+causes the bowels to move.
+
+The bowel injection is best given by means of the single-bulb syringe,
+known as the eye and ear syringe; the bulb holds about two
+tablespoonfuls of liquid. This may be warm cotton-seed oil, sweet oil,
+or glycerin one teaspoonful to warm water two tablespoonfuls. The
+nozle should be small, smooth, and well oiled. It should be very
+carefully introduced into the bowel, being directed a little to the
+left side, and the bulb gently squeezed to force the contents into the
+bowel. The injection is more effective if it is retained for a little
+while; this is accomplished by making slight pressure on the anus with
+a towel.
+
+Rubbing the abdomen for about ten minutes in the direction of the
+large bowel is sometimes very effective in overcoming constipation;
+begin in the right groin and rub up as far as the border of the ribs,
+then across to the left, then down on the left side.
+
+Vomiting.-- Vomiting means often only that the stomach has been
+overfilled, and may be relieved by withholding all food for a few
+hours.
+
+Urination.-- The frequency of urination in a newborn baby will vary
+greatly with the weather and other conditions; in cool weather it is
+not unusual for the napkin to need changing almost every hour. Healthy
+urine should not stain the napkin. The new-born infant secretes very
+little urine until it begins to take nourishment freely. The bladder
+is usually emptied during birth, and very often the bowels also, so
+that if the child seems well and there is no malformation of the
+parts, the family may be assured that the apparent retention of urine
+is only temporary.
+
+The use of hot fomentations over the kidneys and bladder will often
+hasten the evacuation of urine if it has been unduly delayed. If the
+secretion seems highly concentrated, a drop of sweet spirits of niter
+in a teaspoonful of water may be given every two hours.
+
+Teething.-- The first tooth generally appears about the end of the
+fourth month; in delicate children they come later. As a rule, the
+lower front teeth come first, coming in pairs, one tooth coming on
+each side of the mouth; followed in about a month by the corresponding
+teeth in the upper jaw. Preceding their appearance the gums become
+swollen, hot, and painful, and the saliva forms in excess and runs
+from the mouth. The child is irritable, flushed and restless; and
+there usually occurs some disturbance of the bowels, commonly
+diarrhea. This all indicates a nervous derangement, and calls for a
+judicious diet and general careful oversight. The symptoms subside
+when the teeth are through. During teething the child manifests a
+desire to bite on something, and a soft rubber ring will give it great
+comfort.
+
+The first set of teeth are twenty in number, and are usually cut in
+groups, starting about the fourth month and continuing until between
+the twentieth and thirtieth month, when the first dentition should be
+complete. As a rule there is an interval of rest between the eruption
+of the various groups. During dentition children are generally more
+peevish and fretful than usual, but there should be no general
+constitutional disturbance. During dentition it is of especial
+importance to keep the bowels well opened; it is better to have them
+too loose than costive; constipation at this time greatly increases
+the tendency to convulsions.
+
+Bottle-fed babies are apt to cut their teeth later than those nursed
+at the breast. The lack of appearance of any teeth before the end of
+the first year indicates that the nutrition of the child is below par,
+or, in other words, that the child has rickets. The permanent teeth
+begin to appear about the sixth or seventh year.
+                          _________________
+
+  PART IV.-- THE MENOPAUSE.
+                          _________________
+
+ CHAPTER XIV.
+
+ THE MENOPAUSE.
+
+   Average Duration of the Menstrual Function; Duration of Menopause; the
+   Menopause; General Phenomena of the Menopause; Prominent Symptoms of
+   Menopause; Pathologic Conditions of the Menopause; Hemorrhage at the
+   Menopause a Significant Symptom of Cancer; Causes of Suffering at
+   Menopause.
+
+  "Yet I doubt not through the ages one increasing purpose runs,
+   And the thoughts of men are widened with the process of the suns.
+   Knowledge comes, but wisdom lingers, and I linger on the shore,
+   And the individual withers, and the world is more and more.
+   Knowledge comes, but wisdom lingers, and he bears a laden breast,
+   Full of sad experience, moving toward the stillness of his rest."
+
+                                                  -- "Locksley Hall."
+
+Average Duration of Menstrual Function.-- The average duration of the
+menstrual function is from thirty to thirty-two years. Raciborski
+estimated the duration of menstrual life at about thirty-one years and
+nine months. According to him, the mean age of puberty at Paris was
+fourteen years and seven months; therefore, the average age of the
+menopause was forty-six and one-half years. Tilt gives the average age
+of the cessation of menstruation in 1082 cases as forty-five years and
+nine months. The average age is between forty-five and fifty years. It
+has been shown by Krieger, Kisch, and others, that the earlier the
+menses appear, the later they cease, and vice versa. However, when the
+first period is unusually early or late, the menopause comes very
+early. Also that the sexual function is usually abolished earlier in
+the laboring classes, who are compelled to work hard and who have many
+cares, than in the well-to-do and rich.
+
+Race does unquestionably influence the duration, but given a sound
+healthy race, which is not too much enervated with civilization, and
+the menstrual process will, equally with the total physical vigor and
+the vitality, be increased. At the present day there is an increased
+sexual vitality, which shows itself in the fact that the duration of
+menstrual life has been increased three to four years during the past
+generation. The inference can be fairly deduced that vigorous vitality
+causes prolongation of the menstrual process and the actual age.
+
+Duration of Menopause.-- By the menopause or climacteric is understood
+the whole period from the beginning irregularities in the time of
+appearance of the menstrual flow until its actual cessation. The
+average duration of the menopause is from two and a half to three
+years.
+
+The Menopause.-- The menopause is a physiologic and conservative
+process. It occurs at a time of life when all the tissues are most
+stable and the nutrition of the body is at its best. Other physiologic
+changes which occur at the same time are decrease in the size of the
+spleen and lymphatic glands, the muscular coats of the intestine
+atrophy, and lessened peristalsis ensues; hence the increased tendency
+to constipation. These are not the degenerations of age, but the
+blood-supplying, blood-making, and blood-elaborating organs of the
+body have completed the growth of the organism, done their work, and
+are striking a balance with the needs of the economy.
+
+The object of each metamorphic or developmental epoch is a critical
+readjustment of the organism, in order to insure the greatest possible
+amount of health for each subsequent period of life. In the vast
+majority of cases this object is quietly effected, but sometimes the
+constitution only rallies after having been severely shaken for a
+varying period.
+
+General Phenomena of the Menopause.-- Borner states that while many
+women pass this period without noting any change in their former
+condition, and are conscious of the occurrence of the change of life
+only by reason of the absence of the menstrual flow, others suffer for
+years with a host of troubles.
+
+One of the most essential changes is that of the woman s psychic
+condition-- from slight vagaries, loss of interest in the daily
+affairs of life, to melancholia and insanity.
+
+"Two factors are generally taken into account: first, the sudden
+cessation of the menses; second, the reflections of the patient caused
+by her condition, meditations on the loss of youth and sexual power,
+and anxiety in view of the dangers of the climacteric. It cannot be
+denied that there is some truth in the supposed sad thoughts about the
+beginning of old age, and the depression caused by them can scarcely
+be considered abnormal" (Borner).
+
+Napier believes that it is extremely rare for the cessation to occur
+without some physical discomfort or some disturbance of the nervous
+system, but adds that: "Some women, however, cease menstruating with
+very slight inconvenience." As a rule, the woman misses one, two, or
+more periods, then a menstruation of almost normal quantity and
+duration; and this is again repeated at gradually longer intervals,
+and with a diminished flow, until actual cessation occurs.
+
+The periods cease owing to the degeneration and disappearance of the
+glandular tissues of the uterus, and secondarily to similar changes in
+the ovaries and other glands. This is followed by an atrophy of all
+the structures of the genitalia.
+
+An increase in the size of the uterus, from increase in the amount of
+blood, is frequently noticed at the beginning of the menopause; later
+it becomes smaller in all its dimensions. The wall becomes thinner;
+the cervix becomes shorter and thinner, sometimes hard, sometimes
+flabby as a membrane. But the distinguishing feature of the menopastic
+uterus is atrophy of its lining membrane.
+
+The changes in the uterus and Fallopian tubes are earlier than those
+in the ovaries, so that ovulation, though lessened in activity, may
+persist for a considerable time after menstruation has ceased. Ovarian
+atrophy has been referred to senile rather than menopastic changes.
+
+Atrophy of the ovaries occurs very gradually. Peuch found that in one
+case the ovaries were of normal size three years after the
+establishment of the menopause. Kiwisch describes the structural
+change in this gland as consisting, on the one hand, of an increase of
+the connective-tissue stroma; and, on the other hand, the Graafian
+vesicles themselves undergo retrograde change. In consequence of these
+microscopic changes, which take place very slowly, the entire organ
+becomes harder and smaller.
+
+Napier believes that the ovaries secrete specialized substances which
+aid in determining menstruation; and that in a less degree the
+utricular glands and the glands of the Fallopian tubes share in this
+action. He considers that this is probably secondary to the chain of
+peripheral irritation from the uterine glands, but that this secretion
+is none the less an essential feature of the menstrual process.
+
+In support of this view he calls attention to the pigmentation of the
+skin which occurs during pregnancy and chlorosis, showing that the
+absence of the catamenia results in the retention in the blood of some
+substance which would normally be excreted at this time.
+
+Other atrophic changes in the genitalia are shriveling of the vulva,
+with prolapse of the vagina or uterus from relaxation of the ligaments
+and loss of the natural support afforded by the changed perineal body.
+
+Uterine catarrh occurs almost invariably, and only ceases in advanced
+years. Displacements of all kinds are frequent, but on account of the
+now greatly diminished weight of the uterus, these are insignificant.
+
+The vagina is at first almost always hyperemic, but this disappears as
+the vessels successively atrophy. The vagina gradually becomes
+narrower and shorter. The mucous membrane loses its rugae and presents
+a pale, grayish, blanched hue.
+
+The researches of Byron Robinson, made by the dissection of a number
+of old women, show that after the menopause not only is there an
+atrophy of the genital organs, but that the hypogastric plexus of the
+great sympathetic nervous system also shrinks away. "It becomes
+smaller and firmer, and no doubt some strands disappear. On this fact
+must he based the pathologic symptoms accompanying the cessation of
+the menstrual function."
+
+The importance of the genital organs is shown by the vast nerve-supply
+sent to them. When this great nerve-tract becomes atrophic, so that it
+can no longer transmit the higher physiologic orders, all parts of the
+sympathetic system must be unbalanced, until a new line, the next line
+of least resistance is established. And Robinson believes that this is
+the explanation of the many pathologic manifestations of every viscus
+at the menopause; that is, "the irritation which arises by trying to
+pass more nervous impulses over plexuses than normal gives origin to
+what is unfortunately known as functional disease. It is just as
+organic as any disease, only we are unable to detect it."
+
+Chemical changes in the blood and tissues are constant vital
+phenomena; increased oxidation causes increased activity of the
+circulation, increase of temperature, increase of urea and carbonic
+acid in the economy from retrograde changes, and, finally, during
+menstrual life the flow of blood from the uterus carried off the
+effete materials from the highly charged system.
+
+The elimination of albuminoids, as shown by the altered condition of
+the blood after menstruation, is greater than can be accounted for by
+the blood discharged. When the menopause is attained suddenly, the
+retention of such albuminoid substances must act toxically. Hence the
+resulting clinical fact that sudden cessation of the menses is, in the
+majority of cases, attended with pronounced symptoms of discomfort,
+and it is in these cases that untoward results are most likely.
+
+James Oliver believes that the catamenial flow eliminates from the
+body substances whose presence in the blood would exert a deleterious
+influence on the animal economy.
+
+The Prominent Symptoms of the Menopause.-- Christopher Martin holds
+that the symptoms of the change of life are produced largely by a
+condition of instability and increased excitability of certain other
+cerebrospinal centers directly brought about by failure of the
+menstrual center, and adds: "It is probable that the ovaries, like the
+liver and thyroid gland, modify the blood circulating through them,
+and add to the blood some peculiar product of their metabolism. It may
+be that some of the climacteric symptoms are due to the loss of this
+substance from the system."
+
+Arthur Johnstone's theory of the symptoms of the menopause is that the
+lining membrane of the uterus atrophies and becomes old cicatricial
+tissue, and sinks into quiet decay. The nervous system begins to
+readjust itself; but no longer having free outlet through the soft,
+lymphoid tissues of the uterus, the wave pressure meets with
+resistance and a choppy sea results. Vertigos, bilious attacks, and so
+forth are nothing more than reflex waves. The weakest organ of the
+individual is the one that generally suffers. And that the kidneys,
+which all along have borne the brunt of life, should now show positive
+signs of disease is natural.
+
+The etiology and pathology of the menopause lie in the sympathetic
+nervous system. And it is by the breaking up of the harmony of
+previous processes that nervous disturbances are produced.
+
+After the cessation of the flow, over 8% of women suffer from
+"flashes"; this symptom is caused by irritation of the heart and
+vasomotor centers. The blood-vessels of the head and neck seem to be
+most affected, yet the skin of the whole body shares in the
+disturbance. Besides the vasomotor and heat center being disturbed,
+the sweat center is irritated. The flushes and flashes are followed by
+various degrees of sweating, which varies from a slight moisture to
+great drops.
+
+Nervous irritability is a prominent symptom in 8% of women at the time
+of the menopause. Most of the pain arises around the stomach; that is,
+the solar plexus. Digestive disturbances are very common at this time;
+they may be in the shape of fermentation, diarrhea, or constipation,
+accompanied by congestion of the liver.
+
+Tilt holds the very plausible view that the too strong reaction of the
+sexual organs on the central ganglia of the sympathetic nervous system
+is their principal cause of disease. Puberty, menstruation, pregnancy,
+lactation, or the menopause almost always entail some derangement of
+this system which is sometimes sufficiently severe to lead to insanity
+and suicide. Debility underlies all affections of the sympathetic
+nervous system, in the same way as nervous irritability underlies all
+cerebral diseases. Sometimes there is an overpowering sense of
+exhaustion pervading the whole system.
+
+Forms of climacteric insanity are delirium, mania, hypochondriasis,
+melancholia, irresponsible impulses, and the perversion of moral
+instincts.
+
+"If the reproductive apparatus does not act on the brain by the
+instrumentality of the circulating organs of the blood, it must do so
+by means of the nerves. The genital apparatus is richly endowed with
+nerves from the sympathetic system, and I have shown how frequently
+evident signs of disturbance in these centers coincided or alternated
+with headaches, nervousness, hysteria, and epilepsy. What wonder,
+then, if the same powerful influence of the sexual organs, through the
+instrumentality of the sympathetic system, should at times produce a
+permanent derangement of the mental and moral faculties. I am thus led
+to look on the sympathetic nervous center as a source of vital power
+producing reflex morbid phenomena, in accordance with variable
+cerebral predisposition" (Tilt).
+
+Another very frequent symptom of the menopause is distress in the
+region of the heart, with palpitation and shortness of breath. It may
+be caused by the condition of the blood, whether it be impoverished--
+anemia-- or too rich in red globules; by reflex irritation of the
+pneumogastric or sympathetic nerves; by overexertion; or by
+alcoholism. It may also be due to general debility; the woman resists
+fatigue less easily, and she experiences a general malaise. To the
+palpitations are rapidly added faintness and shortness of breath. The
+sleep is troubled with distress in the region of the heart. It is said
+that women in whom the menopause occurs early are more liable to
+tachycardia than those who menstruate later in life; and that it
+occurs with especial frequency when the menopause has been prematurely
+induced by surgical operation or by disease. It is believed that this
+functional heart trouble is caused by the increased connective-tissue
+fibers of the sexual organs acting in some unknown way on the terminal
+fibers of the sympathetic; and it is not infrequently due to the
+formation of scar tissue at the seat of a cervical laceration, and has
+often been promptly and permanently relieved by removing the
+cicatricial tissue and suturing the wound. The cause acts by producing
+a transitory paralysis of the inhibitory fibers of the pneumogastric
+nerve.
+
+Pathologic Conditions of the Menopause.-- Perhaps the most alarming
+symptom of the menopause is hemorrhage. It may be due to general or
+local causes. Among the general causes are diseases of the heart,
+lungs, spleen, and kidneys. Local causes of hemorrhage are:
+inflammation of the lining membrane of the uterus, chronic pelvic
+inflammations, faulty uterine positions, erosions and ulcerations of
+the mouth of the uterus, fibroid tumors, and cancer. All competent
+observers agree that cancer in women is much commoner from forty to
+fifty years than at any other age.
+
+Hemorrhages occupy the foremost place among the pathologic phenomena
+of the genital tract during the menopause. Hemorrhage has been
+attributed in many instances to the senile rigidity and friability of
+the uterine vessels, which are not in a condition to offer sufficient
+resistance to the blood-pressure which is brought to bear on their
+walls; there is also softening and relaxation of the uterine tissue.
+Additional causes are found in the circulatory disturbances in the
+pelvic organs, whereby the outflow of blood from the pelvic vessels is
+hindered a chronic congestion in the uterine vessels is produced. It
+has also been attributed to early and profuse menstruation, frequent
+and difficult labors, frequent abortions, and excess in drinking.
+
+The third and last variety includes those cases which may be referred
+to some disease of the pelvic organs themselves. Anatomic changes may
+lead up to pathologic conditions. A chief feature characteristic of
+uterine disease is malnutrition from atrophy-- a sudden curtailing of
+the blood-supply from the degeneration of the genital-nerve apparatus
+and consequent impaired vitality of tissue from defective nourishment.
+The anatomic changes in the glands and substance of the uterus also
+favor the irritation, and the development of new growths, which may be
+malignant or benign-- as cancers, fibroid growths, and so forth.
+
+Hemorrhage at the Menopause a Significant Symptom of Cancer.-- Not
+only should any excessive and prolonged bleeding at the time of the
+menopause be a source of great anxiety to the woman, but even the
+irregular appearance of a slight show of blood just sufficient to keep
+the clothing stained, or a slight bleeding following coition; since
+all of these are symptoms of very great gravity, and demand an
+immediate local examination and appropriate treatment.
+
+The widespread belief among the laity that hemorrhage at the time of
+the menopause is a normal condition, and that if left alone it will
+stop in the course of a few years, is most erroneous and fatal. On
+this altar of ignorance thousands of women sacrifice their lives every
+year. The case-book of any gynecologist will testify to the truth of
+this statement. The following three cases will serve to illustrate
+different types of hemorrhage in cancer patients, in no one of which
+did the patient even suspect that she was suffering from anything more
+serious than the "vagaries of the menopause."
+
+Case I.-- Woman aged seventy years; came on account of incontinence of
+urine, which had been troublesome for two years. The menopause
+occurred at fifty. She stated that three or four years previous to her
+visit, she had had a return of the flow of blood, perhaps twice in the
+first year, and that during the past year there had been a flow every
+month-- about the same that there used to be. This she took to be a
+return of the menstrual period. She said, further, that there was a
+constant bleeding-- enough to necessitate the wearing of a napkin--
+and an occasional severe hemorrhage; that she could not take long
+walks or drives because of the excessive flow which followed.
+
+The case was one of cancer of the uterus which had spread to all the
+pelvic viscera; and in addition to this, the patient's general
+condition was such that any operation was out of the question. Yet the
+patient had never thought of the possibility of any uterine trouble
+sufficiently serious to make a local examination necessary. It was
+only the loss of control over the bladder that drove her to seek a
+physician's advice.
+
+Case II.-- Woman aged fifty-three years came to consult me because of
+pain, hemorrhage, and loss of weight. There had never been any
+cessation of the menstrual period. She said that she began to have
+irregular hemorrhages three years previously, and that they were
+constantly becoming more frequent and more alarming, and that, in
+addition to this, there was a constant discharge of blood, which
+necessitated her wearing a napkin all the time. She also stated that
+for the preceding six months the pain had been so severe that she had
+not had one solid night's sleep, and that in that time she had lost
+forty pounds in weight.
+
+This patient was in the very last stages of cancer of the uterus, and
+all that could be done for her was to make her comfortable. She had
+given birth to one child which caused a deep tear of the neck of the
+womb; and it is probable that this neglected tear was the primary
+cause of the cancer, which began in the neck of the womb.
+
+Case III.-- Woman aged forty-five years; married, but had never had
+any children. She said that the periods were normal as to duration and
+amount, but that for the past two years they had two days ahead of
+time, and that for the past four months she had been having just
+enough irregular bleeding between the periods to keep her clothing
+stained.
+
+On examination a diagnosis of cancer of the uterus was made. The
+pathological examination proved this to be a most malignant type of
+cancer of the neck of the womb. The entire uterus and appendages were
+at once removed. And although the patient made an excellent recovery
+from the operation, she succumbed to the disease one year after the
+operation was performed.
+
+These cases have been cited at length because they are all typical and
+because of the variety of symptoms and the great difference of age.
+Only in one of the cases was there any very severe pain, and it was
+really the pain, which had become unendurable, which caused the
+patient to seek relief.
+
+It is the concensus of opinion of the medical profession that cancer
+of the uterus is one of the common causes of death among women; that
+the cancer rate of mortality has increased during the last four
+decades; that it is most common near the time of the menopause; and
+that there is a direct causal relation between cancer of the neck of
+the womb and the traumatisms which occur during childbirth.
+
+The symptoms of cancer of the uterus are hemorrhage, a more or less
+offensive discharge, and pain. The quantity of blood may vary from a
+slight amount which occasionally stains the clothing to a profuse
+hemorrhage. In the married, bleeding following coition is always a
+suggestive symptom. During the menopause any irregular or profuse
+bleeding should excite suspicion. After the cessation of the menopause
+any bleeding whatsoever, whether slight or profuse, should always be
+regarded as a danger signal which demands an immediate and thorough
+local examination. The same is true of any offensive vaginal
+discharge. Pain is frequently so late a symptom that to wait for its
+appearance means that the favorable time to perform an operation has
+passed by. Emaciation is also a symptom of advanced disease.
+
+Cancer is chiefly a disease of the climacteric; when there is a
+diminished power on the part of the tissues to resist adverse
+influence. It affects the debilitated and overworked, but it is also
+found in the well nourished and in the comparatively young.
+
+Cancer always begins as a local disease, and when it occurs in the
+uterus, it is easily accessible and eradicable in its earliest stages;
+that is, if the disease is discovered in its incipiency, an operation
+will remove all the diseased tissue. If, on the contrary, the disease
+is left to nature, the growth spreads out into the surrounding viscera
+like the roots of a tree in the earth, and the cancer may be literally
+said to eat into the tissues which it invades. At the same time the
+germs of the disease begin to be carried all through the body, and the
+entire constitution is affected.
+
+Prophylaxis, or the Prevention of Cancer.-- All pelvic inflammations
+should be promptly treated, and not allowed to become chronic.
+Leucorrhea is a symptom of inflammation, the true cause of which can
+be determined only by local examination. Women who have given birth to
+children-- and this is more especially necessary as they near the age
+of forty years-- should be carefully examined for tears of the neck of
+the womb. If these tears are extensive they should be repaired, as it
+is certain that malignant growths frequently do follow local injuries
+and traumatisms.
+
+Any irregular or profuse bleeding demands an immediate investigation
+by means of a local examination.
+
+A stormy, irregular, or delayed menopause should excite in the woman a
+suspicion of some abnormal condition.
+
+The importance of women being carefully watched by gynecologists at
+this period of their lives cannot be too emphatically stated, for upon
+the early recognition of cancer depends the only hope of radical cure
+of the disease. It is estimated that at the present time not less than
+95 per cent. of all cases of cancer of the uterus come under the
+observation of the profession at a stage of the disease when all
+prospect of permanent relief is out of the question.
+
+It is a deplorable state of affairs that women, not knowing what a
+normal climacteric is, attribute all hemorrhages, no matter how
+severe, to the change of life. Therefore, regarding the hemorrhage as
+a necessary evil, they fail to consult a specialist until the
+favorable time for eradicating the disease by means of an operation
+has passed. And whatever knowledge science may bring in the future as
+to the cure of cancer, at present it is a fact universally agreed upon
+that early operation, while the cancer is still local, is the only
+radical cure for the disease.
+
+Pruritus Vulvae. Perhaps one of the most annoying and obstinate
+symptoms of the menopause is pruritus vulvae. This is sometimes caused
+by sugar in the urine; there is a congestion of the liver which
+results in sugar being thrown into the system and this is eliminated
+by the kidneys. It is quite possible that this is due to the altered
+circulatory conditions of the menopause.
+
+Kidney Disease.-- The last pathologic condition which we will mention
+is kidney disease. Le Gendre believes that the menopause exerts a
+deleterious effect on the kidneys, whether this be a congestion,
+followed by a diminution in the quantity of urine, or a sort of
+auto-intoxication due to the retention of a poison in the system that
+has been prevented from leaving by the ordinary path.
+
+Armstrong says that in almost all cases at the time of the menopause
+the amount of urine passed is below normal, the specific gravity is
+increased, and that the urine contains urates and almost always uric
+acid in excess. Further, that the functions of digestion and
+assimilation and the various metabolic changes are so largely under
+the control of the nerve-centers that nothing seems more likely than
+that so great a disturbance of that system as takes place at the
+menopause should cause secondary derangements of these most important
+functions. That being so, the blood becomes loaded with waste
+products, and the usual symptoms follow-- gout and so forth.
+
+It has been a grave question in the mind of the medical profession
+whether the dangers that certainly do attend the menopause are natural
+or acquired; that is, could these dangers be averted by any
+precautions or hygienic measures on the part of women, or are these
+dangers a necessary accompaniment of this period of life?
+
+Tilt has reached the conclusion that: "The best way to avoid the
+dangers of this critical time is to meet its approach with a healthy
+constitution. A marked want of strength prevents the regular
+succession of the vital phenomena by which all critical periods are
+carried on. And as the change of life is marked by debility, when this
+is grafted on constitutional weakness, loss of power will be of long
+duration. All complaints remain chronic because there is not stamina
+enough to carry them through their stages."
+
+Causes of Suffering at Menopause.-- Dusourd, whose practice lay in an
+agricultural district in the south of France, as well as Tilt,
+believes that peasant women suffer little at this time. Their health
+is generally good when the menopause comes on and they are little
+liable to nervous disorders. The poor of large towns suffer much at
+this epoch-- the necessity of working hard, the anxieties of poverty
+and their unhygienic surroundings. But by a fortunate compensation the
+necessity for working hard prevents or cures the nervous affections
+which so often assail the rich at this period.
+
+Tilt's cases showed that women who suffered much at the menopause had
+previously suffered at puberty and at the menstrual periods. And among
+thirty-nine cases where there was no suffering at the menopause, there
+was the same immunity from suffering at puberty and at the menstrual
+epochs.
+
+Tilt's statistics were, or course, taken from English women. In
+forty-four cases of my own, all women past the menopause, the average
+age of the first menstruation was fourteen years and four months; and
+the average age of the actual cessation of the menstrual flow was
+forty-eight years and five and two-thirds months. Subtracting from
+this the average age of the first menstruation, we have as the mean
+age of menstrual life thirty-four years one and two-thirds months;
+that is, the average duration of the menstrual function was from two
+to four years longer than that usually given.
+
+A further investigation in order to ascertain any possible relation
+between the age of marriage and the number of pregnancies and the
+sufferings of the menopause elicited the following statistics. The
+average age of marriage was twenty-five years and ten months. Of the
+four women who were married after thirty-eight years, all were
+sterile; among the remaining there was an average of slightly above
+three children each. Forty per cent. of all these cases had one or
+more miscarriages. Nine had habitually suffered from severe
+dysmenorrhea, eleven had slight dysmenorrhea, and twenty-two had never
+felt the slightest inconvenience.
+
+In a list of fifty-two cases, eight were added to the list already
+given, all of whom had passed the menopause. Five were perfectly
+healthy and had never suffered the slightest inconvenience. Of these,
+one was single and only one had one miscarriage. Ten had suffered at
+the time of the menopause from slight malaise, but not sufficiently to
+call in a medical attendant. Thirty-seven were more or less seriously
+ill; thirty of these needed local as well as constitutional treatment,
+and seven constitutional treatment only.
+
+The prominent symptoms of the climacteric were as follows: Marked
+debility, 24; intense nervousness, 31; nervous prostration, 9;
+melancholia, 10; headache, 14; neuralgia, 6; hysteria, 7; irritable
+heart, 11; tachycardia, 8; insomnia, 19; indigestion, 32;
+constipation, 28; diarrhea, 3; leucorrhea, 38; rheumatism, 21; gout,
+1; Bright's disease, 12; hemorrhage, 6; alcoholism, 2; corpulency, 2.
+
+As a result of the study of these cases, the most striking feature was
+the relation of miscarriages to the sufferings and ill health at the
+time of the menopause. Of the nineteen women who had miscarriages,
+only one did not suffer in some way at the time of the menopause. Four
+suffered only slightly, and fourteen suffered extremely, not only
+during the menopause, but in the post-climacteric period as well. And
+the next most striking feature was that the prominent symptoms of the
+menopause are preeminently reflex or the functional diseases of the
+nervous system.
+
+Tilt believes that single women suffer less than other women at the
+time of the menopause. He further writes: "As at puberty, from the
+ignorance in which it is still thought right to leave young women, so
+at the change of life, women often suffer from ignorance of what may
+occur, or from exaggerated notions of the perils which await them. It
+would be well if they were made to understand that if in tolerable
+health, provided that they will conform to judicious rules, they have
+only blessings to expect from the change of life. Most unfortunately,
+the individual not cognizant of the invisible changes going on in the
+economy does not adapt the mode of life to the new conditions of the
+organism, and the weakened and lessened amount of the digestive fluids
+is unable to master the large quantities of food. The absorbents
+refuse to take more than is needed to repair the tissues. The
+atrophying muscles of the digestive tube, unable to hurry on the mixed
+products of indigestion; fermentation; and micro-organisms inciting
+fermentations and elaborating toxic alkaloids, poison and disorder the
+functions of life. Man's outdoor life enables him to escape many of
+these evils.
+
+"Woman's enervating mode of life, the continued introspection, coupled
+with the peculiar changes in the nutrition of the body at this time,
+render the nervous system peculiarly impressionable and liable to the
+manifold forms of diseases. 'The woman is told that she must be calm
+and patient, and in time the tomb-builder will alleviate all her
+sufferings.' This critical period may be dangerous to those who are
+always ailing, for habitiual sufferers at the menstrual periods, and
+for those affected with uterine diseases. If, on the first indication
+of the change of life, women who are in fair health carefully followed
+a regimen and pursued a line of life in harmony with the physiologic
+processes on which this change depends, disease would be prevented.
+But as the change concerns a natural function, it is left to nature;
+no additional precautions are taken, and advice is sought only when
+the mischief is done."
+
+It is not wise to marry during this period. On the first appearance of
+the irregularities of the menopause the amount of food and stimulants
+to which women have been accustomed should be curtailed rather than
+augmented. The system requires supporting by medicine and regimen--
+as, baths, mental and moral hygiene, and occupation-- rather than
+stimulating by spirits.
+
+We have seen that, in accordance with the plethric theory, which
+prevailed until 1835, and with the nerve theory, which is based on the
+latest anatomic and physiologic researches, menstruation is a
+physiologic process to get rid of effete material, and is therefore an
+excretion.
+
+At the end of perhaps thirty years, by a conservative process of
+nature, the child-bearing period ceases and the organism is readjusted
+to the end that the woman's vitality may all be conserved for her own
+individual life.
+
+Each metamorphic or developmental period of life-- dentition, puberty,
+and the menopause-- throws a special strain on the nervous system, and
+the recent studies of the sympathetic nervous system at the time of
+the menopause show that very extensive anatomic changes occur at this
+time. That being the case, the woman must lead such a life as will
+insure her having on hand a large reserve force necessary to meet
+these heavy demands. Tilt's observations show that women who have
+experienced no suffering at puberty or, at the menstrual periods do
+not suffer at the menopause. It is therefore evident that the time to
+begin this preparation is in childhood.
+
+That single women suffer less than married women would suggest that
+excessive coitus and the occurrence of abortions, frequent
+child-bearing, and lesions as the result of pregnancies, many of which
+lesions could have been prevented or cured by the timely aid of the
+physician, are the combined sources of much of the suffering at the
+time of the menopause.
+
+That the most frequent and serious disturbances are those of the
+nervous system, and that from their mode of life and habits of
+introspection the rich suffer more from these ailments than the poor,
+must cause serious consideration of the physiologic necessity for a
+definite occupation for the daughters as well as for the sons of the
+rich.
+
+The frequency with which Bright's disease is found at the time of the
+menopause is dependent not so much on the local physiologic changes
+which are taking place as on the time of life. Loomis says that it was
+not until life-insurance examinations became so common that the
+frequency with which kidney disease existed in persons who believed
+themselves well was even imagined. And as a result of his observations
+in these cases, and of a large number of autopsies conducted at the
+Bellevue, he stated that it was his belief that 90% of men and women
+over forty years of age suffer from some form of Bright's disease.
+That being the case, it would seem that after this period of life at
+least as much attention should be directed to the kidneys as to the
+teeth, and that a semi-annual examination of the urine should be made.
+
+Although the menopause is a physiologic occurrence, yet, owing to the
+many pathologic changes which are liable to take place at this time,
+the woman should be as carefully watched during the menopause by the
+gynecologist as the pregnant woman now is by the obstetrician. If the
+same care were taken, in the majority of cases, the dangers attending
+the menopause would be avoided, and the woman would be prepared to
+enjoy a healthy and useful post-climacteric period of life.
+
+  CHAPTER XV.
+
+ HYGIENE OF THE MENOPAUSE.
+
+   Diet; Constipation; Stimulants; the Kidneys; the Skin; Turkish Baths;
+   Massage; Exercise; Profuse Menstruation; Hemorrhage; Mental Therapeutics.
+
+  "'Tis the breathing time of day."
+
+                                                         -- "Hamlet."
+
+Hygiene of the Menopause.-- The changes which occur in all the organs
+of the body at the time of the menopause are retrograde, and therefore
+just the opposite of those which occur at the time of puberty. This
+fact should be borne in mind in the matter of alimentation. All that
+is now needed is to make the repair equal to the waste.
+
+Diet.-- Unless the woman is taking a great deal of active exercise, it
+is better to diminish the amount of meat eaten, and to increase the
+vegetable food and take more fluids. Unless the effect of the meat
+eaten is counterbalanced by active outdoor exercise, it produces an
+excess of waste matter, which accumulates and causes biliousness, and
+sometimes rheumatism and gout. A vegetable diet is less taxing to the
+excretory organs than an animal diet.
+
+Indigestion is at this time of life apt to appear in the form of
+fermentation, which may assume the gastric or intestinal type. The
+chief causes of the formation of gases are the lessened peristaltic
+action of the intestines, the increased tendency to congestion of the
+liver and to obstinate constipation.
+
+All dishes rich in sugar, as cake, candy, preserves, and jelly, should
+be indulged in with moderation; or where there is a tendency to
+fermentative indigestion, they should be wholly avoided.
+
+All dishes known to be difficult of digestion, as hot breads, pastry,
+cheese, fried dishes, and rich salads, should be cut off the menu,
+since these readily overtax an already weakened digestive system.
+
+If there is a hereditary tendency to rheumatism or gout, the disease
+is most apt to take on an active form at this time. In either case the
+manifestation of the disease indicates an excess of uric acid in the
+system, and a diet becomes a necessity. Pickles, all highly spiced
+articles of food, and vinegar must be omitted from the bill of fare.
+The vinegar may be replaced in salad-dressings by lemon juice.
+Tomatoes, rhubarb, strawberries and grapefruit are contra-indicated;
+also all articles of food rich in sugar.
+
+In chronic cases animal food cannot, as a rule, be excluded from the
+dietary, but must be limited in quantity. Fish, eggs, and fowl may be
+eaten, also a moderate amount of lean meat in the form of beef, lamb,
+and mutton. Milk may be indulged in freely. The diet should consist
+principally of easily digested fresh green vegetables. The amount of
+tea and coffee should be limited. All malt liquors, sweet wines, and
+champagne must be absolutely prohibited.
+
+Constipation.-- A daily free evacuation of the bowels is essential to
+good health. Where constipation exists, and the woman is full-blooded,
+with a tendency to a rush of blood to the head, saline laxatives are
+indicated. But if the woman is constipated and anemic, cascara sagrada
+is a better laxative; while cod-liver oil acts as a laxative and at
+the same time improves the quality of the blood.
+
+Stimulants.-- Women resort to alcoholic stimulants as an analgesic to
+relieve pain, whether physical or mental; as a narcotic to produce
+sleep; and as a spur to a failing appetite or bodily powers.
+
+The majority of women patients say that they first used alcohol in the
+shape of whisky, brandy or gin to relieve pain at the time of the
+menstrual period. The pain that is caused at this time by a chilling
+of the body would be as effectually relieved by drinking a cup of hot
+tea; while if the pain is intense and constant, recurring every month,
+it is doubtless caused by some local inflammation, and the use of
+alcohol only veils the real trouble, and the woman loses valuable time
+by not consulting a physician at once.
+
+As to the use of alcohol to blunt the nervous sensibility due to
+mental suffering, it is the testimony of the entire medical profession
+that this is the greatest cause of inebriety or drunkenness among
+women of all classes of society.
+
+Sleeplessness generally arises from some well-defined physical cause--
+very frequently from inaction of the liver-- and the proper remedial
+agents should be used to remove the cause.
+
+While at first the use of alcoholic beverages increases the appetite,
+as the amount taken is increased, distaste for food is created, the
+system languishes under an insufficient food-supply, and the original
+aim of increasing the appetite is defeated.
+
+As to taking stimulants to do more work than one could otherwise
+accomplish, it is by means of stimulants that woman can accomplish her
+physiological ruin more quickly than is possible in any other way. And
+the early symptoms of chronic alcoholism show themselves in the form
+of neuralgia, insomnia, palpitation of the heart, and muscular
+tremors.
+
+The Kidneys.-- On account of the prevalence of some form of Bright's
+disease after forty years of life, the kidneys should be carefully
+watched at this time. And in order to keep them in good condition they
+must be well flushed with water every day. Three pints of urine should
+be excreted daily, and three pints of water as such must be taken into
+the system daily. The urine should be examined by the physician every
+six months. In this way kidney disease is often discovered in its
+incipiency, which otherwise might run into a serious form of Bright's
+disease.
+
+The Skin.-- It must be remembered that the skin is one of the
+excretory organs of the body, and the pores should be kept well open
+by the various forms of baths.
+
+The Turkish bath or some modification of it will often be found to be
+particularly useful. Massage with alcohol after the bath lessens the
+tendency to take cold. For a woman who is anemic or run down, it is
+well to follow the Turkish with the Roman bath, which is an inunction
+with almond oil or cocoa-butter. A much more thorough massage is given
+with the Roman bath than with the "alcohol rub." It is often necessary
+to modify the Turkish bath by omitting the steam-room and shortening
+the time spent in the hot dry air. In ordinary cases the time spent in
+the hot dry-room should be only that necessary for producing a free
+perspiration. This time varies in different individuals from ten to
+twenty minutes. No woman should go to a Turkish bath without first
+consulting her physician, since if the woman has a weak heart, the
+bath may be the source of positive danger. Comparatively few women are
+strong enough to take the cold plunge.
+
+Massage.-- Massage, well given by a skilful masseuse twice a week,
+will greatly tone up the nervous and circulatory systems. Women who
+are very stout and who have sluggish livers with obstinate
+constipation will find massage particularly beneficial.
+
+Exercise.-- Daily exercise in the open air is absolutely essential to
+every woman's good health. The minimum amount of outdoor exercise
+compatible with health is an hour's walk, at the rate of three miles
+an hour. If the woman has never taken any exercise, she must begin
+with a very short walk and stop on the first sign of fatigue.
+Gradually increase the distance and the speed until the three miles is
+reached.
+
+Profuse Menstruation.-- If the menstrual flow is unusually profuse or
+lasts beyond the regular time, the woman should stay quietly in bed
+until the flow ceases. All exercise increases the flow.
+
+The flow now becomes less in quantity, and the periods more infrequent
+than formerly. Hemorrhage must always be regarded as a danger-signal
+the significance of which can scarcely be overestimated. To
+immediately consult a specialist on the appearance of any
+irregularities of the flow would, in the opinion of the most eminent
+gynecologists of the day, be the means of saving thousands of women's
+lives every year.
+
+Mental Therapeutics.-- It is particularly necessary at this time of
+life that the mind should be pleasantly occupied. Her children have
+passed the age when they need her constant supervision, and the mother
+must take some relaxation from her home cares, in the form of social
+diversions, amusements, outdoor life, and change of scene. Any mental
+occupation that will take the woman out of herself is the best
+possible safeguard against a state of introspection which conjures up
+a host of evil fantasies, and which is the first step in the downward
+road to a fixed and permanent melancholia.
+
+  "Hang sorrow, care will kill a cat;
+  And therefore let 's be merry."
+
+  CHAPTER XVI.
+
+ HINTS FOR HOME TREATMENT
+
+   Indigestion; Constipation; Diarrhea; Enemas; Vaginal Douche; Baths;
+   Headache; Fainting; Hemorrhage.
+
+  "Woman is woman's natural ally."
+
+                                                        -- EURIPIDES.
+
+Indigestion.-- The chief causes of indigestion are: eating rapidly,
+eating at irregular hours, eating indigestible foods, constipation,
+and lack of exercise. No one who values her good health will allow
+herself to be hurried through a meal, nor will she allow the
+perplexities of life to be thrust upon her at the table for solution.
+The first requisite for the digestion of foods is that they should be
+well masticated, so that the digestive fluids may act on the finely
+divided particles to the greatest possible advantage. And while
+digestion is going on all mental labor should be held in abeyance, in
+order to avoid drawing the blood away from the stomach to the brain.
+Furthermore, it is a well-known fact that digestion is best performed
+when the meals are served at regular hours.
+
+Constipation leads to the formation of gases in the intestines, to
+fermentation, and to the absorption of toxic materials by the blood.
+
+Through lack of exercise, the appetite fails, the liver becomes
+torpid, and the muscular and nervous systems lose their tone.
+
+The exercise which the housekeeper gets in going around her house is
+not sufficient. Daily exercise in the open air is essential to health;
+as this is to supplement the indoor exercise, the amount taken will
+vary in proportion to the former. For teachers or those who have a
+sedentary occupation an hour's active exercise in the open air-- a
+three-mile walk-- should be supplemented by active gymnastic exercise.
+
+For people in good health, a mixed diet-- that is to say, a diet
+consisting of meat, vegetables, and fruit-- is the best. If the
+individual is not well, then the diet must be adapted to meet the
+needs of that particular case.
+
+Hot breads, all articles of food fried in fats, salads, and pastry are
+difficult to digest. Tea is very constipating, and when taken in
+excessive quantities renders the individual nervous. An excess of
+coffee leads to congestion of the liver.
+
+Where indigestion exists, the simplest and most sensible remedies are
+to regulate the diet, and avoid eating between meals. By drinking a
+glass of water as hot as it can be sipped one hour before each meal,
+the mucus is washed out of the stomach, the stomach is empty on coming
+to the table, and in the best possible condition for the gastric juice
+to act on the food-stuffs.
+
+Constipation.-- Constipation is the rule with the average American
+woman; the causes are their corsets, the tight bands of their
+clothing, lack of exercise, and the fact that they drink too little
+water and too much tea. The most rational means to overcome it is to
+drink more water; at least three pints a day should be taken, in
+addition to soups, tea and coffee, and so forth; the water must be
+taken into the system as such. Then attention must be given to the
+diet; plenty of fruit should be eaten, vegetables, and coarse bread.
+
+Regularity in this, as in all other habits of life, is most essential,
+and the individual should go to the toilet at the same hour every day,
+even if there is no inclination to have a bowel movement, and thus the
+habit will be established; the most convenient time is directly after
+breakfast.
+
+Medical Treatment.-- But if all these means have failed, medicines
+must be resorted to. Cold water is a better laxative than hot; to a
+glassful of cold water add from one teaspoonful to one tablespoonful
+of the effervescing granules of the phosphate of soda, and take this
+the first thing on rising in the morning. This preparation of soda is
+particularly useful because it acts slightly on the liver. Other
+laxatives are: a seidlitz powder dissolved in a glass of cold water on
+rising; a wineglass or more of Hunyadi Janos, also taken on rising.
+Any of these may be taken with safety by pregnant women. For children
+the simplest laxative is one teaspoonful of Husband's milk of
+magnesia, to be taken in one glass of water on rising.
+
+Enemas.-- Perhaps one of the most common methods used by the laity for
+the relief of constipation is the rectal injection, or enema. Enemas
+habitually given to unload the bowels are productive of much harm by
+overdistending the rectum, so that in time the rectum fails to react
+to the normal stimulus-- namely, the presence of the feces-- as it
+otherwise would. But by some means or other the bowels must be well
+moved once every twenty-four hours. And it is much better to use an
+enema than to go to bed without a bowel movement. If the woman is
+going around, so that she can give the enema to herself, the most
+effective way to take it is in the knee-chest position or an
+approximation to this. Either a fountain or bulb syringe may be used
+for this purpose; a quart of water at a temperature of 110∞ F. should
+be prepared by making it into a suds with castile soap, or one
+tablespoonful of glycerin may be added to one pint of water. The nozle
+to be used is the smallest one that comes with the syringe, the
+so-called infant's nozle; this is quite large enough, and its
+insertion is not nearly so painful as the larger ones; the nozle must
+be well greased with vaselin. When everything is ready, the patient
+gets down on her knees with the shoulders near the floor, having first
+loosened all of her bands and taken off her corsets; the nozle is
+introduced as far as it will go into the rectum, and if a bulb syringe
+is used the water must be very gradually squeezed into the rectum,
+otherwise it will not retain so much; or if the fountain syringe is
+used, it must not be hung too high. So soon as the patient feels that
+she has taken all that she can retain, she should lie down on the left
+side, and retain the water as long as possible, as it is thus rendered
+more effective. An enema so taken will be very much more effective
+than one taken in the ordinary manner of sitting on the toilet. In the
+method just described more water can be used and it will be longer
+retained; it can be felt to go up along the course of the large bowel,
+and it will often be found very effective when the ordinary enema
+fails. This enema will often be found to be a very valuable aid in
+curing an obstinate chronic diarrhea, which is kept up by particles of
+feces remaining in the folds of the large intestine. If the patient is
+confined to bed, she should lie on the left side, with a heavy towel
+folded under her to prevent the bed from becoming wet; when the nurse
+withdraws the nozle she should make pressure on the anus with the
+towel, to help the patient to retain the water as long as possible.
+But should the patient have gone so long without a bowel movement that
+all these means fail, it will be necessary to precede the water enema
+with one of oil; or still more effective is the following combination:
+take one teaspoonful of the spirits of turpentine, the yolk of one
+egg, and two tablespoonfuls of olive oil, and beat well together, and
+add to these one pint of water at a temperature of 110∞ F.
+Constipation, however, of so obstinate a character as this demands a
+physician's attention.
+
+Diarrhea.-- A diarrhea may be acute or chronic; the treatment is
+essentially different. For an acute attack accompanied by frequent
+stools and severe abdominal pain the first thing to do is to go to
+bed. If there is nausea, drink a glass of water as hot as can be
+taken, at once; for the diet, a glass of scalded milk, not boiled but
+just allowed to come to the boiling-point, every two hours; and
+nothing else should be taken until the diarrhea is well in check. If
+the pain is severe, a spice plaster over the abdomen will be found to
+be very comforting. It is made as follows: take of powdered allspice,
+cinnamon, cloves, and ginger each two tablespoonfuls, and two
+teaspoonfuls of cayenne pepper; mix well together in a bowl; then
+quilt in a piece of flannel large enough to cover the abdomen; when
+ready for use, dip in hot whisky and apply as hot as the patient can
+bear; cover over with a large napkin, as the plaster produces a deep
+stain which does not wash out; keep on as long as necessary. If the
+rest in bed and the milk diet kept up for twenty-four hours do not
+suffice to cure the diarrhea, it is not wise to take any risks, but
+send for your doctor at once. Or if there should be any blood in the
+stools, do not wait for anything, but send for the doctor without
+delay.
+
+For a chronic diarrhea an enema given in the knee-chest position, as
+already described, will often be found a most efficient remedy. In
+diarrheas the use of fruits and vegetables should be avoided; the best
+diet after the milk is bread well toasted through, toast-water,
+soft-boiled eggs, beefsteak, oyster stew, and clam broth.
+
+Vaginal Douche.-- To be of service except for mere cleansing purposes
+the douche must be taken in the horizontal position, either on a couch
+or, if it is not cold, on the floor. Of course, this position
+necessitates the use of a douche-pan. The douche-pan is best of
+agate-ware, oblong in shape, and with a broad strip which comes under
+the nates. On lying down to take the douche the nates must come down
+well over the pan and the clothing must be pushed well up to prevent
+the water from seeping up the back. To make the woman more comfortable
+there should be a pillow under the head, and she must have a shawl or
+some light woolen material to throw over her while taking the douche
+to prevent chilling; thus doing more harm than good.
+
+There are two forms of syringes on the market: the bag or fountain
+syringe, which is hung up sufficiently high-- about three feet above
+the patient-- to cause the water to flow; and the bulb syringe, in
+which the bulb has to be constantly squeezed by the hand, which is
+tiresome to many women, but this is a much more convenient form to
+have in traveling. During pregnancy the fountain syringe only should
+be used, and it should be hung as low as will enable the water to
+flow. For a woman who has never taken douches it is well to begin with
+a temperature of 110∞ F., gradually increasing the temperature to 118∞
+or 120∞; this is as high as the woman should attempt to go, for a
+higher temperature would burn her, leaving the vulva so sensitive that
+she would only be able to take cool douches for a long time after
+this; a bath thermometer should be used in all cases to test the
+temperature, so that the woman knows exactly what she is doing.
+
+In cases of inflammation of the uterus or its adnexa four quarts of
+water should be used, and the douche should be taken in the horizontal
+position. The water thus acts as a hot poultice about the uterus, and
+the woman will find on rising that some water flows out from the
+vagina. Ordinarily plain hot water is all that is necessary to use,
+but where the discharge is acrid and scalding, the plain hot-water
+douche should be followed by a warm douche containing one teaspoonful
+of borax to a pint of water. The best time for taking a douche is at
+night just before retiring; there is also less danger of taking cold
+when the douche is taken at this time.
+
+The scalding sensations at the vulva may be due to the acidity of the
+urine, in which case it will be increased just after urination; or it
+may be due to an acrid discharge from the vagina. A little observation
+on the part of the patient will enable her to distinguish which is the
+real cause. If there is any trouble with the urine, it should be
+carefully examined at once, as some congestion or inflammation of the
+kidneys is not infrequently present, which if attended to might be
+cured, and which if allowed to run on unattended to, may develop into
+a serious form of Bright's disease.
+
+The genitals should be washed with soap and water night and morning.
+Women who do not suffer from leuchorrhea need not take a vaginal
+douche more than once a week; after the menstrual flow the vaginal
+injection is advised to remove the detritus of the flow.
+
+Baths.-- The most ordinary forms of baths used may be classified under
+sponge-, shower-, sitz-, and tub-baths. The sponge-bath as ordinarily
+taken is of service for cleansing purposes, and if the water be cold
+it tones up the system to some extent, and is so a preventive against
+taking cold. The effect of this bath will be found to be vastly more
+beneficial if salt is added to the bath in the proportion of a pint of
+salt to a gallon of water; either sea-salt may be used or the ordinary
+coarse salt. It is most advantageously taken sitting in a bath or
+hat-tub, so that the entire surface of the body will be wet at the
+same time, and the water can be allowed to run down the back and over
+the chest. It is well to begin these baths at a temperature of 80∞ F.
+and to gradually decrease this until the bath is taken at 70∞, which
+is about the temperature of running water, and the bath should be kept
+up at this. For most people the best time to take the bath is just
+before retiring; this bath is not only very strengthening, but also is
+excellent in cases of insomnia and nervousness.
+
+Shower-baths.-- These may be taken after a hot bath, or taken alone
+after violent muscular exercise. The body should be quickly scrubbed
+off and the shower should be warm at the beginning and gradually
+allowed to become cold, stooping over so as to get the full force of
+the shower on the spine and over the region of the stomach and heart.
+They will be found to be most refreshing after great muscular fatigue,
+and, when taken after the hot tub-bath, greatly lessen the
+susceptibility of the individual to taking cold.
+
+Sitz-baths.-- These are given for their local effect in cases of
+inflammation; whether this inflammation be of the kidneys, bladder, or
+of the uterus and its adnexa. A sitz-tub is necessary to properly take
+this form of bath. The water should be used as hot as is comfortable
+to the patient, from 105∞ to 110∞ F., hot water being added as the
+first cools off; a pint of salt should be added to the gallon of
+water, and the patient should remain in this from five to eight
+minutes. A blanket should be wrapped about the patient so that she
+will be thrown into a perspiration; it is almost needless to say that
+the only time for taking this bath is just before retiring, and that
+this bath does make the woman more susceptible to taking cold, so that
+it is necessary to wear an abdominal woolen bandage day and night.
+
+Tub-baths.-- The tub-bath ought not, as a rule, be taken more than
+twice a week, unless the cold plunge is used, which may be taken every
+day. If the tub-bath is taken hot, the woman should remain in it not
+much longer than is necessary to scrub off with a flesh-brush; this
+bath should be followed either with a cold shower-bath, or the water
+in the tub be gradually allowed to cool off until it is down to 70∞ F.
+
+Headaches.-- Headaches, aside from those of acute illness, may be
+roughly divided into three classes: first, those which are due to
+indigestion; second, neuralgic headaches; and, third, those due to
+pelvic inflammations. The headaches due to indigestion are usually
+located over the eyes and all over the forehead; they are more or less
+constant and are accompanied by other symptoms of indigestion, and
+very often by constipation. The feces are allowed to remain in the
+bowels overlong, the toxic matters are taken up by the blood, and
+headaches and vertigo result.
+
+Neuralgic headaches are of an entirely different character; the pains
+are here of a lancinating character, and are not confined to any one
+region of the head. As a rule, they are accompanied by neuralgic pains
+in other parts of the body. Neuralgia generally means a rundown state
+of the system from overwork, worry, or malaria, and tonics and
+cod-deliver oil are indicated.
+
+A constant dull pain on the top of the head or in the back of the neck
+generally indicates some uterine inflammation, and can only be cured
+by removing the cause. In any case it is very evident that taking the
+various "headache powders" with which the market is flooded will never
+cure the woman of her headaches; and many of these powders are very
+dangerous, especially where the heart is weak, as most of them are
+heart-depressants.
+
+Fainting.-- Fainting may be due to a weak heart, to heart disease, or
+to sudden shock, as on receiving a bad piece of news; during pregnancy
+the close air of a room may cause a woman to faint. The first thing to
+be done is to lay the woman down on the floor or bed with nothing
+under her head; loosen all her clothes about the neck and waist, and
+throw the windows open so that she will get plenty of fresh air. If
+she is able to drink, give her one teaspoonful of aromatic spirits of
+ammonia in four tablespoonfuls of cold water. If the feet are cold,
+place hot-water bottles to them to improve the circulation. And if at
+the end of fifteen minutes she does not show signs of decided
+improvement, give her two tablespoonfuls of whisky in an equal
+quantity of hot water. In the meantime the physician will have been
+summoned. These attacks of fainting often occur in a crowded
+ball-room, and are due to tight lacing and the poor ventilation of the
+room.
+
+Hemorrhage.-- A profuse hemorrhage is the most alarming as well as the
+most dangerous thing which can befall a woman, and the very nearest
+doctor should be summoned until the family physician can be gotten
+there. The woman should be made to lie down wherever she may happen to
+be, her clothes loosened, the windows thrown open, so that she will
+not only have plenty of fresh air, but that the air shall be cool. If
+the blood is coming from the mouth, give her pieces of ice to hold in
+it; if she coughs up the blood, it would be well to put a bag of
+ice-cold water or cloths wrung out of ice-water on the chest. If the
+woman is suffering from a uterine hemorrhage, have her take at once a
+hot vaginal douche, from 118∞ to 120∞ F., and have the foot of the bed
+raised. The head should always be kept low.
+
+Women hold their health in their own hands to a far greater extent
+than they have ever dreamed of; and if the majority of women suffer,
+it is very often their own fault, either because they have disregarded
+nearly every law of health, or have allowed trivial ailments to go on
+until they were almost incurable.
+                               _______
+
+  "The broad mountain-top, with its sunlight and free air, is
+  possible to all of us, if we choose to struggle on and reach it."
+
+                                                  -- Phillips Brooks.
+                          _________________
+
+  GLOSSARY.
+                          _________________
+
+Abortion. The expulsion of the fetus before the end of the third lunar
+month.
+Afferent Nerves. Those nerves which convey the impressions to the
+nerve-centers.
+After-pains. The pains which follow labor and which are caused by the
+contractions of the uterus.
+Amenorrhea. Absence of the menstrual flow.
+Anemia. The so-called thinness of the blood, due to a deficiency of
+red blood-corpuscles.
+Antisepsis. The use of chemical substances which have the power of
+destroying germs.
+Anus. The external circular outlet of the rectum or distal part of the
+large intestine.
+Appendages, Uterine. The Fallopian tubes, the ligaments of the uterus,
+and the ovaries.
+Atrophy. A progressive diminution in the bulk of an organ or tissue.
+Automatic. Involuntary, mechanical.
+
+Bulbi Vestibuli. A plexus of veins on each side of the vestibule.
+
+Capillaries. The terminal and very finest branches of the
+blood-vessels.
+Catamenial Flow. See Menstruation.
+Cellular Tissue. A loose, transparent tissue which surrounds the
+muscles and organs of the body.
+Cerebrum. The upper and larger portion of the brain.
+Chlorosis. Anemia of young women about the time of puberty.
+Climacteric. See Menopause.
+Clitoris. A small, elongated, erectile organ situated at the upper
+part of the vulva.
+Cohabitation. See Coitus.
+Coition. See Coitus.
+Coitus. Syn., coition, copulation, cohabitation, sexual congress,
+sexual intercourse. The carnal union of the sexes.
+Colostrum. A thin albuminous fluid which appears in the breasts at the
+fourth month of pregnancy.
+Conception, or impregnation, is the union of the germ and sperm cell
+which results in a new being.
+Confinement. Childbed, the expulsion of the child from the womb.
+Congestion. The abnormal accumulation of blood in a part.
+Constipation. Costiveness; a state in which there is not a free daily
+evacuation of the bowels, or where the evacuations are hard or
+expelled with difficulty.
+Continence. Abstinence from or moderation in sexual indulgence.
+Copulation. See Coitus.
+Cord, Umbilical. The cord which connects the fetus with the mother.
+Through the blood-vessels contained in this cord the child receives
+nourishment.
+Corpuscle. A very small particle.
+
+Decidua. A membranous sac formed in the uterus during gestation, and
+thrown off after parturition.
+Defecation. The act by which the contents of the bowel are expelled
+from the body.
+Dehiscence. The splitting open of an organ.
+Dentition. The cutting of the teeth.
+Dysmenorrhea. Painful and difficult menstruation.
+Dystocia. A difficult labor.
+
+Embryo. The name applied to the very earliest stages of the child in
+utero; that is, up to about the time of quickening.
+Endometrium. The lining membrane of the uterus.
+Epithelium. A layer of minute cells which forms the covering of many
+membranes.
+Erection. The state of a part which, having been soft, becomes rigid
+and elevated by the accumulation of blood within its tissues.
+
+Fallopian Tubes. Two very small tubes extending from the upper angles
+of the uterus to the ovaries and serving to convey the ova from the
+ovaries to the uterus.
+Feces. Stools; the normal discharge from the bowels.
+Fetus. The child in utero from the time of quickening to that of
+birth.
+Fomentations. The application of cloths which have previously been
+dipped in hot water.
+Function. An action of an organ which could be performed only by that
+organ, and which is necessary to the well-being of the individual.
+
+Generative Organs. Syn., genital, reproductive, sexual; those organs
+in the male and female by means of which a new being is created.
+Genital. See Generative.
+Gestation. See pregnancy.
+Gonorrhea. A highly contagious venereal disease, characterized by an
+inflammatory discharge of mucus from the urethra and prepuce in the
+male, and from the urethra and the vagina in the female.
+Graafian Follicles. Minute ovarian vesicles which contain the ova.
+
+Hemorrhoids. Piles or tumors at or within the anus, and consisting of
+enlarged veins.
+Hymen. The semilunar fold situated at the outer orifice of the vagina
+in the virgin.
+Hypertrophy. The increased activity of a part which leads to an
+increase in its bulk.
+Hypochondriasis. Morbid feelings concerning the health and simulating
+disease.
+
+Impregnation. See Conception.
+Infectious. See Contagious.
+
+Katabolic Nerves are those nerves which stimulate the breaking down of
+tissue.
+
+Labia Majora. Two thick folds of skin which extend backward from the
+mons veneris.
+Labia Minora. Nymphae; two very delicate folds of skin which are
+inside of and protected by the labia majora.
+Labor. See Parturition.
+Lactation. The secretion of milk; nursing, suckling the child.
+Lactiferous Ducts. The milk ducts.
+Leucorrhea. Whites; a whitish or yellowish discharge from the vagina.
+Lochia. A discharge which follows labor and which lasts for about two
+weeks.
+Lying-in. The period which follows childbed.
+Lymphatics. The vessels in which the lymph is carried.
+
+Mammae. The mammary glands; the breasts.
+Marital Relations. See Coitus.
+Massage. A systematic kneading of the muscles.
+Meatus Urinarius. The external orifice of the urethra.
+Meconium. The first discharge from the infant's bowel after birth, and
+which had collected in the intestines during the pregnancy.
+Medulla. The base of the brain at its junction with the spinal cord.
+Menopause. Climacteric, change of life, the time of the natural
+cessation of the monthly sickness.
+Menorrhagia. An excessive menstrual flow.
+Menstruation. Menstrual period, menstrual flow, menses, monthly
+sickness, the monthly discharge of blood from the uterus, which, with
+certain exceptions, recurs monthly from about the age of thirteen to
+forty-six years.
+Metabolism. Transformation changes.
+Metamorphoses. Changes of shape or structure.
+Metrorrhagia. A flow of blood between the menstrual periods.
+Micturition. The act of passing water.
+Miscarriage. The expulsion of the fetus between the twelfth and
+twenty-eighth weeks.
+Molecular. Belonging to the molecules, or the minutest portion of
+anything.
+Mons Veneris. The uppermost part of the vulva, which is a fatty
+cushion covered with hair.
+
+Nerve-center. A nerve station from which orders are transmitted and
+where orders are received.
+Nubile. Puberty, that period of life in which young people of both
+sexes are capable of procreating children.
+Nymphae. See Labia minora.
+
+Ovaries. Two small ovoid bodies, one on each side of the uterus, in
+which the ova are formed.
+Oviduct. See Fallopian tobe.
+Ovulation. The formation of the ova in the ovary, and the discharge of
+the same.
+Ovule. See Ovum.
+Ovum. Germ cell, a small, round vesicle situated in the ovaries, and
+which, when fecundated, constitutes the rudiments of the embryo.
+
+Parturition. Labor, delivery, child-birth, the expulsion of the child
+from the womb.
+Pathologic. Relating to the diseased condition of tie body.
+Pelvis. The bony cavity situated at the lower end of the spinal column
+and supported by the thighs.
+Periodicity. The recurrence of physiologic phenomena at regular
+intervals.
+Periphery. The circumference of an organ.
+Peristaltic Action. An alternate contraction, making small, and
+enlargement of the bowel; it is by this means that foods, etc., are
+forced along its passage.
+Peritoneum. A serous membrane which lines the abdominal cavity, and
+wholly or in part envelopes the organs contained in it; it also partly
+covers the organs contained in the pelvic cavity.
+Phenomena. Remarkable appearances.
+Physical. Pertaining to the body.
+Placenta. After-birth, a soft, spongy, vascular body adherent to the
+uterus, and which is connected with the embryo through the umbilical
+cord.
+Plethora. A condition marked by a superabundance of blood.
+Postpartum Hemorrhage. Hemorrhage following labor.
+Pregnant. Enceinte, gravid; the state of a woman who is with child.
+Premature Labor. The expulsion of the fetus between the end of the
+twenty-eighth week and the time that labor ought to have occurred.
+Propagation. The spreading or extension of a thing.
+Pruritus Vulva. An intense itching of the privates, or vulva.
+Psychic. Pertaining or belonging to the mind.
+Puberty. Sexual maturity; nubility; that period of life in which young
+people of both sexes are capable of procreating children.
+Pubes or Pubis. The lowest and middle part of the pelvis in its
+anterior surface.
+Puerperium. The lying-in after child-birth.
+
+Quickening. The sensation experienced by the mother as the result of
+active fetal movements in the womb.
+
+Rectum. The lower extremity of the large intestine.
+Reflex. The reflection of an impulse from a nerve-center which has
+been received from elsewhere by that center.
+Reproduction. See Generative.
+Respiration. Breathing.
+Rugs. Wrinkles.
+Rut. The copulation of animals.
+
+Septicemia, Puerperal. Childbed fever.
+Sexual. That which relates to sex. See Generative.
+Smegma. A cheesy substance which may collect about the vulva.
+Spermatozoa. The essential male fertilizing elements.
+Sympathetic Nervous System. Presides over involuntary acts; as
+digestion, breathing, etc.
+Syphilis. A venereal disease which is highly contagious by coition,
+contact with the lips, etc.
+
+Tachycardia. Distress in the region of the heart, with palpitation and
+shortness of breath.
+
+Umbilicus. Navel.
+Urea. The most important of the solid constituents of the urine.
+Ureters. The ducts leading from the kidneys to the bladder.
+Urethra. The excretory duct from the bladder for the escape of the
+urine.
+Urination. The act of passing water.
+Uterosacral Ligaments. Ligaments which pass from the uterus to the
+sacrum, and assist in holding the uterus in position.
+Uterus. Womb; the hollow, pear-shaped pelvic organ which is destined
+to retain the child from the moment of its conception until the time
+of its expulsion at birth.
+Utricular Glands. Glands of the uterus.
+
+Vagina. The canal which connects the female internal and external
+organs of generation.
+Vascular. Pertaining to the blood-vessels.
+Vasomotor Nervous System. Comprises the brain, spinal cord, and the
+nerves given off from the cord: this system presides over voluntary
+acts, that is, those acts which are under the control of the will.
+Vestibule. A smooth cavity that exists in the female between the
+perineum and the nymphae.
+Viscera. The contents of the large cavities of the body.
+Vulva. The external genitals, private parts, the female external
+organs of generation.
+Vulvitis. Inflammation of the vulva.
+
+
+
+
+*** END OF THE PROJECT GUTENBERG EBOOK THE FOUR EPOCHS OF WOMAN'S LIFE ***
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+<div style='text-align:center; font-size:1.2em; font-weight:bold;'>The Project Gutenberg eBook of The Four Epochs of Woman's Life by Anna M. Galbraith</div>
+<div style='display:block; margin:1em 0'>
+This eBook is for the use of anyone anywhere in the United States and
+most other parts of the world 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 <a href="https://www.gutenberg.org">www.gutenberg.org</a>. If you
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+country where you are located before using this eBook.
+</div>
+<div style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Title: The Four Epochs of Woman's Life</div>
+<div style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Author: Anna M. Galbraith</div>
+<div style='display:block;margin:1em 0'>Release Date: April 7, 2002 [eBook #4986]<br />
+[Most recently updated: February 23, 2021]</div>
+<div style='display:block;margin:1em 0'>Language: English</div>
+<div style='display:block;margin:1em 0'>Character set encoding: UTF-8</div>
+<div style='display:block; margin-left:2em; text-indent:-2em'>Produced by: Jim Weiler, xooqi.com</div>
+<div style='margin-top:2em;margin-bottom:4em'>*** START OF THE PROJECT GUTENBERG EBOOK THE FOUR EPOCHS OF WOMAN'S LIFE ***</div>
+
+<h4>THE</h4>
+
+<h1>FOUR EPOCHS</h1>
+
+<h4>OF</h4>
+
+<h1>WOMAN'S LIFE</h1>
+
+<h2>A Study in Hygiene</h2>
+
+<h4>BY</h4>
+
+<h2>ANNA M. GALBRAITH, M.D.</h2>
+
+<h5>Author of "Hygiene and Physical Culture for Women"; Fellow of
+the New York Academy of Medicine ; Ex-President of the Alumnae
+Association, Woman's Medical College of Pennsylvania; Attending
+Physician, Neorological Department, New York Orthopedic Hospstal
+and Dispensary.
+</h5>
+
+<hr />
+<h5>WITH AN</h5>
+
+<h4>INTRODUCTORY NOTE</h4>
+
+<h5>by</h5>
+
+<h4>JOHN H. MUSSER, M.D.</h4>
+
+<h5>Late Professor of Clinical Medicine, University of
+Pennsylvania.</h5>
+
+<hr />
+<h4><i>SECOND EDITION, REVISED AND ENLARGED</i></h4>
+
+<h5>PHILADELPHIA AND LONDON</h5>
+
+<h4>W. B. SAUNDERS COMPANY</h4>
+
+<h5>1915</h5>
+
+<hr />
+<h5>Copyright, 1901, by W. B. Saunders and Company. Revised,
+electrotyped, reprinted, and recopyrighted August, 1903.
+Reprinted October, 1904, January, 1907, January, 1911, and April,
+1913</h5>
+
+<hr />
+<h5>Copyright, 1903, by W. B. Saunders &amp; Company.</h5>
+
+<hr />
+<h5>Registered at Stationers' Hall, London, England.</h5>
+
+<hr />
+<h5>Reprinted February, 1915</h5>
+
+<hr />
+<h4>PRINTED IN AMERICA</h4>
+
+<hr />
+<h4>PRESS OF</h4>
+
+<h4>S. SAUNDERS COMPANY</h4>
+
+<h4>PHILADELPHIA</h4>
+
+<hr />
+<blockquote><p>
+"As in a building<br/>
+  Stone rests on stone, and wanting the foundation<br/>
+  All would be wanting, so in human life<br/>
+  Each action rests on the foregoing event<br/>
+ That made it possible, but is forgotten<br/>
+  And buried in the earth."</p></blockquote>
+
+<p class="right">
+&#151; LONGFELLOW.
+</p>
+
+<hr />
+<p class="center">INTRODUCTORY NOTE</p>
+
+<hr />
+<p>IT has been well said that the bulwarks of a nation are the
+mothers. Any contribution to the physical, and hence the mental,
+perfection of woman should be welcomed alike by her own sex, by
+the thoughtful citizen, by the political economist, and by the
+hygienist. Observation of the truths, expressed in a modest,
+pleasing, and conclusive manner, in the essay of Dr. Galbraith
+contribute to this end. These truths should be known by every
+woman, and I gladly commend the essay to their thoughtful
+consideration.</p>
+
+<p class="center">JOHN H. MUSSER, M.D.,</p>
+
+<p class="right"><i>Late Professer of Clinical
+Medicine</i><br/>
+<i>in the University of Pennsylvania.</i></p>
+
+<hr />
+<h3>PREFACE TO THE SECOND EDITION.</h3>
+
+<hr />
+<p>THE author takes this opportunity to thank the medical
+profession and the laity for the very cordial reception which has
+been tendered the first edition of this small volume.</p>
+
+<p>The necessity for the use of technical expressions in a book
+written expressly for the laity must always be a matter of
+regret. And only those who have attempted to write a similar work
+can fully appreciate the truth of Herbert Spencer's remark, that
+"Nothing is so difficult as to write an elementary book on
+scientific subjects."</p>
+
+<p>The author has added to this edition a section on "The Hygiene
+of Puberty," one on "Hemorrhage at the Menopause a Significant
+Symptom of Cancer," and one on "The Hygiene of the
+Menopause."</p>
+
+<p class="right">ANNA M. GALBRAITH.</p>
+
+<p class="letter">15 WEST NINETY-FIRST STREET, NEW YORK.</p>
+
+<hr />
+<h3>PREFACE.</h3>
+
+<hr />
+<blockquote><p>"Ignorance is the curse of God;<br/>
+  Knowledge, the wings wherewith we fly to heaven."
+</p>
+<p class="right"><i>&#151; "Henry VI."</i>
+</p></blockquote>
+
+<p>PERFECT health is essential to perfect happiness. The greater
+the knowledge of the laws of nature, and the more closely these
+laws are lived up to, so much nearer "ideal" will be the health
+and happiness of the individual. Hence the necessity that these
+same laws should be as familiar to the adult man and woman as the
+alphabet. Further, with our present knowledge of the certain
+suffering, disease, and death that are bred by ignorance of all
+these subjects, it is little less than criminal to allow girls to
+reach the age of puberty without the slightest knowledge of the
+menstrual function; young women to be married in total ignorance
+of the ethics of married life; women to become mothers without
+any conception of the duties of motherhood; other women, as the
+time approaches, to live in dread apprehension of "the change of
+life;" and many women unnecessarily to succumb to disease at this
+time.</p>
+
+<p>The masses of women have at last awakened to a sense of the
+awful penalties which they have paid for their ignorance of all
+those laws of nature which govern their physical being, and to
+feel keenly the necessity for instruction at least in the
+fundamental principles which underlie the various epochs of their
+lives; and it is in response to a widespread demand that this
+small volume has been written.</p>
+
+<p>This is preeminently the day of preventive medicine; and the
+physician who can prevent the origin of disease is a greater
+benefactor than the one who can lessen the mortality or suffering
+after the disease has occurred.</p>
+
+<p class="right">ANNA M. GALBRAITH.</p>
+
+<p class="letter">15 WEST NINETY-FIRST
+STREET, NEW YORK.</p>
+
+<hr />
+<h3>CONTENTS</h3>
+
+<hr />
+<h4>INTRODUCTION</h4>
+
+<h4>EDUCATION AS THE CONTROLLING FACTOR IN THE PHYSICAL LIFE OF
+WOMAN</h4>
+
+<h5>Huxley's Definition of Education; the Correlation of Mind and
+Body; the Emotional Nature; Age for Going to School; the Effect
+of the Study of the Scientific Branches; Industrial
+Education</h5>
+
+<hr />
+<h4>PART I.&#151; MAIDENHOOD</h4>
+
+<hr />
+<h4>CHAPTER I.</h4>
+
+<h4><b>PUBERTY</b></h4>
+
+<h5>Sexual Development; Age of Puberty; Physical Changes at
+Puberty; First Onset of Menstruation; Psychic Changes at
+Puberty</h5>
+
+<hr />
+<h4>CHAPTER II.</h4>
+
+<h4><b>HYGIENE OF PUBERTY</b></h4>
+
+<h5>Home Life; Corsets; Shoes; Underwear; Nutrition; Diet; Water;
+Constipation; School Life; Spinal Curvature; Exercise; Walking;
+Running</h5>
+
+<hr />
+<h4>CHAPTER III.</h4>
+
+<h4><b>ANATOMY OF THE FEMALE GENERATIVE ORGANS</b></h4>
+
+<h5>The Vulva; the Hymen; Condition of the Hymen as a Proof of
+Virginity; the Bladder; Vagina; Uterus; Respiratory Movements of
+the Uterus; Fallopian Tubes; Ovaries</h5>
+
+<hr />
+<h4>CHAPTER IV.</h4>
+
+<h4><b>PHYSIOLOGY OF THE FEMALE GENERATIVE ORGANS</b></h4>
+
+<h5>Ovulation; Etiology of Menstruation; Uterine Nerve-supply;
+the Function of the Uterus; Stages of the Menstrual Cycle;
+Average Duration of the Menstrual Flow; Character of the Flow;
+Relation of Ovulation to Menstruation; the Menstrual Wave;
+Definition of Menstruation; Premonitory Symptoms of the Flow;
+Hygiene of Menstruation</h5>
+
+<hr />
+<h4>CHAPTER V.</h4>
+
+<h4><b>THE ANOMALIES OF MENSTRUATION</b></h4>
+
+<h5>Menorrhagia and Metrorrhagia; Dysmenorrhea; Amenorrhea;
+Leucorrhea; Pruritus Vulva</h5>
+
+<hr />
+<h4>CHAPTER VI.</h4>
+
+<h4><b>THE MARRIAGE QUESTION</b></h4>
+
+<h5>Herbert Spencer's Definition of Love; What Constitutes a
+Suitable Husband; Best Age for Marriage; Shall Cousins Marry?
+Contraindications to Marriage; Do Reformed Profligates Make Good
+Husbands? the Proper Length of Time for the Engagement; the Right
+Time of the Year to Marry; the Selection of the Wedding Day</h5>
+
+<hr />
+<h3>PART II.&#151; MARRIAGE</h3>
+
+<hr />
+<h4>CHAPTER VII.</h4>
+
+<h4><b>THE ETHICS OF MARRIED LIFE</b></h4>
+
+<h5>The Wedding Journey; the Ethics of Married Life; Shall
+Husband and Wife Occupy the Same Bed? the Consummation of
+Marriage; the Marital Relation; Times when Marital Relations
+Should be Suspended</h5>
+
+<hr />
+<h4>CHAPTER VIII.</h4>
+
+<h4><b>SEXUAL INSTINCT IN WOMEN</b></h4>
+
+<h5>Sexual Instinct in Women; Excessive Coitus; Causes of Sexual
+Excitability</h5>
+
+<hr />
+<h4>CHAPTER IX.</h4>
+
+<h4><b>STERILITY</b></h4>
+
+<h5>Sterility; the Prevention of Conception and the Limitation of
+Offspring; the Crime of Abortion; Infidelity in Women</h5>
+
+<hr />
+<h3>PART III.&#151; MATERNITY</h3>
+
+<hr />
+<h4>CHAPTER X.</h4>
+
+<h4><b>PREGNANCY</b></h4>
+
+<h5>Nature of Conception; Pregnancy Defined; Duration of
+Pregnancy; the Signs of Pregnancy; Quickening; the Determination
+of Sex at Will; the Influence of the Male Sexual Element on the
+Fernale Organism; Heredity; Hygiene of Pregnancy; Causes of
+Miscarriage</h5>
+
+<hr />
+<h4>CHAPTER XI.</h4>
+
+<h4><b>THE CONFINMENT</b></h4>
+
+<h5>Preparation for the Confinement; Signs of Approaching Labor;
+Symptoms of Actual Labor; The Confinement-bed; the Process of
+Labor</h5>
+
+<hr />
+<h4>CHAPTER XII.</h4>
+
+<h4><b>THE LYING-IN</b></h4>
+
+<h5>Management of the Lying-in; Lactation; Nursing</h5>
+
+<hr />
+<h4>CHAPTER XIII.</h4>
+
+<h4><b>THE NEW-BORN INFANT</b></h4>
+
+<h5>The Infant's Toilet; the Crib; Feeding of Infants; the
+Wet-nurse; Artificial Feeding; Characteristics of Healthy
+Infants; the Stools; Constipation; Urination; Teething</h5>
+
+<hr />
+<h3>PART IV.&#151; THE MENOPAUSE</h3>
+
+<hr />
+<h4>CHAPTER XIV.</h4>
+
+<h4><b>THE MENOPAUSE</b></h4>
+
+<h5>Average Duration of the Menstrual Function; Duration of
+Menopause; the Menopause; General Phenomena of the Menopause;
+Prominent Symptoms of Menopause; Pathologic Conditions of
+Menopause; Hemorrhage at the Menopause a Significant Symptom of
+Cancer; Causes of Suffering at Menopause</h5>
+
+<hr />
+<h4>CHAPTER XV.</h4>
+
+<h4><b>HYGIENE OF THE MENOPAUSE</b></h4>
+
+<h5>Diet; Constipation; Stimulants; the Kidneys; Skin; Turkish
+Baths; Massage; Exercise; Profuse Menstruation; Hemorrhage;
+Mental Therapeutics</h5>
+
+<hr />
+<h4>CHAPTER XVI.</h4>
+
+<h4><b>HINTS FOR HOME TREATMENT</b></h4>
+
+<h5>Indigestion; Constipation; Enemas; Diarrhea; Vaginal
+Douch&eacute;, Baths; Headache; Fainting; Hemorrhage</h5>
+
+<hr />
+<h4><b>GLOSSARY</b></h4>
+
+<hr />
+<h3>THE</h3>
+
+<h2>FOUR EPOCHS</h2>
+
+<h4>OF</h4>
+
+<h1>WOMAN'S LIFE</h1>
+
+<hr />
+<h2>INTRODUCTION.</h2>
+
+<hr />
+<h4><b>EDUCATION AS THE CONTROLLING FACTOR IN THE PHYSICAL LIFE
+OF WOMAN.</b></h4>
+
+<h5>Huxley's Definition of Education; the Correlation of Mind and
+Body; the Emotional Nature; Age for Going to School; the Effect
+of the Study of tuse Scientific Branches; Industrial
+Education.</h5>
+
+<blockquote><p>         "What is man,<br/>
+ If his chief good, and market of his time,<br/>
+ Be but to sleep and feed? A beast; no more.<br/>
+ Sure, He that made us with such large discourse,<br/>
+ Looking before and after, gave us not<br/>
+ That capability and godlike reason<br/>
+ To fust in us unused."
+</p>
+<p class="right"><i>&#151; "Hamlet."</i>
+</p></blockquote>
+
+<p>THE word education is here used in its broadest sense, and is
+meant to include the physical, mental, intellectual, and
+industrial. Huxley's definition is as follows: "Education is the
+instruction of the intellect in the laws of nature, under which I
+include not only things and their forces, but men and their ways;
+and the fashioning of their affections and of the will into an
+earnest and living desire to move in harmony with these laws.
+That man, I think, has had a liberal education who has been so
+trained in his youth that his body is the ready servant of his
+will, and does with ease and pleasure all the work that, as a
+mechanism, it is capable of; whose intellect is a clear, cold,
+logic engine, to be turned to any kind of work, to spin the
+gossamers as well as to forge the anchors of the mind; whose mind
+is stored with the great and fundamental truths of nature and the
+laws of her operations; one whose passions are trained to come to
+heel by a vigorous will, the servant of a tender conscience; one
+who has learned to love all beauty, whether of nature or of art,
+to hate all vileness, and to respect others as himself."</p>
+
+<p><b>The Correlation of Mind and Body.</b>&#151; It is of the
+utmost importance that the mutual reaction of mind and body upon
+each other should be thoroughly understood. This reaction is so
+constant, so intricate, and so complex that it is at times
+difficult to say which is cause and which effect. Does the
+depressed state of the mind cause the indigestion, or is a torpid
+liver the real seat of the melancholia?</p>
+
+<p>The brain is the most delicately constructed organ in the
+entire body. In the lower animals the brain is simply the great
+nerve-center which, with its prolongation the spinal cord,
+presides over all the functions of life which differentiate the
+animal from the vegetable. In the human being the brain is much
+more highly developed and complicated; and is, in addition, the
+seat of the mind, the intellect, and the affections. Like all the
+other tissues of the body, the brain receives its nourishment
+from the blood-vessels which pass through it, and its healthy
+maintenance is in a direct ratio to the condition of its
+blood-supply.</p>
+
+<p>A most interesting psychologic study is found in the case of
+cerebral paralysis of young children, where there is mental
+defect amounting to stupidity or imbecility, accompanied by
+extensive paralysis of the body, so that the child is not able to
+sit up. With the gradual improvement of the physical condition,
+so that the muscles become firm and the child can sit, stand, and
+even walk, there is a corresponding mental development; from
+being stupid and dull, the expression of the face brightens and
+becomes intelligent; the child talks quite as well as other
+children of its age, and sometimes becomes really intellectually
+precocious. Here we see the development of the brain as a direct
+result of the improved physical condition. In certain cases of
+insanity, on the contrary, we find that the wasting away of the
+body results from the disease of the brain, <i>i. e.,</i> the
+disease of the brain has wrought the wreck of the body.</p>
+
+<p>From these pathologic studies, or studies of how the diseased
+state of the brain and body may be overcome by physical
+development, on the one hand, and, on the other hand, how the
+healthy body may be wrecked by disease of the brain, we will turn
+to a consideration of the effect of the development of the mind
+and intellect upon the physical health.</p>
+
+<p>On a girl's entering Vassar College an exact and detailed
+physical examination is made by the resident physician, a health
+record is kept during her stay there, and at the time of her
+graduation a final physical examination is made. As a result of
+these statistics Dr. Thelberg says: "These statistics, now
+covering a number of years, show that not only can girls
+profitably take a college education, that is accomplished; but
+will prove that grave physical imperfections can be corrected in
+the period between eighteen and twenty-two years of age,
+coincidently with the development of the mind along the lines of
+college work; the college work, if not excessive in amount, being
+a real and most important factor in the physical
+development."</p>
+
+<p>But a still more striking proof can be cited of the beneficial
+result of mental and intellectual occupation upon the bodily
+health. At Vassar a great deal of attention is very properly paid
+to general hygiene and the physical development, in addition to
+the natural advantages of outdoor life in the country.</p>
+
+<p>Take, for example, a woman's medical college located in the
+city: the four years' course places the greatest strain on both
+mind and body; practically no time is left for recreation, and
+very much too little time is spent in sleep; the amount of
+exercise taken is the minimum. Yet in spite of all these
+disadvantages under which the young women labor, a great many of
+them who enter far below par in health, or, indeed, on the fair
+road to become chronic invalids, graduate very greatly improved
+in health.</p>
+
+<p><b>The Emotional Nature.</b>&#151; Formerly much more than
+now, owing to the defective methods of her education and mode of
+life, the emotional nature of woman was allowed to run riot. The
+child was coddled; the girl was allowed to grow up without any of
+the discipline which young men receive in their college and
+business life, and little or no attention was paid to her
+physical development. The woman naturally became a bundle of
+nerves, highly irritable, unreasonable, and hysterical. All this
+reacted in the most detrimental manner upon her physical
+health.</p>
+
+<p>The seed for much of this emotional hyperesthesia is sown in
+childhood. From birth until the end of the eighth year should be
+one grand holiday. During this time the child develops very
+rapidly, especially during the first two years of life. And at
+the end of the eighth year the brain has attained to within a few
+ounces of its full weight. The muscular system has been developed
+together with the coordination of motion. The child has learned
+to use a language fairly well; she has developed an excellent
+memory and is most inquisitive and acquisitive.</p>
+
+<p>Another method for undermining the healthy tone of the nervous
+system is the intricate dances taught very young children and
+then placing them on public exhibition, where they are wrought up
+to the highest pitch. From a purely medical standpoint, children
+under eight years of age should not be allowed to take dancing
+lessons. After this age a moderate amount of dancing in a
+well-ventilated room is good exercise.</p>
+
+<p>Children's parties belong in the same category, and, on
+account of the injurious effects on the nervous system, should be
+tabooed. They are too exciting, and cause an overstimulation of
+the nervous system and a precocious childhood and puberty.</p>
+
+<p>Instead of rearing an oversensitive hot - house plant that
+must be fragile in the extreme, strive to rear a sturdy plant
+that can hold its own amid the storms. The child should spend as
+much of its life as possible in the open air, and in the warm
+months live out-of-doors. City children should be taken to the
+seashore or country to spend several months every summer.
+Together with outdoor sports, gymnastics adapted to the age of
+the child should be begun early and continued throughout life.
+Good muscular development is attended with good digestion and a
+well-balanced nervous system.</p>
+
+<p>Until after the twelfth year there should be absolutely no
+difference between the physical, mental, or industrial education
+of girls and boys. And, still further, they should be encouraged
+to have their sports together; this will improve the girls
+physically and broaden them mentally, and will do a great deal to
+take the rough edges off the boys. After this age it will be wise
+to allow slight barriers to grow up, without calling the
+attention of any one to the fact, that will cause the
+companionship to be less free and unrestrained.</p>
+
+<p><b>Age for Going to School.</b>&#151; Although the child may
+be allowed to go to kindergarten long before this time, it should
+not be allowed to enter the school-room before eight years of
+age. And from eight to twelve years, not more than four hours a
+day should be spent in study. After this time it may be put down
+more closely to intellectual work; but no more mental work should
+be required than will enable the girl to enter college at
+eighteen. And eighteen years of age is as young as any girl
+should be allowed to go to college; after this age the mind is
+more matured and acquires knowledge more easily than before,
+while the development of the body is less rapid. The physical
+system has become more stable. The literature indulged in by
+girls under eighteen years of age should be most carefully
+selected.</p>
+
+<p><b>The Effect of the Study of the Scientific
+Branches.</b>&#151; A knowledge of the laws of nature is
+essential to health; hence the necessity for the study of the
+natural sciences&#151; anatomy, physiology, chemistry, physics,
+and zoology. Aside from the intrinsic value of this knowledge, it
+is almost universally conceded that these studies develop the
+judgment; and no one will have the temerity to deny that a lack
+of judgment must undermine the health as well as the success and
+happiness of the individual.</p>
+
+<p><b>Industrial Education.</b>&#151; When it is considered how
+intimate are the relations between the physical and the psychic
+states, and how often the psychic condition leads to actual
+disease, and that often of the most incurable type, it needs no
+demonstration that a mental occupation which will take the woman
+out of herself is a physical necessity. Therefore when the girl
+has reached the subjective limit of her intellectual
+education,&#151; that is, when she has reached the limit of her
+capacity or taste,&#151; it is essential to her physical
+well-being that she should turn her attention to some industrial
+occupation. This may be housekeeping or any other occupation for
+which she has taste or talent. A healthy mental occupation is an
+absolute necessity to prevent the individual from becoming
+self-centered. And to become self-centered is the first step on
+the certain road to chronic invalidism.</p>
+
+<p>A most important part of an education is the knowledge of how
+to procure the most perfect development of the body possible, and
+how to maintain the health. This has not been touched upon here,
+since the outlines for the general physical education have
+already been given in "Hygiene and Physical Culture for Women,"*
+and the present volume concerns itself only with the four
+critical epochs of woman's life.</p>
+
+<p class="footnote">* By Anna M. Galbraith, M. D.; published by
+Dodd, Mead &amp; Co.</p>
+
+<p>With this broad view of an education, as a means to procure
+the best physique possible; a mind disciplined to meet to the
+greatest advantage all the vicissitudes of life; an intellect
+developed along the lines of its greatest possibilities; and an
+occupation chosen in accordance with the tastes and talents of
+the individual; it becomes an incontrovertible fact that <i>the
+education is the controlling factor</i> in the physical life of
+every woman.</p>
+
+<hr />
+<p class="center">"Be not simply good; be good for
+something."</p>
+
+<p class="right">THOREAU.</p>
+
+<hr />
+<h3><b>PART I.&#151; MAIDENHOOD.</b></h3>
+
+<hr />
+<h4><b>CHAPTER I.</b></h4>
+
+<h4><b>PUBERTY.</b></h4>
+
+<h5>Sexual Development; Age of Puberty; Physical Changes at
+Puberty; First Onset of Menstruation; Psychic Changes at
+Puberty.</h5>
+
+<blockquote><p>"Self-reverence, self-knowledge, self-control,<br/>
+  These three alone lead life to sovereign power."
+</p>
+<p class="right"><i>&#151; "OEnone."</i>
+</p></blockquote>
+
+<p><b>Sexual Development.</b>&#151; Sexual development goes on
+during all the years of childhood, but is not complete in the
+female sex until between the twenty-second and the twenty-fifth
+year. If the child has no inherited taint, and has been properly
+educated morally, physically, and intellectually, it must follow
+that the structural development of the pelvic organs has been
+normal; and normal organs always perform their functions
+perfectly.</p>
+
+<p>The commencement of the ovarian function does not cause any
+more profound change in the system and habits than does
+dentition. The various epochs of life are generally spoken of as
+if they were paroxysmal&#151; as though they were separated by
+some tremendous chasm, which had to be leapt over or fallen into.
+Nature makes no such egregious blunders; preparations for every
+change in life have been going on for a very long time before the
+evidences of such change become manifest.</p>
+
+<p>In a healthy girl the psychic and physical changes incident to
+puberty occur so gradually as to escape the girl's own notice.
+The first and, if the girl has not been properly prepared for it,
+always startling change is the appearance of the menstrual flow.
+The mother who has not told her daughter of this coming change in
+her life before it is due has committed a serious error; it is no
+uncommon occurrence for girls who know nothing of this function
+to get into a tub of cold water to stop the flow; and if they
+stay in long enough, it generally does stop, and the girl's
+health may be ruined for life.</p>
+
+<p>The opinion of Dr. Ely van de Warker is that "if healthy
+ovulation is the outcome of healthy childhood, the function will
+obey the law of periodicity year by year, and all this time the
+young woman will be able to sustain uninterrupted physical and
+intellectual work as well as the young man. Not that the laws of
+health may be violated with impunity at puberty or any other time
+of a woman's life; but a law of health is no more binding upon a
+young woman than it is upon a young man; and there really is no
+such thing as one law for women and another for men."</p>
+
+<p><b>Age of Puberty.</b>&#151; In the temperate regions the age
+of puberty is reached between the ages of twelve and fourteen
+years. The girl is then said to be nubile; that is, as soon as
+menstruation appears it is possible for her to bear children; but
+she is by no means sufficiently developed to do so, as she
+herself will not be completely developed physically or mentally
+before the age of twenty-two or twenty-five years.</p>
+
+<p><b>Physical Changes at Puberty.</b>&#151; The physical changes
+that gradually take place, beginning at the time of puberty, are:
+the breasts, pelvis, and neck enlarge; hair develops over the
+pubis and in the arm-pits; the voice alters. As a rule, women
+continue to grow in stature until the twenty-fifth year. It is
+said that brunettes develop sooner than blondes, and that large
+women develop more slowly than women of small stature; city girls
+develop younger than girls brought up in the country. Whatever
+stimulates the emotions causes a premature development of the
+sexual organs; as children's parties, late hours, sensational
+novels, loose stories, the drama and the ball-room, talk of
+beaux, of love and marriage, and children being surrounded with
+the atmosphere of riper years. It is generally believed that
+early stimulation of the sexual instincts leads to the premature
+establishment of puberty, as do also spiced foods and alcoholic
+beverages.</p>
+
+<p><b>First Onset of Menstruation.</b>&#151; Sometimes the first
+menstrual discharge appears suddenly, lasts for a few days, and
+then stops; it may appear after an interval of two or three
+weeks, or not for several months. If for several months the flow
+appears at the regular time, and the quantity is about the same
+as the first, the menstrual habit may be said to be established.
+The mode of onset varies considerably within the limits of
+health. So long as the general health remains good, no anxiety
+need be felt in regard to the establishment of the menstrual
+function.</p>
+
+<p>In other cases there may be a discharge of blood at the first
+period, and none afterward for several months; in other words,
+menstruation may be established suddenly, intermittently, or
+gradually. It must be remembered that certain pathologic
+conditions cause many disturbances connected with the onset of
+puberty.</p>
+
+<p><b>Psychic Changes at Puberty.</b>&#151; The angular, gawky
+feeling gradually disappears; the girl becomes self-conscious;
+new impulses arise, and she gives up many of the hoydenish ways
+of childhood. The girl's imagination is more lively, and just at
+this time mathematics form an excellent subject for mental
+occupation. The girl now begins to question the whys and
+wherefores, and demands reasons for the course that is laid out
+for her, and is full of ideas of her own; so that while as a
+child she had accepted almost unquestioningly the commands of her
+parents, she can be managed now only through the power of reason.
+And this is just as it should be, for the girl has reached the
+years of discretion, and now is the time when her reason and
+judgment are capable of rapid cultivation.</p>
+
+<h3>CHAPTER II.</h3>
+
+<h4><b>HYGIENE OF PUBERTY.</b></h4>
+
+<h5>Home Life; Corsets; Shoes; Underwear; Nutrition; Diet; Water;
+Constipation; School Life; Spinal Curvature; Exercise; Walking;
+Running.</h5>
+
+<blockquote><p>"Every man is the architect of his own fortune."
+</p>
+<p class="right">PSEUDO-SALLUST.
+</p></blockquote>
+
+<p><b>Home Life.</b>&#151; With beginning menstruation the
+equilibrium of the body is very easily disturbed, so that even in
+the case of the healthy girl some precautions should be taken and
+a rational regime should be adhered to; while in the case of the
+delicate girl a still more careful attention will have to be
+directed toward her weak points, in order that she may develop
+into a healthy woman.</p>
+
+<p>For every girl at this time of life home is preeminently the
+place; so that she may not only have the benefit of a mother's
+watchful care, but also lead a life as free from
+conventionalities and as much in the open air as possible. No
+girl should be sent away to school at this period of rapid growth
+and development; nor should girls of the working classes, when it
+can possibly be avoided, be sent out to fill positions as clerks
+in illy ventilated stores, in factories, or as domestics. If a
+girl can be kept at home until she is eighteen years old, she
+will be a much stronger, healthier woman than would otherwise be
+possible.</p>
+
+<p><b>Corsets.</b>&#151; At this period of life it is
+particularly necessary that the clothing should be warm and at
+the same time sufficiently loose to prevent the constriction of
+any part of the body. And whatever the adult woman may elect to
+do in the matter of wearing corsets herself, she does her young
+daughter an irreparable injury by constricting and moulding her
+growing body in these corset-splints. Corsets placed on the young
+girl interfere with the functions of circulation, respiration,
+digestion, and of the pelvic organs, also with muscular
+development. In addition to all this, the girl is handicapped in
+taking all outdoor exercises and athletic sports.</p>
+
+<p>The lungs, heart, and great blood-vessels are placed in and
+completely fill an air-tight, distensiblecage, which is most
+distensible at its base.</p>
+
+<p>The least chest girth of the adult woman&#151; that is, the
+under-arm girth around the chest&#151; that is consistent with
+health is twenty-eight inches; and this girth must be enlarged
+three inches in forced inspiration. In ordinary respiration the
+waist expansion should be one-half to one inch, while during
+great muscular activity it should be from one and a half to three
+or four inches. One-third of the lungs lie below the point of
+beginning corset pressure, so that with tight corsets this amount
+of lung substance must be more or less useless.</p>
+
+<p>It is self-evident that any restriction placed about the
+waist, by preventing the full expansion of the ribs and the
+descent of the diaphragm, will further embarrass the heart's
+action by diminishing the amount of room it has to work in, at
+the same time that it diminishes the amount of oxygen which is
+inspired. Fresh air is by far the most important part of the
+daily food. It is in the lungs that the blood throws off its
+carbonic acid and other impurities; but it is able to do this
+only when the lungs are supplied with an abundance of oxygen.
+Every inch which a woman adds to her chest measure adds to the
+measure of her days.</p>
+
+<p>Great physical injury has followed women playing lawn-tennis
+while tightly corseted. And although dancing is a much milder
+exercise, since it frequently takes place in an overheated and
+poorly ventilated room, fatal results occasionally occur from the
+same cause.</p>
+
+<p>Standing erect calls into action almost all the muscles of the
+trunk, neck, and lower extremities. So long as the line of
+gravity falls within the area of the feet, the muscular effort
+required is so slight that it is little more than the tonicity
+contained in all living muscle. The greater the displacement of
+the line of gravity, the greater the muscular effort required to
+maintain the equilibrium of the body. Up to a certain extent,
+exercising the muscle develops the strength and size of the
+muscle. On the other hand, when a muscle within the body is
+unused, it wastes; when used within certain limits, it grows. But
+when the corset splint is applied to the body of the young girl,
+it supplants the functions of the abdominal and back muscles,
+which is to hold the trunk erect, and these muscles gradually
+grow weak and waste. And so the liability to the various spinal
+curvatures is increased.</p>
+
+<p>The original object of the corset was to give greater
+prominence to the hips and abdomen. But fashions change! In "the
+French figure" or straight-front corset now in vogue the pelvis
+is tilted forward, producing a sinking in of the abdomen and a
+marked prominence of the hips and sacrum, necessitating a
+compensatory curve of the spine which increases the curvature
+forward at the small of the back&#151; a deformity which, a few
+years ago, women were going to orthopedic surgeons to have
+corrected. In this attitude the line passing through the centre
+of gravity strikes the heels, the knees are hyper-extended, and
+the muscles of the calves and thighs are rendered tense.</p>
+
+<p>By interfering with the muscular development and digestion,
+the girl is very apt to become angular, flat-chested, anemic, and
+to have a muddy complexion. And so the corset really defeats the
+object for which it was put on&#151; that of giving the girl a
+good figure and enhancing her beauty.</p>
+
+<p>There is no objection to girls wearing any of the various
+forms of hygienic waists now on the market.</p>
+
+<p><b>Shoes.</b>&#151; The feet are the part of the body to come
+in contact with the greatest degree of cold, whether on the floor
+of the house or the pavement of the street. Hence it is a matter
+of prime importance to the entire body that the feet should be
+properly clad.</p>
+
+<p>The thick-soled, flat-heeled shoes which became popular with
+bicycling and golf are most hygienic, and it is highly desirable
+that this style of shoe should be adhered to for outdoor
+exercise.</p>
+
+<p><b>Underwear.</b>&#151; In our cold and changeable climate the
+most suitable undergarment is the "combination" woolen undersuit,
+which reaches from neck to ankles and has long sleeves. Much
+greater warmth is afforded when the undersuit is moderately tight
+fitting. Such a suit should be worn the entire year, the grade of
+weight being adapted to the season.</p>
+
+<p><b>Nutrition.</b>&#151; The nutrition of the body is dependent
+on the food supply, digestion and excretion. The growing girl
+should eat more than the adult woman, because of her more active
+life and of the fact that the food which she takes must not only
+replace the worn-out material of the body, but also provide new
+material needed for growth. Insufficient food and food of
+defective quality and composition work proportionately for more
+harm during the growing age.</p>
+
+<p>The full adult weight is not attained before the twenty-fifth
+year. When the final growth of the body and development of the
+vital organs is completed, the function of food is simply to
+replace waste with new material and to furnish material for the
+development of force.</p>
+
+<p><b>Diet.</b>&#151; The diet should be a mixed one, consisting
+of the various kinds of fresh meats, fish, milk, eggs, poultry,
+vegetables, fruit, and fat in the shape of cream, butter, and the
+fat of beef and mutton. Animal food improves the condition of the
+muscles, which are made firmer than they would be through a
+vegetable diet. Meat in general has a more stimulating effect
+upon the system and is more strengthening than vegetable food,
+and it gives rise to a sensation of energy and activity. The
+common estimate is that meat should occupy one-fourth and
+vegetable food three-fourths of a mixed diet.</p>
+
+<p>Common salt in moderate quantity is essential, but all highly
+spiced or seasoned foods should be avoided, also pickles and
+vinegar. All "sweets" are harmful, because they destroy the
+appetite for other things and upset the digestion. Tea and coffee
+should be tabooed, as well as all alcoholic beverages.</p>
+
+<p>Good digestion depends for the most part on serving the meals
+at the same hour every day, eating leisurely, and masticating the
+food well. There is a great tendency on the part of the school
+girl to sleep late in the morning, then "bolt" her breakfast in
+order to get to school in time. Nothing could be more pernicious
+to the digestion, unless it is the eternal nibbling of candy.</p>
+
+<p>A healthy girl needs nothing between meals. A delicate girl
+will be the better for a glass of milk in the middle of the
+morning and at bed-time; or pure beef juice may be given
+instead.</p>
+
+<p><b>Water.</b>&#151; Water is needed to keep the kidneys
+properly flushed. The amount of urine secreted during the
+twenty-four hours should be three pints. Of course it will be
+less than this if the quantity of water is insufficient. In
+addition to the urine about ten ounces of water are lost from the
+surface of the lungs, and eighteen ounces from the skin, making a
+total of about five pints; and this quantity of water must be
+taken daily in order to maintain the equilibrium of the body. The
+solid food of a mixed diet contains from fifty to sixty per cent.
+of water, so that about twenty-five ounces of water are taken
+into the system daily as an integral part of the food. In
+addition, three pints more should be taken as plain water. The
+bladder acts as a reservoir for the urine, and should be emptied
+at least three or four times a day.</p>
+
+<p><b>Constipation.</b>&#151; In order to keep the digestive
+system in good condition, the refuse matter which collects in the
+lower bowel must be evacuated <i>every</i> day. And in order to
+secure this regular bowel movement, regularity in the time of
+going to the toilet is a prime necessity. And now is the time
+when the habits of a lifetime are being formed. If a tendency to
+constipation exists, it can almost always be overcome by
+increasing the amount of fruit and vegetables eaten, also by
+eating cracked wheat, oatmeal, corn and graham bread; all of
+which increase the peristaltic action of the intestines. The
+small amount of water taken by girls and women is another fertile
+source of constipation.</p>
+
+<p><b>School Life.</b>&#151; When it is considered that fully
+one-half of the girl's waking hours are spent in school or in
+study preparing for school, it becomes evident that the girl's
+attitude at her desk should be the correct one. The malpositions
+at the desk are the most frequent cause of lateral curvatures,
+round shoulders, and flat chests. And these deformities are more
+common in girls than they are in boys.</p>
+
+<p>The common faults of the desk and seat leading to these
+malpositions are unsuitable shape of the back of the seat, too
+great a distance between the seat and the desk, and the incorrect
+slope of the desk.</p>
+
+<p>The edge of the desk should slightly project over the edge of
+the chair. The top of the desk should incline downward about ten
+degrees toward the student, and be low enough to allow the
+forearm to rest on it without raising the shoulder. The seat
+should be sufficiently deep to support almost the entire thigh,
+and close enough to the floor to allow the soles of the feet to
+rest firmly on it. The back of the chair should be arched so as
+to support the hollow of the back, and should reach just above
+the lower part of the shoulder-blades, and so make it easy and
+comfortable for even a weakly child to sit upright.</p>
+
+<p>If the seat is too high, the feet do not rest on the floor,
+and so the girl does not get the proper aid from the legs and
+feet to maintain an erect position. If the desk is too high, the
+elbow can rest on it only by curving the spine and raising the
+shoulder. The work is brought too close to the eyes and causes
+extra strain. If the desk is too low, the child stoops over it
+and becomes round-shouldered, and there is a tendency to become
+short-sighted.</p>
+
+<p>The pupil should sit erect with the weight equally borne by
+both buttocks; the legs should be straight before the trunk, and
+the feet firmly resting on the floor. The book should be held
+about twelve inches from the eyes.</p>
+
+<p><b>Spinal Curvatures.</b>&#151; It should be distinctly borne
+in mind that lateral curvature of the spine is a distortion of
+growth. The deformity appears and is developed during the growing
+years. It is more common in girls than in boys, for two reasons:
+that at the age when lateral curvature is first seen, girls grow
+more rapidly than boys; and their muscular system is less well
+developed.</p>
+
+<p>In most early cases the faulty attitudes are clearly the
+result of muscular weakness. The growth in size has not been
+accompanied by a corresponding development of the muscles. This
+condition is most frequently met with in rapidly growing girls,
+and it is one of the most common causes of lateral curvature. In
+these cases proper gymnastics are indicated, but they should be
+prescribed and carried out with much care.</p>
+
+<p>It is upon the erectness, suppleness, and strength of the
+spinal column that most of the power and grace of the body
+depend.</p>
+
+<p>Lack of ventilation is a fertile cause of headache, anemia (or
+an impoverished condition of the blood in iron and oxygen), and
+dyspepsia. All these are rare before but common after twelve
+years of age.</p>
+
+<p><b>Exercise.</b>&#151; In physical culture the object aimed at
+should be the symmetrical development of all the muscles of the
+body. Hence the necessity for bringing every individual muscle
+into play, at first for its development, and later for its
+maintenance.</p>
+
+<p>The tendency of almost all forms of exercise is to develop
+some portion of the body at the expense of the rest. The most
+perfect form of exercise is therefore that one which will most
+nearly call into play all the muscles of the body.</p>
+
+<p><b>Walking.</b>&#151; Walking is the only form of exercise
+which may be said to be universal. In walking the muscles of the
+chest get little exercise, and those of the spine and abdomen
+even less. In walking the arms should swing easily at the sides,
+both from a physiological and an esthetic point of view. If the
+girl is weak or is unaccustomed to take any exercise, the guide
+for the amount of exercise taken at any one time must be this: At
+the first sense of fatigue, stop at once and rest, otherwise
+positive harm instead of good may be accomplished. The girl who
+depends on walking for her outdoor exercise should walk at least
+three miles every day, and walk at the rate of three miles an
+hour.</p>
+
+<p>After acquiring as great a walking speed as is consistent with
+a graceful and easy carriage, the running exercise should be
+begun, gradually increasing the distance, but not the rate of
+speed.</p>
+
+<p>In exercising, all tight clothing about the neck, chest, and
+waist must be removed. Pure air and full breathing are required
+during and after exercise. Full breathing not only promotes the
+change of air in the lungs, but also quickens the functions of
+the circulation and digestion. Eating must be avoided shortly
+before or shortly after any considerable exercise, as it impairs
+digestion.</p>
+
+<p><b>Running.</b>&#151; Running is the best exercise for
+developing the breathing capacity. While brisk walking is
+allowable, fast running is not. The rule for running is to begin
+slowly, run moderately for perhaps fifty feet, then increase the
+speed gradually; but in running for exercise, never speed to the
+utmost. A five-mile gait is quite sufficient. The run should be
+closed with the same moderation with which it was begun, and the
+girl should never stop short, as this sudden arrest of action
+gives a most undesirable shock to the heart.</p>
+
+<p>In beginning to take any form of exercise the intensity and
+duration of the movements practiced must be increased very
+gradually, or positive harm instead of good will be done. As soon
+as fatigue is appreciable, the exercise should be discontinued
+and at once be followed by complete rest. Rapid respiration,
+palpitation or dizziness, headache, the face becoming pale or
+pinched or flushing suddenly, a feeling of great heat or
+excessive perspiration, are all danger signals showing that the
+exercise has already been carried too far and should cease at
+once. Continued over-exertion carried to a point of exhaustion
+leads to an obstinate irritability of the heart as well as to
+organic lesions.</p>
+
+<p>Mountain-climbing, rowing, and bicycling call into play almost
+all the muscles of the body. Of all the outdoor exercises for
+girls, swimming is one of the most perfect. It not only calls
+into vigorous action most of the muscles of the body, but spares
+many of those muscles that are so commonly overworked, the most
+of the work being performed by muscles that are so little used as
+to have become flabby and weak.</p>
+
+<p>Swimming and sea-bathing must be avoided by girls who have
+weak hearts and in whom the reaction after a plunge into cold
+water is never established; also by girls with heart disease or
+kidney disease.</p>
+
+<p>The principal outdoor games are croquet, archery, golf,
+tennis, cricket, foot-ball, and base-ball. Of these, croquet is
+the mildest, and is for that reason a good beginning exercise.
+Croquet, archery, golf, and tennis are all defective in that they
+cause a greater development of the right than of the left side of
+the body.</p>
+
+<p>As the greater majority of these outdoor exercises can only be
+indulged in for seven months of the year, they should be
+supplemented by exercises in the gymnasium for the remaining five
+winter months.</p>
+
+<p>There should be the greatest variety possible in the kinds of
+exercise taken, not only to develop the body symmetrically, so as
+to obtain strength, vigor, grace, celerity, and accuracy of
+movement, but also because there is no such potent cause of
+fatigue as monotonous repetition of the same act, whether
+physical or mental.</p>
+
+<p>It has been repeatedly proven that physical deterioration can
+be overcome by exercise, and that by so doing the mental capacity
+is greatly increased.</p>
+
+<h3>CHAPTER III.</h3>
+
+<h4><b>ANATOMY OF THE GENERATIVE ORGANS.</b></h4>
+
+<h5>The Vulva; the Hymen; Condition, of the Hymen as a Proof of
+Virginity; the Bladder; Vagina; Uterus; Respiratory Movements of
+the Uterus; Fallopian Tubes; Ovaries.</h5>
+
+<blockquote><p>"He that respects himself is safe from others;<br/>
+ He wears a coat of mail that none can pierce."
+</p>
+<p class="right">&#151; LONGFELLOW.
+</p></blockquote>
+
+<p><b>The Vulva.</b>&#151; The female generative organs consist
+of three groups&#151; the external, the intermediate, and the
+internal. The vulva, or external generative organs, comprises all
+those organs which are external to the body.</p>
+
+<p>The vulva is pierced by two openings, the smallest and most
+anterior of which is the external opening of the urethra, or
+excretory duct of the bladder. This opening is surrounded by a
+slight eminence and has a somewhat puckered aspect.</p>
+
+<p>The larger opening is the vaginal orifice. In the virgin this
+is partially closed by the hymen. About one inch back of this is
+the anus, or the external orifice of the large bowel. This part
+of the bowel is known as the rectum.</p>
+
+<p><b>The Hymen.</b>&#151; The hymen consists of a thin
+duplicature of mucous membrane strengthened by fibrous tissue,
+and is stretched across the posterior part of the vaginal
+orifice, which it partly occludes. Rupture of the hymen usually,
+but not always, occurs during the first sexual intercourse. In
+rare cases it is found intact at the time of the birth of the
+first child. In women who have borne children the vaginal orifice
+is surrounded by small irregular elevations; these are the
+remains of the ruptured hymen, but are usually present only after
+labor has taken place, since the torn hymen is converted into
+eminences as the result of the pressure incident to
+child-bearing, and not to coitus.</p>
+
+<p><b>The Condition of the Hymen as a Proof of
+Virginity.</b>&#151; Formerly much stress was laid on the
+condition of the hymen as a proof of virginity. The hymen tightly
+closed, barely admitting the tip of a small index-finger, is
+positive evidence of virginity. But the hymen may lose its tone
+by a local catarrhal condition or by a general muscular
+relaxation; it may then become so relaxed that the only positive
+evidence rendered by the intact hymen is that the woman has not
+borne a child.</p>
+
+<p>In a paper on the preservation of the hymen, Dr. Hannah M.
+Thompson writes: "Further, if the hymen was intended as a
+guarantee of moral character, and for moral protection, either of
+man or woman, would we not have some reason for reflecting on the
+wisdom and righteousness of a Creator who has failed to make
+equal provision, and to give a like guarantee of an uncorrupted
+manhood? As physicians, we know too well that where one woman
+enters the marriage relation tainted in body there are thousands
+of men reeking with disease; and there is no demonstrable test to
+distinguish these, no proof for the young woman of the virginity
+or virtue of the young man."</p>
+
+<p><b>The Bladder.</b>&#151; The female bladder is relatively
+broad and capacious, and is also highly distensible. When the
+bladder is allowed to become overdistended, it is carried
+backward and tends to cause a backward displacement of the
+uterus. The urethra, or excretory duct of the bladder, is about
+an inch and a half long, and lies firmly imbedded in the anterior
+vaginal wall.</p>
+
+<p><b>The Vagina.</b>&#151; The intermediate organ is the vagina.
+This is a musculo-membranous canal which connects the external
+with the internal organs of generation. The vagina lies in
+relation with the bladder and the urethra in front, and with the
+rectum behind. The vagina is sufficiently distensible to allow of
+the passage of so large a body as the child.</p>
+
+<p><b>The Uterus.</b>&#151; The internal organs of generation are
+the uterus, the ovaries, and the Fallopian tubes. Of these, the
+ovaries and the uterus are the essential female organs of
+generation. The virgin uterus is a small, hollow, muscular organ,
+somewhat pear-shaped, whose cavity is about one and a half inches
+deep. The uterus is divided by a natural constriction into a body
+and a neck. The neck, or cervix, is somewhat spindle-shaped, and
+has a canal running through its center which opens by a small
+aperture&#151; the so-called external orifice,&#151; into the
+vagina. In the virgin uterus the apposition of the anterior and
+posterior walls reduces the cavity to little more than a
+longitudinal cleft. With the advent of old age the whole organ
+suffers marked atrophy.</p>
+
+<p>The uterus is situated in the middle of the pelvic cavity,
+between the bladder and the lower bowel. It is held in place by
+broad elastic bands which go to different sides of the pelvis; it
+is also in part supported by the structures below and above it.
+But so loosely is the uterus held that it is easily pushed
+about&#151; as, for instance, by a full bladder or a packed
+bowel. And persistently allowing the bladder to become overfull,
+and failure to have a daily evacuation of the bowels, are
+prolific sources of displacements of the womb.</p>
+
+<p><b>Respiratory Movements of the Uterus.</b>&#151; When no
+constrictions are placed about the waist, the uterus moves freely
+up and down with every respiration. So distinctly and with such
+regularity do these movements take place that an operator by
+watching the movements of the uterus can tell the effect that the
+anesthetic is having on the patient's breathing. These so-called
+respiratory movements play a very important role in the
+circulation of the uterus, and in the return of the venous blood
+to the heart.</p>
+
+<p>Anything which interferes with these movements, as the use of
+corsets, or of tight bands around the waist, prevents the free
+return of the venous blood. The uterus becomes congested, and
+through the constant abnormal weight of the organ itself, as well
+as the pressing down upon it from above of the superincumbent
+organs, the uterus is pushed down below its normal position, the
+ligaments whose duty it is to hold it up become relaxed, and the
+unhappy woman suffers all the agonies that are attendant on the
+"falling of the womb." For this reason the disorder is frequently
+met with in women who have never borne children as well as in
+those who have.</p>
+
+<p><b>The Fallopian Tubes.</b>&#151; The Fallopian tubes extend
+from the upper, rounded angles of the uterus, within and along
+the free margin of the broad ligaments, for a distance of about
+two inches, to the vicinity of the ovaries, where each one
+terminates in a funnel-shaped orifice surrounded by a series of
+fringed processes. The lumen of the tube is narrowest at its
+inner end, where it opens into the cavity of the uterus by a
+minute orifice which scarcely admits a bristle; the diameter of
+the canal gradually increases until it reaches its ovarian
+extremity. The mucous lining of the tube is clothed by a single
+layer of hair-like epithelium, whose current sweeps from the
+ovarian toward the uterine end of the tube; and it is these
+movements which propel the ovum from the ovary to the uterus.</p>
+
+<p><b>The Ovaries.</b>&#151; The ovaries are two small bodies of
+an almond shape, and lie on either side of the uterus. The bulk
+of the entire organ consists of connective tissue, in which lie
+imbedded the Graafian follicles or ovisacs, in which the ova are
+contained. These follicles or ovisacs are minute cells which are
+packed immediately beneath the surface, where they occur in all
+stages of development. With the increase in size which
+accompanies their development the follicles pass toward the
+surface, where they form a distinct projection, and at this point
+will occur the final rupture of the sac and the escape of the
+ovum. It is supposed that the ovum is grasped by the fringe-like
+extremity of the Fallopian tube and is carried through it by the
+movements of the ciliary epithelium to the uterus.</p>
+
+<p>The formation of new follicles continues only for a short time
+after birth, when the Graafian follicles are the most numerous;
+the entire number contained within the ovaries of the child being
+estimated at over 70,000. In view of the unquestionably large
+number of follicles in very young ovaries, and the relatively
+small number of ova which reach maturity, the degeneration of
+many follicles after reaching a certain degree of development
+seems certain.</p>
+
+<h3>CHAPTER IV.</h3>
+
+<h4><b>PHYSIOLOGY OF THE FEMALE GENERATIVE ORGANS.</b></h4>
+
+<h5>Ovulation; Etiology of Menstruation; Uterine Nerve-supply;
+the Function of the Uterus; Stages of the Menstrual Cycle;
+Average Duration of the Menstrual Flow; Character of tahe Flow;
+Relation of Ovulation to Menstruation; the Menstrual Wave;
+Definition of Menstruation; Premomitory Symptoms of the Flow;
+Hygiene of Menstruution.</h5>
+
+<blockquote><p>"Toil and grow strong; by toil the flaccid nerves<br/>
+ Grow firm, and gain a more compacted tone."
+</p>
+<p class="right">&#151; ARMSTRONG.
+</p></blockquote>
+
+<p><b>Ovulation.</b>&#151; At birth the formation of the ova is
+nearly completed; the production of' new cells probably ceases
+after the second year. The ovaries of the child of two years
+contain, therefore, the full quota of ova, although the vast
+majority of these cells always remain immature and undeveloped.
+While it is probable that a variable number of the immature ova
+undergo partial development before puberty, yet the advent of
+sexual maturity at that time marks the establishment of the
+regular development of the Graafian follicles and their contained
+ova, accompanied by the attendant phenomena of menstruation.</p>
+
+<p>During the entire child-bearing period, or from about the age
+of fifteen to forty-five years, the development of the Graafian
+follicles and the discharge of the ova are continually taking
+place. The liberation of the ova usually takes place at definite
+times, which in general coincide with the menstrual epochs, one
+or more ova being set free at each period; but this is by no
+means invariable.</p>
+
+<p>The ripe human ovum or germ cell is a spheric cell, about 0.2
+mm. in diameter, consisting of granular protoplasm, in which lies
+a nucleus which contains the germinal spot. The proper cell-wall
+is a structure of great delicacy, outside of which is a secondary
+envelope.</p>
+
+<p><b>Menstruation.</b>&#151; The etiology of menstruation has
+been variously explained at different epochs. The chief theories
+have been that of plethora, and the ovulation, the tubal, and the
+nerve theories.</p>
+
+<p><i>First, the Theory of Plethora.&#151;</i> From the time of
+Hippocrates to 1835 the theory prevailed that in the female body
+the formation of blood is sufficiently rich to provide every four
+weeks for an overflow of the same, the evacuation of which
+becomes a necessity. It was believed that this excess of blood
+depended on an excess of formative power in the woman.</p>
+
+<p><i>Second, the Ovulation Theory.&#151;</i> This was distinctly
+formulated about 1845. It construed the menstrual hemorrhage as a
+subsidiary phenomenon, entirely dependent on the periodic
+dehiscence of ovules. The changes supposed to take place in the
+Graafian follicles at each menstrual period were believed to
+involve a peculiar expenditure of nerve force, which was so much
+dead loss to the individual life of the woman. The growth of the
+Graafian vesicle and its contained ovum was supposed to cause an
+irritation of the nerves of the ovary, which was reflected to the
+entire nervous system. The gradual accumulation of this
+irritation finally caused a reflex action which determined an
+afflux of blood to the uterus and ovaries, which constitutes the
+catamenial flow.</p>
+
+<p>The ovulation theory was refuted by the following facts:
+Ovulation may and does occur without menstruation; women who have
+never menstruated may conceive; conception may occur during
+lactation, without the menses having returned since the last
+parturition; children at birth have many ovules contained within
+the ovaries; ovulation may persist for a time after the
+menopause, and even pregnancy has occurred, although very rarely
+after this time; the menses may continue regularly after the
+removal of the ovaries and Fallopian tubes; this is exceptional,
+and, as a rule, the periods only continue for two or three years
+at longest.</p>
+
+<p><i>Third, the Tubal Theory.&#151;</i> Lawson Tait thought that
+thorough removal of the tubes was far more essential in
+determining the menopause, and that cases of periodically
+recurring hemorrhage after the removal of the ovaries were to be
+explained by the fact that the tubes had not been sufficiently
+removed. As an anatomic and surgical fact, the tubes can never be
+wholly excised unless the upper part of the uterus is also
+amputated.</p>
+
+<p><i>Fourth, the Nerve Theory of Menstruation.&#151;</i> This is
+based upon the following views:</p>
+
+<p>1. That menstruation is a process directly controlled by a
+nerve-center situated in the lumbar region of the spinal
+cord.</p>
+
+<p>2. That the menstrual impulses reach the uterus through two
+sets of nerves.</p>
+
+<p>3. That menstruation is the result of nerve irritation,
+vascular congestion, and the subsequent relief of these by
+hemorrhagic discharges.</p>
+
+<p>4. That hemorrhage from the uterus is the result either of a
+local uterine condition, or of influences outside of the uterus
+acting directly on the center.</p>
+
+<p>5. That the removal of the appendages arrests menstruation by
+preventing the propagation of uterine influences to the
+center.</p>
+
+<p><b>Uterine Nerve Supply.</b>&#151; One set of nerves causes
+contraction of the muscular fibers of the uterus, while the other
+set transmits impulses which bring about its vascular
+engorgement; and they are probably concerned in bringing about
+the determination of blood to the uterus and its appendages,
+which is so marked a feature of the menstrual process.</p>
+
+<p>As the result of long-continued investigation, Johnstone has
+come to the conclusion that the lining membrane of the uterus
+belongs to that class of organs whose function it is to replace
+organic waste. "Menstruation is a periodic wasting away of those
+corpuscles that are too old to make a placenta." He has further
+found that, as compared with the uteri of very many of the lower
+animals, the human uterus is very scantily supplied with
+lymphatics, and the only way to rid the uterus of the overripe,
+and therefore consequently useless, tissue is to wash it out
+through the vagina by a blood-stream. The tough wall of the human
+uterus and the increased blood-pressure caused by the erect
+position cause the difference between menstruation in the human
+female and rut in the lower animals.</p>
+
+<p>The strong light of recent investigations has necessitated the
+laying aside of many time-honored theories; and as the close of
+the nineteenth century has seen the emancipation of the uterus
+from the thralldom of the ovary, so we may believe that the
+twentieth century will find women of such fine physique as to
+prove the error of the popular fallacy that the cause of woman's
+weakness lies in the performance of her functions.</p>
+
+<p><b>The Function of the Uterus.</b>&#151; The function of the
+uterus is to provide a favorable place for the reception of the
+product of conception, where it may be protected and nourished
+during the period of its development. The purpose of menstruation
+is to keep the uterus in suitable condition for the reception of
+this product of conception at any time. It is now known that the
+menstrual flow is not the whole of menstruation, and that the
+changes going on in the uterus are almost as continuous as the
+process of digestion. The whole of the reproductive life of woman
+has been divided into cycles of twenty-eight days each; these
+cycles have been divided into four stages.</p>
+
+<p><b>Stages of the Menstrual Cycle.</b>&#151; The first or
+constructive stage is one of preparation for the reception of the
+ovum. During this stage the preparing of a decidua takes place,
+or building a nest for the expected egg; there is a swelling of
+the mucous membrane, an enlargement of the uterine glands, and an
+increase in the connective tissue. It is thought that this stage
+lasts for one week; when pregnancy does not occur, it is followed
+by degenerative changes.</p>
+
+<p>The second or destructive stage is marked by destructive
+changes which give rise to the usual phenomena of the menstrual
+period; there is a discharge of blood, mucus, and disintegrated
+mucous membrane. The actively growing cells of the uterine lining
+membrane undergo rapid destructive changes, the fabric of the
+half-formed decidua tumbles to pieces, the turgid capillaries
+burst and pour out the menstrual flow, which sweeps away all the
+useless debris. The irritation sets up reflex uterine
+contractions, and so the blood is squeezed out of the distended
+capillaries and washes away the degenerated cells.</p>
+
+<p>The third or reparative stage, as its name indicates, is one
+of repair, in which by constructive changes the epithelial lining
+which was thrown off is replaced by new, which is formed in from
+three to four days.</p>
+
+<p>The fourth or quiescent stage includes the remaining twelve or
+fourteen days of the menstrual cycle, and represents the
+quiescent period prior to the initiative changes which mark the
+beginning of the next period.</p>
+
+<p><b>Average Duration of the Menstrual Flow.</b>&#151; The
+average duration of the menstrual flow is five days, although the
+variations are considerable in healthy women. A flow lasting any
+place from two to six days is perfectly consistent with health;
+but a flow continuing less than two or more than six days
+generally indicates local or general disease.</p>
+
+<p><b>Character of the Menstrual Flow.</b>&#151; For the first
+few hours, or perhaps for the first day, the flow is usually
+slight in quantity and light in color; on the second and third
+days the flow reaches its height, and is profuse and dark, but it
+should never be clotted; after this it gradually ceases. The
+amount of the flow varies from five to ten ounces. If less than
+five or six or more than eighteen napkins are pretty well
+saturated through, the amount may be considered abnormal.</p>
+
+<p><b>Relation of Ovulation to Menstruation.</b>&#151; It has not
+yet been decided just in what relation the processes of ovulation
+and menstruation stand to each other. It is supposed that the
+transit of the ovum to the uterus occupies at least one week. It
+has been thought that the decidua of a particular menstrual
+period is related, not to the ovum discharged at that period, but
+to the ovum discharged at the preceding period.</p>
+
+<p><b>The menstrual wave,</b> or the wave of "supplementary
+nutrition,"[*] upon which the menstrual process ultimately
+depends, was first established by Dr. Mary Putnam Jacobi in the
+Boylston prize essay for 1876; showing that menstrual life is
+associated with a wave of well-marked vital energy, which
+manifests itself in a monthly fluctuation of the tempera ture of
+the body, in the daily amount of the excretion of urea and of
+carbonic acid, and of the rate and tension of the pulse. The wave
+attains its maximum during the week preceding menstruation, and
+slowly falls to its minimum, which is reached the week after
+menstruation.</p>
+
+<p class="footnote">* Dr. Goodman and Dr. Stephenson have since
+written on this subject, and the "wave" is often known as the
+Stephenson wave.</p>
+
+<p>This wave indicates a periodic variation in the bodily
+metabolism, and is probably directly influenced by the rhythmic
+activity of the menstrual center. This observation would seem to
+be nullified by the fact that the phenomena referred to have been
+found to occur in men as well as in women; and that the lower
+animals also seem to show the same periodic variations. "It is
+therefore evident that the phenomena belong not to the function
+of menstruation, but to a general law of vital energy."</p>
+
+<p><b>Definition of Menstruation.</b>&#151; Menstruation may,
+then, be defined as the periodic discharge of blood from the
+uterus, accompanied by the shedding of the epithelium of the
+body, as well as that of the uterine glands near their
+orifices.</p>
+
+<p>The sanguineous discharge is due partly to the oozing of blood
+from the surfaces denuded of epithelium, and partly to active
+congestion. The discharge from the uterus is largely augmented by
+mucus secreted in increased quantity at this period from the
+enlarged uterine glands.</p>
+
+<p>The tubes take some part in the process of menstruation; their
+mucous membrane is swollen, the epithelium is shed in places, and
+they are filled with a thin bloody fiuid, containing
+blood-corpuscles and cast-off epithelium cells.</p>
+
+<p>The menstrual wave continues from puberty to the menopause; it
+is a nervous phenomenon. Ovulation is a progressive, non-periodic
+process; it begins before birth and continues till the ovarian
+tissue is atrophied or worn out.</p>
+
+<p><b>Premonitory Symptoms of the Flow.</b>&#151; The premonitory
+symptoms of the monthly flow should not be so marked as to cause
+the individual any discomfort. The first indication of the return
+of the period should be the appearance of the flow. There is
+generally a feeling of abdominal fulness with some lassitude, and
+sometimes slight headache. The temperature is lower and the pulse
+is slower than at other times. This lowered tone of the system is
+an additional reason for increased care against exposure in wet
+or cold weather.</p>
+
+<p><b>Hygiene of Menstruation.</b>&#151; During the menstrual
+periods all <i>cold baths</i> must be strictly prohibited,
+whether tub-baths or cold sponges. The reason of this is that the
+application of cold to the surface causes a driving in of the
+blood from the exterior of the body to the internal organs; and
+at the menstrual periods there is already a congested condition
+of the pelvic organs, and it must be remembered that congestion
+is the first stage of inflammation.</p>
+
+<p><i>Hot</i> or <i>warm sponge-baths</i> may be taken throughout
+the period; and the vulva should be bathed with warm water twice
+a day through the entire period of the flow, as this not only
+removes the clotted blood before it decomposes and becomes the
+source of irritation, but also removes other irritating matters,
+and prevents the nervousness that is caused by a local
+irritation.</p>
+
+<p>It is strange how women who are scrupulously neat in all other
+respects will allow the smegma to collect in and about the vulva;
+as a matter of fact, for the purpose of cleanliness it is much
+more necessary that the external genitals should be washed twice
+a day with soap and water all through life than that the face
+should be washed that often.</p>
+
+<p>Another question which is still <i>sub judice</i> is the
+necessity for and the frequency with which vaginal douches should
+be taken; all physicians are agreed that a vaginal douche taken
+immediately after the menstrual period is beneficial, as it
+removes all the debris of the flow, which is sometimes very
+irritating.</p>
+
+<p><i>Exercise.&#151;</i> A moderate amount of exercise should be
+taken every day; this is needed now quite as much as at any other
+time, and only good can result from it. And no harm comes of a
+woman going out in the rain or in cold weather; as has been
+shown, the menstrual process is going on for a large part of the
+time, and the flow is only the external appearance, but during
+the time of the flow the woman must be unusually careful not to
+get her feet wet or to sit down with damp clothing on. Violent
+exercise of all kinds is to be prohibited at this time, as
+dancing, rides on the bicycle, gymnastics, and walks of over
+three miles. The reason for this is very obvious; the uterus has
+now reached the height of its turgescence, and is heavier than at
+any other time, hence the danger that displacements or a very
+profuse flow would be caused by any kind of violent exercise.</p>
+
+<p><i>Treatment.&#151;</i> If the woman has been so unfortunate
+as to get caught out in a heavy rain so that her clothes have
+been wet through, or if in the cold weather she should come into
+the house thoroughly chilled, the best thing to do is to take off
+her wet things as quickly as possible, be well rubbed down with
+hot, rough towels, drink a cup of hot tea, go to bed at once and
+place a hot-water bag over the abdomen. She should remain in bed
+until the next morning, to the end that the circulation may
+regain its equilibrium as quickly as possible by the immediate
+relief of the pelvic congestion. If this exposure should have
+caused the sudden cessation of the flow, a hot mustard foot-bath
+should be taken. One tablespoonful of mustard is used to a gallon
+of water as hot as can be borne; the pail should be made as full
+as can be without running over, and a blanket wrapped around the
+pail and woman, so as to cause a profuse perspiration; this
+should be kept up for ten minutes; if the water cools off, hot
+water may be added.</p>
+
+<h3>CHAPTER V.</h3>
+
+<h4><b>THE ANOMALIES OF MENSTRUATION.</b></h4>
+
+<h5>Menorrhagia and Metrorrhagia; Dysmenorrhea; Amenorrhea;
+Leuchorrhea; Pruritus Vulvae.</h5>
+
+<blockquote><p>"Defer not till to-morrow to be wise,<br/>
+ To-morrow's sun on thee may never rise."
+</p>
+<p class="right">&#151; CONGREVE
+</p></blockquote>
+
+<p><b>Menorrhagia and Metrorrhagia.</b>&#151; By menorrhagia is
+meant an excessive or too profuse menstrual flow; by
+metrorrhagia, a flow of blood between the menstrual periods.
+Neither one constitutes a disease by itself, but is a symptom of
+some pathologic condition.</p>
+
+<p>It has already been stated that the excretory organs, by
+constantly eliminating from the system the worn-out material,
+keep the machine healthy and in good working order. Kept within
+natural limits, this elimination is the source of strength and
+health; beyond these limits, the menstrual flow becomes an actual
+hemorrhage that, by draining away the life, becomes the source of
+weakness and disease.</p>
+
+<p>No physician would dare to bleed a man or woman once a month,
+year in and year out for thirty years; but, through ignorance or
+folly, this is what many girls do for themselves.</p>
+
+<p>This excessive flow, aside from actual local disease, is
+brought about by excessive muscular exercise during menstruation;
+by the use of all stimulants, whether alcoholic beverages or
+quinin; as well as by the thinness of the blood.</p>
+
+<p>When the flow is excessive, it must be considered a pathologic
+condition, which needs the physician's attention. Rest in the
+recumbent position is the first essential; the diet must be plain
+and unstimulating, and attention must be paid to the condition of
+the blood.</p>
+
+<p>The general diseases which generally cause this condition are
+anemia, Bright's disease, malaria, the early stages of
+tuberculosis, and heart disease.</p>
+
+<p>The local causes may be reflex, as powerful emotions; or due
+to local disease of the uterus and its appendages, as the various
+inflammations and displacements of the uterus, fibroid tumors,
+polypi, and cancer.</p>
+
+<p><b>Dysmenorrhea</b> is painful menstruation. The most frequent
+forms are due to uterine congestion; to mechanical causes, as a
+narrowing of the cervical canal, particularly at its internal
+opening, or to a constriction caused by the bending over of the
+uterus at the junction of the body and the neck; or to ovarian
+irritation.</p>
+
+<p>The pain varies in intensity from slight discomfort to the
+most intense uterine colic, which is experienced in the lower
+part of the abdomen. In severe cases the general health becomes
+undermined, the nervous system gives way, and hysteria and other
+disorders of the nervous system result.</p>
+
+<p>The congestive variety usually occurs in patients who have
+previously menstruated painlessly. The pain comes on suddenly
+with the flow and ceases when the flow stops; it is very severe
+and is generally accompanied by a diminution or a cessation of
+the flow. There is severe headache, marked diminution in the
+secretion of the kidneys, and general restlessness. The patient
+frequently experiences pain in walking, is easily fatigued, has
+leucorrhea and an irritable bladder.</p>
+
+<p>In ovarian dysmenorrhea the pain precedes the flow for several
+days and ceases when a free flow is established. The pain is of a
+dull aching character, and may be felt on one or both sides of
+the abdomen, according as one or both ovaries are involved.</p>
+
+<p><b>Amenorrhea.</b>&#151; In amenorrhea the menstrual flow may
+not appear for some years after it is normally due; or the flow
+may cease after some months or years of continuance; or the flow
+may be abnormally scanty or even absent.</p>
+
+<p>The menstrual flow is much later in appearing in some families
+than in others, so that this may be considered as a family
+idiosyncrasy; and if the girl's health is good, it need cause no
+anxiety. If, on the contrary, the girl has severe headaches, or
+suffers in any way, the physician should be summoned at once, as
+the absence of menstruation may be indicative of some serious
+pathologic condition,</p>
+
+<p>A scanty flow is often indicative of thinness of the blood; on
+the other hand, serious anemias often lead to profuse
+menorrhagias or metrorrhagias, as has already been stated. The
+cause of the profound anemia itself may be insufficient
+nutrition, overwork, or lack of exercise.</p>
+
+<p>Scanty menstruation is often seen to occur in fevers, in the
+later stages of consumption, in advanced Bright's disease, in
+malaria, or in any other very serious disease. In these cases it
+seems to be a conservative process on the part of nature in the
+run-down state of the system. As consumption progresses
+menstruation generally ceases absolutely, never to return again;
+and in this case nothing should be done to try to induce a return
+of the flow.</p>
+
+<p>Great shock sometimes causes a sudden cessation of the flow;
+and sometimes a sea-voyage, followed by the change of habitat,
+will cause an obstinate form of amenorrhea.</p>
+
+<p>But it cannot be too well understood that, after the menstrual
+flow has been regularly established, it continues with the
+greatest regularity throughout the child-bearing period, unless
+the exposure to wet or cold has been sufficiently severe to cause
+great indisposition on the part of the woman. In this case it is
+possible that, if the exposure took place just previous to the
+time of the expected flow, one period may remain out. But except
+in case of serious illness,&#151; as for example, typhoid
+fever,&#151; two or more periods do not fail to appear except in
+the case of pregnancy.</p>
+
+<p><b>Leucorrhea.</b>&#151; Leuchorrhea, or "whites," is a mucous
+or mucopurulent discharge from the vagina; it may be a symptom of
+uterine or vaginal disease.</p>
+
+<p>Immediately after the menstrual flow there is a well-marked
+vaginal secretion which is whitish in appearance; it may be
+transparent or of a milky color, and is sometimes very acrid.
+This secretion may also precede the flow, and there is nothing
+abnormal in this. But any discharge occurring between the periods
+sufficient to stain the clothing&#151; the so-called whites or
+leucorrhea&#151; is abnormal, and is caused by an inflammation of
+the vagina or the neighboring parts. In addition to the discharge
+there is heat and swelling of the parts, more or less local
+distress, and generally intense nervousness.</p>
+
+<p>If the disease is not cured, it may become chronic. The pain,
+heat, and scalding disappear, but a copious discharge continues,
+and in this stage the disease may be very obstinate and greatly
+reduces the strength. The constant drain breaks down the system,
+producing pallor, debility, pain in the back, palpitation,
+indigestion, and so forth.</p>
+
+<p>The character of the discharge in leucorrhea varies
+considerably, from a whitish or mucous secretion, to a yellowish
+or mucopurulent secretion, and is debilitating in proportion as
+it is profuse. It is to be remembered that this is not in itself
+a disease, but indicates a disease of some of the pelvic organs;
+and that all such inflammations left to themselves incline to
+grow worse.</p>
+
+<p>A severe leucorrhea is generally attended with frequent and
+finally painful micturition; pain in walking in the lower part of
+the abdomen, which may become so severe as to compel the patient
+to go to bed.</p>
+
+<p><b>Pruritus Vulva.</b>&#151; This is an intense and persistent
+itching of the vulva, and is a symptom rather than a disease. It
+is not an infrequent result of leucorrhea, the acrid discharge of
+the latter leading to an irritation of the parts; this causes
+rubbing of the parts until a veritable inflammation is
+produced.</p>
+
+<p>Other causes of pruritus vulvae are: The local congestion,
+such as occurs at the menstrual period, or in certain cases of
+pelvic inflammations, or in early pregnancy; constipation;
+sedentary habits; congestion of the liver; incontinence of urine,
+and diabetes. When dependent on the latter, the malady is most
+obstinate in yielding to treatment. Indigestible foods or drinks,
+the rubbing of the clothes, the friction of walking, and the heat
+of the bed act as exciting causes in those predisposed to it.</p>
+
+<p>The essential treatment here is to at once ascertain and
+remove the cause; aids in the treatment are vaginal douches and
+cooling lotions.</p>
+
+<h3>CHAPTER VI.</h3>
+
+<h4><b>THE MARRIAGE QUESTION.</b></h4>
+
+<h5>Herbert Spencer's Definition of Love; What Constitutes a
+Suitable Husband; Best Age for Marriage; Shall Cousins Marry?
+Contraindications to Marriage; Do Reformed Profligates Make Good
+Husbands? the Proper Length of Time for the Engagement; the Right
+Time of the Year to Marry; the Selection of the Wedding Day.</h5>
+
+<blockquote><p>"Well, Brutus, thou art noble; yet, I see,<br/>
+ Thy honourable mettle may be wrought<br/>
+ From that it is disposed: Therefore, 'tis meet<br/>
+ That noble minds keep ever with their likes.<br/>
+  For who so firm that cannot be seduced?"
+</p>
+<p class="right"><i>&#151; "Julius Caesar."</i>
+</p></blockquote>
+
+<p><b>Herbert Spencer's Definition of Love.</b>&#151; "Love is
+habitually spoken of as though it were a simple feeling, whereas
+it is the most compound, and therefore the most powerful, of all
+the feelings. Added to the purely physical elements of it, are
+first to be noticed those highly complex impressions produced by
+physical beauty; around which are aggregated a variety of
+pleasurable ideas, not themselves amatory, but which have an
+organized relation to the amatory feelings. With this there is
+united the complex sentiment we term affection&#151; a sentiment
+which, as it can exist between those of the same sex, must be
+regarded as an independent sentiment, but one which is here
+greatly exalted. Then there is the sentiment of admiration,
+respect, reverence, in itself one of considerable power, and
+which in this relation becomes in a high degree active. There
+comes next the feeling called the love of approbation. To be
+preferred above all the world, and that by the one admired above
+all others, is to have the love of approbation gratified in a
+degree passing every other experience, especially as there is
+added that indirect gratification of it which results from the
+preference being witnessed by others. Further, the allied emotion
+of self-esteem comes into play. To have succeeded in gaining such
+attachment from and sway over another is a proof of power which
+cannot fail to agreeably excite <i>amour propre.</i> Yet again,
+the proprietary feeling has its share in the general activity.
+There is the pleasure of possession, the two belonging to each
+other. Once more, the relation allows of an extended liberty of
+action. Toward each other a strained behavior is requisite.
+Around each there is a suitable boundary that may not be crossed;
+an individuality on which none may trespass. But in this case the
+barriers are thrown down, and the love of unrestrained activity
+is gratified. Finally, there is an exaltation of sympathies,
+egotistic pleasures of all kinds are doubled by another's
+sympathetic participation, and the pleasures of another are added
+to the egotistic pleasures. Thus around the physical feeling
+forming the nucleus of the whole, are gathered the feelings
+produced by personal beauty that constitutes simple attachments,
+of self-esteem, of property, of love of freedom, of sympathy.
+These, all greatly exalted and severally tending to reflect their
+excitements on one another, unite to form the mental state we
+call love. And as each of them is comprehensive of multidinous
+states of consciousness, we may say that this passion fans into
+immense aggregate most of the elementary excitations of which we
+are capable; and that hence results its irresistible power."</p>
+
+<p><b>What Constitutes a Suitable Husband.</b>&#151; It is
+desirable that the husband shall be a few years older than the
+wife. Man is later in coming to maturity, and also retains his
+sexual powers considerably longer than woman; so that for these
+functions to cease about the same time, the wife must be younger
+than the husband. A difference of from two to five years is best;
+if the parties are young, it is not essential that the husband
+should be much the wife's senior, as it is later in life. The
+husband may be ten years older, but a greater disparity of age
+than this is rarely compatible with congeniality of tastes and
+dispositions, so essential to a happy married life. The woman who
+risks her happiness with a man many years younger than herself
+violates a precept of nature.</p>
+
+<p>The average stature of the man is about three inches greater
+than that of the woman, and in the physiologic marriage any great
+deviation from this should be avoided.</p>
+
+<p>The essentials for a happy marriage may be summed up as
+follows: that the parties shall be of suitable age; that they
+shall be physically well mated and in full sympathy with each
+other's views of life, of the same social position, and of equal
+education.</p>
+
+<p><b>The Best Age for Marriage.</b>&#151; The reproductive life
+begins with puberty, but maturity is not reached before the age
+of twenty-one. It is only then that the standard of development
+is reached that is most compatible with the successful bearing of
+the grave responsibilities of wifehood and motherhood. The too
+early exercise of the reproductive functions leads to increased
+suffering on the part of the mother, depresses her vitality, and
+increases her liability to disease. Statistics show that the
+mortality is very much greater where girls marry under twenty
+years of age.</p>
+
+<p>The offspring are apt to be small and ill developed, and die
+in large numbers in early life; only a small percentage live long
+and robust lives. In France it has been observed that where the
+fear of conscription has caused many young people to marry the
+offspring were lacking in vigor. Among the offspring of immature
+parents there is a larger proportion of idiots, cripples,
+criminals, scrofulous, insane, and tubercular than among the
+children of nubile parents.</p>
+
+<p>In our climate women are best fitted to become wives and
+mothers between the ages of twenty-four and twenty-eight years.
+Before this age neither their self-knowledge, their knowledge of
+the world, nor their experience is sufficiently mature to fit
+them to wisely make the choice of a companion for life, or to
+become mothers. After forty, most women cannot hope for children.
+Men had better wait until between the ages of twenty-seven and
+thirty years, before they undertake the responsibilities of
+parenthood.</p>
+
+<p><b>Shall Cousins Marry?</b>&#151; They might if both families
+were perfectly healthy; but as few families are without some
+lurking predisposition to disease, it is not well, as a rule, to
+run the risk of developing this by too repeated unions.</p>
+
+<p><b>Contraindications to Marriage.</b>&#151; Young women in
+whose family there is a distinct history of such hereditary
+diseases as cancer, tuberculosis, or insanity for two generations
+back, should not marry at all. Not only is this a fearful legacy
+to hand down to their children, but pregnancy and child-bearing
+very decidedly favor the development of these diseases.</p>
+
+<p>Syphilis in either sex is a distinct bar to marriage; first,
+the party married is sure to contract the disease, even though it
+may have been supposed to have been cured. Fortunately, the
+children of such marriages are generally still-born; still, they
+do sometimes live, and are most pitiable and sickly objects. For
+any one to marry under these conditions is a crime against
+society, against the State, and against posterity.</p>
+
+<p>Women who have serious forms of heart disease, tuberculosis,
+or Bright's disease would, by becoming pregnant, run a serious
+risk of losing their lives toward the close of the pregnancy or
+at the time of their confinement. In case of heart disease, the
+pulmonary congestion that accompanies pregnancy, together with
+the encroachment of the pregnant uterus on the cavity of the
+chest, would greatly add to the embarrassment of the heart's
+action.</p>
+
+<p>In normal pregnancy there is some congestion of the kidneys;
+where there is actual disease of the kidneys prior to the
+pregnancy, this congestion is apt to become so severe as to
+threaten the woman's life. These organic diseases are not to be
+confounded with functional diseases which are dependent on some
+other cause; as palpitation of the heart due to indigestion, or
+heart murmurs dependent on the thin state of the blood, or
+congestion of the kidneys due to exposure to cold;&#151; all of
+which may be cured by proper treatment.</p>
+
+<p>Should a woman with a fibroid tumor marry, she would run a
+great risk to her life; she should have the tumor removed, or, if
+this is not possible, she should give up all thoughts of
+marriage, since the increased irritation and congestion
+consequent upon the marital relations would tend to favor its
+growth. Should pregnancy ensue, delivery might be attended with
+serious complications, as very difficult labor, postpartum
+hemorrhage, or, as these tumors have but little vitality, and the
+pressure to which they are subjected during labor is liable to
+cause their death, disorganization, sloughing, and, as a result,
+puerperal septicemia.</p>
+
+<p>Sometimes there is such a lack of development of the genital
+organs as to prevent the woman from having children.</p>
+
+<p>Two persons with even a slight tendency to the same disease,
+either inherited or acquired, should not intermarry, even if they
+are in comparatively good health at the time. Their offspring
+would be quite sure to inherit their diseased tendencies.</p>
+
+<p>Persons whose constitutions have been somewhat injured, but
+who are not tainted with actual disease, may rear children much
+healthier than themselves, provided their own lives are wisely
+regulated. If they are growing better all the time, and are not
+too much broken in constitution, it may be safe for them to
+marry.</p>
+
+<p>Among the Jews the physician is frequently consulted before
+matrimonial alliances are contracted. This custom could not but
+be of universal benefit; many local or general diseases would be
+eradicated before marriage, and in this way much suffering and
+unhappiness would be spared; or, in other cases, the patient
+would be advised of the inadvisability of marriage.</p>
+
+<p><b>Do Reformed Profligates Make Good Husbands?</b>&#151; The
+manner of life that has been led by this class of men is such as
+to undermine their health, if not to have rendered them physical
+wrecks. There is the overindulgence in alcoholic beverages, and
+perhaps, added to this, some drug habit. In addition to this,
+these men early in their career are apt to become infected with
+some of the venereal diseases, or perhaps with all of them&#151;
+gonorrhea, syphilis, and so forth; and these diseases have the
+horrible characteristics of becoming latent. A man who contracts
+this kind of a disease can never be really sure that he is cured.
+All venereal diseases are highly contagious.</p>
+
+<p>It is now a well-established fact that gonnorrheal infection
+is not only one of the most common causes of pelvic inflammations
+in women, but that these same inflammations are of the most
+virulent types, unless they are recognized and treated in the
+early stages. It is also a well-known fact that a large
+percentage of married women suffer from this disease. Sterility
+almost always results.</p>
+
+<p>In the case of a syphilitic parent, one or two children may be
+born, but the offspring is generally sickly and diseased.
+Inebriety as well as sexual excesses are both well recognized as
+distinct forms of disease accompanied by degeneracy of brain
+tissue. It is nothing less than criminal for such men to have
+children, since these children would at least inherit the
+tendency to the same diseases, if they did not actually have
+them; there is also a strong probability of such children being
+born idiots or imbeciles.</p>
+
+<p>It is therefore self-evident that, instead of a reformed
+profligate making a good husband, he must make a very diseased
+one. It has therefore been suggested that the parents of the
+prospective bride should demand from the intended groom a
+certificate of freedom from all venereal diseases by a physician
+of their own selection. Also that there should be legislation
+upon the subject, and that before a man is granted a license of
+marriage, he should have a certificate from the health officer of
+freedom from syphilis, gonorrhea, and tuberculosis.</p>
+
+<p><b>The Proper Length of Time for the Engagement.</b>&#151; A
+period not shorter than three months, nor longer than one year,
+should elapse between the engagement and the marriage.</p>
+
+<p>There are strong physiologic reasons against long engagements:
+they keep the affections and the passions in an excited and
+unnatural condition, which after a time tends to weaken the
+nervous system and undermine the health. These evil consequences
+are common to both sexes. It is far better that the subject of
+marriage should not be entertained at all unless the
+circumstances are such that the union might with propriety be
+effected at once.</p>
+
+<p><b>The Right Time of the Year to Marry.</b>&#151; When woman
+marries she enters upon a new life, and a very trying one.
+Extreme heat and extreme cold are both very taxing to the human
+economy. Midsummer and midwinter are therefore both
+objectionable, but especially the former.</p>
+
+<p><b>The Selection of the Wedding-day.</b>&#151; This is by
+common consent left to the bride. She should select a time about
+ten or fifteen days after the end of one of her menstrual
+periods, as this is the time of comparative sterility, and it is
+most desirable that the first sexual relations should be
+fruitless.</p>
+
+<hr />
+<h3>PART II.&#151; MARRIAGE.</h3>
+
+<hr />
+<h4><b>CHAPTER VII.</b></h4>
+
+<h4><b>THE ETHICS OF MARRIED LIFE.</b></h4>
+
+<h5>The Wedding Journey; the Ethics of Married Life; Shall
+Husband and Wife Occupy the Same Bed? the Comsummation of
+Marriage; the Marital Relation; Times when Marital Relations
+Should be Suspended.</h5>
+
+<blockquote><p>"If it is possible to perfect mankind, the means of
+doing so will be found in the medical sciences."&#151;
+DESCARTES.</p></blockquote>
+
+<p><b>The Wedding-journey.</b>&#151; The wedding-journey, which
+was formerly the cause of so much discomfort to both husband and
+wife, has fortunately gone out of vogue; and in its place has
+come the retirement to a quiet country or seaside spot, away from
+the prying eyes of friends. Thus the nervous strain incident to
+sight-seeing and travel is avoided.</p>
+
+<p><b>The Ethics of Married Life.</b>&#151; It has been said that
+God set men and women in pairs in order that they might perfect
+each other and complete each other's happiness. The secret of all
+true happiness in life lies in the spirit of altruism; one must
+be able to wholly forget herself and to find her happiness in the
+welfare of others.</p>
+
+<p>The woman who exhausts herself physically and financially on
+the preparation of her trousseau and her wedding does her husband
+a wrong by bringing him a wife who is on the verge of nervous
+prostration.</p>
+
+<p>The secret of a happy married life depends to no small extent
+on the very beginning: the relation is so entirely new, and much
+lies hidden in the character of each that was never suspected by
+the other.</p>
+
+<p>Between husband and wife there must always be mutual
+concessions, forbearance, and sympathy; a mutual helpfulness to
+attain all that is best. This, of course, implies that the life
+of each is an open book for the other to read; that there is an
+unreserved exchange of thought; and that no privilege is claimed
+by the one that would not willingly be accorded to the other.</p>
+
+<p>"How many men," says Balzac, "proceed with women as the monkey
+of Cassan with the violin; they have broken the heart without
+knowing it, as they have tarnished and disdained the jewel whose
+secret they never understood. Almost all men are married in
+ignorance of women and of love. They have commenced by forcing
+open the doors of a strange house and have wished to be well
+received in its salon. But the most ordinary artist knows that
+there exists between him and his instrument&#151; his instrument
+which is made of wood or ivory&#151; a sort of indefinable
+friendship. He knows by experience that it has taken years to
+establish this mysterious rapport between an inert material and
+himself. He could not have divined at the first stroke all its
+resources and caprices, its faults and its virtues. His
+instrument only became a soul for him and a source of melody
+after long study; he only came to understand it as two friends
+after the most learned interrogation.</p>
+
+<p>"So the world is full of young women who grow pale and feeble,
+sick and suffering. The ones are a prey to inflammations more or
+less severe; the others remain under the dominion of nervous
+attacks more or less violent. All these husbands have caused
+their own unhappiness and ruin. Never begin married life with a
+rape. To demand of a young girl whom one has seen forty times in
+fifteen days to love you because of the law, the king, and
+justice is an absurdity.</p>
+
+<p>"Love is the union of necessity and of sentiment. Happiness in
+marriage is the result of perfect understanding between the
+spirits of husband and wife. From this it happens that in order
+to be happy, a man is obliged to bind himself to certain rules of
+delicacy and honor. After taking advantage of the social laws
+which consecrate the necessity, it is necessary to obey the
+secret laws of nature, in order to make the sentiments flourish.
+If a man places his happiness on being loved, it is necessary
+that he should love sincerely; nothing resists a veritable
+passion."</p>
+
+<p><b>Shall Husband and Wife Occupy the Same Bed?</b>&#151; Among
+civilized nations custom differs in this regard; in Germany, for
+instance, the husband and wife occupy separate beds in the same
+room; formerly in this country it was almost the universal custom
+for husband and wife to occupy the same bed. The current of
+opinion has changed in this respect, and it is now considered in
+the highest interests of both that they shall occupy not only
+separate beds, but separate rooms; these rooms communicating
+through a door which connects their respective dressing-rooms.
+This is unquestionably the best arrangement from the hygienic as
+well as from the ethical point of view. Health requires that
+one-third of the time shall be spent in sleep; the bed was made
+for sleep; and the most refreshing sleep can only be obtained by
+occupying the bed alone. If two persons occupy the same bed and
+one is restless, the sleep of the other is necessarily disturbed.
+Again, two persons occupying the same bed necessitates the same
+hour for rising and retiring, which is not always convenient or
+agreeable. Balzac writes on this subject: "To put the system of
+separate bed-rooms into practice is to attain to the highest
+degree of intellectual power and of virility. By what syllogism
+man arrived at establishing as a custom that of man and wife
+sleeping together, a practice so fatal to happiness, to health,
+to pleasure, and even to self-love, would be curious to seek
+out." If for financial reasons it is not possible to have
+separate bed-rooms, the German custom of having separate beds
+should be adopted.</p>
+
+<p><b>The Consummation of Marriage.</b>&#151; The consummation of
+marriage is often attended with difficulty owing to the rigidity
+of the hymen; this, if present, must usually be ruptured before
+connection takes place. Great gentleness and care must be
+exercised by the husband if it does not readily yield, the use of
+hot vaginal injections should be kept up for several weeks before
+the trial is repeated. These usually relax the parts very
+considerably; but if coitus is still found impossible, it is
+better to consult a physician at once, when a simple operation
+will generally remove the trouble and the woman is spared much
+suffering. In no case is any violence on the part of the husband
+allowable, as it might produce irreparable injuries.</p>
+
+<p>There is always more or less suffering on the part of the wife
+at first, partly due to the rupture of the hymen, and partly to
+the forcible dilatation of the vagina and she should be allowed a
+sufficient time for nature to repair these injuries. By so doing,
+the constitutional disturbances and the nervous disorders which
+are so very prevalent may be prevented. Too frequent indulgence
+at this period is a prolific source of inflammatory diseases, and
+often occasions sterility and ill-health.</p>
+
+<p>The first nuptial relations should be fruitless, in order that
+any indisposition arising therefrom should have had time to
+disappear before the woman becomes pregnant.</p>
+
+<p><b>The Marital Relation.</b>&#151; It is most important for
+the interest of both parties that there should be chastity in the
+marriage relation as well as out of it. Many young couples have
+had their lives ruined by excessive sexual indulgence. The effect
+is usually most severe upon the husband, yet the wife becomes
+weak, nervous, and excitable. Sexual excess is also the grave of
+domestic affection. The general rule given is that coitus should
+never take place oftener than every seven or ten days. When
+coitus is succeeded by langour, depression, or malaise, it has
+been indulged in too frequently.</p>
+
+<p>Among civilized people there are three widely diferent views
+as to the proper course to be pursued:</p>
+
+<p>First, those who maintain that sexual intercourse should not
+take place except for the propagation of the species.</p>
+
+<p>Second, those who believe that the act is a love relation,
+mutually demanded and enjoyed by both sexes, and serving other
+purposes besides that of procreation.</p>
+
+<p>Third, those who hold that sexual intercourse is a physical
+necessity for the man, but not for the woman.</p>
+
+<p>The first theory, "that the sexual relations should never be
+sustained save for the purpose of procreation," has many
+advocates. They teach that there are other uses for the
+procreative element than the generation of offspring, and far
+better uses than its waste in pleasures. They claim that a life
+of total chastity increases the physical and mental vigor; and
+there will result a procreation on the mental and spiritual
+planes, instead of on the physical ones.</p>
+
+<p>They also claim that to woman belongs the creative power; that
+she must choose when a new life shall be evolved; and that only
+by adhering to this law can she be protected in the highest
+function of her being&#151; the function of maternity.</p>
+
+<p>The adherents of the second theory, "that the act is a love
+relation, mutually demanded and enjoyed by both sexes, and that
+it serves other purposes besides that of procreation," claim that
+the female sexual life indicates that the healthy woman is
+neither indifferent nor passive in the generative act. It has
+much the same effect as in man&#151; a powerful increase in her
+sensations, whole groups of muscles are set in motion, and the
+uterus as well as the entire nervous system are in an excited
+condition and activity. And that it is the province of the mother
+to decide when a new life should begin.</p>
+
+<p>The third theory, "that sexual intercourse is a physical
+necessity for the man, but not for the woman," is by far the most
+widely accepted. We will consider, first, the practical results
+of this last theory; and, second, the scientific basis on which
+it rests.</p>
+
+<p>It is generally acknowledged that this practice has done more
+to cause domestic misery, sickness, and death than that dreadful
+scourge of the human race, tuberculosis.</p>
+
+<p>This man, accustomed all his life to gratify his sexual
+passions promisculously, marries a virtuous young girl. In her
+menstrual periods she has had to do only with the secondary
+phenomena; with the expulsion of the ova not at all. She has had
+no instruction in the corresponding physiologic life of the man,
+and is astonished at the male sexual indications, and is led to
+believe in their physiologic necessities. The result is that she
+not only suffers physically, but feels outraged and disgraced.
+She is liable to the chance of maternity at any time; and such
+offspring will probably be sickly.</p>
+
+<p>Passion is presented to the young wife in so hideous a guise
+that it will take the utmost consideration of her husband
+afterward to enable her to completely overcome her repugnance. If
+she be worn and weary of excesses in the early days of her
+married life, the husband will have only himself to blame if he
+is bound all his life to an apathetic and irresponsive wife.
+Husbands place great strains upon the affections of their wives,
+and lower themselves almost past reinstatement in their respect
+and esteem.</p>
+
+<p>Lastly, on what scientific basis does this "physilogic
+necessity" for sexual gratification on the part of the male rest?
+Analogy with the lower animals does not bear it out. Among
+animals, except in rare instances under domestication, the female
+admits the male in sexual embrace only for procreation. Among
+many savage tribes this same rule has but few exceptions. The
+analogies between the male and the female sexual organs; between
+seminal emissions and menstruation; between the sexual life of
+the male and of the female, only go to accentuate the fact that
+this so-called physiologic necessity on the part of the male has
+arisen chiefly through the difference of education; so that it
+has come to be that the woman is chaste and the man is degraded;
+that the woman is too sentimental and the man too passionate.
+From a purely medical standpoint, the most eminent physicians and
+physiologists of the day all unite in advocating a chaste and
+continent life, simply for the sake of the man's own health,
+independently of all other considerations.</p>
+
+<p><b>Times when Marital Relations Should be Suspended.</b>&#151;
+The marital relations should always be suspended during the
+menstrual period. During pregnancy intercourse should never, or
+at least very rarely, be indulged in. At this time the mother
+needs to conserve all her strength and energies for herself and
+child; and any sexual relations during this time increase the
+sufferings of the mother and impair the vitality of the child. It
+has been even suggested that much of the pain during parturition
+would be avoided by entire continence during pregnancy.
+Intercourse during the early months of pregnancy is a frequent
+cause of abortion. Women who have supposed that they have never
+been pregnant have in reality been having abortions every second
+or third month.</p>
+
+<p>A woman should never be subjected to coitus until three months
+after delivery. During lactation intercourse should never, or at
+least very rarely, be indulged in; as the function of lactation
+makes a heavy drain on the strength of the mother, and anything
+which would further weaken her would tend to impoverish the
+quality of the milk and thus the child would suffer.</p>
+
+<h3>CHAPTER VIII.</h3>
+
+<h4><b>SEXUAL INSINCT IN WOMEN.</b></h4>
+
+<h5>Sexual Instinct in Women; Excessive Coitus; Causes of Sexual
+Excitability.</h5>
+
+<blockquote><p>"Virtue, the strength and beauty of the soul,<br/>
+ Is the best gift of heaven."
+</p>
+<p class="right">&#151; ARMSTRONG.
+</p></blockquote>
+
+<p><b>Sexual Instinct in Women.</b>&#151; After careful
+observation of the sexes in the married state, it is found that
+the sexual appetence is less in women than it is in men. Much of
+this difference in sexual appetence is doubtless due to the
+chastity of their lives, coupled with and resulting from the
+difference of education. The girl is taught repression, and the
+boy expression; that girls must be chaste; that chastity for boys
+is impossible.</p>
+
+<p>According to the intensity of the sexual instinct women have
+been divided into three classes: A larger number than is supposed
+have little or no sexual feeling. Second, those who are subject
+to strong passion; this class is larger than the first, but small
+as compared with the whole of their sex. Third, those in whom the
+sexual appetite is moderate; this class comprises the vast
+majority of women.</p>
+
+<p>And, even granting to woman more pleasure in sexual indulgence
+than usually comes to her by largest allowance, it is safe to say
+that in nine cases out of ten maternity, with its early pains and
+later cares, greatly lessens her power of enjoyment; and that for
+the larger part of her married life she is either positively
+distressed by the apparently necessary demands of her husband
+upon her, and irresponsive to them, or kept to a cheerful
+response by a self-abnegation and regard for his comfort, not to
+say fear of his moral aberration, which is a positive drain upon
+her health and strength.</p>
+
+<p><b>Excessive Coitus.</b>&#151; Those who are most frequently
+found to suffer from venereal excesses are the newly married;
+especially if they have weak constitutions and excitable
+temperaments. A great deal of mischief is done by two persons of
+unequal constitutions being matched together; the husband may
+exhaust the wife or vice versa, the weaker party being constantly
+tempted to exceed their strength. In all sexual matters there
+must be a consideration for others. It is not so much from
+selfishness as from ignorance that such a mistake is made. The
+ignorance comes from a lamentable morbid delicacy which prevails
+on all sexual matters, and which prevents all open and rational
+conversation on them, even between those who have the most
+intimate knowledge of each other.</p>
+
+<p>When the conjugal act is repeated too often, the man will
+become gradually conscious of diminished strength, diminished
+nerve force, and diminished mental powers. Excess weakens a man's
+energies, and enervates and effeminates him. Moreover, it renders
+him liable to an infinity of diseases and a readier victim to
+death.</p>
+
+<p>Not only is the strength of the constitution lowered by the
+excessive expenditure of force and matter requisite for the
+perpetuation of the species, but this lowered standard of
+vitality is transmitted to children. There can be but little
+doubt that this is one of the reasons why so many healthy parents
+beget sickly children, who die early. They have exhausted
+themselves of the material from which a new life is created, and
+so it is not properly started at the beginning and never reaches
+its highest development. To the truth of this statement attests
+the mental imbecility, the pallid and attenuated forms, of the
+children who are the earlier products of marriage. The effect of
+excessive coitus in women is seen by the confirmed ill health of
+so many women after marriage and repeated child-bearing. A large
+number of these cases are dependent upon alteration and diseases
+of the genitalia; but a considerable number are unconnected with
+local disease, and in many other cases the health is never
+regained after all local phenomena have disappeared.</p>
+
+<p>Sexual excitement in the woman causes certain congestion of
+the genital organs; and at the time of the orgasm there is a
+reflex movement which corresponds to erection, and which consists
+of a peristaltic movement of the tubes and uterus; to the uterus
+also is ascribed an act of suction by which the spermatozoa are
+drawn up into its interior. Even when pregnancy does not follow,
+the too frequent excitation and activity of the uterus in weak
+constitutions causes illness, first of the genital organs and
+then of the nervous system.</p>
+
+<p>Local diseases caused in women by excessive coitus are:
+vaginal catarrh, acute catarrh of the vulva, acute inflammation
+of the lining membrane of the uterus as well as of the uterus
+itself, inflammation of the ovaries, and even peritonitis. It is
+also known to be an important factor in the origin of
+blood-tumors and of cancer of the uterus. Especially is coitus at
+a time of great physical fatigue liable to be provocative of
+uterine inflammations. Aside from ethical considerations, coitus
+during the menstrual period may be the cause of rupture of the
+impaired blood-vessels, thus causing blood-tumors. Excessive
+coitus is a well-known cause of chronic inflammation of the
+uterus; that is, a habitual congestion of the uterus is induced
+by excessive sexual intercourse. This has been frequently
+mentioned by authors as leading to enlargement of the uterus in
+the non-pregnant condition; and it is a still more potent factor
+in the recently impregnated organ, whose tissues are succulent
+and the vessels enlarged, a condition inviting congestion and
+enhancing the susceptibility to engorgement.</p>
+
+<p>The general manifestations of impaired health in women due to
+excessive coitus are: chronic anemia, with malnutrition; impaired
+and altered functions in all the organs, especially those of the
+nervous system. Menorrhagia is apt to be induced by
+overstimulation of the ovaries, together with exhaustion and
+sexual apathy.</p>
+
+<p>The source of so much misery is the increasing physical
+weakness of the female and the increasing nervous weakness of the
+male, with an increasing sexual excitability, two factors of
+tragic effect for the wife. Here is seen the unfortunate result
+of teaching two kinds of morals, one for men and another for
+women.</p>
+
+<p><b>Causes of Sexual Excitability.</b>&#151; Too frequent
+genital irritation, onanism, too frequent intercourse, alcohol,
+too rich and too highly seasoned foods, lack of exercise.</p>
+
+<p><i>Treatment of Sexual Excitability.&#151;</i> Avoid alcohol
+and precocious puberty. Strictest attention must be paid to the
+diet; everything is to be avoided which is difficult of digestion
+or which retards it. The following articles of diet must all be
+avoided: cheese, foods seasoned with pepper and curry, highly
+salted and acid foods, and all rich foods; and meat must be eaten
+only in moderate quantities. Constipation irritates the genitalia
+directly and increases the inflammation. The close relation of
+Venus and Bacchus is known not only in mythology. Carbonated
+waters are to be especially avoided, such as soda, seltzers,
+Preblauer, Geisshubler, and acid waters; also champagne and beer,
+heavy Italian, Spanish, and English wines. All alcoholic drinks
+must be forbidden.</p>
+
+<p>As heavy gymnastics as the strength of the individual will
+admit, and plenty of exercise out-of-doors must be taken. There
+must also be constant mental and physical employment. In women
+sexual excitability is often caused by local diseases, and passes
+off with their cure; if not, she must use her will-power, and
+take the various forms of cold baths. Sexual intercourse not
+oftener than once in two or three weeks, and avoid all intimate
+approaches; if this is not sufficient, she will have to leave her
+husband for a few months.</p>
+
+<h3>CHAPTER IX.</h3>
+
+<h4><b>STERILITY.</b></h4>
+
+<h5>Sterility; the Prevention of Conception and the Limitation of
+Offspring; the Crime of Abortion; Infidelity in Women.</h5>
+
+<blockquote><p>"Never let yourselves do evil that good may come. If
+you do, you hinder the coming of the real, the perfect good in
+its due time."
+</p>
+<p class="right">&#151; PHILLIPS BROOKS.
+</p></blockquote>
+
+<p><b>Sterility.</b>&#151; Conception is least apt to take place
+from the tenth day after one period until the third day before
+the next; but there is practically no time during a woman's
+sexual life when she may not be impregnated; in this connection
+it must be remembered that the spermatozoa stay alive in her for
+more than a week.</p>
+
+<p>During lactation women are generally sterile, especially in
+the first months which follow the accouchement, because the vital
+forces are then concentrated on the secretion of milk.</p>
+
+<p>The age of the wife at the time of marriage has much to do
+with the expectation of children. As the age increases over
+twenty-five years the interval between the marriage and the birth
+of the first child is lengthened. For it has been ascertained
+that not only are women most fecund between twenty and
+twenty-five years, but that they begin their career of
+child-bearing sooner after marriage than either their younger or
+older sisters.</p>
+
+<p>A wife who has had children and ceases to conceive for three
+years will probably bear no more.</p>
+
+<p>When marriages are fruitless, the wife is almost always
+blamed; but it is by no means the wife that is always at fault;
+many husbands are absolutely sterile. Every man is not prolific
+who enjoys good health and is vigorous. Gross states that in one
+case out of six the sterility was due to the male. Kehrer, after
+a series of carefully conducted experiments, has arrived at the
+conclusion that in at least a third of the cases of sterile
+marriages the husband was the party at fault, and that gonorrhea
+was the cause of the barrenness.</p>
+
+<p>Venereal diseases have their share of influence, and the
+gonorrheal infection is a potent cause of sterility. It is by no
+means proved that syphilis has any unfavorable influence on
+conception, though abortions due to this are frequent.</p>
+
+<p>Gonorrhea often prevents conception by the inflammation
+traveling up the womb, and along the Fallopian tubes to the
+ovaries, whose covering is rendered thick and dense, so that the
+ovum cannot escape, or if it does, the fimbriated end of the tube
+is so agglutinated that it cannot grasp the ovum.</p>
+
+<p>Alcoholism is considered a cause of sterility. It evidently
+does diminish the sexual potency in the male, and for this the
+female is often blamed.</p>
+
+<p>It does not follow because a woman has not given birth to a
+child that she has not conceived. The life of an infant for a
+long time after birth is a frail one, and before birth its
+existence is extremely precarious; it often perishes a few days
+after conception. A period coming on a few days late, and at the
+same time one which is unusually profuse, is the only evidence
+which the young wife may have of an abortion. Among prostitutes,
+the frequent delay of menstruation, then abundant hemorrhage, is
+in many cases only habitual abortion, and leads to changes in the
+generative organs which must result in sterility. A tendency to
+miscarriage may therefore be all that stands in the way of having
+a family; this can frequently be remedied.</p>
+
+<p>Sexual incompatibility is well known to exist; prominent
+examples being Augustus and Livia; Napoleon and Josephine. It is
+also a well-known fact that frigidity is a cause of barrenness. A
+short separation of husband and wife is often salutary in its
+influence upon fertility.</p>
+
+<p>It is a well-established fact that the time immediately before
+the period, but still more that immediately following the period,
+are the most favorable times for conception to take place; the
+remaining quiet in bed of the woman after the generative act is
+also favorable to conception.</p>
+
+<p>The most frequent causes of sterility in women are
+inflammation of the lining membrane of the uterus, or of the neck
+of the uterus, or of both. The source of this condition in women
+who have had children is most frequently due to parturition or
+abortion. In the newly married it may be due to a previously
+existing slight uterine catarrh in a displaced uterus, or it may
+be a manifestation of a run-down state of the system. In a
+majority of the newly married, however, the inflammation of the
+endometrium is probably due to the first efforts at conjugal
+approach. Many young women as the result of the preparation of
+the trosseau, augmented by a round of gaities at the time of
+marriage, enter the married state in a condition bordering on
+physical and nervous exhaustion; and then begin engorgements and
+inflammations which lead to future suffering and to sterility.
+Displacements and flexions of the uterus also cause sterility.
+Such displacements of the neck of the uterus may occur that,
+instead of lying in a pool of semen, as it should, it is above,
+in front of, or away from it, and this may prevent
+conception.</p>
+
+<p>Vulvar and vaginal hyperesthesia, inflammations of the vulva,
+undue shortness of the vagina, unless great care is exercised by
+the husband, will induce painful coitus, and may bring about
+sterility by favoring the formation of a copulation sac outside
+of the axis of the uterine canal, and consequently misdirection
+of the semen.</p>
+
+<p>Scrofula, probably by its effects on the general condition,
+leading to deficient development of the whole body, the genital
+organs included, may be productive of sterility.</p>
+
+<p>The female being less passionate than the male, the orgasm
+comes on later with her, or the male orgasm occurs so soon that
+she may not reach that stage at all. If both were simultaneous,
+it is reasonable to suppose that conception would be more likely
+to occur.</p>
+
+<p>Ovulation is doubtless more frequently performed in some women
+than in others. Some women conceive with more or less regularity
+every fifteen or eighteen months, and others at intervals of
+several years.</p>
+
+<p>The effect of repeated coition, provided that impregnation
+does not take place at once, is to engorge the uterine vessels,
+to alter the nature of the glandular secretions, to cause
+profound reflex disturbances, and thus to produce such changes in
+the endometrium as to lead to local inflammation and to general
+nervous exhaustion. Backache, leucorrhea, and irritable bladder
+are the first symptoms of this disorder; but frequently there are
+added to these, headache, indigestion, rectal tenesmus, painful
+and profuse menstruation. In many cases the disease continues in
+a mild catarrhal form, giving the woman little inconvenience
+besides the slight leucorrheal discharge which stains her
+clothing; but often this is indicative of such a change of the
+lining membrane of the uterus as to render it unfit for the
+fixation and development of the ovum, even should impregnation
+take place.</p>
+
+<p>Under normal conditions, during the intermenstrual period, a
+plug of clear viscid mucus, which is secreted by the glands of
+the cervical canal, blocks up that passage, but is washed away
+each month by the menstrual discharge. Under ordinary conditions
+this obstruction must seriously interfere with the entrance of
+the spermatozoa into the cavity of the uterus, and renders the
+former theory, recently revived by Bossi, quite tenable, that
+impregnation is most likely to occur just after the menstrual
+epoch.</p>
+
+<p>The vaginal secretion under certain pathologic conditions may
+become so acid that it induces sterility. Women who suffer m
+severe vaginal catarrh are frequently sterile, the spermatozoa
+being found dead in the vagina some hours after copulation,
+although an examination a shorter time afterward revealed them
+still alive. In cases where conception takes place in spite of a
+very acid condition of the vaginal secretion, it is probable that
+some of the spermatozoa enter the uterus before the secretion has
+had time to act on them, or possibly the spermatozoa being
+injected in a mass, the acid secretion is unable to penetrate and
+kill them all.</p>
+
+<p>The reaction of the normal vaginal mucus is always acid, that
+of the cervix alkaline; but as the result of the inflammatory
+condition, the reaction of each is often intensified, especially
+that of the vagina, which has an exceedingly sour and penetrating
+odor. This acid discharge, bathing the neck of the uterus,
+penetrates more or less into the cervical plug and causes
+coagulation of the alkaline mucus.</p>
+
+<p>The chief constituent of the semen is albumin; agents which
+affect albuminous substances influence the functional activity of
+the spermatozoa&#151; heat, concentrated acids, and probably
+concentrated alkalies. In normal conditions the alkalinity of the
+seminal fiuid seems to be sufficient to neutralize the acidity of
+the vaginal secretions, so that the spermatozoa may remain
+seventeen days or more (Bossi) within the vaginal canal, even
+during a menstrual period, without having their vitality
+destroyed.</p>
+
+<p>When hyperacidity of the vaginal secretion is present, it is
+probable that the fertilizing element is at once rendered inert;
+but should some of the spermatozoa succeed in reaching the
+interior of the cervical canal, the increased alkalinity of the
+secretion there would in all probability put an end to all
+further progress.</p>
+
+<p>The conditions, then, which appear to prevent fecundation are:
+First, the absence of the proper nidus for the ovum; second, the
+obstruction of the cervical canal by a mucus plug; third,
+increased alkalinity of the cervical secretion, often accompanied
+by the increased acidity of the vaginal secretion. Three
+conditions must, then, be determined: First, are there
+spermatozoa in the semen? Second, do they get into the
+uterocervical canal? Third, do the secretions in the canal poison
+the spermatozoa?</p>
+
+<p>"For those who are very anxious for offspring," wrote Marion
+Sims, "I usually order sexual intercourse on the third, fifth,
+and seventh days after the flow has ceased; and on the fifth and
+third days before its return. For the most obvious reasons this
+would always be before going to bed at night, instead of just
+before rising in the morning. The horizontal position favors the
+retention of semen; the erect its expulsion. I am satisfied that
+too frequent sexual indulgence is fraught with mischief to both
+parties. It weakens the semen; in other words, that this is not
+so rich in spermatozoa after too frequent indulgence; and when
+carried to the extent of a debauch, the fiuid ejaculated may be
+wholly destitute of spermatozoa. Thus it will be seen that it
+will be much better to husband the resources of both man and
+wife."</p>
+
+<p><b>The Prevention of Conception and the Limitation of
+Offspring.</b>&#151; Some of the contraindications to procreation
+are when either parent suffers from a disease which is
+transmissible, and such diseases frequently manifest themselves
+only after marriage; when the pregnancy would endanger the
+mother's life, or even where the pregnancy is a nine months'
+torture to her; where either parent is suffering from ill health;
+or where for economical reasons no more children are desired.</p>
+
+<p>If there exists no condition in either parent or in their
+circumstances why they should not have children, the next
+consideration due to their children, is how the same may be
+procreated under the most favorable conditions possible; this
+condition can only be secured by making the circumtsances such
+that the mother shall be able to choose the time for their
+conception when both parents are in the best physical condition.
+That children should be brought into the world haphazard, as the
+result of accident, is to degrade the human race below that of
+the lower animals, where the female admits the male only at the
+time of the rut, which in the majority of cases occurs only once
+a year.</p>
+
+<p>Another requisite to bearing healthy children is that the
+pregnancies shall not follow each other too rapidly. Aside from
+the consideration for the health of the mother herself, she must
+be in good physical condition to bear the healthiest children she
+is capable of giving birth to; and for this there must be from
+two and a half to three years between the successive pregnancies.
+The results of overproduction on the children are frequently,
+that they are sickly, short-lived, or suffer from rickets,
+cerebral paralysis, idiocy, or imbecility.</p>
+
+<p>And last, but certainly not least, many women become chronic
+invalids, or are hastened to premature graves, by having children
+as fast as they possibly can.</p>
+
+<p>The most natural and moral way for the artificial prevention
+of conception, when on account of ill health or for economic
+reasons no more children are desired, is to abstain from sexual
+intercourse. But in the majority of cases the husband will not
+agree to this, and so the greatest number of methods have come to
+be used to prevent conception.</p>
+
+<p>Perhaps the most frequent method use to prevent conception is
+withdrawal before the ejaculation of semen. While this is most
+injurious to the husband&#151; debility, nervous prostration, and
+even paralysis are said to ensue&#151; the health of the wife
+also suffers. If, this interrupted sexual congress is continued
+for years, there develop gradual nervous disturbances on both
+sides, and a serious disease of the uterus makes itself felt. The
+generative organs become engorged with blood, but are not
+permitted to enjoy relaxation consequent upon the full completion
+of the act. This engorgement may lead to undue local nutrition,
+and diffuse growth and proliferation of the connective tissue may
+take place. Hence the uterine walls become dense and thickened
+and the nerves compressed. Of course, pain and tenderness and a
+sense of bearing down will be the result. Flexions and versions
+may be consequent upon the engorgement. The nerves become
+shattered, and the woman will be fortunate if she contracts no
+serious womb trouble.</p>
+
+<p>"It is strange," says John Stuart Mill, "that intemperance in
+drink or any other appetite, should be condemned so readily, but
+that incontinence in this respect should always meet not only
+with indulgence, but with praise. Little improvement can be
+expected in morality until the producing of too large families is
+regarded with the same feeling as drunkenness, or any other
+physical excess."</p>
+
+<p>Sismondi writes: "When our true duties toward those whom we
+give life are not obscured in the name of a sacred authority, no
+man will have more children than he can properly bring up. If a
+woman has a right to decide any question it is how many children
+she should bear. Whenever it becomes unwise that the family
+should be increased, justice and humanity require that the
+husband should impose on himself the same restraint which is
+submitted to by the unmarried."</p>
+
+<p>In the opinion of Dr. Edward Reich, it is very much to be
+wished that the function of conception should be placed under the
+domain of the will. But the strongest appeal has been made for
+the sake of morality itself; namely, to prevent the crime of
+abortion. Dr. Raciborski, of Paris, took the position that the
+prevention of offspring to a certain extent is not only
+legitimate, but it is to be recommended as a means of public
+good.</p>
+
+<p>Continence, self-control, and a willingness to deny
+himself&#151; that is what is required of the husband. But
+suffering women assure us that this will not suffice; that men
+refuse to restrain themselves; that it leads to loss of domestic
+happiness, to illegitimate amours; or that it is injurious
+physically and mentally; that, in short, such advice is useless
+because it is impracticable.</p>
+
+<p>Dr. Napheys writes: "Is it amiss to hope that science will
+find resources, simple and certain, which will enable a woman to
+let reason and sound judgment, not blind passions, control the
+increase of her family?"</p>
+
+<p><b>The Crime of Abortion.</b>&#151; From the moment of
+conception a new life begins, a new individual exists; another
+child is added to the family. The mother who deliberately sets
+about to destroy this life by want of care, or by taking drugs,
+or by the use of instruments, commits a great crime, and is just
+as guilty as if she strangled her new-born infant. The crime she
+commits is child-murder. Women in their frenzy at finding
+themselves in this condition, and with no slightest idea of the
+sin that they are committing, are constantly guilty of committing
+abortions on themselves, or going to professional abortionists to
+have this crime of child-murder committed. This is another of the
+sins due to the ignorance of the sex in all matters pertaining to
+reproduction; and it is a fearfully prevalent one.</p>
+
+<p><b>Infidelity in Women.</b>&#151; "We have now reached the
+last infernal circle of the divine comedy of marriage; we are at
+the depths of the inferno. There is something, I do not know
+what, terrible in the situation in which a married woman finds
+herself when an illegitimate love has ruined her for the duties
+of a wife and mother. As has been so well and strongly expressed
+by Diderot, infidelity in woman is like incredulity in a priest;
+it is the last step in human forfeitures; it is for her the great
+social crime, for it implies all the others.</p>
+
+<p>"Weigh the sufferings of the future, the agonies of years by
+the ecstasy of half an hour. If this conservative sentiment of
+the creature, the fear of death, does not stop her, what could be
+expected of laws? Oh, sublime infamy!"&#151; (Balzac).</p>
+
+<hr />
+<h3>PART III.&#151; MATERNITY.</h3>
+
+<hr />
+<h4><b>CHAPTER X.</b></h4>
+
+<h4><b>PREGNANCY.</b></h4>
+
+<h5>Nature of Conception; Pregnancy Defined; Duration of
+Pregnancy; the Signs of Pregnancy; Quickening; the Determination
+of Sex at Will; the Influence of the Male Sexual Element on the
+Female Organism; Heredity; Hygiene of Pregnancy; Causes of
+Miscarriage.</h5>
+
+<blockquote><p>                "Happy he<br/>
+With such a mother, faith in womankind<br/>
+ Beats with his bood, and trust in all things high<br/>
+Comes easy to him, and though he trip and fall,<br/>
+He shall not bind his soul with clay."
+</p>
+<p class="right">&#151; TENNYSON.
+</p></blockquote>
+
+<p><b>Nature of Conception.</b>&#151; Conception, or
+impregnation, is the union of the germ and the sperm cell, the
+result of which is a new being. On coition, the semen being
+received into the female organs, which are at that time in a
+state of turgescence, the spermatozoa, by means of their own
+vibratile activity, find their way into the Fallopian tubes, and
+here come in contact with the ovule.</p>
+
+<p>The ovule is a minute cell with a transparent membrane, within
+which is the yolk containing the germinal vesicle. The
+spermatozoon penetrates into the ovule and becomes fused with it.
+The processes of development begin at once to occur. There is
+congestion of the uterine mucous membrane out of proportion to
+the rest of the uterus; the ovum finds lodging here, and becomes
+surrounded by a membrane which incloses it in a separate sac.</p>
+
+<p><b>Pregnancy Defined.</b>&#151; Pregnancy begins with
+conception and ends with parturition; it provides for the
+nutrition and the expulsion of the embryo and for its nutrition
+for a short time after birth.</p>
+
+<p>The average duration of pregnancy is ten lunar months, or two
+hundred and eighty days. The date of the confinement is
+calculated by reckoning from the date of the last menstrual flow;
+count backward three months from the date of the first appearance
+of the last menses; to this add twelve months and seven days,
+five days being for the average menstrual duration and two days
+for the possibility of fecundation.</p>
+
+<p><b>Duration of Pregnancy.</b>&#151; Many difficulties are
+experienced in determining the date of the expected confinement.
+As most pregnancies occur in married women, we cannot base any
+calculations on a single act of coitus. And even if there was but
+one, all physiologists agree that there is a variable period in
+different women, and in the same woman at different times,
+between insemination and the fertilization of the ovum. It is the
+moment of fecundation, or the union of the germ and sperm cells,
+which marks the beginning of pregnancy. The uncertainty becomes
+still greater owing to our inadequate knowledge as to the length
+of time during which the sexual elements, the ova and the
+spermatozoa, retain their vitality after liberation from their
+respective sources. While it is not certainly known, it is
+probable that the ovum is capable of impregnation any time during
+its sojourn within the oviduct and before reaching the uterus, or
+probably for a period of about one week from the time of its
+escape from the Graafian follicle. The remarkable vitality of the
+spermatozoa even under less favorable circumstances&#151; direct
+observation shows that these elements retain their movements for
+over nine days outside of the body&#151; renders it almost
+certain that their powers of fertilization are maintained for a
+long time after they are deposited within the healthy female
+genital tract; it is believed that the spermatozoa are capable of
+fertilization after a sojourn of three or more weeks within the
+oviduct.</p>
+
+<p>Consideration of these facts renders apparent the
+impossibility of fixing with certainty the date of the beginning
+of pregnancy, since conception may result from the union of the
+ovum liberated at the beginning of the period with the
+spermatozoon introduced at the end of that time; or it may result
+from the meeting of the male elements already within the oviduct
+with an ovum discharged a day or two before the occurrence of the
+menstrual period.</p>
+
+<p><b>The Signs of Pregnancy.</b>&#151; The cessation of the
+menstrual period is the sign of the greatest value in women who
+have been regular; but it must always be remembered that there
+may be an irregularity of menstruation for the first few months
+after marriage. The appetite is capricious; morning sickness or
+nausea in the morning on first getting up is a very common
+symptom in the early months of pregnancy; enlargement of the
+abdomen; in the first two months of pregnancy the abdomen is
+flattened and the umbilicus is depressed; after this the abdomen
+begins to enlarge. There is also an increase in the size of the
+breasts, with a deepened color of their areolae and later a
+watery secretion. The external genitals become swollen and of a
+bluish color. Feeling of the fetal movements&#151; that is, the
+movements of the small parts of the child in the womb&#151; by
+the mother is not always reliable, since gas in the intestines
+has sometimes been mistaken for this. These signs are more
+valuable when several exist together.</p>
+
+<p>The nausea and vomiting of pregnancy, the so-called morning
+sickness, consists of nausea accompanied often by vomiting or
+retching of a glairy fiuid, showing itself most frequently on
+rising in the morning, but sometimes appearing after breakfast.
+It is aggravated by the assumption of the erect position. It may
+begin within a few days, but as a rule it does not show itself
+until the fourth week of pregnancy; and it generally ceases about
+the fourth month, rarely persisting throughout the entire time.
+In the majority of cases it does not sensibly impair the health.
+It is a sympathetic disorder reflected from the uterus; it is
+aggravated by indigestible food, by sexual excitement, and by
+emotional disturbances; it is most marked in first pregnancies
+and in women of highly emotional natures. It is not infrequently
+due to some inflammation of the uterus or erosion about the
+external orifice, and disappears on the removal of the cause.</p>
+
+<p><i>Mammary Changes.&#151;</i> During pregnancy the mammary
+glands are in immediate sympathy with the growing reproductive
+organs of the pelvis; consequently a genuine physiologic
+enlargement commences in these organs from the beginning of
+gestation. Their glandular structure becomes larger, fuller, and
+firmer; a sensation of weight or pricking is felt by the patient;
+the veins become more prominent. The nipples also become
+enlarged, more elongated, and somewhat erect. Surrounding the
+nipple is the areola; this becomes darker in color.</p>
+
+<p>In most women a drop of watery fiuid, the so-called colostrum,
+may be squeezed out from the nipple at the end of the third month
+of pregnancy.</p>
+
+<p>The signs of pregnancy are divided into the presumptive, the
+probable, and the positive. The presumptive signs are: menstrual
+suppression, morning sickness, irritable bladder, mental and
+emotional phenomena. The probable signs are: mammary changes,
+abdominal enlargement, changes in the neck of the womb, and
+certain changes which are felt on bimanual examination. The
+positive signs are: feeling the various parts of the fetus,
+active movements of the fetus, and hearing the fetal heart
+sounds.</p>
+
+<p>Functional disturbances of the bladder are quite often
+noticeable in the early part of the pregnancy. In the first part
+of the pregnancy the bladder is dragged upon, and later it is
+pressed upon by the enlarged uterus so that the bladder capacity
+is lessened and frequency of urination is the result. In the
+fourth month, when the uterus ascends into the abdominal cavity,
+these bladder symptoms subside, until the very close of the
+pregnancy, when by the descent of the now greatly enlarged uterus
+there may be even incontinence of urine.</p>
+
+<p><i>Changes in the Abdomen.&#151;</i> During the first two
+months of the pregnancy there is a flattening of the abdominal
+surface, due to the descent of the uterus into the pelvic cavity,
+thus slightly dragging the bladder downward and drawing the
+umbilicus inward. In the latter part of the fourth month there is
+noticeable a slight abdominal enlargement, and the umbilicus is
+no longer sunken. By the end of the fourth month the base of the
+uterus has risen two inches above the symphysis, and at the end
+of the thirty-eighth week it touches the lower extremity of the
+breast-bone; the umbilicus has been for many weeks protruding;
+during the last two weeks of pregnancy the uterus again descends
+and the woman feels more comfortable.</p>
+
+<p>On the inspection of the abdomen of a pregnant woman there
+will be noticed a brown line which extends from the umbilicus to
+the pubes, and all over the surface the presence of striae, or
+long purple grooves, due to the distention of the abdomen; on the
+sides of the abdomen and down the thighs, red, blue, or white
+markings, like cicatrices, may be seen.</p>
+
+<p><b>Quickening.</b>&#151; Quickening is the sensation
+experienced by the mother as the result of the active fetal
+movements of the child in the womb. These movements are first
+felt between the eighteenth and the twentieth week; the common
+rule is that quickening occurs at the middle of pregnancy; that
+is, at four and a half months. As pregnancy advances these active
+motions increase in frequency and become more marked. When felt
+or seen by the physician, as can be done in the sixth month,
+fetal movements constitute a positive sign of pregnancy.</p>
+
+<p><b>The Determination of Sex at Will.</b>&#151; Although this
+has always been a question of great interest, and the subject of
+much experimentation, no rule can as yet be given by which the
+parents can know in advance of the birth of the child what the
+sex will be. Dr. Schenck's theory is that the ruling factor in
+determining the sex is the food partaken of by the mother.</p>
+
+<p>Furst believes that the differentiation may occur before,
+during, and a little while after the impregnation; that the
+chances of the development of one or another sex in one and the
+same woman may vary before final differentiation occurs. It is
+impossible to determine the sex of the embryo before the tenth
+week of fetal life. The cause of the differentiation, he
+believes, lies largely in the good or bad state of the health of
+the parents; in the first instance there being an excess of
+females, and in the latter an excess of males, relatively
+speaking. He believes that there is an excess of male children
+when conception takes place during the post-menstrual anemia. He
+has investigated one hundred and ninety-three cases carefully in
+regard to the probable date of conception after menstruation, and
+there is a notable increase of male births over female in the
+cases where conception occurred in the first five days after
+menstruation; that is to say, where the woman is not so well
+nourished as later.</p>
+
+<p>Dr. J. Griffith Davis gives as the result of her experiments
+in this direction, that when conception takes place three days
+before the menstrual period or within forty-eight hours
+afterward, the child will be a girl; when conception takes place
+ten days after the period, the child will be a boy.</p>
+
+<p>Although there are a greater number of the female than the
+male sex in all parts of the world where reliable statistics have
+been taken, in all civilized countries the proportion of male
+births is greater than that of females. There is a greater
+tendency of the male offspring to die earlier, and this is seen
+even before birth, in the proportion of three to two. For this
+reason the stronger sex as applied to men has been regarded by
+some authors as a misnomer. They are physically weaker in early
+life and succumb more readily to noxious influences.</p>
+
+<p>The relative age of the parents is said to be another factor
+in determining the sex of the children. Seniority on the father's
+side gives an excess of male children; equality in the age of the
+parents gives a slight preponderance of females; seniority on the
+mother's side gives an excess of females. Men, and especially
+scholars, who pass a sedentary life and who exhaust their nervous
+force to a great extent, beget more girls than boys; so, also, a
+very advanced age on the part of the man diminishes the number of
+male offspring.</p>
+
+<p><b>The Influence of the Male Sexual Element on the Female
+Organism.</b>&#151; Dr. Alexander Harvey, of Aberdeen, has
+adopted the theory of fetal inoculation. He believes that the
+effect is first due to the influence of the male element upon the
+ovum, which, in consequence of the subsequent close attachment
+and freely inter-communicating blood-vessels between the modified
+embryo and the mother, inoculates the condition of the mother
+with the qualities of the male; and so, on the subsequent
+impregnation by another male, the offspring resembles the first
+male and not its real parent. He even goes further, and says that
+it is conceivable, by successive impregnations effected by him,
+that the influence may be increased, and if so the younger
+children begotten by him, rather than the elder, might be
+expected, <i>ceteris paribus,</i> to bear their father's image.
+And as regards the mother, he suggests the question, whether
+there is not something in the popular notion that in the course
+of years the wife comes to resemble the husband; and that not
+merely in respect of temper, disposition, or habits of thought,
+but in bodily appearance, which may be referable to this
+influence exerted by the husband on her constitution, through the
+medium of the fetuses <i>in utero.</i></p>
+
+<blockquote><p>"Yet it shall be; thou shalt lower to his level day
+by day,<br/>
+  What is fine within thee growing coarse to sympathize with
+clay.<br/>
+  As the husband is the wife is; thou art mated with a clown,<br/>
+  And the grossness of his nature will have weight to drag thee
+down.<br/>
+  He will hold thee, when his passion shall have spent its novel
+force,<br/>
+  Something better than his dog, a little dearer than his
+horse."</p></blockquote>
+
+<p>Darwin, on the other hand, considers it a most improbable
+hypothesis that the mere blood of one individual should affect
+the reproductive organs of another individual in such a manner as
+to affect the subsequent offspring. The analogy, he says, from
+the direct action of the foreign pollen on the ovaries and seed
+coats of the mother plant strongly supports the belief that the
+male element acts directly on the reproductive organs of the
+female, and not through the intervention of the crossed
+embryo.</p>
+
+<p>Dr. John Brown, in reviewing the subject, says it must be
+conceded that the male element has an influence on the female,
+over and above its fertilizing influence upon the ovum. The limit
+of this influence is at present unknown.</p>
+
+<p><b>Heredity.</b>&#151; Girls are more apt to resemble their
+fathers in mental traits, disposition, and constitution; while
+boys take after their mothers. Boys procreated by intelligent
+mothers will be intelligent; while it does not always follow that
+the sons of intelligent fathers are intelligent. The poets Burns,
+Ben Johnson, Goethe, Walter Scott, Byron, and Lamartine were all
+born of women remarkable for vivacity and brilliance of
+language.</p>
+
+<p><b>Hygiene of Pregnancy.</b>&#151; The health and perfection
+of the child depend largely upon the health and perfection of the
+parents at the time of its conception, as well as upon the
+condition of the mother during the pregnancy. Even when both
+parents possess a strong constitution, but one or both of them is
+suffering from a temporary exhaustion or malaise, the child will
+be born below the standard of health it ought to possess.
+Children born during the first year of married life seldom equal
+in health the children born of the same parents later; they are
+not only apt to be sickly, but the liability to premature death
+is greatly increased. For this reason it is better that the first
+year of married life should be allowed to pass without conception
+taking place. A child begotten in an intoxicated or depraved
+condition of a parent may be depraved itself in the same way, and
+is apt to be feeble-minded or idiotic.</p>
+
+<p>It must be borne in mind that prenatal culture of some sort
+begins at the time of conception; and that on the mental as well
+as on the physical state of the mother, the health as well as the
+disposition of the child will depend to no slight extent. The
+prospective mother who constantly gives way to her feelings does
+a wrong to her unborn child. The mother is at this time more
+impressionable, more nervous, and more irritable than is natural
+to her; and while her family should make a certain allowance for
+her condition, she, on her part, should not allow herself to give
+way to her morbid feelings. The prospective mother should not
+lead a life of self-indulgence, on the one hand, or, on the
+other, should not be weighed down with cares; she should interest
+herself in her usual duties, and be relieved of all anxiety
+possible.</p>
+
+<p><i>Dress.&#151;</i> The clothing must be loose, and all
+compression about the waist and abdomen must be especially
+avoided. If the woman wears corsets, she must take them off at
+once, and substitute a Ferris or some similar hygienic waist. The
+corset prevents the proper development of the abdominal muscles,
+which play so important a role in the expulsion of the child from
+the womb, as well as in the proper growth and development of the
+fetus itself. If the woman has already borne children, and toward
+the end of the pregnancy the abdomen becomes pendulous, she will
+very materially add to her comfort by swearing a muslin abdominal
+bandage.</p>
+
+<p>A woolen undersuit, or undervest and drawers, with high neck
+and long sleeves, must be worn winter and summer; the grade of
+the wool to be adapted to the season of the year. The especial
+necessity for wearing wool next the skin during the pregnancy is
+because of the intimate relation between the skin and the
+kidneys. Any chilling of the body at this time is apt to lead to
+the congestion of the kidneys. If there is already any congestion
+of the kidneys present, or any abdominal pain, in addition to the
+undersuit an abdominal bandage should be worn. These bandages
+come woven in ribbed woolen, and fit the body snugly. This
+bandage is to be constantly worn, and, of course, changed at
+night. During the cold weather the stockings should also be of
+wool. Under no circumstances are garters allowed to be worn, as
+they form a constriction around the leg and interfere with the
+return of the venous blood to the heart, and so increase the
+tendency to the formation of the varicose veins. It is better not
+to use any means to hold the stockings up; they will be kept
+sufficiently well in place by the under-drawers. Low shoes should
+never be worn except in the hottest weather. It is of the
+greatest importance that the woman should be impressed with the
+necessity of the avoidance of taking cold, since any lung or
+kidney trouble is a serious complication of pregnancy.</p>
+
+<p><i>Diet.&#151;</i> The diet is the same as that at any other
+time, only it is more necessary to guard against anything which
+is likely to cause indigestion. In other words, the diet should
+be plain, simple, and easy of digestion; nutritious and partaken
+of at regular intervals. In the latter part of pregnancy owing to
+the pressure of the enlarged uterus on the stomach, the food may
+have to be partaken of in smaller quantities and at shorter
+intervals. At this time also the appetite is abnormally large.
+Where it does not disagree with the patient, milk is the best
+adjuvant possible to the diet.</p>
+
+<p><i>Constipation.&#151;</i> Constipation is the rule of
+pregnancy. This is due to the great pressure that the enlarged
+uterus makes on the bowel; and as important as it is at all times
+to keep the bowels regular, it is at this time more necessary
+than ever that the woman should have the bowels well evacuated
+every day. A retention of fecal matter in the body causes the
+reabsorption into the blood of the toxic matters, with the
+resulting headaches, dizziness, loss of appetite, and intense
+nervousness. To obviate this tendency to constipation, plenty of
+fruit and vegetables should be eaten, as well as cereals if the
+woman is taking a good deal of outdoor exercise, otherwise the
+latter had better be omitted. The woman should drink plenty of
+water&#151; at least three pints a day; this acts as a laxative
+as well as to flush out the kidneys. If, in spite of all these
+measures, constipation still persists, as it probably will, a
+seidlitz powder can be taken the first thing on rising in the
+morning; or from one teaspoonful to one tablespoonful of the
+effervescing granules of the phosphate of soda in a glass of
+water, also to be taken on rising in the morning; or one-half
+grain of the solid extract of cascara sagrada night and morning.
+The object of these is to keep the bowels open, but purgation
+must always be avoided.</p>
+
+<p><i>Bladder Symptoms.&#151;</i> If there is any irritability of
+the bladder, any scalding on urination, or a very great frequency
+of emptying the bladder in the early months of pregnancy, a
+physician should be consulted at once; in the last months of
+pregnancy there is a desire to evacuate the bladder frequently,
+and sometimes at the last there is an incontinence of urine,
+which is due to the descent of the uterus and the great pressure
+on the bladder; this condition disappears with the
+confinement.</p>
+
+<p><i>Leucorrhea.&#151;</i> If this is present to any marked
+degree, the vaginal douche should be continued throughout the
+pregnancy; the temperature of the douche should be from 110&deg;
+to 112&deg; F.; it must never be taken very hot or very cold. The
+fountain syringe should be used, and the bag should not be hung
+more than three feet above the bed, so that there shall not be
+too much force to the stream of water.</p>
+
+<p><i>Baths.&#151;</i> Warm tub-baths may be taken throughout the
+pregnancy, but never oftener than twice a week, and the woman
+should never stay in the tub longer than is absolutely necessary
+for the bath, as otherwise the bath is too enervating. A daily
+sponge-bath of cool or cold salt water at a temperature of from
+80&deg; to 70&deg; F., and in the proportion of a pint of rock or
+sea salt to a gallon of water is most invigorating, and
+counteracts many of the nervous symptoms and promotes sleep and
+good digestion. The temperature of the room in which this bath is
+taken should be 72&deg; F. Shower-baths cause too great a shock
+to the nervous system, and they as well as foot-baths must be
+prohibited. Sitz-baths at a temperature from 110&deg; to 90&deg;
+F. may be taken just before retiring throughout the pregnancy.
+The frequency and duration of the bath as well as the temperature
+should be regulated by the attending physician. In cases of
+intense nervousness and insomnia these baths have an excellent
+sedative effect. A pregnant woman must never under any
+circumstances take ocean baths, since there is always great
+danger that the shock of the waves will cause an abortion.
+Sea-voyages should be avoided because of the severe nausea and
+vomiting, as well as the danger that the lurching of the vessel
+may cause miscarriage.</p>
+
+<p>The sewing-machine is a tabooed thing for the pregnant woman,
+because of the jarring of the pelvis which it produces. Sweeping
+of heavy carpets is also injurious. There must be no lifting of
+heavy pieces of furniture, and especially no lifting from the
+floor, as it interferes with the circulation in the uterus and is
+apt to produce miscarriage.</p>
+
+<p>Driving in an easy carriage over smooth roads is permissible;
+dogcarts, or any conveyance which produces much jolting, must be
+avoided; and while driving is good, the woman should not do her
+own driving, on account of the danger of the jars that would be
+caused by the sudden pulling of the horse upon the lines.
+Horseback-riding and bicycling are, of course, forbidden, as are
+also golf, tennis, and dancing.</p>
+
+<p><i>Exercise.&#151;</i> Exercise in the open air should be
+taken every day, when the weather is suitable, and walking is the
+best form of exercise. The amount will be regulated to some
+extent by what the woman has been accustomed to taking, and it
+should always stop short of fatigue. The woman should live as
+much as possible in the open air, and she should attend to her
+ordinary duties about the house. Long railway journeys are always
+objectionable.</p>
+
+<p>Hemorrhoids or piles are very often troublesome toward the
+close of the pregnancy. To overcome this, the patient should lie
+down immediately after the bowel movement, and remain in the
+recumbent position for ten or fifteen minutes. In addition, care
+should be taken to secure a loose movement of the bowels. Should
+the piles come down, applications of cloths wrung out of hot
+water, and held well pressed against the bowel, should be made;
+the piles should then be pressed back until the finger feels that
+the mass has been pushed above the second constriction of the
+bowel, which is felt to exist at about two inches above the
+sphincter ani muscle. Should these means not suffice, the
+physician must be consulted at once.</p>
+
+<p>Swelling and pain of the external genitals and of the lower
+limbs are best relieved by the recumbent position. Should the
+veins of the legs be much enlarged or the feet swollen, the
+patient should have compression made by the wearing of elastic
+stockings. Or in some cases a bandage is sufficient; in this case
+the bandage may be made of muslin; it should be three inches
+wide, and, beginning at the toes, should extend up as high as the
+enlargement of the veins continues. This bandage should be
+freshly applied every morning before rising.</p>
+
+<p>Pain caused by the stretching of the skin may be relieved by
+the inunction of the skin with cottonseed or cocoanut oil. For
+severe pain in the small of the back, rubbing with soap liniment
+or alcohol will be found useful.</p>
+
+<p><i>Mental Occupation.&#151;</i> Important as this always is,
+it is doubly so now. The mind should be constantly and pleasantly
+occupied, but no severe study should be indulged in. The
+emotional susceptibility is generally somewhat increased. The
+pregnant woman, quite excitable and irritable, readily responds
+to influences by which in the non-gravid condition she could not
+be affected. Sometimes she feels unusually well, is
+intellectually brightened and more active, and says she is
+positively happier. At other times she is despondent and
+morose.</p>
+
+<p>Physiologists admit and observation proves that maternal
+emotions do affect the development and the exterior of the fetus;
+likewise the mental organization of the fetus may be affected.
+All unpleasant news, frights, and physical shocks, also scenes of
+suffering and distress, must be avoided, as the mind is
+particularly impressionable at this time. Around the patient
+should be thrown a gentle and protective care, and she should be
+treated with the considerate kindness which her condition
+demands. Theatres and all places where there will be a large
+assemblage of people should be avoided, as the close air and
+general bad ventilation are apt to produce vertigo and sometimes
+attacks of fainting.</p>
+
+<p><i>Sleep.&#151;</i> During pregnancy a large amount of sleep
+is required; there should be eight hours spent in sleep at night,
+and one hour every afternoon. Pregnant women should never do any
+night watching. There is unusual necessity for good ventilation
+during sleep at this time.</p>
+
+<p><i>The Marital Relation.&#151;</i> Coitus is, as a rule,
+distasteful to pregnant women. It is for the best interest of the
+wife as well as for that of the child that all marital relation
+should be suspended at this time. Even uncivilized nations have
+condemned the privilege of sexual intercourse during pregnancy,
+and have visited punishment on the offender. If these relations
+are not wholly suspended, they must at least be at those periods
+which correspond to the time at which the woman would have been
+unwell had she not been pregnant. To the continuance of these
+relations throughout the pregnancy is due much of the suffering
+of the wife, not only then, but at the time of the labor as well;
+and the nourishment of the child is interfered with.</p>
+
+<p><b>Causes of Miscarriage.</b>&#151; Hemorrhoids; straining at
+stool; excessive intercourse in the newly married; nursing;
+ocean-bathing; overexertion; overexcitement; a fall; any violent
+emotion; anger; sudden or excessive joy; a fright; running;
+dancing; horseback-riding; riding in a heavily built carriage
+over rough roads; great fatigue; lifting heavy weights; the abuse
+of purgative medicines; disease or displacements of the womb; and
+a general condition of ill health.</p>
+
+<p>The danger of miscarriage is greatest during the first three
+months of pregnancy. Miscarriage is a fruitful source of disease
+and often of danger to wives; it is said that thirty-seven out of
+every hundred pregnant women miscarry. Miscarriage is most apt to
+occur during the first pregnancy; and great care should be taken
+to prevent this, as the habit is easily established, and after
+one miscarriage has occurred, another is likely to follow, so
+that it is sometimes with the greatest difficulty that the woman
+can be made to carry the fetus to full term. Artificially
+produced abortions are not an infrequent cause of sterility; the
+young wife becomes pregnant, and has an abortion produced because
+she is not yet ready to give up all her pleasures; and eventually
+when she does become very anxious to have a child such an extent
+of uterine disease has been produced by the abortions that she
+cannot conceive.</p>
+
+<p><i>To Prevent Miscarriage.&#151;</i> The life must be free
+from all excitement, and must be as quiet as possible without
+becoming monotonous; especial care must be exercised at the
+return of the dates for the menstrual periods.</p>
+
+<p>The symptoms of miscarriage are a show of blood, more or less
+profuse, with intense abdominal pain; on the slightest show of
+blood the patient should go to bed at once and the physician
+should be sent for.</p>
+
+<h3>CHAPTER XI.</h3>
+
+<h4><b>THE CONFINEMENT.</b></h4>
+
+<h5>Preparation for the Confinement; Signs of Approaching Labor;
+Symptoms of Actual Labor; the Confinement-bed; the Process of
+Labor.</h5>
+
+<blockquote><p>"To my conception one generation of educated mothers
+would do more for the regeneration of the race than all other
+human agencies combined; and it is an instruction of the head
+they need, and not of the heart. The doctrine of responsibility
+has been ground into Christian mothers above what they are able
+to bear."
+</p>
+<p class="right">&#151; ISABELLE BEECHER HOOKER.
+</p></blockquote>
+
+<p><b>Preparations for the Confinement.</b>&#151; The right time
+to engage the physician who is to take charge of the woman at her
+confinement is just so soon as the woman knows that she is
+pregnant. It used to be argued that, since giving birth to
+children was a physiologic process, there was no necessity for
+the woman to consult the physician until he was sent for when the
+labor pains began. Take the case of the woman who is for the
+first time pregnant; she is absolutely at sea; she has not the
+least idea how she ought to feel, what she ought to do or to
+leave undone; the result is that she often has a miscarriage
+which is the source of the greatest disappointment to her husband
+and herself, or she suffers very unnecessarily throughout the
+entire pregnancy, has a difficult labor, and perhaps gives birth
+to a sickly child.</p>
+
+<p>The educated physician will explain to her what symptoms are
+normal and what are pathologic, and often he will be able to
+entirely cure the latter. It is now a well-established fact that
+the most serious complications of the pregnancy, and of the labor
+itself are caused by severe congestion or disease of the kidneys.
+The condition of the kidneys can only be determined by frequent
+examinations of the urine; during the early months of pregnancy
+these examinations are made once a month, and during the last
+month they are made every week. The amount of urine passed in the
+normal condition is three pints a day.</p>
+
+<p>Nowhere, perhaps, is the constant vigilance of the physician
+so well rewarded as in the careful oversight of the pregnant
+woman. She goes through her entire pregnancy feeling well, and
+often the greatest discomfort that she suffers is due to her
+size; her labor and her lying-in are normal, and she gives birth
+to a healthy child.</p>
+
+<p><i>Engagement of the Nurse.&#151;</i> This is generally left
+to the physician in charge of the case, since he is responsible
+for the safe delivery of the woman; but if the patient has any
+decided choice in the matter, it is acceded to unless there
+should be some very valid objections, and the physician always
+sends the nurse in view for that case to see the patient in order
+to ascertain if she is personally agreeable to the patient.</p>
+
+<p><i>Choice of Room for the Confinement and Lying-in.&#151;</i>
+The room should be light, sunny, and well ventilated; it should
+not be too near a water-closet. In the city as quiet a room as
+possible should be selected, and one that is well removed from
+the rest of the house, so that if necessary perfect quiet can be
+maintained. The room should be as cheery as possible.</p>
+
+<p>The dress of the mother during the lying-in consists of a
+merino undervest, with high neck and long sleeves, and a
+nightgown, which shall be open all the way down the front. The
+gowns should be made of light muslin or of cambric; and there
+should be a sufficient number so that they may be changed every
+day.</p>
+
+<p>Six abdominal bandages should be provided. These are made of
+light muslin, and they should be eighteen inches wide and long
+enough to go once and a third around the patient's hips at the
+sixth month of pregnancy, or about one yard and a quarter long;
+they may be made straight or to fit the patient at the sixth
+month. This bandage is fastened down the front; it is applied
+directly after the labor, and adds greatly to the patient's
+comfort during the lying-in.</p>
+
+<p>The vulvar pads used during the lying-in are the antiseptic
+absorbent pads which can be obtained at any place where surgical
+dressings are sold; they are made of absorbent cotton, covered
+with cheesecloth, and sterilized.</p>
+
+<p>There must be a sufficiently generous supply of sheets so that
+they can be changed every day, and the drawsheet as often as may
+be required. Nothing is so important to a good lying-in as to
+have a clean, well-ventilated room, and plenty of fresh
+bed-linen. Cleanliness is the first requisite to antisepsis, and
+this is the secret of avoiding puerperal fever.</p>
+
+<p>Articles to be provided for the confinement are:</p>
+
+<ol>
+<li>An oblong douche-pan of agate-ware.</li>
+
+<li>An agate bed-pan.</li>
+
+<li>A bath thermometer.</li>
+
+<li>Two pieces of rubber sheeting; one, one yard square, and the
+other two yards square.</li>
+
+<li>Two sterilized bed-pads, 30 inches square by 3 to 4 inches
+thick.</li>
+
+<li>Three dozen antiseptic absorbent pads.</li>
+
+<li>One pound of sterilized absorbent cotton; twelve yards of
+cheese-cloth.</li>
+
+<li>Six abdominal bandages, eighteen inches wide, preferably made
+to fit the figure at the sixth month of gestation.</li>
+
+<li>Two hand-scrubs.</li>
+
+<li>Four ounces of the tincture of green soap.</li>
+
+<li>Bottle of corrosive sublimate tablets.</li>
+
+<li>Four ounces of powdered boric acid.</li>
+
+<li>Half a pint of good whisky.</li>
+
+<li>Two ounces of aromatic spirits of ammonia.</li>
+
+<li>Two ounces of aqua ammonia.</li>
+
+<li>One pint of alcohol.</li>
+
+<li>Two tubes sterilized white vaselin.</li>
+
+<li>Plenty of large and small safety-pins.</li>
+
+<li>Hot-water bag.</li>
+
+<li>New fountain syringe, to hold four quarts; with glass
+nozle.</li>
+
+<li>One small basin for vomited matter.</li>
+
+<li>Two very large agate basins or wash-bowls for washing
+doctor's hands and for antiseptic solutions.</li>
+
+<li>Vessel for after-birth.</li>
+
+<li>Three large pitchers; one for boiling water, one for cold
+boiled water, and one for antiseptic solution.</li>
+
+<li>Tumbler for boric acid solution for washing baby's eyes, with
+fine old linen sterilized.</li>
+
+<li>One dozen freshly laundered sheets, and two dozen
+towels.</li>
+
+<li>Stocking-drawers, muslin.</li>
+
+<li>Change of night-clothing warmed for the mother.</li>
+
+<li>A warm blanket to receive the baby.</li>
+
+<li>An infant bath-tub.</li>
+
+<li>A large piece of oil-cloth to protect the floor.*<br/>
+</li>
+</ol>
+
+<p class="footnote">* Van Horn &amp; Co., Park Avenue and 41st
+Street, New York, keep an obstetric outfit, containing many of
+the above articles, cleansed, sterilized, and packed in a box
+ready for use, so that they remain intact until needed. The price
+of this outfit is $16.50.</p>
+
+<p><i>Baby's Outfit.&#151;</i> Four flannel bandages, to be made
+of fine, soft flannel, four inches wide, to go once and a third
+around the body. The edges may be pinked or whipped, but should
+never be hemmed; a tape is sewed on double, the ends passing
+around the body, and so the bandage is fastened without
+pinning.</p>
+
+<p>Six merino shirts, with high neck and long sleeves, made to
+button down the front.</p>
+
+<p>Cotton diaper napkins, not too large; old soft ones are
+preferable.</p>
+
+<p>Long merino stockings which can be pinned to the napkin.</p>
+
+<p>Flannel petticoats, not too long; these may be made on muslin
+bands, which are held up on the shoulders by means of straps. The
+essential in all the clothing is that it should be sufficiently
+loose.</p>
+
+<p>Dress-slips should not be so elaborate that they cannot be
+washed and changed with sufficient frequency; and not so long
+that the baby's feet will be hampered in their movements by them.
+All of baby's clothes but the dress should be fastened by
+safety-pins.</p>
+
+<p>Baby's basket should contain:</p>
+
+<ol>
+<li>One outfit of clothes.</li>
+
+<li>One tube of sterilized tape.</li>
+
+<li>A pair of blunt-pointed scissors.</li>
+
+<li>Large and small safety-pins.</li>
+
+<li>Pieces of fine old linen; old handkerchiefs are the
+best.</li>
+
+<li>A soft hair-brush.</li>
+
+<li>A powder box and puff, with talcum powder.</li>
+
+<li>Two tubes of sterilized white vaselin.</li>
+
+<li>Two soft towels.</li>
+
+<li>Castile soap.</li>
+
+<li>Single-bulb syringe; so-called "eye and ear syringe."</li>
+
+<li>A woolen shawl or wrap.</li>
+</ol>
+
+<p>If there is no nurse available before the labor sets in, and
+it is necessary for the patient to see to the sterilizing of the
+above articles, she should first scrub off all pitchers, basins,
+and other utensils, as well as the douche-pan, fountain syringe,
+and rubber sheeting, with a brush and hot soap-suds; the
+hand-scrubs are to be well washed; then each article should be
+pinned separately in coarse towels, and put to boil for half an
+hour in an ordinary wash-boiler. The articles so boiled are then
+dried without removing the towels, put away, and not opened till
+the time of the labor.</p>
+
+<p>The abdominal bandages must be laundried and pinned up in
+separate towels until they are needed. The cheese-cloth must be
+laundried and then sterilized.</p>
+
+<p>The vulvar pads should be pinned in an old napkin, in packages
+of half a dozen each; and one package is sterilized at a time by
+placing it in the oven until the outer covering is scorched. The
+linen for the baby's eyes and the cheese-cloth are treated in the
+same way; they are to be cut up into small pieces and sterilized
+as needed.</p>
+
+<p><b>Signs of Approaching Labor.</b>&#151; About two weeks
+before labor there is a sinking of the womb. At the beginning of
+the ninth lunar month this was at the end of the breast-bone; it
+now descends to a point midway between this and the navel; the
+abdomen becomes smaller, the pressure on the lungs is relieved,
+and the woman breathes more freely. But at the same time that the
+woman is relieved of the pressure on the chest, she experiences
+increase of the troubles in the lower extremities. There is an
+increase of the bladder symptoms, with a desire for frequent
+unrination. Constipation becomes more troublesome, and there may
+be hemorrhoids; the veins of the lower extremities may become
+greatly enlarged.</p>
+
+<p>There is an increased fullness of the external genitals and a
+greatly augmented amount of mucous discharge. There is a feeling
+of anxiety and nervousness, with depression of spirits.</p>
+
+<p>During the last two weeks of pregnancy patients are apt to
+have cramp-like pains in the lower part of the abdomen. These are
+often mistaken for labor pains. True labor pains are
+characterized by starting in the back, extending around the
+abdomen and toward the pubes and down the thighs; they come at
+more or less regular intervals of half to three-quarters of an
+hour, and increase in intensity with a decrease in the intervals.
+A strong pain is apt to be followed by two weaker ones. The
+so-called false pains are irregular in their occurrence.</p>
+
+<p><b>Symptoms of Actual Labor.</b>&#151; First is generally the
+show; this is a discharge of mucous tinged with blood; at the
+same time the true labor pains set in. When the patient or nurse
+is in any doubt as to the character of the pains, or when the
+show appears, the physician should be summoned at once. Other
+symptoms are frequent desire to empty the bladder and bowels, and
+a sensation of shivering.</p>
+
+<p><b>The Confinement-Bed.</b>&#151; A single bed is much more
+convenient, but it is rarely found in a private house. The double
+bed is arranged as follows: The hair mattress is covered with a
+large rubber sheet, which is pinned with safety-pins at the
+corners and tucked well under the mattress; the rubber sheet must
+not be drawn too tightly for fear of tearing. Over this comes the
+sheet, and over the upper half of the bed, the draw-sheet; this
+is a sheet folded four double, which goes across the bed so as to
+come under the hips of the patient, and is tucked under the
+mattress at both sides. The object of this is so that it may be
+frequently and easily changed without disturbing the patient. The
+sheet, blanket, and spread which are to serve as a covering after
+delivery are folded back and placed on the left side of the
+bed.</p>
+
+<p>The lower right-hand corner of the bed&#151; the right side of
+the bed is that side which is toward the right hand as one stands
+facing the foot-board&#151; is arranged for the confinement; on
+this is fastened the smaller rubber sheet, and over this the
+sheet is folded, and both are fastened down with safety-pins. The
+pillow for the patient should be placed at the upper and inner
+corner of the square. After the delivery the patient is lifted to
+the upper part of the bed and the temporary dressing is removed.
+A sheet and blanket are used for a covering during the
+confinement.</p>
+
+<p>Before the labor begins it is well to fasten up the vest and
+gown, so that they will not be soiled, as it is important that
+the patient shall be moved as little as possible after the labor,
+as all movements tend to increase the bleeding.</p>
+
+<p>The floor oilcloth must be spread at the side of the bed which
+is made up for the confinement, and should extend slightly under
+the bed.</p>
+
+<p>A bureau in the room should contain the mother's and baby's
+clothing, bed-linen, towels, and any other articles which will be
+needed, all properly arranged.</p>
+
+<p>The clothing for the mother and baby will be placed where it
+will keep warm, and the infant bathtub will be in readiness in
+case of sudden need for it.</p>
+
+<p>All water used about the confinement must have been carefully
+sterilized in advance. The best way to sterilize the water is by
+boiling it in a large wash-boiler; whatever vessel is used must
+be scrupulously clean, and ought to be new. The vessel is covered
+over, and the water is allowed to boil for half an hour; it is
+then, still covered, set aside to cool. There should be three
+gallons each of sterilized hot and cold water; since in case of
+an emergency there must be plenty of water ready for use.</p>
+
+<p>The various articles ordered in the confinement outfit will be
+at hand ready for use. It is the duty of the nurse to have
+everything ready for the doctor before his arrival. The patient
+should have a full warm tub-bath, fresh night-clothes put on, and
+an enema should be at once given to unload the bowels, and this
+even though there may have been a bowel movement only a few hours
+previously. The patient should remain in bed until the arrival of
+the doctor. After an examination has assured the latter that all
+is right, she may be allowed to go around the room, with a
+wrapper thrown on over the night-gown.</p>
+
+<p>Conveniently near the bed should be a small table, covered
+with one or two freshly laundried towels. This table should have
+on it a wash-basin, a hand-brush, soap and hot water, an
+antiseptic solution, scissors, a ligature for the navel, and a
+suitable aseptic lubricant for the hands.</p>
+
+<p><b>The Process of Labor.</b>&#151; The process of labor is
+divided into three stages. The first stage is that of dilatation;
+by which is meant the stretching of the mouth of the womb so that
+the child may pass through. At the first confinement this stage
+lasts about fifteen hours; at subsequent labors the length of
+this stage is much shorter, the average time being eight hours.
+The pains during this stage are sharp and cutting, and they are
+accompanied by a slight show of blood. The patient is fretful and
+nervous</p>
+
+<p>The second stage of labor is called that of expulsion, because
+in this stage the uterus contracts down together with the
+abdominal muscles to expel the child from the womb and the vagina
+into the world. The duration of this stage in the first
+confinement is about an hour and a half.</p>
+
+<p>The third stage of labor includes the time from the expulsion
+of the child till the coming away of the after-birth; the average
+length of this stage is from twenty minutes to half an hour.</p>
+
+<p>The average length of time for the first labor is seventeen
+hours; and for subsequent labors from eight to eleven hours.</p>
+
+<p>The bag of waters is the sac of membranes in which the child
+is inclosed. It contains a liquid in which the child floats; the
+object of the water is to protect the child from sudden shocks or
+any kind of injury during pregnancy. During labor this membrane
+with its contained water serves as a dilating wedge to assist in
+the opening of the womb, and it also protects the child from the
+direct contraction of the uterus upon it. When the waters break
+prematurely, the labor is much longer and more tedious; normally
+this should not occur before the mouth of the womb is fully
+dilated.</p>
+
+<p>The pains of the second stage of labor are of a bearing down
+character, and constantly increase in force and frequency; the
+climax being reached as the head passes through the vulvar
+orifice.</p>
+
+<p>A child usually lies in the womb with the head downward; the
+reason of this is that there is more room in the upper part of
+the uterus, and as the small parts of the child as it is folded
+upon itself take up the most space, they occupy this position,
+while the head lies just above the pubes. The normal position of
+the child is: the head is flexed on the chest, the legs on the
+thighs and the thighs on the abdomen, and the hands are folded
+across the chest. And so the child is usually born head
+first.</p>
+
+<p>During the stage of expulsion the head of the child is forced
+down slightly during each pain, to recede a little during the
+intervals between the pains; in this way the vagina and its
+external orifice are gradually stretched so that the head of the
+child may pass through without tearing the parts. If the head is
+allowed to pass through suddenly, or where the labors are rapid,
+as in the case of women who have given birth to several children,
+much mischief may be done by tearing the soft parts.</p>
+
+<p>After the birth of the head there is a short interval of rest,
+when the shoulders are born; the rest of the body easily slips
+out; and with the expulsion of the after-birth the labor is
+over.</p>
+
+<p>At the very beginning of labor the patient should be given a
+full warm tub-bath, and make an entire change of linen. She will
+usually prefer to be dressed in her night-clothing, over which
+during the first stage she may wear a loose wrapper; a sterilized
+napkin should be worn over the vulva during this stage. During
+the first stage, as a rule, the patient should not be confined to
+bed until the dilatation is well advanced; she is generally more
+comfortable if she is allowed to move around the room, and the
+pains are thereby advanced.</p>
+
+<p>The only way in which the physician can determine whether
+labor has begun is by making an internal examination; and this
+will enable him to decide as to whether it is necessary to remain
+or not.</p>
+
+<p>The nurse should always wear a wash dress in the confinement
+and lying-in room.</p>
+
+<p>If the labor is long, nourishment in the form of beef-tea,
+broths, and milk may be given. No stimulants should be given
+without the direction of the physician. The frequent taking of
+cold water is permissible.</p>
+
+<p>At the beginning of the labor the family and friends must be
+excluded from the room, and it must be kept as quiet and as
+cheerful as possible.</p>
+
+<p><i>Toilet of the Patient.&#151;</i> The newly born child is
+received in a small blanket, is well wrapped, and laid in a warm
+place. The nurse then turns her attention to the mother; the
+external genitals and soiled parts of the body are cleansed with
+sterilized cheese-cloth wrung out of an antiseptic solution; if
+the body-linen has become soiled, it is also changed, and all
+blood-stained articles are removed from the bed. The patient is
+then carefully lifted up on the permanent bed, and the vulvar pad
+and the abdominal bandage are applied; after which the patient is
+allowed to rest.</p>
+
+<h3>CHAPTER XII.</h3>
+
+<h4><b>LYING-IN.</b></h4>
+
+<h5>Management of the Lying-in; Lactation; Nursing.</h5>
+
+<blockquote><p>"'Tis is ourselves that we are thus or thus. Our
+bodies are our gardens; to the which, our wills are
+gardeners."&#151; <i>"Othello."</i></p></blockquote>
+
+<p><b>Management of the Lying-in.</b>&#151; Immediately after the
+delivery the first essential for the patient is absolute quiet
+and rest; the room must be kept quiet and darkened, and
+ordinarily the patient is allowed to fall into a light sleep.
+During the first few hours after labor the best position for the
+mother is flat on the back, with only a small pillow under the
+head. After the first twenty-four hours the patient may be
+allowed to turn on the side as she prefers. Since absolute rest
+is the first requisite for the patient, she must be left alone
+with the nurse, who must see that she does not fall into too deep
+a sleep. If the child's cries disturb the mother, it must be
+taken into another room.</p>
+
+<p>The lying-in room must be kept free from all odors, all soiled
+clothing must be at once removed from the room, and good
+ventilation must be insured, being careful to prevent any
+drafts.</p>
+
+<p>While the patient is asleep, and after the baby has been
+attended to, the nurse should place all blood-stained articles in
+cold water to soak. If in the city, the after-birth may be burned
+in the furnace or range; it should be well covered with coal. In
+the country the after-birth can be buried in a deep hole.</p>
+
+<p>During the first two or three days the vulvar dressings should
+be changed from every three to six hours, and at all times as
+often as they are soiled. Each time that the dressing is renewed
+the external genitals and their immediate surroundings are to be
+carefully cleansed with sterilized water, and finally washed with
+a solution of boric acid, in the proportion of one tablespoonful
+of boric acid to one quart of water. It is convenient to keep
+this solution mixed and on hand, as it takes some little time to
+prepare it; it should be kept in a strength double that which is
+desired, so that it may be diluted with warm water to give the
+desired temperature. This solution may be poured over the parts
+from a small pitcher, the douche-pan having been placed under the
+patient before the washing began. After labor the vulva is very
+sensitive, so that while the greatest care must be used to remove
+all clots of blood and the discharge, there must be no brisk
+rubbing of the parts. No blood-stained linen should be permitted
+to remain about the patient or the bed.</p>
+
+<p>Since the lying-in woman perspires freely, her skin ought to
+be frequently cleansed by sponging with a weak solution of
+alcohol in tepid water; this should be followed by friction with
+a towel until the skin is in a glow. Cleanliness of the bed is
+promoted by the use of a draw-sheet, which is a sheet folded to
+four thicknesses and placed beneath the patient's hips in such a
+way that the upper edge of the sheet shall come under the lower
+part of the pillows. Air and light must be freely admitted at all
+times in order that the room may be bright and cheerful. For the
+first few weeks the eyes of the new-born infant should be
+shielded from all strong light.</p>
+
+<p><i>Visitors.&#151;</i> For the first week after the
+confinement the patient should see no visitors. Even the husband
+or mother should not remain in the room long at a time. Nothing
+of a disagreeable nature should be told to the patient; and
+whoever goes into the sick-room should always carry the most
+cheerful manner, as it is highly necessary that the patient
+should be kept mentally as well as physically quiet at this
+time.</p>
+
+<p><i>Diet.&#151;</i> For the first twenty-four hours the diet
+must be restricted to liquids, and in most cases nothing is given
+until the patient has had a few hours' rest. The first thing that
+is given to the patient should be a cup of warm milk or tea. Milk
+is the best diet; this may be varied with beef-tea, bouillon,
+mutton or chicken broth; any of these broths may be made with
+rice or barley to vary the flavor, but these must not be given to
+the patient. The patient should have six ounces of the liquid
+every two hours during the day and every three hours during the
+night.</p>
+
+<p>On the second day bread well toasted through may be added to
+any of the liquids. On the third day stewed or baked apples
+should be added to the diet. On the fourth day, and from this on,
+the patient will have regular meals, but the diet must be a plain
+one. For breakfast, stale bread, a soft-boiled egg, fruit, and a
+cup of tea, not too strong. For dinner, which should always be
+given in the middle of the day, an oyster-stew or clam broth, a
+lamb chop, or a very small piece of beefsteak or chicken; but
+with these there must be no gravies or dressings; a potato baked
+in the skin; raw tomatoes, if in season; apple sauce or
+cranberry; celery; junket, plain corn-starch, lemon jelly, plain
+cup-custard. From this list the diet must be arranged so as to
+give as much variety as possible from day to day. Midway between
+breakfast and dinner, and again in the middle of the afternoon,
+the patient should have a glass of milk. The diet should be
+generous, but simple.</p>
+
+<p><i>Urination.&#151;</i> The feeble condition of the bladder in
+the first few hours after delivery frequently leads to the
+retention of urine. Owing to the copious secretion of urine which
+is so common at this time, painful and injurious distention of
+the bladder may result. The patient should therefore endeavor to
+pass her urine in at least six hours after labor, whether she
+feels any inclination to do so or not; the sound of running water
+or warm fomentations over the bladder, warm water in the
+douche-pan, and moderate pressure applied by the hand over the
+suprapubic region, are often effective in accomplishing the
+desired result. If all these means fail, the catheter must be
+used as the last resort. During the entire lying-in the bladder
+should be emptied every six hours.</p>
+
+<p><i>Evacuation of the Bowels.&#151;</i> There should be an
+evacuation of the bowels in from twenty-four to thirty-six hours
+after the labor. For this purpose a seidlitz powder may be given,
+or the liquid citrate of magnesia. If this does not suffice, an
+enema of warm water, to which a little soap or two teaspoonfuls
+of glycerin have been added, may be given. Two pints of water
+should be prepared; the patient will retain as much as she
+comfortably can, and as long as she can. The bowels should be
+opened daily after the first day.</p>
+
+<p>After-pains are caused by the same physiologic process that
+causes labor pains&#151; namely, by the contractions of the
+uterus. After the first confinement the after-pains are, as a
+rule, not severe; attention to the regular emptying of the
+bladder and bowels also lessens the severity of the after-pains;
+these pains seldom last after the second day.</p>
+
+<p><i>The Lochia.&#151;</i> The discharges of the mother continue
+for about two weeks, and are called lochia. For the first
+twenty-four hours they are pure blood; the second and the third
+day they are of the character of bloody water; from the fourth to
+the sixth day they have a, greenish-yellow color, and from the
+tenth to the twelfth day they become pure white. Soiled napkins
+and dressings should never be allowed to remain in the patient's
+room.</p>
+
+<p><i>Duration of the Lying-in.&#151;</i> This lasts for six
+weeks. During this time the organs of generation are returning to
+their normal size and condition. In order that the woman may be
+in the best condition possible at the end of this time, it is
+essential that for the first two weeks she should remain in bed;
+and so long as there is any blood in the discharge the woman
+should not be allowed to sit up. The first sitting up should be
+in bed, the patient being supported by a bed-rest. During the
+second two weeks the patient may be allowed to divide her time
+between the bed and the couch; in the latter part of this time
+she may be allowed to go around her room a very little; and for
+two weeks more she should remain on the same floor. The first
+sitting up should not last more than half an hour. Getting up and
+going around too soon after the confinement, "being too smart,"
+is one of the most prolific sources of falling of the womb, and
+all manner of uterine trouble, by which the general health of the
+woman is greatly impaired.</p>
+
+<p><b>Lactation.</b>&#151; If it is at all possible, every mother
+should nurse her own child; in the interests of both the mother
+and the child. So far as the mother is concerned, the process of
+lactation is beneficial because it hastens the return of the
+uterus to its normal size. Wet-nurses are known tyrants, and if
+the quality of the milk has anything to do with the disposition
+of the child, as is believed to be the case, the idea is
+distasteful of having a woman who belongs to the lower classes
+provide nourishment for your child; and artificial feeding is one
+unmitigated trouble.</p>
+
+<p>A deficiency of the quantity or the quality of the mother's
+milk can generally be remedied by the diet and attention to the
+health of the mother; if the deficiency in quantity persists, the
+mother's milk can be supplemented by artificial feeding.</p>
+
+<p>There may exist certain conditions of the mother in which
+nursing her own infant would be inadvisable or even impossible.
+Syphilis contracted late in the pregnancy, and tuberculosis, are
+contraindications, owing to the danger of the mother infecting
+the child. Inversion of the nipples, their excoriation, or
+persistent sensitiveness may make it impossible. In marked
+general debility of the mother from any cause whatever, it would
+be injurious to the mother and the child.</p>
+
+<p>After the mother and the new-born infant have had some hours
+of rest and sleep, it is advisable to apply the child to the
+breast, to receive by this first effort the small quantity of
+milk which is an especial provision to act as a natural purge and
+to start the bowels of the child into a healthy activity; this
+also excites the milk glands to secretion. The mother's milk in
+full supply may be expected in from forty to sixty hours after
+delivery.</p>
+
+<p><b>Nursing.</b>&#151; When the mother's nipples are of the
+normal size and well formed, the healthy infant instinctively
+suckles at once when placed at the breast, but sometimes it has
+to be taught; by squeezing out a few drops of milk to wet the
+nipple, the child will usually take hold, or a little sugar and
+water may be put on the nipple; a little patience and tact are
+all that is necessary to insure success. But the infant must be
+taught to nurse at once before the breasts become engorged with
+milk.</p>
+
+<p>Under ordinary circumstances the child is to be kept at the
+breast for one year. But if within this time the menstrual period
+should recur and be profuse, or should the woman again become
+pregnant, the quality of the milk becomes poor, and necessitates
+the immediate weaning of the child; the character of the milk is
+also altered, and even its secretion may be checked. Nervous
+agitation may so alter the quality of the milk as to make it
+poisonous. A fretful temper, fits of anger, grief, and sudden
+terror not only lessen the quantity of the milk, but render it
+thin and unhealthful, inducing disturbances of the child's
+bowels, diarrhea, and so forth.</p>
+
+<p><i>Position of the Mother When Nursing.&#151;</i> When in bed
+in the recumbent position, the mother should lie on that side
+from which the infant is going to nurse; when up, the mother
+should sit erect.</p>
+
+<p><i>Care of the Nipples.&#151;</i> Immediately after each
+nursing the nipples should be washed off in a saturated solution
+of boric acid in cold water, and dried with a soft cloth. If they
+are disposed to crack, anoint them with cocoa-butter immediately
+after each cleansing. If the skin of the nipple is very
+sensitive, a nipple-shield should be used for the first few days;
+or should the nipple become sore at any time, the shield can be
+resorted to. The nipple-shield must fit tightly; the best ones
+are made of glass with a rubber tip. In the intervals of nursing
+the nipple-shield should be kept in cold water after it has been
+thoroughly cleansed by being brushed on both sides.</p>
+
+<p>The breasts are sometimes distended from an over-secretion of
+milk; this is relieved by saline cathartics, by abstinence from
+liquids, and by the use of a compression breast bandage. This is
+made of a straight piece of muslin, with a shallow notch cut in
+one edge for the neck, and, a deep one for each arm; the bandage
+is closely applied over the breasts, and the ends pinned in
+front; it is also pinned over the shoulders.</p>
+
+<p>In debilitated women the supply of milk may be insufficient;
+the most reliable evidence of this is the fact that the infant
+ceases to gain in weight.</p>
+
+<h3>CHAPTER XIII.</h3>
+
+<h4><b>THE NEW-BORN INFANT.</b></h4>
+
+<h5>The Infant's Toilet; the Crib; Feeding of Infants; Artificial
+Feeding; the Wet-nurse; Characteristics of Healthy Infants; the
+Stools; Constipation; Urination; Dentition.</h5>
+
+<blockquote><p>"O thou child of many prayers,<br/>
+ Life hath quicksands; life hath snares."
+</p>
+<p class="right">&#151; LONGFELLOW.
+</p></blockquote>
+
+<p><b>The Infant's Toilet.</b>&#151; So soon as the mother has
+been made comfortable, the toilet of the infant is attended to.
+This should be made near the register or stove; and the lap of
+the nurse should be covered with a small flannel blanket. The
+baby's body will be found to be covered over with a white,
+greasy, somewhat cheesy substance; some sort of grease is needed
+for its removal; rendered lard, sweet oil, and lanolin are the
+best; vaselin is less effective. All of this cheesy substance
+must be at once removed; the most difficult parts will be in the
+folds and creases. The nurse should grease the palms of her
+hands, then take the head of the child between them, and
+thoroughly grease it; particular attention must be given to the
+ears; then come the neck, shoulders, arms, chest and back,
+groins, external genital organs, and lower extremities. After the
+child has been thoroughly gone over, the grease should be rubbed
+off with a soft towel.</p>
+
+<p>A rectal injection of one tablespoonful of warm water is given
+at once to unload the bowels of the meconium; this generally acts
+before the baby's toilet is completed. The meconium is the first
+discharge from the infant's bowels after birth, and that which
+had collected in the intestines during the pregnancy.</p>
+
+<p><i>The Baby's Bath.&#151;</i> The baby's bath-tub is filled
+about one-third full of water at a temperature of 100&deg; F.,
+tested by the thermometer. The baby is then gradually immersed in
+the water, with the exception of the head; this is supported on
+the left wrist of the nurse, which passes under the infant's
+neck, while her hand grasps the left shoulder; with the right
+hand the nurse quickly rubs over the child's head and body; the
+entire bath should not occupy over five minutes. The infant is
+then lifted out into the lap of the nurse, on which is spread a
+soft, warm towel, with which it is carefully dried. One of the
+important points in giving the infant its bath is to be sure that
+the groins, arm-pits, and genitals are thoroughly well dried;
+otherwise excoriation at these parts is sure to occur.</p>
+
+<p>After this a daily tub-bath is given in the same way; soap is
+rarely needed; when it is, castile soap should be used; its
+constant use is not necessary and would only irritate the skin.
+These daily baths strengthen the nervous system and prevent
+coughs and colds. The bath should be given during the morning,
+one hour after feeding, and should not last more than five
+minutes. The mother herself, just as soon as she is able to go
+around, should superintend the bath; in this way she is assured
+that if properly given, and will also recognize any incipient
+affection of the child. These daily baths should be continued
+till the child is four years old. Powder is not essential; but if
+it is desired, a plain talcum powder may be used.</p>
+
+<p><i>The Dressing of the Cord.&#151;</i> After the bath the
+ligature which was tied around the cord at the birth of the child
+will be found slightly loosened; this should first be made tight,
+and then the cord, doubled back on itself, should be tied by the
+ends of the same ligature. A square of soft sterilized linen or
+gauze is slit up to its center; the cord is allowed to pass
+through this slit, which looks toward the child's right; the
+stump of cord is laid on the left and the ends of gauze are
+folded over this; the whole is kept in place by the abdominal
+bandage. As there is some exudation from the cord, it is
+necessary to change these dressings twice a day; as this
+exudation is of a somewhat gluey nature, it will be found that
+the dressings stick to the cord. In removing the gauze great care
+must be used not to make any traction on the cord; when the
+infant is placed in the bath, the water loosens the dressing and
+it falls off in the water; at other times it must be removed with
+the greatest care. There should never be any odor about the cord;
+it usually drops off about the fifth day.</p>
+
+<p>The process of ulceration by which the cord falls off leaves
+an open surface on the child's body which offers an avenue for
+septic infection. Great care must therefore be taken that the
+nurse's hands or anything which comes in contact with this
+surface should be perfectly clean. The dressings used must be
+thoroughly antiseptic.</p>
+
+<p>Care should be used not to fasten the abdominal bandage too
+tightly; the bath is given on an empty stomach, and allowance
+should be made for this; the binder should be loose enough to
+allow two or three fingers to easily slip under it.</p>
+
+<p><i>The Meconium.&#151;</i> The First discharge that comes from
+the bowels is of a dark, greenish color, and should come away
+during the first twenty-four hours; if it does not, the baby may
+suffer a good deal of pain, and an enema of warm water must be
+given. As this substance is very difficult to be washed out of
+napkins, the first ones used should be old and afterward be
+burned.</p>
+
+<p><i>Cleansing.&#151;</i> Every time the napkin needs to be
+changed, even if it is only wet, the baby should be washed with
+warm water. A napkin should never be used twice without washing;
+it chafes the child, and it is an unsafe as well as a filthy
+practice; the napkin must always be removed as soon as it is
+wet.</p>
+
+<p><i>The Infant's Toilet.&#151;</i> After the application of the
+binder and napkin, comes the undervest; the fingers of the nurse
+are passed up through the sleeve to seize the infant's hand and
+pull it through; as soon as it gets a little older the child will
+grasp a finger laid in its palm, which greatly facilitates this
+part of the toilet. The stockings are next put on and pinned with
+safety-pins to the napkin; then comes the petticoat, the band of
+which is also loosely fastened with safety-pins, and with the
+slip the toilet is complete. All the clothing should be changed
+night and morning.</p>
+
+<p>The eyes and mouth should be washed out with separate pieces
+of gauze or old linen. For the mouth, a small piece of cloth wet
+in warm water is wrapped around the little finger of the right
+hand, going into the left angle of the baby's mouth and coming
+out at the right, going between the gums and cheeks as well as
+over the tongue. This procedure should be gone through with every
+time preceding and following the nursing, and in this way the
+milk is prevented from souring in the mouth, and the digestion is
+kept in good condition. A sore mouth in a baby indicates
+carelessness on the part of the nurse.</p>
+
+<p>A soft hair-brush may be used, but the scalp is too tender to
+permit the use of a comb.</p>
+
+<p>After the toilet has been completed, the baby is laid in its
+crib, on the right side of the body, and warmly covered. The
+weaker the baby, the more attention must be paid to the external
+warmth. It may be necessary to place a warm-water bottle in the
+crib, but this must never touch the infant.</p>
+
+<p><i>The Crib.&#151;</i> The infant must have its own crib,
+without rockers, and it must on no account be put to sleep in the
+same bed with its mother. In its early life it should never be
+taken out of its crib except to be fed, to have its clothing
+changed, or to be bathed. There should be no holding on the lap,
+no dangling, no carrying or fussing over the new-born infant; and
+the more the baby is let alone, the better and healthier it will
+be. If baby cries, look at once to see if it needs a fresh
+napkin; if not, if any pins are sticking into it, if the clothing
+is possibly too tight; if none of these things are wrong, give it
+a sup of water and turn it over on the other side. The baby often
+becomes restless by sleeping for several hours in the same
+position. But on no account take the infant up out of its crib
+simply because it cries.</p>
+
+<p>Cheerfulness and good nature on the part of the infant are
+dependent on its general good health. A healthy infant should not
+have colic, but if such is the case, there is a peculiar look of
+distress on the face, which indicates that the child is in pain;
+what is needed is warmth or medication according to the severity
+of the case, but never floor walking. Begin the latter procedure,
+and you may hope to keep it up for several years.</p>
+
+<p><i>Ventilation.&#151;</i> The air is sometimes vitiated for
+children's uses in various ways; their nervous susceptibilities
+are greater than those of older people. A very little odor of
+tobacco may cause nausea and discomfort to an infant in arms. The
+atmosphere of the room should be sweet and pure and unscented.
+All scents and perfumes affect the nervous system, and by
+constant excitation do it damage. A bouquet of flowers renders
+the air of a closed room too heavy.</p>
+
+<p><i>Feeding of Infants.&#151;</i> During the day the infant
+should be put to the breast once every two hours, and once every
+three hours during the night. This interval of time between the
+feeding is necessary in order that there may be sufficient time
+given for digestion to take place. Regurgitation of milk soon
+after feeding is a sign that the stomach has been overfilled. As
+the infant usually falls asleep after nursing, it is necessary to
+waken it up at the time for the next nursing, as good digestion
+depends upon regularity of feeding.</p>
+
+<p>For the first nursing the infant may be put to the breast in
+from two to six hours after the labor if the mother is
+sufficiently rested; from ten to twenty minutes is long enough
+for each nursing. Before each nursing the nipples should be
+carefully washed off with a solution of boric acid. The first
+secretion of the breasts is laxative; that is, it acts on the
+bowels, and makes is unnecessary to give the infant anything to
+take for this purpose. The breasts should be used alternately in
+feeding the infant, as this allows a longer time for the
+accumulation of the milk. For the first few days the infant needs
+very little food, and the mother's milk is generally
+sufficient.</p>
+
+<p>The infant should be given a teaspoonful of cool water to
+drink two or three times a day, as the milk does not quench the
+thirst. The water should be sterilized by boiling, and be kept in
+an air-tight flask.</p>
+
+<p>At the end of the third month the intervals of nursing for the
+daytime should be three hours, and the last nursing at night
+should be at eleven o'clock, and the first nursing in the morning
+at five o'clock; thus allowing the mother an interval of six
+hours of unbroken sleep.</p>
+
+<p>The best evidence of the proper nutrition of the child is a
+progressive gain in weight. The child should be weighed every
+week. A loss of a few ounces usually takes place during the first
+few days after birth, so that the child does well if at the end
+of the first week it weighs as much as it did at birth. After the
+first week the weekly gain should not fall below five ounces.</p>
+
+<p><i>The Wet-nurse.&#151;</i> When the mother for any reason
+whatever is not able to nurse her child, the best substitute is a
+wet-nurse. Before she is employed the wet-nurse should always be
+carefully examined by a physician to insure her freedom from
+disease. The best age is between twenty and thirty years, and the
+age of the child of the nurse should be at least within a month
+of that of the child to be nursed. The best sign of the good
+health of the nurse and of the condition of her milk is furnished
+by the health of her own child. The breasts should be well formed
+and the nipple of good shape. It is well, if possible, to get a
+woman who has borne several children, as she will understand the
+care of the child better. No woman who is not perfectly healthy
+is fit to be a wet-nurse; and even after she has been engaged her
+health and her habits must be watched over.</p>
+
+<p>Artificia1 Feeding.&#151; The first requisite in artificial
+feeding is that the milk shall be made to correspond as nearly as
+possible to that of the mother. For this purpose the following
+formula, prepared by Rotch, of modified cow's milk is considered
+the best:</p>
+
+<table summary="Women" border="0">
+<tr>
+<td align="left">Milk</td>
+<td> </td>
+<td align="right">2 ounces</td>
+</tr>
+
+<tr>
+<td align="left">Cream</td>
+<td> </td>
+<td align="right">3 ounces</td>
+</tr>
+
+<tr>
+<td align="left">Water</td>
+<td> </td>
+<td align="right">10 drams</td>
+</tr>
+
+<tr>
+<td align="left">Milk-sugar</td>
+<td> </td>
+<td align="right">6 3/4 drams</td>
+</tr>
+
+<tr>
+<td align="left">Lime-water</td>
+<td> </td>
+<td align="right">1 ounce</td>
+</tr>
+</table>
+
+<p class="footnote">To make one pint of the mixture for use in
+the twenty-four hours, take the milk and cream as soon as it
+comes in the morning, and mix as above directed.</p>
+
+<p>No less important than the correct proportions of the
+ingredients, is freedom from disease germs and bacteria of
+putrefaction. Complete sterilization is possible by prolonged
+boiling; but experience has proved that under prolonged exposure
+to a temperature near the boiling-point certain changes take
+place in the albuminoids of the milk which greatly impair its
+digestibility. Full sterilization of milk for infant feeding has
+therefore practically been abandoned. It has been found that milk
+heated to 167&deg; F. for twenty minutes, and promptly chilled by
+placing on ice, remains practically sterile for twenty-four
+hours, and it is spared the injurious changes which take place at
+a higher temperature. This process is known as Pasteurization.
+The Arnold steam sterilizer affords a convenient method of
+sterilizing; if used with the cover removed, the steam chamber
+being open, the temperature of the steam chamber does not exceed
+170&deg; F.</p>
+
+<p>It is claimed that in the Arnold steam sterilizer, with the
+use of a suitable gas stove, the water begins to boil at the end
+of two minutes after the gas is lighted. A four-ounce bottle of
+milk at an initial temperature of 70&deg; F. in the open steam
+chamber attains a temperature of 170&deg; in just one hour. An
+exposure of about one hour and twenty minutes in the steam
+chamber is therefore necessary for the Pasteurization.</p>
+
+<p>The rules for sterilizing are as follows:</p>
+
+<p>First, clean the bottles thoroughly; then place them in cold
+water, which is allowed to come to boil and boiled for ten
+minutes.</p>
+
+<p>Second, fill each with the milk you wish to use; put in the
+rubber cork without the glass plug; this leaves a small opening
+in the rubber cork; set the bottle in the basket, then in the
+boiler.</p>
+
+<p>Third, set in the refrigerator until needed for use.</p>
+
+<p>Fourth, when wanted for use, place a bottle of the milk so
+prepared in the tin mug which accompanies the sterilizer; fill
+the mug with hot water to the height of the milk in the bottle,
+heat the milk to the temperature of 99&deg; F., remove the rubber
+cork and put on the nipple, when it is ready for use.</p>
+
+<p>Fifth, cleanse the bottle immediately after using; throw away
+any milk that has not been used.</p>
+
+<p>Sixth, if the steaming process is preferred, place the basket
+without the bottles in the boiler, fill the water up to, but not
+above, the bottom of the basket, place the bottles in the basket,
+and proceed as before.</p>
+
+<p>It is important that the milk should be sterilized or
+Pasteurized as soon as it is served in the morning. Each bottle
+must be thoroughly washed as soon as it is emptied. Milk
+sterilized in this way will keep for days without spoiling, as it
+is hermetically sealed and all the unhealthy germs have been
+removed.</p>
+
+<p>The most exact method for the artificial feeding of infants,
+and that which most nearly approaches the mother's milk, is that
+used by the "Walker-Gordon Laboratory," branches of which are to
+be found in many of the large cities.</p>
+
+<p>Not only is the greatest care taken that the milk used shall
+be pure and sterilized ready for use, but these laboratories are
+equipped by special machinery which separates the important
+elements of the milk&#151; namely, the fat, the milk-sugar, and
+the proteids. So that the physician can modify the proportions of
+these various ingredients of the milk to meet the necessity of
+the age and requirements of the infant.</p>
+
+<p>When the milk contains too little sugar, the infant does not
+gain as rapidly in weight as it would otherwise do. Too much
+sugar in the milk is indicated by colic, thin, green, or acid
+stools, or eructations of gas from the stomach.</p>
+
+<p>An excess of fat in the milk is indicated by vomiting; too
+little fat causes constipation with dry hard stools. Proteids in
+excess are a prolific cause of colic and also of diarrhea.</p>
+
+<p>Prescription blanks are furnished the physician, who fills out
+the percentages of fat, milk-sugar, proteids, and alkalinity, to
+suit the age, weight, and general condition of the child. He
+orders also the amount to be given at each feeding, and the
+number of feedings to be given in the twenty-four hours. Each
+bottle contains just the amount to be given at one feeding. All
+that the mother needs to do is to place the bottle in a
+receptacle containing warm water, until the milk has attained a
+temperature of 99&deg; F., remove the cotton stopper, and put on
+the nipple, when it is ready for use.</p>
+
+<p><i>The Nursing Bottle.&#151;</i> This should be of clear
+glass, with a rounded bottom, and of such a shape as is easy to
+clean; so that no particles will cling around a corner which
+cannot be reached. The graduated bottle is the most convenient,
+as it enables the quantities of each of the materials used in the
+preparation of the feeding to be mixed in the bottle, doing away
+with the trouble of measuring before putting into the bottle.</p>
+
+<p><i>Rubber Nipples.&#151;</i> Two nipples should be kept for
+alternate use, and no nipple should be used longer than two
+weeks. A soft rubber of conical shape is best, with an opening at
+the top which is not too large, so that the milk will not flow
+through, as it is desirable that the child should obtain the milk
+by suction. So soon as the feeding is over, the nipple should be
+removed from the bottle, and brushed on both sides with a stiff
+brush. It should then be put in cold water, where it is kept
+until it is again wanted.</p>
+
+<p>The baby should be fed slowly, from ten to twenty minutes
+being taken for each feeding. Sucking from an empty bottle or
+with a nipple in the mouth should never be permitted, as in this
+way the baby draws air into its stomach, which will result in
+colic. Each flask should contain only enough for one feeding.</p>
+
+<p>In lieu of the regular sterilizing apparatus, milk may be
+similarly prepared by placing the milk in an ordinary glass
+fruit-jar with a screw lid. This is placed in a colander over a
+pot of boiling water; the milk should be allowed to boil in the
+open jar for two minutes; the jar-lid is then screwed on, and it
+should steam for twenty minutes longer.</p>
+
+<p>The capacity of the infant stomach at birth is about one
+ounce, which is the average quantity of food that should be taken
+at one meal. The average rate of increase in the amount of food
+is one and a half drams a week for the first six months;
+subsequently somewhat less. The intervals of feeding should be
+two hours at birth, and increased to three hours at the end of
+the third month. The food should be given at a temperature of
+99&deg; F. and fed directly from the sterilizing bottle.</p>
+
+<p><i>Fresh Air.&#151;</i> In warm weather the baby is taken
+out-of-doors in from three to four weeks after birth; in cold
+weather not before two to three months. In the latter case it is
+prepared for the change by being first dressed as for the street,
+with wrap and cap; the windows of the room are then opened, and
+the infant is carried about here. In the winter months when the
+baby is first taken out, it is better to carry it in the arms, as
+it will be kept warmer in this way, and if it does become chilled
+it will be more quickly noticed.</p>
+
+<p><b>Characteristics of the Healthy Infant.</b>&#151; The
+average weight of an infant at birth is about seven pounds, and
+its length is about twenty inches; the extremes are four pounds
+or a little less up to eleven pounds. The head and trunk of the
+child are developed out of proportion to the limbs.</p>
+
+<p>The skin of the new-born infant varies from pinkish to red;
+about the fourth day the color becomes somewhat yellowish; this
+tinge should disappear about the end of the second week, and at
+the same time the skin begins to peel off.This process lasts
+about two weeks longer, when the baby's skin takes on its normal
+color.</p>
+
+<p>The shape of the head varies greatly, much being due to the
+amount of pressure during labor; but this disappears in a few
+days. As a rule, the large bones of the head are felt to be
+separated by membranous ridges called sutures; there is one on
+the median line on the top of the head, and at either end of the
+suture is a large open space, called a fontanel. The largest one
+is at the front of the head, and is called the anterior fontanel;
+it is about large enough to be covered by the tips of two
+fingers, and is of a lozenge shape; this opening does not close
+till the child is about eighteen months old. In a healthy baby
+this fontanel should be on a level with the bones of the head; a
+slight pulsation may be noticed in it, due to the pulsations of
+the vessels of the brain. There is a much smaller three-cornered
+fontanel at the back of the suture, and one behind either ear;
+these soon close up with bone.</p>
+
+<p>A new-born baby cannot probably do any more than distinguish
+light from darkness. Up to the sixth week there is an inability
+at coordination of the ocular muscles; after this time the eyes
+begin to move in an orderly manner, and they will follow a bright
+object moved slowly in front of them. At about the end of the
+second month rapid movements are perceived, as is evinced by the
+child's closing its eyes quickly on an object suddenly
+approaching it. At three months the child begins to recognize
+colors; the first recognized are yellow, red, pure white, gray,
+and black. But the faculty of distinguishing between colors is
+not perfected till the third year. The mother is recognized about
+the third month. Hearing and a sense of smell develop rapidly
+after birth; loud noises in its vicinity will cause a child to
+start during the first day after birth. By the time the child has
+reached three months of age it shows signs of having a mind of
+its own, and is capable of exercising thought. It grasps for
+objects, and indicates its likes and dislikes. At from eight to
+ten months it can utter several syllables, and at the age of one
+year should be able to say mama and papa; at two years it should
+be able to frame short sentences.</p>
+
+<p><i>Weight of the Baby.&#151;</i> By the end of the sixth month
+the child's weight should be double what it was at birth; that
+is, about fourteen pounds; at the end of the twelfth month be
+three times as much as at birth, or about twenty pounds.</p>
+
+<p><i>Muscular Action.&#151;</i> Muscular action in the new-born
+infant is entirely involuntary, there being no voluntary acts
+until about the end of the third month. Sucking and licking are
+largely instinctive. The movements of the arms and legs are
+impulsive acts, and occur during sleep, just as they did in the
+intra-uterine life. The act of raising the head, which is
+attempted about the fourth month in healthy children, is
+volitional, requiring not so much added strength of muscle as
+power of coordination. As volition develops the power of
+coordination gradually increases, and the child learns to perform
+voluntary or purposeful acts. Voluntary grasping is done after
+the fourth month. As the child learns to balance its head, it
+attempts to sit up. This act is not successfully accomplished
+until about the fortieth week; the child sits firmly alone when
+ten or eleven months old. Before this time it is necessary to
+support the head and spine of the child with the hand. By the
+third or fourth month the infant should be able to grasp things.
+The child begins to creep about the ninth month. The clothing
+should be so arranged as to allow entire freedom of motion.</p>
+
+<p>It should be able to stand up by a chair by the tenth month,
+and be able to walk alone at the end of the first year. It is
+important that parents should know this, since not knowing what a
+normal baby ought to be able to do, cases of birth palsy, or even
+an attack of paralysis due to teething, are not infrequently
+overlooked, not only by the mother, but even by the doctor, who
+attributes the inability of the child to do what other children
+can do at this age simply to weakness, which the child will
+outgrow; and thus the time passes in which the most could be done
+to cure the child and to prevent the subsequent deformity.</p>
+
+<p>A baby should not be forced to stand or walk; a very stout
+baby, on account of its weight, will stand up and walk much later
+than a slight one, the two being equally healthy. Or if a baby
+has been sick, it will feel no inclination to stand up.
+Naturally, a child creeps before it walks, and this develops the
+muscles of the lower limbs, so that they will support the weight
+of the child in standing. By prematurely forcing a child to stand
+up and walk, there is danger of causing bow-legs, as the bones of
+the legs are still weak; the child should be discouraged from
+standing up too much rather than encouraged to stand up more.</p>
+
+<p><i>Sleep.&#151;</i> A large proportion of the time of early
+infancy is spent in sleep; for the first few weeks the infant
+only wakens up to be fed. During sleep the eyelids should be
+tightly closed; a partial opening of the lids, showing the whites
+of the eyes, is an indication of ill health. Up to the age of
+six, children require twelve hours of sleep at night, besides an
+hour or more in the middle of the day; the child should be
+permitted to sleep as long in the morning as it will.</p>
+
+<p><i>Respiration.&#151;</i> The healthy infant breathes on an
+average forty-four times a minute; the only time the respirations
+can be satisfactorily counted is during sleep. When the child is
+awake, the respirations are hurried by slight movements of the
+body, crying, and so forth. The average pulse of a newborn baby
+is one hundred and forty; this is hurried by the same causes that
+hastens respirations; the pulse is most easily counted at the
+anterior fontanel. The average temperature of the infant is
+99&deg; F. When the tip of the nose and the extremities are cold,
+it indicates a lowered vitality.</p>
+
+<p>The nature of the child's cry indicates, variously, hunger,
+temper, or pain; the mother will soon learn to distinguish these
+varieties. If the child cries because it is hungry, the cry
+ceases so soon as it is fed. But a child is never to be fed
+simply because it cries; it must be fed on the hour by the clock.
+If this rule is not strictly adhered to, it will suffer all the
+forms of indigestion and colic that babies are heir to. If it
+cries because of colic, there is a drawn look on the face, and at
+the same time the legs are sharply flexed on the thighs and the
+thighs on the abdomen. If the cries are due to earache, the head
+will be rolled about from one side to the other. In either case
+nothing will stop the cries until the pain is relieved. A baby
+does not shed tears until the third month.</p>
+
+<p><b>The Stools.</b>&#151; The stools of a very young baby fed
+on breast-milk should be of a yellow or orange color. There
+should be three or four evacuations daily; they should contain no
+curds. Stools of bottle-fed babies are lighter in color and more
+offensive.</p>
+
+<p><i>Constipation.&#151;</i> Constipation is not uncommon in
+infancy; it may be overcome by the use of a soap suppository, or
+by an injection of warm soap-suds into the bowel, or by an
+injection of oil and water, or by gentle friction over the bowel,
+following the course of the large intestine.</p>
+
+<p>To make the soap suppository, take a piece of castile soap
+about an inch long, give it the shape of a cone not any larger
+than the end of the little finger, and make it perfectly smooth.
+This is inserted to about half of its length into the rectum and
+held there until it causes the bowels to move.</p>
+
+<p>The bowel injection is best given by means of the single-bulb
+syringe, known as the eye and ear syringe; the bulb holds about
+two tablespoonfuls of liquid. This may be warm cotton-seed oil,
+sweet oil, or glycerin one teaspoonful to warm water two
+tablespoonfuls. The nozle should be small, smooth, and well
+oiled. It should be very carefully introduced into the bowel,
+being directed a little to the left side, and the bulb gently
+squeezed to force the contents into the bowel. The injection is
+more effective if it is retained for a little while; this is
+accomplished by making slight pressure on the anus with a
+towel.</p>
+
+<p>Rubbing the abdomen for about ten minutes in the direction of
+the large bowel is sometimes very effective in overcoming
+constipation; begin in the right groin and rub up as far as the
+border of the ribs, then across to the left, then down on the
+left side.</p>
+
+<p><i>Vomiting.&#151;</i> Vomiting means often only that the
+stomach has been overfilled, and may be relieved by withholding
+all food for a few hours.</p>
+
+<p><b>Urination.</b>&#151; The frequency of urination in a
+newborn baby will vary greatly with the weather and other
+conditions; in cool weather it is not unusual for the napkin to
+need changing almost every hour. Healthy urine should not stain
+the napkin. The new-born infant secretes very little urine until
+it begins to take nourishment freely. The bladder is usually
+emptied during birth, and very often the bowels also, so that if
+the child seems well and there is no malformation of the parts,
+the family may be assured that the apparent retention of urine is
+only temporary.</p>
+
+<p>The use of hot fomentations over the kidneys and bladder will
+often hasten the evacuation of urine if it has been unduly
+delayed. If the secretion seems highly concentrated, a drop of
+sweet spirits of niter in a teaspoonful of water may be given
+every two hours.</p>
+
+<p><b>Teething.</b>&#151; The first tooth generally appears about
+the end of the fourth month; in delicate children they come
+later. As a rule, the lower front teeth come first, coming in
+pairs, one tooth coming on each side of the mouth; followed in
+about a month by the corresponding teeth in the upper jaw.
+Preceding their appearance the gums become swollen, hot, and
+painful, and the saliva forms in excess and runs from the mouth.
+The child is irritable, flushed and restless; and there usually
+occurs some disturbance of the bowels, commonly diarrhea. This
+all indicates a nervous derangement, and calls for a judicious
+diet and general careful oversight. The symptoms subside when the
+teeth are through. During teething the child manifests a desire
+to bite on something, and a soft rubber ring will give it great
+comfort.</p>
+
+<p>The first set of teeth are twenty in number, and are usually
+cut in groups, starting about the fourth month and continuing
+until between the twentieth and thirtieth month, when the first
+dentition should be complete. As a rule there is an interval of
+rest between the eruption of the various groups. During dentition
+children are generally more peevish and fretful than usual, but
+there should be no general constitutional disturbance. During
+dentition it is of especial importance to keep the bowels well
+opened; it is better to have them too loose than costive;
+constipation at this time greatly increases the tendency to
+convulsions.</p>
+
+<p>Bottle-fed babies are apt to cut their teeth later than those
+nursed at the breast. The lack of appearance of any teeth before
+the end of the first year indicates that the nutrition of the
+child is below par, or, in other words, that the child has
+rickets. The permanent teeth begin to appear about the sixth or
+seventh year.</p>
+
+<hr />
+<h3>PART IV.&#151; THE MENOPAUSE.</h3>
+
+<hr />
+<h4><b>CHAPTER XIV.</b></h4>
+
+<h4><b>THE MENOPAUSE.</b></h4>
+
+<h5>Average Duration of the Menstrual Function; Duration of
+Menopause; the Menopause; General Phenomena of the Menopause;
+Prominent Symptoms of Menopause; Pathologic Conditions of the
+Menopause; Hemorrhage at the Menopause a Significant Symptom of
+Cancer; Causes of Suffering at Menopause.</h5>
+
+<blockquote><p>"Yet I doubt not through the ages one increasing
+purpose runs,<br/>
+ And the thoughts of men are widened with the process of the
+suns.<br/>
+ Knowledge comes, but wisdom lingers, and I linger on the
+shore,<br/>
+ And the individual withers, and the world is more and more.<br/>
+ Knowledge comes, but wisdom lingers, and he bears a laden
+breast,<br/>
+ Full of sad experience, moving toward the stillness of his
+rest."
+</p>
+<p class="right"><i>&#151; "Locksley Hall."</i>
+</p></blockquote>
+
+<p><b>Average Duration of Menstrual Function.</b>&#151; The
+average duration of the menstrual function is from thirty to
+thirty-two years. Raciborski estimated the duration of menstrual
+life at about thirty-one years and nine months. According to him,
+the mean age of puberty at Paris was fourteen years and seven
+months; therefore, the average age of the menopause was forty-six
+and one-half years. Tilt gives the average age of the cessation
+of menstruation in 1082 cases as forty-five years and nine
+months. The average age is between forty-five and fifty years. It
+has been shown by Krieger, Kisch, and others, that the earlier
+the menses appear, the later they cease, and vice versa. However,
+when the first period is unusually early or late, the menopause
+comes very early. Also that the sexual function is usually
+abolished earlier in the laboring classes, who are compelled to
+work hard and who have many cares, than in the well-to-do and
+rich.</p>
+
+<p>Race does unquestionably influence the duration, but given a
+sound healthy race, which is not too much enervated with
+civilization, and the menstrual process will, equally with the
+total physical vigor and the vitality, be increased. At the
+present day there is an increased sexual vitality, which shows
+itself in the fact that the duration of menstrual life has been
+increased three to four years during the past generation. The
+inference can be fairly deduced that vigorous vitality causes
+prolongation of the menstrual process and the actual age.</p>
+
+<p><b>Duration of Menopause.</b>&#151; By the menopause or
+climacteric is understood the whole period from the beginning
+irregularities in the time of appearance of the menstrual flow
+until its actual cessation. The average duration of the menopause
+is from two and a half to three years.</p>
+
+<p><b>The Menopause.</b>&#151; The menopause is a physiologic and
+conservative process. It occurs at a time of life when all the
+tissues are most stable and the nutrition of the body is at its
+best. Other physiologic changes which occur at the same time are
+decrease in the size of the spleen and lymphatic glands, the
+muscular coats of the intestine atrophy, and lessened peristalsis
+ensues; hence the increased tendency to constipation. These are
+not the degenerations of age, but the blood-supplying,
+blood-making, and blood-elaborating organs of the body have
+completed the growth of the organism, done their work, and are
+striking a balance with the needs of the economy.</p>
+
+<p>The object of each metamorphic or developmental epoch is a
+critical readjustment of the organism, in order to insure the
+greatest possible amount of health for each subsequent period of
+life. In the vast majority of cases this object is quietly
+effected, but sometimes the constitution only rallies after
+having been severely shaken for a varying period.</p>
+
+<p><b>General Phenomena of the Menopause.</b>&#151; Borner states
+that while many women pass this period without noting any change
+in their former condition, and are conscious of the occurrence of
+the change of life only by reason of the absence of the menstrual
+flow, others suffer for years with a host of troubles.</p>
+
+<p>One of the most essential changes is that of the woman s
+psychic condition&#151; from slight vagaries, loss of interest in
+the daily affairs of life, to melancholia and insanity.</p>
+
+<p>"Two factors are generally taken into account: first, the
+sudden cessation of the menses; second, the reflections of the
+patient caused by her condition, meditations on the loss of youth
+and sexual power, and anxiety in view of the dangers of the
+climacteric. It cannot be denied that there is some truth in the
+supposed sad thoughts about the beginning of old age, and the
+depression caused by them can scarcely be considered abnormal"
+(Borner).</p>
+
+<p>Napier believes that it is extremely rare for the cessation to
+occur without some physical discomfort or some disturbance of the
+nervous system, but adds that: "Some women, however, cease
+menstruating with very slight inconvenience." As a rule, the
+woman misses one, two, or more periods, then a menstruation of
+almost normal quantity and duration; and this is again repeated
+at gradually longer intervals, and with a diminished flow, until
+actual cessation occurs.</p>
+
+<p>The periods cease owing to the degeneration and disappearance
+of the glandular tissues of the uterus, and secondarily to
+similar changes in the ovaries and other glands. This is followed
+by an atrophy of all the structures of the genitalia.</p>
+
+<p>An increase in the size of the uterus, from increase in the
+amount of blood, is frequently noticed at the beginning of the
+menopause; later it becomes smaller in all its dimensions. The
+wall becomes thinner; the cervix becomes shorter and thinner,
+sometimes hard, sometimes flabby as a membrane. But the
+distinguishing feature of the menopastic uterus is atrophy of its
+lining membrane.</p>
+
+<p>The changes in the uterus and Fallopian tubes are earlier than
+those in the ovaries, so that ovulation, though lessened in
+activity, may persist for a considerable time after menstruation
+has ceased. Ovarian atrophy has been referred to senile rather
+than menopastic changes.</p>
+
+<p>Atrophy of the ovaries occurs very gradually. Peuch found that
+in one case the ovaries were of normal size three years after the
+establishment of the menopause. Kiwisch describes the structural
+change in this gland as consisting, on the one hand, of an
+increase of the connective-tissue stroma; and, on the other hand,
+the Graafian vesicles themselves undergo retrograde change. In
+consequence of these microscopic changes, which take place very
+slowly, the entire organ becomes harder and smaller.</p>
+
+<p>Napier believes that the ovaries secrete specialized
+substances which aid in determining menstruation; and that in a
+less degree the utricular glands and the glands of the Fallopian
+tubes share in this action. He considers that this is probably
+secondary to the chain of peripheral irritation from the uterine
+glands, but that this secretion is none the less an essential
+feature of the menstrual process.</p>
+
+<p>In support of this view he calls attention to the pigmentation
+of the skin which occurs during pregnancy and chlorosis, showing
+that the absence of the catamenia results in the retention in the
+blood of some substance which would normally be excreted at this
+time.</p>
+
+<p>Other atrophic changes in the genitalia are shriveling of the
+vulva, with prolapse of the vagina or uterus from relaxation of
+the ligaments and loss of the natural support afforded by the
+changed perineal body.</p>
+
+<p>Uterine catarrh occurs almost invariably, and only ceases in
+advanced years. Displacements of all kinds are frequent, but on
+account of the now greatly diminished weight of the uterus, these
+are insignificant.</p>
+
+<p>The vagina is at first almost always hyperemic, but this
+disappears as the vessels successively atrophy. The vagina
+gradually becomes narrower and shorter. The mucous membrane loses
+its rugae and presents a pale, grayish, blanched hue.</p>
+
+<p>The researches of Byron Robinson, made by the dissection of a
+number of old women, show that after the menopause not only is
+there an atrophy of the genital organs, but that the hypogastric
+plexus of the great sympathetic nervous system also shrinks away.
+"It becomes smaller and firmer, and no doubt some strands
+disappear. On this fact must he based the pathologic symptoms
+accompanying the cessation of the menstrual function."</p>
+
+<p>The importance of the genital organs is shown by the vast
+nerve-supply sent to them. When this great nerve-tract becomes
+atrophic, so that it can no longer transmit the higher
+physiologic orders, all parts of the sympathetic system must be
+unbalanced, until a new line, the next line of least resistance
+is established. And Robinson believes that this is the
+explanation of the many pathologic manifestations of every viscus
+at the menopause; that is, "the irritation which arises by trying
+to pass more nervous impulses over plexuses than normal gives
+origin to what is unfortunately known as functional disease. It
+is just as organic as any disease, only we are unable to detect
+it."</p>
+
+<p>Chemical changes in the blood and tissues are constant vital
+phenomena; increased oxidation causes increased activity of the
+circulation, increase of temperature, increase of urea and
+carbonic acid in the economy from retrograde changes, and,
+finally, during menstrual life the flow of blood from the uterus
+carried off the effete materials from the highly charged
+system.</p>
+
+<p>The elimination of albuminoids, as shown by the altered
+condition of the blood after menstruation, is greater than can be
+accounted for by the blood discharged. When the menopause is
+attained suddenly, the retention of such albuminoid substances
+must act toxically. Hence the resulting clinical fact that sudden
+cessation of the menses is, in the majority of cases, attended
+with pronounced symptoms of discomfort, and it is in these cases
+that untoward results are most likely.</p>
+
+<p>James Oliver believes that the catamenial flow eliminates from
+the body substances whose presence in the blood would exert a
+deleterious influence on the animal economy.</p>
+
+<p><b>The Prominent Symptoms of the Menopause.</b>&#151;
+Christopher Martin holds that the symptoms of the change of life
+are produced largely by a condition of instability and increased
+excitability of certain other cerebrospinal centers directly
+brought about by failure of the menstrual center, and adds: "It
+is probable that the ovaries, like the liver and thyroid gland,
+modify the blood circulating through them, and add to the blood
+some peculiar product of their metabolism. It may be that some of
+the climacteric symptoms are due to the loss of this substance
+from the system."</p>
+
+<p>Arthur Johnstone's theory of the symptoms of the menopause is
+that the lining membrane of the uterus atrophies and becomes old
+cicatricial tissue, and sinks into quiet decay. The nervous
+system begins to readjust itself; but no longer having free
+outlet through the soft, lymphoid tissues of the uterus, the wave
+pressure meets with resistance and a choppy sea results.
+Vertigos, bilious attacks, and so forth are nothing more than
+reflex waves. The weakest organ of the individual is the one that
+generally suffers. And that the kidneys, which all along have
+borne the brunt of life, should now show positive signs of
+disease is natural.</p>
+
+<p>The etiology and pathology of the menopause lie in the
+sympathetic nervous system. And it is by the breaking up of the
+harmony of previous processes that nervous disturbances are
+produced.</p>
+
+<p>After the cessation of the flow, over 8% of women suffer from
+"flashes"; this symptom is caused by irritation of the heart and
+vasomotor centers. The blood-vessels of the head and neck seem to
+be most affected, yet the skin of the whole body shares in the
+disturbance. Besides the vasomotor and heat center being
+disturbed, the sweat center is irritated. The flushes and flashes
+are followed by various degrees of sweating, which varies from a
+slight moisture to great drops.</p>
+
+<p>Nervous irritability is a prominent symptom in 8% of women at
+the time of the menopause. Most of the pain arises around the
+stomach; that is, the solar plexus. Digestive disturbances are
+very common at this time; they may be in the shape of
+fermentation, diarrhea, or constipation, accompanied by
+congestion of the liver.</p>
+
+<p>Tilt holds the very plausible view that the too strong
+reaction of the sexual organs on the central ganglia of the
+sympathetic nervous system is their principal cause of disease.
+Puberty, menstruation, pregnancy, lactation, or the menopause
+almost always entail some derangement of this system which is
+sometimes sufficiently severe to lead to insanity and suicide.
+Debility underlies all affections of the sympathetic nervous
+system, in the same way as nervous irritability underlies all
+cerebral diseases. Sometimes there is an overpowering sense of
+exhaustion pervading the whole system.</p>
+
+<p>Forms of climacteric insanity are delirium, mania,
+hypochondriasis, melancholia, irresponsible impulses, and the
+perversion of moral instincts.</p>
+
+<p>"If the reproductive apparatus does not act on the brain by
+the instrumentality of the circulating organs of the blood, it
+must do so by means of the nerves. The genital apparatus is
+richly endowed with nerves from the sympathetic system, and I
+have shown how frequently evident signs of disturbance in these
+centers coincided or alternated with headaches, nervousness,
+hysteria, and epilepsy. What wonder, then, if the same powerful
+influence of the sexual organs, through the instrumentality of
+the sympathetic system, should at times produce a permanent
+derangement of the mental and moral faculties. I am thus led to
+look on the sympathetic nervous center as a source of vital power
+producing reflex morbid phenomena, in accordance with variable
+cerebral predisposition" (Tilt).</p>
+
+<p>Another very frequent symptom of the menopause is distress in
+the region of the heart, with palpitation and shortness of
+breath. It may be caused by the condition of the blood, whether
+it be impoverished&#151; anemia&#151; or too rich in red
+globules; by reflex irritation of the pneumogastric or
+sympathetic nerves; by overexertion; or by alcoholism. It may
+also be due to general debility; the woman resists fatigue less
+easily, and she experiences a general malaise. To the
+palpitations are rapidly added faintness and shortness of breath.
+The sleep is troubled with distress in the region of the heart.
+It is said that women in whom the menopause occurs early are more
+liable to tachycardia than those who menstruate later in life;
+and that it occurs with especial frequency when the menopause has
+been prematurely induced by surgical operation or by disease. It
+is believed that this functional heart trouble is caused by the
+increased connective-tissue fibers of the sexual organs acting in
+some unknown way on the terminal fibers of the sympathetic; and
+it is not infrequently due to the formation of scar tissue at the
+seat of a cervical laceration, and has often been promptly and
+permanently relieved by removing the cicatricial tissue and
+suturing the wound. The cause acts by producing a transitory
+paralysis of the inhibitory fibers of the pneumogastric
+nerve.</p>
+
+<p><b>Pathologic Conditions of the Menopause.</b>&#151; Perhaps
+the most alarming symptom of the menopause is <i>hemorrhage.</i>
+It may be due to general or local causes. Among the general
+causes are diseases of the heart, lungs, spleen, and kidneys.
+Local causes of hemorrhage are: inflammation of the lining
+membrane of the uterus, chronic pelvic inflammations, faulty
+uterine positions, erosions and ulcerations of the mouth of the
+uterus, fibroid tumors, and cancer. All competent observers agree
+that cancer in women is much commoner from forty to fifty years
+than at any other age.</p>
+
+<p>Hemorrhages occupy the foremost place among the pathologic
+phenomena of the genital tract during the menopause. Hemorrhage
+has been attributed in many instances to the senile rigidity and
+friability of the uterine vessels, which are not in a condition
+to offer sufficient resistance to the blood-pressure which is
+brought to bear on their walls; there is also softening and
+relaxation of the uterine tissue. Additional causes are found in
+the circulatory disturbances in the pelvic organs, whereby the
+outflow of blood from the pelvic vessels is hindered a chronic
+congestion in the uterine vessels is produced. It has also been
+attributed to early and profuse menstruation, frequent and
+difficult labors, frequent abortions, and excess in drinking.</p>
+
+<p>The third and last variety includes those cases which may be
+referred to some disease of the pelvic organs themselves.
+Anatomic changes may lead up to pathologic conditions. A chief
+feature characteristic of uterine disease is malnutrition from
+atrophy&#151; a sudden curtailing of the blood-supply from the
+degeneration of the genital-nerve apparatus and consequent
+impaired vitality of tissue from defective nourishment. The
+anatomic changes in the glands and substance of the uterus also
+favor the irritation, and the development of new growths, which
+may be malignant or benign&#151; as cancers, fibroid growths, and
+so forth.</p>
+
+<p><b>Hemorrhage at the Menopause a Significant Symptom of
+Cancer.</b>&#151; Not only should any excessive and prolonged
+bleeding at the time of the menopause be a source of great
+anxiety to the woman, but even the irregular appearance of a
+slight show of blood just sufficient to keep the clothing
+stained, or a slight bleeding following coition; since all of
+these are symptoms of very great gravity, and demand an immediate
+local examination and appropriate treatment.</p>
+
+<p>The widespread belief among the laity that hemorrhage at the
+time of the menopause is a normal condition, and that if left
+alone it will stop in the course of a few years, is most
+erroneous and fatal. On this altar of ignorance thousands of
+women sacrifice their lives every year. The case-book of any
+gynecologist will testify to the truth of this statement. The
+following three cases will serve to illustrate different types of
+hemorrhage in cancer patients, in no one of which did the patient
+even suspect that she was suffering from anything more serious
+than the "vagaries of the menopause."</p>
+
+<p>Case I.&#151; Woman aged seventy years; came on account of
+incontinence of urine, which had been troublesome for two years.
+The menopause occurred at fifty. She stated that three or four
+years previous to her visit, she had had a return of the flow of
+blood, perhaps twice in the first year, and that during the past
+year there had been a flow every month&#151; about the same that
+there used to be. This she took to be a return of the menstrual
+period. She said, further, that there was a constant
+bleeding&#151; enough to necessitate the wearing of a
+napkin&#151; and an occasional severe hemorrhage; that she could
+not take long walks or drives because of the excessive flow which
+followed.</p>
+
+<p>The case was one of cancer of the uterus which had spread to
+all the pelvic viscera; and in addition to this, the patient's
+general condition was such that any operation was out of the
+question. Yet the patient had never thought of the possibility of
+any uterine trouble sufficiently serious to make a local
+examination necessary. It was only the loss of control over the
+bladder that drove her to seek a physician's advice.</p>
+
+<p>Case II.&#151; Woman aged fifty-three years came to consult me
+because of pain, hemorrhage, and loss of weight. There had never
+been any cessation of the menstrual period. She said that she
+began to have irregular hemorrhages three years previously, and
+that they were constantly becoming more frequent and more
+alarming, and that, in addition to this, there was a constant
+discharge of blood, which necessitated her wearing a napkin all
+the time. She also stated that for the preceding six months the
+pain had been so severe that she had not had one solid night's
+sleep, and that in that time she had lost forty pounds in
+weight.</p>
+
+<p>This patient was in the very last stages of cancer of the
+uterus, and all that could be done for her was to make her
+comfortable. She had given birth to one child which caused a deep
+tear of the neck of the womb; and it is probable that this
+neglected tear was the primary cause of the cancer, which began
+in the neck of the womb.</p>
+
+<p>Case III.&#151; Woman aged forty-five years; married, but had
+never had any children. She said that the periods were normal as
+to duration and amount, but that for the past two years they had
+two days ahead of time, and that for the past four months she had
+been having just enough irregular bleeding between the periods to
+keep her clothing stained.</p>
+
+<p>On examination a diagnosis of cancer of the uterus was made.
+The pathological examination proved this to be a most malignant
+type of cancer of the neck of the womb. The entire uterus and
+appendages were at once removed. And although the patient made an
+excellent recovery from the operation, she succumbed to the
+disease one year after the operation was performed.</p>
+
+<p>These cases have been cited at length because they are all
+typical and because of the variety of symptoms and the great
+difference of age. Only in one of the cases was there any very
+severe pain, and it was really the pain, which had become
+unendurable, which caused the patient to seek relief.</p>
+
+<p>It is the concensus of opinion of the medical profession that
+cancer of the uterus is one of the common causes of death among
+women; that the cancer rate of mortality has increased during the
+last four decades; that it is most common near the time of the
+menopause; and that there is a direct causal relation between
+cancer of the neck of the womb and the traumatisms which occur
+during childbirth.</p>
+
+<p>The symptoms of cancer of the uterus are hemorrhage, a more or
+less offensive discharge, and pain. The quantity of blood may
+vary from a slight amount which occasionally stains the clothing
+to a profuse hemorrhage. In the married, bleeding following
+coition is always a suggestive symptom. During the menopause any
+irregular or profuse bleeding should excite suspicion. After the
+cessation of the menopause any bleeding whatsoever, whether
+slight or profuse, should always be regarded as a danger signal
+which demands an immediate and thorough local examination. The
+same is true of any offensive vaginal discharge. Pain is
+frequently so late a symptom that to wait for its appearance
+means that the favorable time to perform an operation has passed
+by. Emaciation is also a symptom of <i>advanced</i> disease.</p>
+
+<p>Cancer is chiefly a disease of the climacteric; when there is
+a diminished power on the part of the tissues to resist adverse
+influence. It affects the debilitated and overworked, but it is
+also found in the well nourished and in the comparatively
+young.</p>
+
+<p>Cancer always begins as a <i>local</i> disease, and when it
+occurs in the uterus, it is easily accessible and eradicable in
+its earliest stages; that is, if the disease is discovered in its
+incipiency, an operation will remove all the diseased tissue. If,
+on the contrary, the disease is left to nature, the growth
+spreads out into the surrounding viscera like the roots of a tree
+in the earth, and the cancer may be literally said to eat into
+the tissues which it invades. At the same time the germs of the
+disease begin to be carried all through the body, and the entire
+constitution is affected.</p>
+
+<p><i>Prophylaxis, or the Prevention of Cancer.&#151;</i> All
+pelvic inflammations should be promptly treated, and not allowed
+to become chronic. Leucorrhea is a symptom of inflammation, the
+true cause of which can be determined only by local examination.
+Women who have given birth to children&#151; and this is more
+especially necessary as they near the age of forty years&#151;
+should be carefully examined for tears of the neck of the womb.
+If these tears are extensive they should be repaired, as it is
+certain that malignant growths frequently do follow local
+injuries and traumatisms.</p>
+
+<p>Any irregular or profuse bleeding demands an immediate
+investigation by means of a local examination.</p>
+
+<p>A stormy, irregular, or delayed menopause should excite in the
+woman a suspicion of some abnormal condition.</p>
+
+<p>The importance of women being carefully watched by
+gynecologists at this period of their lives cannot be too
+emphatically stated, for upon the early recognition of cancer
+depends the only hope of radical cure of the disease. It is
+estimated that at the present time not less than 95 per cent. of
+all cases of cancer of the uterus come under the observation of
+the profession at a stage of the disease when all prospect of
+permanent relief is out of the question.</p>
+
+<p>It is a deplorable state of affairs that women, not knowing
+what a normal climacteric is, attribute all hemorrhages, no
+matter how severe, to the change of life. Therefore, regarding
+the hemorrhage as a necessary evil, they fail to consult a
+specialist until the favorable time for eradicating the disease
+by means of an operation has passed. And whatever knowledge
+science may bring in the future as to the cure of cancer, at
+present it is a fact universally agreed upon that early
+operation, while the cancer is still local, is the only radical
+cure for the disease.</p>
+
+<p><i>Pruritus Vulvae.</i> Perhaps one of the most annoying and
+obstinate symptoms of the menopause is <i>pruritus vulvae.</i>
+This is sometimes caused by sugar in the urine; there is a
+congestion of the liver which results in sugar being thrown into
+the system and this is eliminated by the kidneys. It is quite
+possible that this is due to the altered circulatory conditions
+of the menopause.</p>
+
+<p><i>Kidney Disease.&#151;</i> The last pathologic condition
+which we will mention is <i>kidney disease.</i> Le Gendre
+believes that the menopause exerts a deleterious effect on the
+kidneys, whether this be a congestion, followed by a diminution
+in the quantity of urine, or a sort of auto-intoxication due to
+the retention of a poison in the system that has been prevented
+from leaving by the ordinary path.</p>
+
+<p>Armstrong says that in almost all cases at the time of the
+menopause the amount of urine passed is below normal, the
+specific gravity is increased, and that the urine contains urates
+and almost always uric acid in excess. Further, that the
+functions of digestion and assimilation and the various metabolic
+changes are so largely under the control of the nerve-centers
+that nothing seems more likely than that so great a disturbance
+of that system as takes place at the menopause should cause
+secondary derangements of these most important functions. That
+being so, the blood becomes loaded with waste products, and the
+usual symptoms follow&#151; gout and so forth.</p>
+
+<p>It has been a grave question in the mind of the medical
+profession whether the dangers that certainly do attend the
+menopause are natural or acquired; that is, could these dangers
+be averted by any precautions or hygienic measures on the part of
+women, or are these dangers a necessary accompaniment of this
+period of life?</p>
+
+<p>Tilt has reached the conclusion that: "The best way to avoid
+the dangers of this critical time is to meet its approach with a
+healthy constitution. A marked want of strength prevents the
+regular succession of the vital phenomena by which all critical
+periods are carried on. And as the change of life is marked by
+debility, when this is grafted on constitutional weakness, loss
+of power will be of long duration. All complaints remain chronic
+because there is not stamina enough to carry them through their
+stages."</p>
+
+<p><b>Causes of Suffering at Menopause.</b>&#151; Dusourd, whose
+practice lay in an agricultural district in the south of France,
+as well as Tilt, believes that peasant women suffer little at
+this time. Their health is generally good when the menopause
+comes on and they are little liable to nervous disorders. The
+poor of large towns suffer much at this epoch&#151; the necessity
+of working hard, the anxieties of poverty and their unhygienic
+surroundings. But by a fortunate compensation the necessity for
+working hard prevents or cures the nervous affections which so
+often assail the rich at this period.</p>
+
+<p>Tilt's cases showed that women who suffered much at the
+menopause had previously suffered at puberty and at the menstrual
+periods. And among thirty-nine cases where there was no suffering
+at the menopause, there was the same immunity from suffering at
+puberty and at the menstrual epochs.</p>
+
+<p>Tilt's statistics were, or course, taken from English women.
+In forty-four cases of my own, all women past the menopause, the
+average age of the first menstruation was fourteen years and four
+months; and the average age of the actual cessation of the
+menstrual flow was forty-eight years and five and two-thirds
+months. Subtracting from this the average age of the first
+menstruation, we have as the mean age of menstrual life
+thirty-four years one and two-thirds months; that is, the average
+duration of the menstrual function was from two to four years
+longer than that usually given.</p>
+
+<p>A further investigation in order to ascertain any possible
+relation between the age of marriage and the number of
+pregnancies and the sufferings of the menopause elicited the
+following statistics. The average age of marriage was twenty-five
+years and ten months. Of the four women who were married after
+thirty-eight years, all were sterile; among the remaining there
+was an average of slightly above three children each. Forty per
+cent. of all these cases had one or more miscarriages. Nine had
+habitually suffered from severe dysmenorrhea, eleven had slight
+dysmenorrhea, and twenty-two had never felt the slightest
+inconvenience.</p>
+
+<p>In a list of fifty-two cases, eight were added to the list
+already given, all of whom had passed the menopause. Five were
+perfectly healthy and had never suffered the slightest
+inconvenience. Of these, one was single and only one had one
+miscarriage. Ten had suffered at the time of the menopause from
+slight malaise, but not sufficiently to call in a medical
+attendant. Thirty-seven were more or less seriously ill; thirty
+of these needed local as well as constitutional treatment, and
+seven constitutional treatment only.</p>
+
+<p>The prominent symptoms of the climacteric were as follows:
+Marked debility, 24; intense nervousness, 31; nervous
+prostration, 9; melancholia, 10; headache, 14; neuralgia, 6;
+hysteria, 7; irritable heart, 11; tachycardia, 8; insomnia, 19;
+indigestion, 32; constipation, 28; diarrhea, 3; leucorrhea, 38;
+rheumatism, 21; gout, 1; Bright's disease, 12; hemorrhage, 6;
+alcoholism, 2; corpulency, 2.</p>
+
+<p>As a result of the study of these cases, the most striking
+feature was the relation of miscarriages to the sufferings and
+ill health at the time of the menopause. Of the nineteen women
+who had miscarriages, only one did not suffer in some way at the
+time of the menopause. Four suffered only slightly, and fourteen
+suffered extremely, not only during the menopause, but in the
+post-climacteric period as well. And the next most striking
+feature was that the prominent symptoms of the menopause are
+preeminently reflex or the functional diseases of the nervous
+system.</p>
+
+<p>Tilt believes that single women suffer less than other women
+at the time of the menopause. He further writes: "As at puberty,
+from the ignorance in which it is still thought right to leave
+young women, so at the change of life, women often suffer from
+ignorance of what may occur, or from exaggerated notions of the
+perils which await them. It would be well if they were made to
+understand that if in tolerable health, provided that they will
+conform to judicious rules, they have only blessings to expect
+from the change of life. Most unfortunately, the individual not
+cognizant of the invisible changes going on in the economy does
+not adapt the mode of life to the new conditions of the organism,
+and the weakened and lessened amount of the digestive fluids is
+unable to master the large quantities of food. The absorbents
+refuse to take more than is needed to repair the tissues. The
+atrophying muscles of the digestive tube, unable to hurry on the
+mixed products of indigestion; fermentation; and micro-organisms
+inciting fermentations and elaborating toxic alkaloids, poison
+and disorder the functions of life. Man's outdoor life enables
+him to escape many of these evils.</p>
+
+<p>"Woman's enervating mode of life, the continued introspection,
+coupled with the peculiar changes in the nutrition of the body at
+this time, render the nervous system peculiarly impressionable
+and liable to the manifold forms of diseases. 'The woman is told
+that she must be calm and patient, and in time the tomb-builder
+will alleviate all her sufferings.' This critical period may be
+dangerous to those who are always ailing, for habitiual sufferers
+at the menstrual periods, and for those affected with uterine
+diseases. If, on the first indication of the change of life,
+women who are in fair health carefully followed a regimen and
+pursued a line of life in harmony with the physiologic processes
+on which this change depends, disease would be prevented. But as
+the change concerns a natural function, it is left to nature; no
+additional precautions are taken, and advice is sought only when
+the mischief is done."</p>
+
+<p>It is not wise to marry during this period. On the first
+appearance of the irregularities of the menopause the amount of
+food and stimulants to which women have been accustomed should be
+curtailed rather than augmented. The system requires supporting
+by medicine and regimen&#151; as, baths, mental and moral
+hygiene, and occupation&#151; rather than stimulating by
+spirits.</p>
+
+<p>We have seen that, in accordance with the plethric theory,
+which prevailed until 1835, and with the nerve theory, which is
+based on the latest anatomic and physiologic researches,
+menstruation is a physiologic process to get rid of effete
+material, and is therefore an excretion.</p>
+
+<p>At the end of perhaps thirty years, by a conservative process
+of nature, the child-bearing period ceases and the organism is
+readjusted to the end that the woman's vitality may all be
+conserved for her own individual life.</p>
+
+<p>Each metamorphic or developmental period of life&#151;
+dentition, puberty, and the menopause&#151; throws a special
+strain on the nervous system, and the recent studies of the
+sympathetic nervous system at the time of the menopause show that
+very extensive anatomic changes occur at this time. That being
+the case, the woman must lead such a life as will insure her
+having on hand a large reserve force necessary to meet these
+heavy demands. Tilt's observations show that women who have
+experienced no suffering at puberty or, at the menstrual periods
+do not suffer at the menopause. It is therefore evident that the
+time to begin this preparation is in childhood.</p>
+
+<p>That single women suffer less than married women would suggest
+that excessive coitus and the occurrence of abortions, frequent
+child-bearing, and lesions as the result of pregnancies, many of
+which lesions could have been prevented or cured by the timely
+aid of the physician, are the combined sources of much of the
+suffering at the time of the menopause.</p>
+
+<p>That the most frequent and serious disturbances are those of
+the nervous system, and that from their mode of life and habits
+of introspection the rich suffer more from these ailments than
+the poor, must cause serious consideration of the physiologic
+necessity for a definite occupation for the daughters as well as
+for the sons of the rich.</p>
+
+<p>The frequency with which Bright's disease is found at the time
+of the menopause is dependent not so much on the local
+physiologic changes which are taking place as on the time of
+life. Loomis says that it was not until life-insurance
+examinations became so common that the frequency with which
+kidney disease existed in persons who believed themselves well
+was even imagined. And as a result of his observations in these
+cases, and of a large number of autopsies conducted at the
+Bellevue, he stated that it was his belief that 90% of men and
+women over forty years of age suffer from some form of Bright's
+disease. That being the case, it would seem that after this
+period of life at least as much attention should be directed to
+the kidneys as to the teeth, and that a semi-annual examination
+of the urine should be made.</p>
+
+<p>Although the menopause is a physiologic occurrence, yet, owing
+to the many pathologic changes which are liable to take place at
+this time, the woman should be as carefully watched during the
+menopause by the gynecologist as the pregnant woman now is by the
+obstetrician. If the same care were taken, in the majority of
+cases, the dangers attending the menopause would be avoided, and
+the woman would be prepared to enjoy a healthy and useful
+post-climacteric period of life.</p>
+
+<h3>CHAPTER XV.</h3>
+
+<h4><b>HYGIENE OF THE MENOPAUSE.</b></h4>
+
+<h5>Diet; Constipation; Stimulants; the Kidneys; the Skin;
+Turkish Baths; Massage; Exercise; Profuse Menstruation;
+Hemorrhage; Mental Therapeutics.</h5>
+
+<blockquote><p>"'Tis the breathing time of day."
+</p>
+<p class="right"><i>&#151; "Hamlet."</i>
+</p></blockquote>
+
+<p><b>Hygiene of the Menopause.</b>&#151; The changes which occur
+in all the organs of the body at the time of the menopause are
+retrograde, and therefore just the opposite of those which occur
+at the time of puberty. This fact should be borne in mind in the
+matter of alimentation. All that is now needed is to make the
+repair equal to the waste.</p>
+
+<p><b>Diet.</b>&#151; Unless the woman is taking a great deal of
+active exercise, it is better to diminish the amount of meat
+eaten, and to increase the vegetable food and take more fluids.
+Unless the effect of the meat eaten is counterbalanced by active
+outdoor exercise, it produces an excess of waste matter, which
+accumulates and causes biliousness, and sometimes rheumatism and
+gout. A vegetable diet is less taxing to the excretory organs
+than an animal diet.</p>
+
+<p>Indigestion is at this time of life apt to appear in the form
+of fermentation, which may assume the gastric or intestinal type.
+The chief causes of the formation of gases are the lessened
+peristaltic action of the intestines, the increased tendency to
+congestion of the liver and to obstinate constipation.</p>
+
+<p>All dishes rich in sugar, as cake, candy, preserves, and
+jelly, should be indulged in with moderation; or where there is a
+tendency to fermentative indigestion, they should be wholly
+avoided.</p>
+
+<p>All dishes known to be difficult of digestion, as hot breads,
+pastry, cheese, fried dishes, and rich salads, should be cut off
+the menu, since these readily overtax an already weakened
+digestive system.</p>
+
+<p>If there is a hereditary tendency to rheumatism or gout, the
+disease is most apt to take on an active form at this time. In
+either case the manifestation of the disease indicates an excess
+of uric acid in the system, and a diet becomes a necessity.
+Pickles, all highly spiced articles of food, and vinegar must be
+omitted from the bill of fare. The vinegar may be replaced in
+salad-dressings by lemon juice. Tomatoes, rhubarb, strawberries
+and grapefruit are contra-indicated; also all articles of food
+rich in sugar.</p>
+
+<p>In chronic cases animal food cannot, as a rule, be excluded
+from the dietary, but must be limited in quantity. Fish, eggs,
+and fowl may be eaten, also a moderate amount of lean meat in the
+form of beef, lamb, and mutton. Milk may be indulged in freely.
+The diet should consist principally of easily digested fresh
+green vegetables. The amount of tea and coffee should be limited.
+All malt liquors, sweet wines, and champagne must be absolutely
+prohibited.</p>
+
+<p><b>Constipation.</b>&#151; A daily free evacuation of the
+bowels is essential to good health. Where constipation exists,
+and the woman is full-blooded, with a tendency to a rush of blood
+to the head, saline laxatives are indicated. But if the woman is
+constipated and anemic, cascara sagrada is a better laxative;
+while cod-liver oil acts as a laxative and at the same time
+improves the quality of the blood.</p>
+
+<p><b>Stimulants.</b>&#151; Women resort to alcoholic stimulants
+as an analgesic to relieve pain, whether physical or mental; as a
+narcotic to produce sleep; and as a spur to a failing appetite or
+bodily powers.</p>
+
+<p>The majority of women patients say that they first used
+alcohol in the shape of whisky, brandy or gin to relieve pain at
+the time of the menstrual period. The pain that is caused at this
+time by a chilling of the body would be as effectually relieved
+by drinking a cup of hot tea; while if the pain is intense and
+constant, recurring every month, it is doubtless caused by some
+local inflammation, and the use of alcohol only veils the real
+trouble, and the woman loses valuable time by not consulting a
+physician at once.</p>
+
+<p>As to the use of alcohol to blunt the nervous sensibility due
+to mental suffering, it is the testimony of the entire medical
+profession that this is the greatest cause of inebriety or
+drunkenness among women of all classes of society.</p>
+
+<p>Sleeplessness generally arises from some well-defined physical
+cause&#151; very frequently from inaction of the liver&#151; and
+the proper remedial agents should be used to remove the
+cause.</p>
+
+<p>While at first the use of alcoholic beverages increases the
+appetite, as the amount taken is increased, distaste for food is
+created, the system languishes under an insufficient food-supply,
+and the original aim of increasing the appetite is defeated.</p>
+
+<p>As to taking stimulants to do more work than one could
+otherwise accomplish, it is by means of stimulants that woman can
+accomplish her physiological ruin more quickly than is possible
+in any other way. And the early symptoms of chronic alcoholism
+show themselves in the form of neuralgia, insomnia, palpitation
+of the heart, and muscular tremors.</p>
+
+<p><b>The Kidneys.</b>&#151; On account of the prevalence of some
+form of Bright's disease after forty years of life, the kidneys
+should be carefully watched at this time. And in order to keep
+them in good condition they must be well flushed with water every
+day. Three pints of urine should be excreted daily, and three
+pints of water as such must be taken into the system daily. The
+urine should be examined by the physician every six months. In
+this way kidney disease is often discovered in its incipiency,
+which otherwise might run into a serious form of Bright's
+disease.</p>
+
+<p><b>The Skin.</b>&#151; It must be remembered that the skin is
+one of the excretory organs of the body, and the pores should be
+kept well open by the various forms of baths.</p>
+
+<p>The Turkish bath or some modification of it will often be
+found to be particularly useful. Massage with alcohol after the
+bath lessens the tendency to take cold. For a woman who is anemic
+or run down, it is well to follow the Turkish with the Roman
+bath, which is an inunction with almond oil or cocoa-butter. A
+much more thorough massage is given with the Roman bath than with
+the "alcohol rub." It is often necessary to modify the Turkish
+bath by omitting the steam-room and shortening the time spent in
+the hot dry air. In ordinary cases the time spent in the hot
+dry-room should be only that necessary for producing a free
+perspiration. This time varies in different individuals from ten
+to twenty minutes. No woman should go to a Turkish bath without
+first consulting her physician, since if the woman has a weak
+heart, the bath may be the source of positive danger.
+Comparatively few women are strong enough to take the cold
+plunge.</p>
+
+<p><b>Massage.</b>&#151; Massage, well given by a skilful
+masseuse twice a week, will greatly tone up the nervous and
+circulatory systems. Women who are very stout and who have
+sluggish livers with obstinate constipation will find massage
+particularly beneficial.</p>
+
+<p><b>Exercise.</b>&#151; Daily exercise in the open air is
+absolutely essential to every woman's good health. The minimum
+amount of outdoor exercise compatible with health is an hour's
+walk, at the rate of three miles an hour. If the woman has never
+taken any exercise, she must begin with a very short walk and
+stop on the first sign of fatigue. Gradually increase the
+distance and the speed until the three miles is reached.</p>
+
+<p><b>Profuse Menstruation.</b>&#151; If the menstrual flow is
+unusually profuse or lasts beyond the regular time, the woman
+should stay quietly in bed until the flow ceases. All exercise
+increases the flow.</p>
+
+<p>The flow now becomes less in quantity, and the periods more
+infrequent than formerly. <i>Hemorrhage</i> must always be
+regarded as a danger-signal the significance of which can
+scarcely be overestimated. To immediately consult a specialist on
+the appearance of any irregularities of the flow would, in the
+opinion of the most eminent gynecologists of the day, be the
+means of saving thousands of women's lives every year.</p>
+
+<p><b>Mental Therapeutics.</b>&#151; It is particularly necessary
+at this time of life that the mind should be pleasantly occupied.
+Her children have passed the age when they need her constant
+supervision, and the mother must take some relaxation from her
+home cares, in the form of social diversions, amusements, outdoor
+life, and change of scene. Any mental occupation that will take
+the woman out of herself is the best possible safeguard against a
+state of introspection which conjures up a host of evil
+fantasies, and which is the first step in the downward road to a
+fixed and permanent melancholia.</p>
+
+<blockquote><p>"Hang sorrow, care will kill a cat;<br/>
+ And therefore let 's be merry."</p></blockquote>
+
+<h3>CHAPTER XVI.</h3>
+
+<h4><b>HINTS FOR HOME TREATMENT</b></h4>
+
+<h5>Indigestion; Constipation; Diarrhea; Enemas; Vaginal Douche;
+Baths; Headache; Fainting; Hemorrhage.</h5>
+
+<blockquote><p>"Woman is woman's natural ally."
+</p>
+<p class="right">&#151; EURIPIDES.
+</p></blockquote>
+
+<p><b>Indigestion.</b>&#151; The chief causes of indigestion are:
+eating rapidly, eating at irregular hours, eating indigestible
+foods, constipation, and lack of exercise. No one who values her
+good health will allow herself to be hurried through a meal, nor
+will she allow the perplexities of life to be thrust upon her at
+the table for solution. The first requisite for the digestion of
+foods is that they should be well masticated, so that the
+digestive fluids may act on the finely divided particles to the
+greatest possible advantage. And while digestion is going on all
+mental labor should be held in abeyance, in order to avoid
+drawing the blood away from the stomach to the brain.
+Furthermore, it is a well-known fact that digestion is best
+performed when the meals are served at regular hours.</p>
+
+<p>Constipation leads to the formation of gases in the
+intestines, to fermentation, and to the absorption of toxic
+materials by the blood.</p>
+
+<p>Through lack of exercise, the appetite fails, the liver
+becomes torpid, and the muscular and nervous systems lose their
+tone.</p>
+
+<p>The exercise which the housekeeper gets in going around her
+house is not sufficient. Daily exercise in the open air is
+essential to health; as this is to supplement the indoor
+exercise, the amount taken will vary in proportion to the former.
+For teachers or those who have a sedentary occupation an hour's
+active exercise in the open air&#151; a three-mile walk&#151;
+should be supplemented by active gymnastic exercise.</p>
+
+<p>For people in good health, a mixed diet&#151; that is to say,
+a diet consisting of meat, vegetables, and fruit&#151; is the
+best. If the individual is not well, then the diet must be
+adapted to meet the needs of that particular case.</p>
+
+<p>Hot breads, all articles of food fried in fats, salads, and
+pastry are difficult to digest. Tea is very constipating, and
+when taken in excessive quantities renders the individual
+nervous. An excess of coffee leads to congestion of the
+liver.</p>
+
+<p>Where indigestion exists, the simplest and most sensible
+remedies are to regulate the diet, and avoid eating between
+meals. By drinking a glass of water as hot as it can be sipped
+one hour before each meal, the mucus is washed out of the
+stomach, the stomach is empty on coming to the table, and in the
+best possible condition for the gastric juice to act on the
+food-stuffs.</p>
+
+<p><b>Constipation.</b>&#151; Constipation is the rule with the
+average American woman; the causes are their corsets, the tight
+bands of their clothing, lack of exercise, and the fact that they
+drink too little water and too much tea. The most rational means
+to overcome it is to drink more water; at least three pints a day
+should be taken, in addition to soups, tea and coffee, and so
+forth; the water must be taken into the system as such. Then
+attention must be given to the diet; plenty of fruit should be
+eaten, vegetables, and coarse bread.</p>
+
+<p>Regularity in this, as in all other habits of life, is most
+essential, and the individual should go to the toilet at the same
+hour every day, even if there is no inclination to have a bowel
+movement, and thus the habit will be established; the most
+convenient time is directly after breakfast.</p>
+
+<p><i>Medical Treatment.&#151;</i> But if all these means have
+failed, medicines must be resorted to. Cold water is a better
+laxative than hot; to a glassful of cold water add from one
+teaspoonful to one tablespoonful of the effervescing granules of
+the phosphate of soda, and take this the first thing on rising in
+the morning. This preparation of soda is particularly useful
+because it acts slightly on the liver. Other laxatives are: a
+seidlitz powder dissolved in a glass of cold water on rising; a
+wineglass or more of Hunyadi Janos, also taken on rising. Any of
+these may be taken with safety by pregnant women. For children
+the simplest laxative is one teaspoonful of Husband's milk of
+magnesia, to be taken in one glass of water on rising.</p>
+
+<p><b>Enemas.</b>&#151; Perhaps one of the most common methods
+used by the laity for the relief of constipation is the rectal
+injection, or enema. Enemas habitually given to unload the bowels
+are productive of much harm by overdistending the rectum, so that
+in time the rectum fails to react to the normal stimulus&#151;
+namely, the presence of the feces&#151; as it otherwise would.
+But by some means or other the bowels must be well moved once
+every twenty-four hours. And it is much better to use an enema
+than to go to bed without a bowel movement. If the woman is going
+around, so that she can give the enema to herself, the most
+effective way to take it is in the knee-chest position or an
+approximation to this. Either a fountain or bulb syringe may be
+used for this purpose; a quart of water at a temperature of
+110&deg; F. should be prepared by making it into a suds with
+castile soap, or one tablespoonful of glycerin may be added to
+one pint of water. The nozle to be used is the smallest one that
+comes with the syringe, the so-called infant's nozle; this is
+quite large enough, and its insertion is not nearly so painful as
+the larger ones; the nozle must be well greased with vaselin.
+When everything is ready, the patient gets down on her knees with
+the shoulders near the floor, having first loosened all of her
+bands and taken off her corsets; the nozle is introduced as far
+as it will go into the rectum, and if a bulb syringe is used the
+water must be very gradually squeezed into the rectum, otherwise
+it will not retain so much; or if the fountain syringe is used,
+it must not be hung too high. So soon as the patient feels that
+she has taken all that she can retain, she should lie down on the
+left side, and retain the water as long as possible, as it is
+thus rendered more effective. An enema so taken will be very much
+more effective than one taken in the ordinary manner of sitting
+on the toilet. In the method just described more water can be
+used and it will be longer retained; it can be felt to go up
+along the course of the large bowel, and it will often be found
+very effective when the ordinary enema fails. This enema will
+often be found to be a very valuable aid in curing an obstinate
+chronic diarrhea, which is kept up by particles of feces
+remaining in the folds of the large intestine. If the patient is
+confined to bed, she should lie on the left side, with a heavy
+towel folded under her to prevent the bed from becoming wet; when
+the nurse withdraws the nozle she should make pressure on the
+anus with the towel, to help the patient to retain the water as
+long as possible. But should the patient have gone so long
+without a bowel movement that all these means fail, it will be
+necessary to precede the water enema with one of oil; or still
+more effective is the following combination: take one teaspoonful
+of the spirits of turpentine, the yolk of one egg, and two
+tablespoonfuls of olive oil, and beat well together, and add to
+these one pint of water at a temperature of 110&deg; F.
+Constipation, however, of so obstinate a character as this
+demands a physician's attention.</p>
+
+<p><b>Diarrhea.</b>&#151; A diarrhea may be acute or chronic; the
+treatment is essentially different. For an acute attack
+accompanied by frequent stools and severe abdominal pain the
+first thing to do is to go to bed. If there is nausea, drink a
+glass of water as hot as can be taken, at once; for the diet, a
+glass of scalded milk, not boiled but just allowed to come to the
+boiling-point, every two hours; and nothing else should be taken
+until the diarrhea is well in check. If the pain is severe, a
+spice plaster over the abdomen will be found to be very
+comforting. It is made as follows: take of powdered allspice,
+cinnamon, cloves, and ginger each two tablespoonfuls, and two
+teaspoonfuls of cayenne pepper; mix well together in a bowl; then
+quilt in a piece of flannel large enough to cover the abdomen;
+when ready for use, dip in hot whisky and apply as hot as the
+patient can bear; cover over with a large napkin, as the plaster
+produces a deep stain which does not wash out; keep on as long as
+necessary. If the rest in bed and the milk diet kept up for
+twenty-four hours do not suffice to cure the diarrhea, it is not
+wise to take any risks, but send for your doctor at once. Or if
+there should be any blood in the stools, do not wait for
+anything, but send for the doctor without delay.</p>
+
+<p>For a chronic diarrhea an enema given in the knee-chest
+position, as already described, will often be found a most
+efficient remedy. In diarrheas the use of fruits and vegetables
+should be avoided; the best diet after the milk is bread well
+toasted through, toast-water, soft-boiled eggs, beefsteak, oyster
+stew, and clam broth.</p>
+
+<p><b>Vaginal Douche.</b>&#151; To be of service except for mere
+cleansing purposes the douche must be taken in the horizontal
+position, either on a couch or, if it is not cold, on the floor.
+Of course, this position necessitates the use of a douche-pan.
+The douche-pan is best of agate-ware, oblong in shape, and with a
+broad strip which comes under the nates. On lying down to take
+the douche the nates must come down well over the pan and the
+clothing must be pushed well up to prevent the water from seeping
+up the back. To make the woman more comfortable there should be a
+pillow under the head, and she must have a shawl or some light
+woolen material to throw over her while taking the douche to
+prevent chilling; thus doing more harm than good.</p>
+
+<p>There are two forms of syringes on the market: the bag or
+fountain syringe, which is hung up sufficiently high&#151; about
+three feet above the patient&#151; to cause the water to flow;
+and the bulb syringe, in which the bulb has to be constantly
+squeezed by the hand, which is tiresome to many women, but this
+is a much more convenient form to have in traveling. During
+pregnancy the fountain syringe only should be used, and it should
+be hung as low as will enable the water to flow. For a woman who
+has never taken douches it is well to begin with a temperature of
+110&deg; F., gradually increasing the temperature to 118&deg; or
+120&deg;; this is as high as the woman should attempt to go, for
+a higher temperature would burn her, leaving the vulva so
+sensitive that she would only be able to take cool douches for a
+long time after this; a bath thermometer should be used in all
+cases to test the temperature, so that the woman knows exactly
+what she is doing.</p>
+
+<p>In cases of inflammation of the uterus or its adnexa four
+quarts of water should be used, and the douche should be taken in
+the horizontal position. The water thus acts as a hot poultice
+about the uterus, and the woman will find on rising that some
+water flows out from the vagina. Ordinarily plain hot water is
+all that is necessary to use, but where the discharge is acrid
+and scalding, the plain hot-water douche should be followed by a
+warm douche containing one teaspoonful of borax to a pint of
+water. The best time for taking a douche is at night just before
+retiring; there is also less danger of taking cold when the
+douche is taken at this time.</p>
+
+<p>The scalding sensations at the vulva may be due to the acidity
+of the urine, in which case it will be increased just after
+urination; or it may be due to an acrid discharge from the
+vagina. A little observation on the part of the patient will
+enable her to distinguish which is the real cause. If there is
+any trouble with the urine, it should be carefully examined at
+once, as some congestion or inflammation of the kidneys is not
+infrequently present, which if attended to might be cured, and
+which if allowed to run on unattended to, may develop into a
+serious form of Bright's disease.</p>
+
+<p>The genitals should be washed with soap and water night and
+morning. Women who do not suffer from leuchorrhea need not take a
+vaginal douche more than once a week; after the menstrual flow
+the vaginal injection is advised to remove the detritus of the
+flow.</p>
+
+<p><b>Baths.</b>&#151; The most ordinary forms of baths used may
+be classified under sponge-, shower-, sitz-, and tub-baths. The
+sponge-bath as ordinarily taken is of service for cleansing
+purposes, and if the water be cold it tones up the system to some
+extent, and is so a preventive against taking cold. The effect of
+this bath will be found to be vastly more beneficial if salt is
+added to the bath in the proportion of a pint of salt to a gallon
+of water; either sea-salt may be used or the ordinary coarse
+salt. It is most advantageously taken sitting in a bath or
+hat-tub, so that the entire surface of the body will be wet at
+the same time, and the water can be allowed to run down the back
+and over the chest. It is well to begin these baths at a
+temperature of 80&deg; F. and to gradually decrease this until
+the bath is taken at 70&deg;, which is about the temperature of
+running water, and the bath should be kept up at this. For most
+people the best time to take the bath is just before retiring;
+this bath is not only very strengthening, but also is excellent
+in cases of insomnia and nervousness.</p>
+
+<p><i>Shower-baths.&#151;</i> These may be taken after a hot
+bath, or taken alone after violent muscular exercise. The body
+should be quickly scrubbed off and the shower should be warm at
+the beginning and gradually allowed to become cold, stooping over
+so as to get the full force of the shower on the spine and over
+the region of the stomach and heart. They will be found to be
+most refreshing after great muscular fatigue, and, when taken
+after the hot tub-bath, greatly lessen the susceptibility of the
+individual to taking cold.</p>
+
+<p><i>Sitz-baths.&#151;</i> These are given for their local
+effect in cases of inflammation; whether this inflammation be of
+the kidneys, bladder, or of the uterus and its adnexa. A sitz-tub
+is necessary to properly take this form of bath. The water should
+be used as hot as is comfortable to the patient, from 105&deg; to
+110&deg; F., hot water being added as the first cools off; a pint
+of salt should be added to the gallon of water, and the patient
+should remain in this from five to eight minutes. A blanket
+should be wrapped about the patient so that she will be thrown
+into a perspiration; it is almost needless to say that the only
+time for taking this bath is just before retiring, and that this
+bath does make the woman more susceptible to taking cold, so that
+it is necessary to wear an abdominal woolen bandage day and
+night.</p>
+
+<p><i>Tub-baths.&#151;</i> The tub-bath ought not, as a rule, be
+taken more than twice a week, unless the cold plunge is used,
+which may be taken every day. If the tub-bath is taken hot, the
+woman should remain in it not much longer than is necessary to
+scrub off with a flesh-brush; this bath should be followed either
+with a cold shower-bath, or the water in the tub be gradually
+allowed to cool off until it is down to 70&deg; F.</p>
+
+<p><b>Headaches.</b>&#151; Headaches, aside from those of acute
+illness, may be roughly divided into three classes: first, those
+which are due to indigestion; second, neuralgic headaches; and,
+third, those due to pelvic inflammations. The headaches due to
+indigestion are usually located over the eyes and all over the
+forehead; they are more or less constant and are accompanied by
+other symptoms of indigestion, and very often by constipation.
+The feces are allowed to remain in the bowels overlong, the toxic
+matters are taken up by the blood, and headaches and vertigo
+result.</p>
+
+<p>Neuralgic headaches are of an entirely different character;
+the pains are here of a lancinating character, and are not
+confined to any one region of the head. As a rule, they are
+accompanied by neuralgic pains in other parts of the body.
+Neuralgia generally means a rundown state of the system from
+overwork, worry, or malaria, and tonics and cod-deliver oil are
+indicated.</p>
+
+<p>A constant dull pain on the top of the head or in the back of
+the neck generally indicates some uterine inflammation, and can
+only be cured by removing the cause. In any case it is very
+evident that taking the various "headache powders" with which the
+market is flooded will never cure the woman of her headaches; and
+many of these powders are very dangerous, especially where the
+heart is weak, as most of them are heart-depressants.</p>
+
+<p><b>Fainting.</b>&#151; Fainting may be due to a weak heart, to
+heart disease, or to sudden shock, as on receiving a bad piece of
+news; during pregnancy the close air of a room may cause a woman
+to faint. The first thing to be done is to lay the woman down on
+the floor or bed with nothing under her head; loosen all her
+clothes about the neck and waist, and throw the windows open so
+that she will get plenty of fresh air. If she is able to drink,
+give her one teaspoonful of aromatic spirits of ammonia in four
+tablespoonfuls of cold water. If the feet are cold, place
+hot-water bottles to them to improve the circulation. And if at
+the end of fifteen minutes she does not show signs of decided
+improvement, give her two tablespoonfuls of whisky in an equal
+quantity of hot water. In the meantime the physician will have
+been summoned. These attacks of fainting often occur in a crowded
+ball-room, and are due to tight lacing and the poor ventilation
+of the room.</p>
+
+<p><b>Hemorrhage.</b>&#151; A profuse hemorrhage is the most
+alarming as well as the most dangerous thing which can befall a
+woman, and the very nearest doctor should be summoned until the
+family physician can be gotten there. The woman should be made to
+lie down wherever she may happen to be, her clothes loosened, the
+windows thrown open, so that she will not only have plenty of
+fresh air, but that the air shall be cool. If the blood is coming
+from the mouth, give her pieces of ice to hold in it; if she
+coughs up the blood, it would be well to put a bag of ice-cold
+water or cloths wrung out of ice-water on the chest. If the woman
+is suffering from a uterine hemorrhage, have her take at once a
+hot vaginal douche, from 118&deg; to 120&deg; F., and have the
+foot of the bed raised. The head should always be kept low.</p>
+
+<p>Women hold their health in their own hands to a far greater
+extent than they have ever dreamed of; and if the majority of
+women suffer, it is very often their own fault, either because
+they have disregarded nearly every law of health, or have allowed
+trivial ailments to go on until they were almost incurable.</p>
+
+<hr />
+<blockquote><p>"The broad mountain-top, with its sunlight and free
+air, is possible to all of us, if we choose to struggle on and
+reach it."
+</p>
+<p class="right">&#151; Phillips Brooks.
+</p></blockquote>
+
+<hr />
+<h3>GLOSSARY.</h3>
+
+<hr />
+<p class="letter"><b>Abortion.</b> The expulsion of
+the fetus before the end of the third lunar month.<br/>
+ <b>Afferent Nerves.</b> Those nerves which convey the
+impressions to the nerve-centers.<br/>
+ <b>After-pains.</b> The pains which follow labor and which are
+caused by the contractions of the uterus.<br/>
+ <b>Amenorrhea.</b> Absence of the menstrual flow.<br/>
+ <b>Anemia.</b> The so-called thinness of the blood, due to a
+deficiency of red blood-corpuscles.<br/>
+ <b>Antisepsis.</b> The use of chemical substances which have the
+power of destroying germs.<br/>
+ <b>Anus.</b> The external circular outlet of the rectum or
+distal part of the large intestine.<br/>
+ <b>Appendages, Uterine.</b> The Fallopian tubes, the ligaments
+of the uterus, and the ovaries.<br/>
+ <b>Atrophy.</b> A progressive diminution in the bulk of an organ
+or tissue.<br/>
+ <b>Automatic.</b> Involuntary, mechanical.<br/>
+  <br/>
+ <b>Bulbi Vestibuli.</b> A plexus of veins on each side of the
+vestibule.<br/>
+  <br/>
+ <b>Capillaries.</b> The terminal and very finest branches of the
+blood-vessels.<br/>
+ <b>Catamenial Flow.</b> See <i>Menstruation.</i><br/>
+ <b>Cellular Tissue.</b> A loose, transparent tissue which
+surrounds the muscles and organs of the body.<br/>
+ <b>Cerebrum.</b> The upper and larger portion of the brain.<br/>
+ <b>Chlorosis.</b> Anemia of young women about the time of
+puberty.<br/>
+ <b>Climacteric.</b> See <i>Menopause.</i><br/>
+ <b>Clitoris.</b> A small, elongated, erectile organ situated at
+the upper part of the vulva.<br/>
+ <b>Cohabitation.</b> See <i>Coitus.</i><br/>
+ <b>Coition.</b> See <i>Coitus.</i><br/>
+ <b>Coitus.</b> Syn., coition, copulation, cohabitation, sexual
+congress, sexual intercourse. The carnal union of the sexes.<br/>
+ <b>Colostrum.</b> A thin albuminous fluid which appears in the
+breasts at the fourth month of pregnancy.<br/>
+ <b>Conception,</b> or impregnation, is the union of the germ and
+sperm cell which results in a new being.<br/>
+ <b>Confinement.</b> Childbed, the expulsion of the child from
+the womb.<br/>
+ <b>Congestion.</b> The abnormal accumulation of blood in a
+part.<br/>
+ <b>Constipation.</b> Costiveness; a state in which there is not
+a free daily evacuation of the bowels, or where the evacuations
+are hard or expelled with difficulty.<br/>
+ <b>Continence.</b> Abstinence from or moderation in sexual
+indulgence.<br/>
+ <b>Copulation.</b> See <i>Coitus.</i><br/>
+ <b>Cord, Umbilical.</b> The cord which connects the fetus with
+the mother. Through the blood-vessels contained in this cord the
+child receives nourishment.<br/>
+ <b>Corpuscle.</b> A very small particle.<br/>
+  <br/>
+ <b>Decidua.</b> A membranous sac formed in the uterus during
+gestation, and thrown off after parturition.<br/>
+ <b>Defecation.</b> The act by which the contents of the bowel
+are expelled from the body.<br/>
+ <b>Dehiscence.</b> The splitting open of an organ.<br/>
+ <b>Dentition.</b> The cutting of the teeth.<br/>
+ <b>Dysmenorrhea.</b> Painful and difficult menstruation.<br/>
+ <b>Dystocia.</b> A difficult labor.<br/>
+  <br/>
+ <b>Embryo.</b> The name applied to the very earliest stages of
+the child in utero; that is, up to about the time of
+quickening.<br/>
+ <b>Endometrium.</b> The lining membrane of the uterus.<br/>
+ <b>Epithelium.</b> A layer of minute cells which forms the
+covering of many membranes.<br/>
+ <b>Erection.</b> The state of a part which, having been soft,
+becomes rigid and elevated by the accumulation of blood within
+its tissues.<br/>
+  <br/>
+ <b>Fallopian Tubes.</b> Two very small tubes extending from the
+upper angles of the uterus to the ovaries and serving to convey
+the ova from the ovaries to the uterus.<br/>
+ <b>Feces.</b> Stools; the normal discharge from the bowels.<br/>
+ <b>Fetus.</b> The child in utero from the time of quickening to
+that of birth.<br/>
+ <b>Fomentations.</b> The application of cloths which have
+previously been dipped in hot water.<br/>
+ <b>Function.</b> An action of an organ which could be performed
+only by that organ, and which is necessary to the well-being of
+the individual.<br/>
+  <br/>
+ <b>Generative Organs.</b> Syn., genital, reproductive, sexual;
+those organs in the male and female by means of which a new being
+is created.<br/>
+ <b>Genital.</b> See <i>Generative.</i><br/>
+ <b>Gestation.</b> See <i>pregnancy.</i><br/>
+ <b>Gonorrhea.</b> A highly contagious venereal disease,
+characterized by an inflammatory discharge of mucus from the
+urethra and prepuce in the male, and from the urethra and the
+vagina in the female.<br/>
+ <b>Graafian Follicles.</b> Minute ovarian vesicles which contain
+the ova.<br/>
+  <br/>
+ <b>Hemorrhoids.</b> Piles or tumors at or within the anus, and
+consisting of enlarged veins.<br/>
+ <b>Hymen.</b> The semilunar fold situated at the outer orifice
+of the vagina in the virgin.<br/>
+ <b>Hypertrophy.</b> The increased activity of a part which leads
+to an increase in its bulk.<br/>
+ <b>Hypochondriasis.</b> Morbid feelings concerning the health
+and simulating disease.<br/>
+  <br/>
+ <b>Impregnation.</b> See <i>Conception.</i><br/>
+ <b>Infectious.</b> See <i>Contagious.</i><br/>
+  <br/>
+ <b>Katabolic Nerves</b> are those nerves which stimulate the
+breaking down of tissue.<br/>
+  <br/>
+ <b>Labia Majora.</b> Two thick folds of skin which extend
+backward from the mons veneris.<br/>
+ <b>Labia Minora.</b> Nymphae; two very delicate folds of skin
+which are inside of and protected by the labia majora.<br/>
+ <b>Labor.</b> See <i>Parturition.</i><br/>
+ <b>Lactation.</b> The secretion of milk; nursing, suckling the
+child.<br/>
+ <b>Lactiferous Ducts.</b> The milk ducts.<br/>
+ <b>Leucorrhea.</b> Whites; a whitish or yellowish discharge from
+the vagina.<br/>
+ <b>Lochia.</b> A discharge which follows labor and which lasts
+for about two weeks.<br/>
+ <b>Lying-in.</b> The period which follows childbed.<br/>
+ <b>Lymphatics.</b> The vessels in which the lymph is
+carried.<br/>
+  <br/>
+ <b>Mammae.</b> The mammary glands; the breasts.<br/>
+ <b>Marital Relations.</b> See <i>Coitus.</i><br/>
+ <b>Massage.</b> A systematic kneading of the muscles.<br/>
+ <b>Meatus Urinarius.</b> The external orifice of the
+urethra.<br/>
+ <b>Meconium.</b> The first discharge from the infant's bowel
+after birth, and which had collected in the intestines during the
+pregnancy.<br/>
+ <b>Medulla.</b> The base of the brain at its junction with the
+spinal cord.<br/>
+ <b>Menopause.</b> Climacteric, change of life, the time of the
+natural cessation of the monthly sickness.<br/>
+ <b>Menorrhagia.</b> An excessive menstrual flow.<br/>
+ <b>Menstruation.</b> Menstrual period, menstrual flow, menses,
+monthly sickness, the monthly discharge of blood from the uterus,
+which, with certain exceptions, recurs monthly from about the age
+of thirteen to forty-six years.<br/>
+ <b>Metabolism.</b> Transformation changes.<br/>
+ <b>Metamorphoses.</b> Changes of shape or structure.<br/>
+ <b>Metrorrhagia.</b> A flow of blood between the menstrual
+periods.<br/>
+ <b>Micturition.</b> The act of passing water.<br/>
+ <b>Miscarriage.</b> The expulsion of the fetus between the
+twelfth and twenty-eighth weeks.<br/>
+ <b>Molecular.</b> Belonging to the molecules, or the minutest
+portion of anything.<br/>
+ <b>Mons Veneris.</b> The uppermost part of the vulva, which is a
+fatty cushion covered with hair.<br/>
+  <br/>
+ <b>Nerve-center.</b> A nerve station from which orders are
+transmitted and where orders are received.<br/>
+ <b>Nubile.</b> Puberty, that period of life in which young
+people of both sexes are capable of procreating children.<br/>
+ <b>Nymphae.</b> See <i>Labia minora.</i><br/>
+  <br/>
+ <b>Ovaries.</b> Two small ovoid bodies, one on each side of the
+uterus, in which the ova are formed.<br/>
+ <b>Oviduct.</b> See <i>Fallopian tobe.</i><br/>
+ <b>Ovulation.</b> The formation of the ova in the ovary, and the
+discharge of the same.<br/>
+ <b>Ovule.</b> See <i>Ovum.</i><br/>
+ <b>Ovum.</b> Germ cell, a small, round vesicle situated in the
+ovaries, and which, when fecundated, constitutes the rudiments of
+the embryo.<br/>
+  <br/>
+ <b>Parturition.</b> Labor, delivery, child-birth, the expulsion
+of the child from the womb.<br/>
+ <b>Pathologic.</b> Relating to the diseased condition of tie
+body.<br/>
+ <b>Pelvis.</b> The bony cavity situated at the lower end of the
+spinal column and supported by the thighs.<br/>
+ <b>Periodicity.</b> The recurrence of physiologic phenomena at
+regular intervals.<br/>
+ <b>Periphery.</b> The circumference of an organ.<br/>
+ <b>Peristaltic Action.</b> An alternate contraction, making
+small, and enlargement of the bowel; it is by this means that
+foods, etc., are forced along its passage.<br/>
+ <b>Peritoneum.</b> A serous membrane which lines the abdominal
+cavity, and wholly or in part envelopes the organs contained in
+it; it also partly covers the organs contained in the pelvic
+cavity.<br/>
+ <b>Phenomena.</b> Remarkable appearances.<br/>
+ <b>Physical.</b> Pertaining to the body.<br/>
+ <b>Placenta.</b> After-birth, a soft, spongy, vascular body
+adherent to the uterus, and which is connected with the embryo
+through the umbilical cord.<br/>
+ <b>Plethora.</b> A condition marked by a superabundance of
+blood.<br/>
+ <b>Postpartum Hemorrhage.</b> Hemorrhage following labor.<br/>
+ <b>Pregnant.</b> Enceinte, gravid; the state of a woman who is
+with child.<br/>
+ <b>Premature Labor.</b> The expulsion of the fetus between the
+end of the twenty-eighth week and the time that labor ought to
+have occurred.<br/>
+ <b>Propagation.</b> The spreading or extension of a thing.<br/>
+ <b>Pruritus Vulva.</b> An intense itching of the privates, or
+vulva.<br/>
+ <b>Psychic.</b> Pertaining or belonging to the mind.<br/>
+ <b>Puberty.</b> Sexual maturity; nubility; that period of life
+in which young people of both sexes are capable of procreating
+children.<br/>
+ <b>Pubes or Pubis.</b> The lowest and middle part of the pelvis
+in its anterior surface.<br/>
+ <b>Puerperium.</b> The lying-in after child-birth.<br/>
+  <br/>
+ <b>Quickening.</b> The sensation experienced by the mother as
+the result of active fetal movements in the womb.<br/>
+  <br/>
+ <b>Rectum.</b> The lower extremity of the large intestine.<br/>
+ <b>Reflex.</b> The reflection of an impulse from a nerve-center
+which has been received from elsewhere by that center.<br/>
+ <b>Reproduction.</b> See <i>Generative.</i><br/>
+ <b>Respiration.</b> Breathing.<br/>
+ <b>Rugs.</b> Wrinkles.<br/>
+ <b>Rut.</b> The copulation of animals.<br/>
+  <br/>
+ <b>Septicemia, Puerperal.</b> Childbed fever.<br/>
+ <b>Sexual.</b> That which relates to sex. See
+<i>Generative.</i><br/>
+ <b>Smegma.</b> A cheesy substance which may collect about the
+vulva.<br/>
+ <b>Spermatozoa.</b> The essential male fertilizing elements.<br/>
+ <b>Sympathetic Nervous System.</b> Presides over involuntary
+acts; as digestion, breathing, etc.<br/>
+ <b>Syphilis.</b> A venereal disease which is highly contagious
+by coition, contact with the lips, etc.<br/>
+  <br/>
+ <b>Tachycardia.</b> Distress in the region of the heart, with
+palpitation and shortness of breath.<br/>
+  <br/>
+ <b>Umbilicus.</b> Navel.<br/>
+ <b>Urea.</b> The most important of the solid constituents of the
+urine.<br/>
+ <b>Ureters.</b> The ducts leading from the kidneys to the
+bladder.<br/>
+ <b>Urethra.</b> The excretory duct from the bladder for the
+escape of the urine.<br/>
+ <b>Urination.</b> The act of passing water.<br/>
+ <b>Uterosacral Ligaments.</b> Ligaments which pass from the
+uterus to the sacrum, and assist in holding the uterus in
+position.<br/>
+ <b>Uterus.</b> Womb; the hollow, pear-shaped pelvic organ which
+is destined to retain the child from the moment of its conception
+until the time of its expulsion at birth.<br/>
+ <b>Utricular Glands.</b> Glands of the uterus.<br/>
+  <br/>
+ <b>Vagina.</b> The canal which connects the female internal and
+external organs of generation.<br/>
+ <b>Vascular.</b> Pertaining to the blood-vessels.<br/>
+ <b>Vasomotor Nervous System.</b> Comprises the brain, spinal
+cord, and the nerves given off from the cord: this system
+presides over voluntary acts, that is, those acts which are under
+the control of the will.<br/>
+ <b>Vestibule.</b> A smooth cavity that exists in the female
+between the perineum and the nymphae.<br/>
+ <b>Viscera.</b> The contents of the large cavities of the
+body.<br/>
+ <b>Vulva.</b> The external genitals, private parts, the female
+external organs of generation.<br/>
+ <b>Vulvitis.</b> Inflammation of the vulva.</p>
+
+<div style='display:block;margin-top:4em'>*** END OF THE PROJECT GUTENBERG EBOOK THE FOUR EPOCHS OF WOMAN'S LIFE ***</div>
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+The Project Gutenberg EBook of The Four Epochs of Woman's Life
+by Anna M. Galbraith
+
+Copyright laws are changing all over the world. Be sure to check the
+copyright laws for your country before downloading or redistributing
+this or any other Project Gutenberg eBook.
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+Title: The Four Epochs of Woman's Life
+
+Author: Anna M. Galbraith
+
+Release Date: January, 2004  [EBook #4986]
+[Yes, we are more than one year ahead of schedule]
+[This file was first posted on April 7, 2002]
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+Edition: 10
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+Language: English
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+Character set encoding: ASCII
+
+*** START OF THE PROJECT GUTENBERG EBOOK, THE FOUR EPOCHS OF WOMAN'S LIFE ***
+
+
+
+
+This eBook was produced by Jim Weiler, xooqi.com
+
+
+
+                    THE FOUR EPOCHS OF WOMAN'S LIFE
+
+
+                          A Study in Hygiene
+
+ BY
+
+ANNA M. GALBRAITH, M.D.
+
+   Author of "Hygiene and Physical Culture for Women"; Fellow of the New
+   York Academy of Medicine ; Ex-President of the Alumnae Association,
+   Woman's Medical College of Pennsylvania; Attending Physician,
+   Neorological Department, New York Orthopedic Hospstal and Dispensary.
+  _________________________________________________________________
+
+   WITH AN
+
+ INTRODUCTORY NOTE
+
+   by
+
+ JOHN H. MUSSER, M.D.
+
+   Late Professor of Clinical Medicine, University of Pennsylvania.
+
+  "As in a building
+   Stone rests on stone, and wanting the foundation
+   All would be wanting, so in human life
+   Each action rests on the foregoing event
+   That made it possible, but is forgotten
+   And buried in the earth."
+
+                                                        -- LONGFELLOW.
+  _________________________________________________________________
+
+                          INTRODUCTORY NOTE
+                          _________________
+
+IT has been well said that the bulwarks of a nation are the mothers.
+Any contribution to the physical, and hence the mental, perfection of
+woman should be welcomed alike by her own sex, by the thoughtful
+citizen, by the political economist, and by the hygienist. Observation
+of the truths, expressed in a modest, pleasing, and conclusive manner,
+in the essay of Dr. Galbraith contribute to this end. These truths
+should be known by every woman, and I gladly commend the essay to
+their thoughtful consideration.
+
+                        JOHN H. MUSSER, M.D.,
+
+                                   Late Professer of Clinical Medicine
+                                    in the University of Pennsylvania.
+  _________________________________________________________________
+
+  PREFACE TO THE SECOND EDITION.
+                          _________________
+
+THE author takes this opportunity to thank the medical profession and
+the laity for the very cordial reception which has been tendered the
+first edition of this small volume.
+
+The necessity for the use of technical expressions in a book written
+expressly for the laity must always be a matter of regret. And only
+those who have attempted to write a similar work can fully appreciate
+the truth of Herbert Spencer's remark, that "Nothing is so difficult
+as to write an elementary book on scientific subjects."
+
+The author has added to this edition a section on "The Hygiene of
+Puberty," one on "Hemorrhage at the Menopause a Significant Symptom of
+Cancer," and one on "The Hygiene of the Menopause."
+
+                                                    ANNA M. GALBRAITH.
+
+15 WEST NINETY-FIRST STREET, NEW YORK.
+  _________________________________________________________________
+
+  PREFACE.
+                          _________________
+
+  "Ignorance is the curse of God;
+   Knowledge, the wings wherewith we fly to heaven."
+
+                                                       -- "Henry VI."
+
+PERFECT health is essential to perfect happiness. The greater the
+knowledge of the laws of nature, and the more closely these laws are
+lived up to, so much nearer "ideal" will be the health and happiness
+of the individual. Hence the necessity that these same laws should be
+as familiar to the adult man and woman as the alphabet. Further, with
+our present knowledge of the certain suffering, disease, and death
+that are bred by ignorance of all these subjects, it is little less
+than criminal to allow girls to reach the age of puberty without the
+slightest knowledge of the menstrual function; young women to be
+married in total ignorance of the ethics of married life; women to
+become mothers without any conception of the duties of motherhood;
+other women, as the time approaches, to live in dread apprehension of
+"the change of life;" and many women unnecessarily to succumb to
+disease at this time.
+
+The masses of women have at last awakened to a sense of the awful
+penalties which they have paid for their ignorance of all those laws
+of nature which govern their physical being, and to feel keenly the
+necessity for instruction at least in the fundamental principles which
+underlie the various epochs of their lives; and it is in response to a
+widespread demand that this small volume has been written.
+
+This is preeminently the day of preventive medicine; and the physician
+who can prevent the origin of disease is a greater benefactor than the
+one who can lessen the mortality or suffering after the disease has
+occurred.
+
+                                                    ANNA M. GALBRAITH.
+
+15 WEST NINETY-FIRST STREET, NEW YORK.
+  _________________________________________________________________
+
+  CONTENTS
+                          _________________
+
+ INTRODUCTION
+
+ EDUCATION AS THE CONTROLLING FACTOR IN THE PHYSICAL LIFE OF WOMAN
+
+   Huxley's Definition of Education; the Correlation of Mind and Body; the
+   Emotional Nature; Age for Going to School; the Effect of the Study of the
+   Scientific Branches; Industrial Education
+                          _________________
+
+ PART I.-- MAIDENHOOD
+  _________________________________________________________________
+
+ CHAPTER I.
+
+ PUBERTY
+
+   Sexual Development; Age of Puberty; Physical Changes at Puberty; First
+   Onset of Menstruation; Psychic Changes at Puberty
+  _________________________________________________________________
+
+ CHAPTER II.
+
+ HYGIENE OF PUBERTY
+
+   Home Life; Corsets; Shoes; Underwear; Nutrition; Diet; Water;
+   Constipation; School Life; Spinal Curvature; Exercise; Walking; Running
+  _________________________________________________________________
+
+ CHAPTER III.
+
+ ANATOMY OF THE FEMALE GENERATIVE ORGANS
+
+   The Vulva; the Hymen; Condition of the Hymen as a Proof of Virginity; the
+   Bladder; Vagina; Uterus; Respiratory Movements of the Uterus; Fallopian
+   Tubes; Ovaries
+  _________________________________________________________________
+
+ CHAPTER IV.
+
+ PHYSIOLOGY OF THE FEMALE GENERATIVE ORGANS
+
+   Ovulation; Etiology of Menstruation; Uterine Nerve-supply; the Function
+   of the Uterus; Stages of the Menstrual Cycle; Average Duration of the
+   Menstrual Flow; Character of the Flow; Relation of Ovulation to
+   Menstruation; the Menstrual Wave; Definition of Menstruation; Premonitory
+   Symptoms of the Flow; Hygiene of Menstruation
+  _________________________________________________________________
+
+ CHAPTER V.
+
+ THE ANOMALIES OF MENSTRUATION
+
+   Menorrhagia and Metrorrhagia; Dysmenorrhea; Amenorrhea; Leucorrhea;
+   Pruritus Vulva
+  _________________________________________________________________
+
+ CHAPTER VI.
+
+ THE MARRIAGE QUESTION
+
+   Herbert Spencer's Definition of Love; What Constitutes a Suitable
+   Husband; Best Age for Marriage; Shall Cousins Marry? Contraindications to
+   Marriage; Do Reformed Profligates Make Good Husbands? the Proper Length
+   of Time for the Engagement; the Right Time of the Year to Marry; the
+   Selection of the Wedding Day
+                          _________________
+
+  PART II.-- MARRIAGE
+  _________________________________________________________________
+
+ CHAPTER VII.
+
+ THE ETHICS OF MARRIED LIFE
+
+   The Wedding Journey; the Ethics of Married Life; Shall Husband and Wife
+   Occupy the Same Bed? the Consummation of Marriage; the Marital Relation;
+   Times when Marital Relations Should be Suspended
+  _________________________________________________________________
+
+ CHAPTER VIII.
+
+ SEXUAL INSTINCT IN WOMEN
+
+   Sexual Instinct in Women; Excessive Coitus; Causes of Sexual Excitability
+  _________________________________________________________________
+
+ CHAPTER IX.
+
+ STERILITY
+
+   Sterility; the Prevention of Conception and the Limitation of Offspring;
+   the Crime of Abortion; Infidelity in Women
+                          _________________
+
+  PART III.-- MATERNITY
+  _________________________________________________________________
+
+ CHAPTER X.
+
+ PREGNANCY
+
+   Nature of Conception; Pregnancy Defined; Duration of Pregnancy; the Signs
+   of Pregnancy; Quickening; the Determination of Sex at Will; the Influence
+   of the Male Sexual Element on the Fernale Organism; Heredity; Hygiene of
+   Pregnancy; Causes of Miscarriage
+  _________________________________________________________________
+
+ CHAPTER XI.
+
+ THE CONFINMENT
+
+   Preparation for the Confinement; Signs of Approaching Labor; Symptoms of
+   Actual Labor; The Confinement-bed; the Process of Labor
+  _________________________________________________________________
+
+ CHAPTER XII.
+
+ THE LYING-IN
+
+   Management of the Lying-in; Lactation; Nursing
+  _________________________________________________________________
+
+ CHAPTER XIII.
+
+ THE NEW-BORN INFANT
+
+   The Infant's Toilet; the Crib; Feeding of Infants; the Wet-nurse;
+   Artificial Feeding; Characteristics of Healthy Infants; the Stools;
+   Constipation; Urination; Teething
+                          _________________
+
+  PART IV.-- THE MENOPAUSE
+  _________________________________________________________________
+
+ CHAPTER XIV.
+
+ THE MENOPAUSE
+
+   Average Duration of the Menstrual Function; Duration of Menopause; the
+   Menopause; General Phenomena of the Menopause; Prominent Symptoms of
+   Menopause; Pathologic Conditions of Menopause; Hemorrhage at the
+   Menopause a Significant Symptom of Cancer; Causes of Suffering at
+   Menopause
+  _________________________________________________________________
+
+ CHAPTER XV.
+
+ HYGIENE OF THE MENOPAUSE
+
+   Diet; Constipation; Stimulants; the Kidneys; Skin; Turkish Baths;
+   Massage; Exercise; Profuse Menstruation; Hemorrhage; Mental Therapeutics
+  _________________________________________________________________
+
+ CHAPTER XVI.
+
+ HINTS FOR HOME TREATMENT
+
+   Indigestion; Constipation; Enemas; Diarrhea; Vaginal Douché, Baths;
+   Headache; Fainting; Hemorrhage
+                          _________________
+
+ GLOSSARY
+                          _________________
+
+  THE
+
+FOUR EPOCHS
+
+ OF
+
+                              WOMAN'S LIFE
+                          _________________
+
+INTRODUCTION.
+                          _________________
+
+ EDUCATION AS THE CONTROLLING FACTOR IN THE PHYSICAL LIFE OF WOMAN.
+
+   Huxley's Definition of Education; the Correlation of Mind and Body; the
+   Emotional Nature; Age for Going to School; the Effect of the Study of
+   tuse Scientific Branches; Industrial Education.
+
+           "What is man,
+   If his chief good, and market of his time,
+   Be but to sleep and feed? A beast; no more.
+   Sure, He that made us with such large discourse,
+   Looking before and after, gave us not
+   That capability and godlike reason
+   To fust in us unused."
+
+                                                         -- "Hamlet."
+
+THE word education is here used in its broadest sense, and is meant to
+include the physical, mental, intellectual, and industrial. Huxley's
+definition is as follows: "Education is the instruction of the
+intellect in the laws of nature, under which I include not only things
+and their forces, but men and their ways; and the fashioning of their
+affections and of the will into an earnest and living desire to move
+in harmony with these laws. That man, I think, has had a liberal
+education who has been so trained in his youth that his body is the
+ready servant of his will, and does with ease and pleasure all the
+work that, as a mechanism, it is capable of; whose intellect is a
+clear, cold, logic engine, to be turned to any kind of work, to spin
+the gossamers as well as to forge the anchors of the mind; whose mind
+is stored with the great and fundamental truths of nature and the laws
+of her operations; one whose passions are trained to come to heel by a
+vigorous will, the servant of a tender conscience; one who has learned
+to love all beauty, whether of nature or of art, to hate all vileness,
+and to respect others as himself."
+
+The Correlation of Mind and Body.-- It is of the utmost importance
+that the mutual reaction of mind and body upon each other should be
+thoroughly understood. This reaction is so constant, so intricate, and
+so complex that it is at times difficult to say which is cause and
+which effect. Does the depressed state of the mind cause the
+indigestion, or is a torpid liver the real seat of the melancholia?
+
+The brain is the most delicately constructed organ in the entire body.
+In the lower animals the brain is simply the great nerve-center which,
+with its prolongation the spinal cord, presides over all the functions
+of life which differentiate the animal from the vegetable. In the
+human being the brain is much more highly developed and complicated;
+and is, in addition, the seat of the mind, the intellect, and the
+affections. Like all the other tissues of the body, the brain receives
+its nourishment from the blood-vessels which pass through it, and its
+healthy maintenance is in a direct ratio to the condition of its
+blood-supply.
+
+A most interesting psychologic study is found in the case of cerebral
+paralysis of young children, where there is mental defect amounting to
+stupidity or imbecility, accompanied by extensive paralysis of the
+body, so that the child is not able to sit up. With the gradual
+improvement of the physical condition, so that the muscles become firm
+and the child can sit, stand, and even walk, there is a corresponding
+mental development; from being stupid and dull, the expression of the
+face brightens and becomes intelligent; the child talks quite as well
+as other children of its age, and sometimes becomes really
+intellectually precocious. Here we see the development of the brain as
+a direct result of the improved physical condition. In certain cases
+of insanity, on the contrary, we find that the wasting away of the
+body results from the disease of the brain, i. e., the disease of the
+brain has wrought the wreck of the body.
+
+From these pathologic studies, or studies of how the diseased state of
+the brain and body may be overcome by physical development, on the one
+hand, and, on the other hand, how the healthy body may be wrecked by
+disease of the brain, we will turn to a consideration of the effect of
+the development of the mind and intellect upon the physical health.
+
+On a girl's entering Vassar College an exact and detailed physical
+examination is made by the resident physician, a health record is kept
+during her stay there, and at the time of her graduation a final
+physical examination is made. As a result of these statistics Dr.
+Thelberg says: "These statistics, now covering a number of years, show
+that not only can girls profitably take a college education, that is
+accomplished; but will prove that grave physical imperfections can be
+corrected in the period between eighteen and twenty-two years of age,
+coincidently with the development of the mind along the lines of
+college work; the college work, if not excessive in amount, being a
+real and most important factor in the physical development."
+
+But a still more striking proof can be cited of the beneficial result
+of mental and intellectual occupation upon the bodily health. At
+Vassar a great deal of attention is very properly paid to general
+hygiene and the physical development, in addition to the natural
+advantages of outdoor life in the country.
+
+Take, for example, a woman's medical college located in the city: the
+four years' course places the greatest strain on both mind and body;
+practically no time is left for recreation, and very much too little
+time is spent in sleep; the amount of exercise taken is the minimum.
+Yet in spite of all these disadvantages under which the young women
+labor, a great many of them who enter far below par in health, or,
+indeed, on the fair road to become chronic invalids, graduate very
+greatly improved in health.
+
+The Emotional Nature.-- Formerly much more than now, owing to the
+defective methods of her education and mode of life, the emotional
+nature of woman was allowed to run riot. The child was coddled; the
+girl was allowed to grow up without any of the discipline which young
+men receive in their college and business life, and little or no
+attention was paid to her physical development. The woman naturally
+became a bundle of nerves, highly irritable, unreasonable, and
+hysterical. All this reacted in the most detrimental manner upon her
+physical health.
+
+The seed for much of this emotional hyperesthesia is sown in
+childhood. From birth until the end of the eighth year should be one
+grand holiday. During this time the child develops very rapidly,
+especially during the first two years of life. And at the end of the
+eighth year the brain has attained to within a few ounces of its full
+weight. The muscular system has been developed together with the
+coordination of motion. The child has learned to use a language fairly
+well; she has developed an excellent memory and is most inquisitive
+and acquisitive.
+
+Another method for undermining the healthy tone of the nervous system
+is the intricate dances taught very young children and then placing
+them on public exhibition, where they are wrought up to the highest
+pitch. From a purely medical standpoint, children under eight years of
+age should not be allowed to take dancing lessons. After this age a
+moderate amount of dancing in a well-ventilated room is good exercise.
+
+Children's parties belong in the same category, and, on account of the
+injurious effects on the nervous system, should be tabooed. They are
+too exciting, and cause an overstimulation of the nervous system and a
+precocious childhood and puberty.
+
+Instead of rearing an oversensitive hot - house plant that must be
+fragile in the extreme, strive to rear a sturdy plant that can hold
+its own amid the storms. The child should spend as much of its life as
+possible in the open air, and in the warm months live out-of-doors.
+City children should be taken to the seashore or country to spend
+several months every summer. Together with outdoor sports, gymnastics
+adapted to the age of the child should be begun early and continued
+throughout life. Good muscular development is attended with good
+digestion and a well-balanced nervous system.
+
+Until after the twelfth year there should be absolutely no difference
+between the physical, mental, or industrial education of girls and
+boys. And, still further, they should be encouraged to have their
+sports together; this will improve the girls physically and broaden
+them mentally, and will do a great deal to take the rough edges off
+the boys. After this age it will be wise to allow slight barriers to
+grow up, without calling the attention of any one to the fact, that
+will cause the companionship to be less free and unrestrained.
+
+Age for Going to School.-- Although the child may be allowed to go to
+kindergarten long before this time, it should not be allowed to enter
+the school-room before eight years of age. And from eight to twelve
+years, not more than four hours a day should be spent in study. After
+this time it may be put down more closely to intellectual work; but no
+more mental work should be required than will enable the girl to enter
+college at eighteen. And eighteen years of age is as young as any girl
+should be allowed to go to college; after this age the mind is more
+matured and acquires knowledge more easily than before, while the
+development of the body is less rapid. The physical system has become
+more stable. The literature indulged in by girls under eighteen years
+of age should be most carefully selected.
+
+The Effect of the Study of the Scientific Branches.-- A knowledge of
+the laws of nature is essential to health; hence the necessity for the
+study of the natural sciences-- anatomy, physiology, chemistry,
+physics, and zoology. Aside from the intrinsic value of this
+knowledge, it is almost universally conceded that these studies
+develop the judgment; and no one will have the temerity to deny that a
+lack of judgment must undermine the health as well as the success and
+happiness of the individual.
+
+Industrial Education.-- When it is considered how intimate are the
+relations between the physical and the psychic states, and how often
+the psychic condition leads to actual disease, and that often of the
+most incurable type, it needs no demonstration that a mental
+occupation which will take the woman out of herself is a physical
+necessity. Therefore when the girl has reached the subjective limit of
+her intellectual education,-- that is, when she has reached the limit
+of her capacity or taste,-- it is essential to her physical well-being
+that she should turn her attention to some industrial occupation. This
+may be housekeeping or any other occupation for which she has taste or
+talent. A healthy mental occupation is an absolute necessity to
+prevent the individual from becoming self-centered. And to become
+self-centered is the first step on the certain road to chronic
+invalidism.
+
+A most important part of an education is the knowledge of how to
+procure the most perfect development of the body possible, and how to
+maintain the health. This has not been touched upon here, since the
+outlines for the general physical education have already been given in
+"Hygiene and Physical Culture for Women,"* and the present volume
+concerns itself only with the four critical epochs of woman's life.
+
+* By Anna M. Galbraith, M. D.; published by Dodd, Mead & Co.
+
+With this broad view of an education, as a means to procure the best
+physique possible; a mind disciplined to meet to the greatest
+advantage all the vicissitudes of life; an intellect developed along
+the lines of its greatest possibilities; and an occupation chosen in
+accordance with the tastes and talents of the individual; it becomes
+an incontrovertible fact that the education is the controlling factor
+in the physical life of every woman.
+  _________________________________________________________________
+
+             "Be not simply good; be good for something."
+
+                                                              THOREAU.
+                          _________________
+
+  PART I.-- MAIDENHOOD.
+                          _________________
+
+ CHAPTER I.
+
+ PUBERTY.
+
+   Sexual Development; Age of Puberty; Physical Changes at Puberty; First
+   Onset of Menstruation; Psychic Changes at Puberty.
+
+  "Self-reverence, self-knowledge, self-control,
+   These three alone lead life to sovereign power."
+
+                                                         -- "OEnone."
+
+Sexual Development.-- Sexual development goes on during all the years
+of childhood, but is not complete in the female sex until between the
+twenty-second and the twenty-fifth year. If the child has no inherited
+taint, and has been properly educated morally, physically, and
+intellectually, it must follow that the structural development of the
+pelvic organs has been normal; and normal organs always perform their
+functions perfectly.
+
+The commencement of the ovarian function does not cause any more
+profound change in the system and habits than does dentition. The
+various epochs of life are generally spoken of as if they were
+paroxysmal-- as though they were separated by some tremendous chasm,
+which had to be leapt over or fallen into. Nature makes no such
+egregious blunders; preparations for every change in life have been
+going on for a very long time before the evidences of such change
+become manifest.
+
+In a healthy girl the psychic and physical changes incident to puberty
+occur so gradually as to escape the girl's own notice. The first and,
+if the girl has not been properly prepared for it, always startling
+change is the appearance of the menstrual flow. The mother who has not
+told her daughter of this coming change in her life before it is due
+has committed a serious error; it is no uncommon occurrence for girls
+who know nothing of this function to get into a tub of cold water to
+stop the flow; and if they stay in long enough, it generally does
+stop, and the girl's health may be ruined for life.
+
+The opinion of Dr. Ely van de Warker is that "if healthy ovulation is
+the outcome of healthy childhood, the function will obey the law of
+periodicity year by year, and all this time the young woman will be
+able to sustain uninterrupted physical and intellectual work as well
+as the young man. Not that the laws of health may be violated with
+impunity at puberty or any other time of a woman's life; but a law of
+health is no more binding upon a young woman than it is upon a young
+man; and there really is no such thing as one law for women and
+another for men."
+
+Age of Puberty.-- In the temperate regions the age of puberty is
+reached between the ages of twelve and fourteen years. The girl is
+then said to be nubile; that is, as soon as menstruation appears it is
+possible for her to bear children; but she is by no means sufficiently
+developed to do so, as she herself will not be completely developed
+physically or mentally before the age of twenty-two or twenty-five
+years.
+
+Physical Changes at Puberty.-- The physical changes that gradually
+take place, beginning at the time of puberty, are: the breasts,
+pelvis, and neck enlarge; hair develops over the pubis and in the
+arm-pits; the voice alters. As a rule, women continue to grow in
+stature until the twenty-fifth year. It is said that brunettes develop
+sooner than blondes, and that large women develop more slowly than
+women of small stature; city girls develop younger than girls brought
+up in the country. Whatever stimulates the emotions causes a premature
+development of the sexual organs; as children's parties, late hours,
+sensational novels, loose stories, the drama and the ball-room, talk
+of beaux, of love and marriage, and children being surrounded with the
+atmosphere of riper years. It is generally believed that early
+stimulation of the sexual instincts leads to the premature
+establishment of puberty, as do also spiced foods and alcoholic
+beverages.
+
+First Onset of Menstruation.-- Sometimes the first menstrual discharge
+appears suddenly, lasts for a few days, and then stops; it may appear
+after an interval of two or three weeks, or not for several months. If
+for several months the flow appears at the regular time, and the
+quantity is about the same as the first, the menstrual habit may be
+said to be established. The mode of onset varies considerably within
+the limits of health. So long as the general health remains good, no
+anxiety need be felt in regard to the establishment of the menstrual
+function.
+
+In other cases there may be a discharge of blood at the first period,
+and none afterward for several months; in other words, menstruation
+may be established suddenly, intermittently, or gradually. It must be
+remembered that certain pathologic conditions cause many disturbances
+connected with the onset of puberty.
+
+Psychic Changes at Puberty.-- The angular, gawky feeling gradually
+disappears; the girl becomes self-conscious; new impulses arise, and
+she gives up many of the hoydenish ways of childhood. The girl's
+imagination is more lively, and just at this time mathematics form an
+excellent subject for mental occupation. The girl now begins to
+question the whys and wherefores, and demands reasons for the course
+that is laid out for her, and is full of ideas of her own; so that
+while as a child she had accepted almost unquestioningly the commands
+of her parents, she can be managed now only through the power of
+reason. And this is just as it should be, for the girl has reached the
+years of discretion, and now is the time when her reason and judgment
+are capable of rapid cultivation.
+
+  CHAPTER II.
+
+ HYGIENE OF PUBERTY.
+
+   Home Life; Corsets; Shoes; Underwear; Nutrition; Diet; Water;
+   Constipation; School Life; Spinal Curvature; Exercise; Walking; Running.
+
+  "Every man is the architect of his own fortune."
+
+                                                      PSEUDO-SALLUST.
+
+Home Life.-- With beginning menstruation the equilibrium of the body
+is very easily disturbed, so that even in the case of the healthy girl
+some precautions should be taken and a rational regime should be
+adhered to; while in the case of the delicate girl a still more
+careful attention will have to be directed toward her weak points, in
+order that she may develop into a healthy woman.
+
+For every girl at this time of life home is preeminently the place; so
+that she may not only have the benefit of a mother's watchful care,
+but also lead a life as free from conventionalities and as much in the
+open air as possible. No girl should be sent away to school at this
+period of rapid growth and development; nor should girls of the
+working classes, when it can possibly be avoided, be sent out to fill
+positions as clerks in illy ventilated stores, in factories, or as
+domestics. If a girl can be kept at home until she is eighteen years
+old, she will be a much stronger, healthier woman than would otherwise
+be possible.
+
+Corsets.-- At this period of life it is particularly necessary that
+the clothing should be warm and at the same time sufficiently loose to
+prevent the constriction of any part of the body. And whatever the
+adult woman may elect to do in the matter of wearing corsets herself,
+she does her young daughter an irreparable injury by constricting and
+moulding her growing body in these corset-splints. Corsets placed on
+the young girl interfere with the functions of circulation,
+respiration, digestion, and of the pelvic organs, also with muscular
+development. In addition to all this, the girl is handicapped in
+taking all outdoor exercises and athletic sports.
+
+The lungs, heart, and great blood-vessels are placed in and completely
+fill an air-tight, distensiblecage, which is most distensible at its
+base.
+
+The least chest girth of the adult woman-- that is, the under-arm
+girth around the chest-- that is consistent with health is
+twenty-eight inches; and this girth must be enlarged three inches in
+forced inspiration. In ordinary respiration the waist expansion should
+be one-half to one inch, while during great muscular activity it
+should be from one and a half to three or four inches. One-third of
+the lungs lie below the point of beginning corset pressure, so that
+with tight corsets this amount of lung substance must be more or less
+useless.
+
+It is self-evident that any restriction placed about the waist, by
+preventing the full expansion of the ribs and the descent of the
+diaphragm, will further embarrass the heart's action by diminishing
+the amount of room it has to work in, at the same time that it
+diminishes the amount of oxygen which is inspired. Fresh air is by far
+the most important part of the daily food. It is in the lungs that the
+blood throws off its carbonic acid and other impurities; but it is
+able to do this only when the lungs are supplied with an abundance of
+oxygen. Every inch which a woman adds to her chest measure adds to the
+measure of her days.
+
+Great physical injury has followed women playing lawn-tennis while
+tightly corseted. And although dancing is a much milder exercise,
+since it frequently takes place in an overheated and poorly ventilated
+room, fatal results occasionally occur from the same cause.
+
+Standing erect calls into action almost all the muscles of the trunk,
+neck, and lower extremities. So long as the line of gravity falls
+within the area of the feet, the muscular effort required is so slight
+that it is little more than the tonicity contained in all living
+muscle. The greater the displacement of the line of gravity, the
+greater the muscular effort required to maintain the equilibrium of
+the body. Up to a certain extent, exercising the muscle develops the
+strength and size of the muscle. On the other hand, when a muscle
+within the body is unused, it wastes; when used within certain limits,
+it grows. But when the corset splint is applied to the body of the
+young girl, it supplants the functions of the abdominal and back
+muscles, which is to hold the trunk erect, and these muscles gradually
+grow weak and waste. And so the liability to the various spinal
+curvatures is increased.
+
+The original object of the corset was to give greater prominence to
+the hips and abdomen. But fashions change! In "the French figure" or
+straight-front corset now in vogue the pelvis is tilted forward,
+producing a sinking in of the abdomen and a marked prominence of the
+hips and sacrum, necessitating a compensatory curve of the spine which
+increases the curvature forward at the small of the back-- a deformity
+which, a few years ago, women were going to orthopedic surgeons to
+have corrected. In this attitude the line passing through the centre
+of gravity strikes the heels, the knees are hyper-extended, and the
+muscles of the calves and thighs are rendered tense.
+
+By interfering with the muscular development and digestion, the girl
+is very apt to become angular, flat-chested, anemic, and to have a
+muddy complexion. And so the corset really defeats the object for
+which it was put on-- that of giving the girl a good figure and
+enhancing her beauty.
+
+There is no objection to girls wearing any of the various forms of
+hygienic waists now on the market.
+
+Shoes.-- The feet are the part of the body to come in contact with the
+greatest degree of cold, whether on the floor of the house or the
+pavement of the street. Hence it is a matter of prime importance to
+the entire body that the feet should be properly clad.
+
+The thick-soled, flat-heeled shoes which became popular with bicycling
+and golf are most hygienic, and it is highly desirable that this style
+of shoe should be adhered to for outdoor exercise.
+
+Underwear.-- In our cold and changeable climate the most suitable
+undergarment is the "combination" woolen undersuit, which reaches from
+neck to ankles and has long sleeves. Much greater warmth is afforded
+when the undersuit is moderately tight fitting. Such a suit should be
+worn the entire year, the grade of weight being adapted to the season.
+
+Nutrition.-- The nutrition of the body is dependent on the food
+supply, digestion and excretion. The growing girl should eat more than
+the adult woman, because of her more active life and of the fact that
+the food which she takes must not only replace the worn-out material
+of the body, but also provide new material needed for growth.
+Insufficient food and food of defective quality and composition work
+proportionately for more harm during the growing age.
+
+The full adult weight is not attained before the twenty-fifth year.
+When the final growth of the body and development of the vital organs
+is completed, the function of food is simply to replace waste with new
+material and to furnish material for the development of force.
+
+Diet.-- The diet should be a mixed one, consisting of the various
+kinds of fresh meats, fish, milk, eggs, poultry, vegetables, fruit,
+and fat in the shape of cream, butter, and the fat of beef and mutton.
+Animal food improves the condition of the muscles, which are made
+firmer than they would be through a vegetable diet. Meat in general
+has a more stimulating effect upon the system and is more
+strengthening than vegetable food, and it gives rise to a sensation of
+energy and activity. The common estimate is that meat should occupy
+one-fourth and vegetable food three-fourths of a mixed diet.
+
+Common salt in moderate quantity is essential, but all highly spiced
+or seasoned foods should be avoided, also pickles and vinegar. All
+"sweets" are harmful, because they destroy the appetite for other
+things and upset the digestion. Tea and coffee should be tabooed, as
+well as all alcoholic beverages.
+
+Good digestion depends for the most part on serving the meals at the
+same hour every day, eating leisurely, and masticating the food well.
+There is a great tendency on the part of the school girl to sleep late
+in the morning, then "bolt" her breakfast in order to get to school in
+time. Nothing could be more pernicious to the digestion, unless it is
+the eternal nibbling of candy.
+
+A healthy girl needs nothing between meals. A delicate girl will be
+the better for a glass of milk in the middle of the morning and at
+bed-time; or pure beef juice may be given instead.
+
+Water.-- Water is needed to keep the kidneys properly flushed. The
+amount of urine secreted during the twenty-four hours should be three
+pints. Of course it will be less than this if the quantity of water is
+insufficient. In addition to the urine about ten ounces of water are
+lost from the surface of the lungs, and eighteen ounces from the skin,
+making a total of about five pints; and this quantity of water must be
+taken daily in order to maintain the equilibrium of the body. The
+solid food of a mixed diet contains from fifty to sixty per cent. of
+water, so that about twenty-five ounces of water are taken into the
+system daily as an integral part of the food. In addition, three pints
+more should be taken as plain water. The bladder acts as a reservoir
+for the urine, and should be emptied at least three or four times a
+day.
+
+Constipation.-- In order to keep the digestive system in good
+condition, the refuse matter which collects in the lower bowel must be
+evacuated every day. And in order to secure this regular bowel
+movement, regularity in the time of going to the toilet is a prime
+necessity. And now is the time when the habits of a lifetime are being
+formed. If a tendency to constipation exists, it can almost always be
+overcome by increasing the amount of fruit and vegetables eaten, also
+by eating cracked wheat, oatmeal, corn and graham bread; all of which
+increase the peristaltic action of the intestines. The small amount of
+water taken by girls and women is another fertile source of
+constipation.
+
+School Life.-- When it is considered that fully one-half of the girl's
+waking hours are spent in school or in study preparing for school, it
+becomes evident that the girl's attitude at her desk should be the
+correct one. The malpositions at the desk are the most frequent cause
+of lateral curvatures, round shoulders, and flat chests. And these
+deformities are more common in girls than they are in boys.
+
+The common faults of the desk and seat leading to these malpositions
+are unsuitable shape of the back of the seat, too great a distance
+between the seat and the desk, and the incorrect slope of the desk.
+
+The edge of the desk should slightly project over the edge of the
+chair. The top of the desk should incline downward about ten degrees
+toward the student, and be low enough to allow the forearm to rest on
+it without raising the shoulder. The seat should be sufficiently deep
+to support almost the entire thigh, and close enough to the floor to
+allow the soles of the feet to rest firmly on it. The back of the
+chair should be arched so as to support the hollow of the back, and
+should reach just above the lower part of the shoulder-blades, and so
+make it easy and comfortable for even a weakly child to sit upright.
+
+If the seat is too high, the feet do not rest on the floor, and so the
+girl does not get the proper aid from the legs and feet to maintain an
+erect position. If the desk is too high, the elbow can rest on it only
+by curving the spine and raising the shoulder. The work is brought too
+close to the eyes and causes extra strain. If the desk is too low, the
+child stoops over it and becomes round-shouldered, and there is a
+tendency to become short-sighted.
+
+The pupil should sit erect with the weight equally borne by both
+buttocks; the legs should be straight before the trunk, and the feet
+firmly resting on the floor. The book should be held about twelve
+inches from the eyes.
+
+Spinal Curvatures.-- It should be distinctly borne in mind that
+lateral curvature of the spine is a distortion of growth. The
+deformity appears and is developed during the growing years. It is
+more common in girls than in boys, for two reasons: that at the age
+when lateral curvature is first seen, girls grow more rapidly than
+boys; and their muscular system is less well developed.
+
+In most early cases the faulty attitudes are clearly the result of
+muscular weakness. The growth in size has not been accompanied by a
+corresponding development of the muscles. This condition is most
+frequently met with in rapidly growing girls, and it is one of the
+most common causes of lateral curvature. In these cases proper
+gymnastics are indicated, but they should be prescribed and carried
+out with much care.
+
+It is upon the erectness, suppleness, and strength of the spinal
+column that most of the power and grace of the body depend.
+
+Lack of ventilation is a fertile cause of headache, anemia (or an
+impoverished condition of the blood in iron and oxygen), and
+dyspepsia. All these are rare before but common after twelve years of
+age.
+
+Exercise.-- In physical culture the object aimed at should be the
+symmetrical development of all the muscles of the body. Hence the
+necessity for bringing every individual muscle into play, at first for
+its development, and later for its maintenance.
+
+The tendency of almost all forms of exercise is to develop some
+portion of the body at the expense of the rest. The most perfect form
+of exercise is therefore that one which will most nearly call into
+play all the muscles of the body.
+
+Walking.-- Walking is the only form of exercise which may be said to
+be universal. In walking the muscles of the chest get little exercise,
+and those of the spine and abdomen even less. In walking the arms
+should swing easily at the sides, both from a physiological and an
+esthetic point of view. If the girl is weak or is unaccustomed to take
+any exercise, the guide for the amount of exercise taken at any one
+time must be this: At the first sense of fatigue, stop at once and
+rest, otherwise positive harm instead of good may be accomplished. The
+girl who depends on walking for her outdoor exercise should walk at
+least three miles every day, and walk at the rate of three miles an
+hour.
+
+After acquiring as great a walking speed as is consistent with a
+graceful and easy carriage, the running exercise should be begun,
+gradually increasing the distance, but not the rate of speed.
+
+In exercising, all tight clothing about the neck, chest, and waist
+must be removed. Pure air and full breathing are required during and
+after exercise. Full breathing not only promotes the change of air in
+the lungs, but also quickens the functions of the circulation and
+digestion. Eating must be avoided shortly before or shortly after any
+considerable exercise, as it impairs digestion.
+
+Running.-- Running is the best exercise for developing the breathing
+capacity. While brisk walking is allowable, fast running is not. The
+rule for running is to begin slowly, run moderately for perhaps fifty
+feet, then increase the speed gradually; but in running for exercise,
+never speed to the utmost. A five-mile gait is quite sufficient. The
+run should be closed with the same moderation with which it was begun,
+and the girl should never stop short, as this sudden arrest of action
+gives a most undesirable shock to the heart.
+
+In beginning to take any form of exercise the intensity and duration
+of the movements practiced must be increased very gradually, or
+positive harm instead of good will be done. As soon as fatigue is
+appreciable, the exercise should be discontinued and at once be
+followed by complete rest. Rapid respiration, palpitation or
+dizziness, headache, the face becoming pale or pinched or flushing
+suddenly, a feeling of great heat or excessive perspiration, are all
+danger signals showing that the exercise has already been carried too
+far and should cease at once. Continued over-exertion carried to a
+point of exhaustion leads to an obstinate irritability of the heart as
+well as to organic lesions.
+
+Mountain-climbing, rowing, and bicycling call into play almost all the
+muscles of the body. Of all the outdoor exercises for girls, swimming
+is one of the most perfect. It not only calls into vigorous action
+most of the muscles of the body, but spares many of those muscles that
+are so commonly overworked, the most of the work being performed by
+muscles that are so little used as to have become flabby and weak.
+
+Swimming and sea-bathing must be avoided by girls who have weak hearts
+and in whom the reaction after a plunge into cold water is never
+established; also by girls with heart disease or kidney disease.
+
+The principal outdoor games are croquet, archery, golf, tennis,
+cricket, foot-ball, and base-ball. Of these, croquet is the mildest,
+and is for that reason a good beginning exercise. Croquet, archery,
+golf, and tennis are all defective in that they cause a greater
+development of the right than of the left side of the body.
+
+As the greater majority of these outdoor exercises can only be
+indulged in for seven months of the year, they should be supplemented
+by exercises in the gymnasium for the remaining five winter months.
+
+There should be the greatest variety possible in the kinds of exercise
+taken, not only to develop the body symmetrically, so as to obtain
+strength, vigor, grace, celerity, and accuracy of movement, but also
+because there is no such potent cause of fatigue as monotonous
+repetition of the same act, whether physical or mental.
+
+It has been repeatedly proven that physical deterioration can be
+overcome by exercise, and that by so doing the mental capacity is
+greatly increased.
+
+  CHAPTER III.
+
+ ANATOMY OF THE GENERATIVE ORGANS.
+
+   The Vulva; the Hymen; Condition, of the Hymen as a Proof of Virginity;
+   the Bladder; Vagina; Uterus; Respiratory Movements of the Uterus;
+   Fallopian Tubes; Ovaries.
+
+  "He that respects himself is safe from others;
+   He wears a coat of mail that none can pierce."
+
+                                                       -- LONGFELLOW.
+
+The Vulva.-- The female generative organs consist of three groups--
+the external, the intermediate, and the internal. The vulva, or
+external generative organs, comprises all those organs which are
+external to the body.
+
+The vulva is pierced by two openings, the smallest and most anterior
+of which is the external opening of the urethra, or excretory duct of
+the bladder. This opening is surrounded by a slight eminence and has a
+somewhat puckered aspect.
+
+The larger opening is the vaginal orifice. In the virgin this is
+partially closed by the hymen. About one inch back of this is the
+anus, or the external orifice of the large bowel. This part of the
+bowel is known as the rectum.
+
+The Hymen.-- The hymen consists of a thin duplicature of mucous
+membrane strengthened by fibrous tissue, and is stretched across the
+posterior part of the vaginal orifice, which it partly occludes.
+Rupture of the hymen usually, but not always, occurs during the first
+sexual intercourse. In rare cases it is found intact at the time of
+the birth of the first child. In women who have borne children the
+vaginal orifice is surrounded by small irregular elevations; these are
+the remains of the ruptured hymen, but are usually present only after
+labor has taken place, since the torn hymen is converted into
+eminences as the result of the pressure incident to child-bearing, and
+not to coitus.
+
+The Condition of the Hymen as a Proof of Virginity.-- Formerly much
+stress was laid on the condition of the hymen as a proof of virginity.
+The hymen tightly closed, barely admitting the tip of a small
+index-finger, is positive evidence of virginity. But the hymen may
+lose its tone by a local catarrhal condition or by a general muscular
+relaxation; it may then become so relaxed that the only positive
+evidence rendered by the intact hymen is that the woman has not borne
+a child.
+
+In a paper on the preservation of the hymen, Dr. Hannah M. Thompson
+writes: "Further, if the hymen was intended as a guarantee of moral
+character, and for moral protection, either of man or woman, would we
+not have some reason for reflecting on the wisdom and righteousness of
+a Creator who has failed to make equal provision, and to give a like
+guarantee of an uncorrupted manhood? As physicians, we know too well
+that where one woman enters the marriage relation tainted in body
+there are thousands of men reeking with disease; and there is no
+demonstrable test to distinguish these, no proof for the young woman
+of the virginity or virtue of the young man."
+
+The Bladder.-- The female bladder is relatively broad and capacious,
+and is also highly distensible. When the bladder is allowed to become
+overdistended, it is carried backward and tends to cause a backward
+displacement of the uterus. The urethra, or excretory duct of the
+bladder, is about an inch and a half long, and lies firmly imbedded in
+the anterior vaginal wall.
+
+The Vagina.-- The intermediate organ is the vagina. This is a
+musculo-membranous canal which connects the external with the internal
+organs of generation. The vagina lies in relation with the bladder and
+the urethra in front, and with the rectum behind. The vagina is
+sufficiently distensible to allow of the passage of so large a body as
+the child.
+
+The Uterus.-- The internal organs of generation are the uterus, the
+ovaries, and the Fallopian tubes. Of these, the ovaries and the uterus
+are the essential female organs of generation. The virgin uterus is a
+small, hollow, muscular organ, somewhat pear-shaped, whose cavity is
+about one and a half inches deep. The uterus is divided by a natural
+constriction into a body and a neck. The neck, or cervix, is somewhat
+spindle-shaped, and has a canal running through its center which opens
+by a small aperture-- the so-called external orifice,-- into the
+vagina. In the virgin uterus the apposition of the anterior and
+posterior walls reduces the cavity to little more than a longitudinal
+cleft. With the advent of old age the whole organ suffers marked
+atrophy.
+
+The uterus is situated in the middle of the pelvic cavity, between the
+bladder and the lower bowel. It is held in place by broad elastic
+bands which go to different sides of the pelvis; it is also in part
+supported by the structures below and above it. But so loosely is the
+uterus held that it is easily pushed about-- as, for instance, by a
+full bladder or a packed bowel. And persistently allowing the bladder
+to become overfull, and failure to have a daily evacuation of the
+bowels, are prolific sources of displacements of the womb.
+
+Respiratory Movements of the Uterus.-- When no constrictions are
+placed about the waist, the uterus moves freely up and down with every
+respiration. So distinctly and with such regularity do these movements
+take place that an operator by watching the movements of the uterus
+can tell the effect that the anesthetic is having on the patient's
+breathing. These so-called respiratory movements play a very important
+role in the circulation of the uterus, and in the return of the venous
+blood to the heart.
+
+Anything which interferes with these movements, as the use of corsets,
+or of tight bands around the waist, prevents the free return of the
+venous blood. The uterus becomes congested, and through the constant
+abnormal weight of the organ itself, as well as the pressing down upon
+it from above of the superincumbent organs, the uterus is pushed down
+below its normal position, the ligaments whose duty it is to hold it
+up become relaxed, and the unhappy woman suffers all the agonies that
+are attendant on the "falling of the womb." For this reason the
+disorder is frequently met with in women who have never borne children
+as well as in those who have.
+
+The Fallopian Tubes.-- The Fallopian tubes extend from the upper,
+rounded angles of the uterus, within and along the free margin of the
+broad ligaments, for a distance of about two inches, to the vicinity
+of the ovaries, where each one terminates in a funnel-shaped orifice
+surrounded by a series of fringed processes. The lumen of the tube is
+narrowest at its inner end, where it opens into the cavity of the
+uterus by a minute orifice which scarcely admits a bristle; the
+diameter of the canal gradually increases until it reaches its ovarian
+extremity. The mucous lining of the tube is clothed by a single layer
+of hair-like epithelium, whose current sweeps from the ovarian toward
+the uterine end of the tube; and it is these movements which propel
+the ovum from the ovary to the uterus.
+
+The Ovaries.-- The ovaries are two small bodies of an almond shape,
+and lie on either side of the uterus. The bulk of the entire organ
+consists of connective tissue, in which lie imbedded the Graafian
+follicles or ovisacs, in which the ova are contained. These follicles
+or ovisacs are minute cells which are packed immediately beneath the
+surface, where they occur in all stages of development. With the
+increase in size which accompanies their development the follicles
+pass toward the surface, where they form a distinct projection, and at
+this point will occur the final rupture of the sac and the escape of
+the ovum. It is supposed that the ovum is grasped by the fringe-like
+extremity of the Fallopian tube and is carried through it by the
+movements of the ciliary epithelium to the uterus.
+
+The formation of new follicles continues only for a short time after
+birth, when the Graafian follicles are the most numerous; the entire
+number contained within the ovaries of the child being estimated at
+over 70,000. In view of the unquestionably large number of follicles
+in very young ovaries, and the relatively small number of ova which
+reach maturity, the degeneration of many follicles after reaching a
+certain degree of development seems certain.
+
+  CHAPTER IV.
+
+ PHYSIOLOGY OF THE FEMALE GENERATIVE ORGANS.
+
+   Ovulation; Etiology of Menstruation; Uterine Nerve-supply; the Function
+   of the Uterus; Stages of the Menstrual Cycle; Average Duration of the
+   Menstrual Flow; Character of tahe Flow; Relation of Ovulation to
+   Menstruation; the Menstrual Wave; Definition of Menstruation; Premomitory
+   Symptoms of the Flow; Hygiene of Menstruution.
+
+  "Toil and grow strong; by toil the flaccid nerves
+   Grow firm, and gain a more compacted tone."
+
+                                                        -- ARMSTRONG.
+
+Ovulation.-- At birth the formation of the ova is nearly completed;
+the production of' new cells probably ceases after the second year.
+The ovaries of the child of two years contain, therefore, the full
+quota of ova, although the vast majority of these cells always remain
+immature and undeveloped. While it is probable that a variable number
+of the immature ova undergo partial development before puberty, yet
+the advent of sexual maturity at that time marks the establishment of
+the regular development of the Graafian follicles and their contained
+ova, accompanied by the attendant phenomena of menstruation.
+
+During the entire child-bearing period, or from about the age of
+fifteen to forty-five years, the development of the Graafian follicles
+and the discharge of the ova are continually taking place. The
+liberation of the ova usually takes place at definite times, which in
+general coincide with the menstrual epochs, one or more ova being set
+free at each period; but this is by no means invariable.
+
+The ripe human ovum or germ cell is a spheric cell, about 0.2 mm. in
+diameter, consisting of granular protoplasm, in which lies a nucleus
+which contains the germinal spot. The proper cell-wall is a structure
+of great delicacy, outside of which is a secondary envelope.
+
+Menstruation.-- The etiology of menstruation has been variously
+explained at different epochs. The chief theories have been that of
+plethora, and the ovulation, the tubal, and the nerve theories.
+
+First, the Theory of Plethora.-- From the time of Hippocrates to 1835
+the theory prevailed that in the female body the formation of blood is
+sufficiently rich to provide every four weeks for an overflow of the
+same, the evacuation of which becomes a necessity. It was believed
+that this excess of blood depended on an excess of formative power in
+the woman.
+
+Second, the Ovulation Theory.-- This was distinctly formulated about
+1845. It construed the menstrual hemorrhage as a subsidiary
+phenomenon, entirely dependent on the periodic dehiscence of ovules.
+The changes supposed to take place in the Graafian follicles at each
+menstrual period were believed to involve a peculiar expenditure of
+nerve force, which was so much dead loss to the individual life of the
+woman. The growth of the Graafian vesicle and its contained ovum was
+supposed to cause an irritation of the nerves of the ovary, which was
+reflected to the entire nervous system. The gradual accumulation of
+this irritation finally caused a reflex action which determined an
+afflux of blood to the uterus and ovaries, which constitutes the
+catamenial flow.
+
+The ovulation theory was refuted by the following facts: Ovulation may
+and does occur without menstruation; women who have never menstruated
+may conceive; conception may occur during lactation, without the
+menses having returned since the last parturition; children at birth
+have many ovules contained within the ovaries; ovulation may persist
+for a time after the menopause, and even pregnancy has occurred,
+although very rarely after this time; the menses may continue
+regularly after the removal of the ovaries and Fallopian tubes; this
+is exceptional, and, as a rule, the periods only continue for two or
+three years at longest.
+
+Third, the Tubal Theory.-- Lawson Tait thought that thorough removal
+of the tubes was far more essential in determining the menopause, and
+that cases of periodically recurring hemorrhage after the removal of
+the ovaries were to be explained by the fact that the tubes had not
+been sufficiently removed. As an anatomic and surgical fact, the tubes
+can never be wholly excised unless the upper part of the uterus is
+also amputated.
+
+Fourth, the Nerve Theory of Menstruation.-- This is based upon the
+following views:
+
+1. That menstruation is a process directly controlled by a
+nerve-center situated in the lumbar region of the spinal cord.
+
+2. That the menstrual impulses reach the uterus through two sets of
+nerves.
+
+3. That menstruation is the result of nerve irritation, vascular
+congestion, and the subsequent relief of these by hemorrhagic
+discharges.
+
+4. That hemorrhage from the uterus is the result either of a local
+uterine condition, or of influences outside of the uterus acting
+directly on the center.
+
+5. That the removal of the appendages arrests menstruation by
+preventing the propagation of uterine influences to the center.
+
+Uterine Nerve Supply.-- One set of nerves causes contraction of the
+muscular fibers of the uterus, while the other set transmits impulses
+which bring about its vascular engorgement; and they are probably
+concerned in bringing about the determination of blood to the uterus
+and its appendages, which is so marked a feature of the menstrual
+process.
+
+As the result of long-continued investigation, Johnstone has come to
+the conclusion that the lining membrane of the uterus belongs to that
+class of organs whose function it is to replace organic waste.
+"Menstruation is a periodic wasting away of those corpuscles that are
+too old to make a placenta." He has further found that, as compared
+with the uteri of very many of the lower animals, the human uterus is
+very scantily supplied with lymphatics, and the only way to rid the
+uterus of the overripe, and therefore consequently useless, tissue is
+to wash it out through the vagina by a blood-stream. The tough wall of
+the human uterus and the increased blood-pressure caused by the erect
+position cause the difference between menstruation in the human female
+and rut in the lower animals.
+
+The strong light of recent investigations has necessitated the laying
+aside of many time-honored theories; and as the close of the
+nineteenth century has seen the emancipation of the uterus from the
+thralldom of the ovary, so we may believe that the twentieth century
+will find women of such fine physique as to prove the error of the
+popular fallacy that the cause of woman's weakness lies in the
+performance of her functions.
+
+The Function of the Uterus.-- The function of the uterus is to provide
+a favorable place for the reception of the product of conception,
+where it may be protected and nourished during the period of its
+development. The purpose of menstruation is to keep the uterus in
+suitable condition for the reception of this product of conception at
+any time. It is now known that the menstrual flow is not the whole of
+menstruation, and that the changes going on in the uterus are almost
+as continuous as the process of digestion. The whole of the
+reproductive life of woman has been divided into cycles of
+twenty-eight days each; these cycles have been divided into four
+stages.
+
+Stages of the Menstrual Cycle.-- The first or constructive stage is
+one of preparation for the reception of the ovum. During this stage
+the preparing of a decidua takes place, or building a nest for the
+expected egg; there is a swelling of the mucous membrane, an
+enlargement of the uterine glands, and an increase in the connective
+tissue. It is thought that this stage lasts for one week; when
+pregnancy does not occur, it is followed by degenerative changes.
+
+The second or destructive stage is marked by destructive changes which
+give rise to the usual phenomena of the menstrual period; there is a
+discharge of blood, mucus, and disintegrated mucous membrane. The
+actively growing cells of the uterine lining membrane undergo rapid
+destructive changes, the fabric of the half-formed decidua tumbles to
+pieces, the turgid capillaries burst and pour out the menstrual flow,
+which sweeps away all the useless debris. The irritation sets up
+reflex uterine contractions, and so the blood is squeezed out of the
+distended capillaries and washes away the degenerated cells.
+
+The third or reparative stage, as its name indicates, is one of
+repair, in which by constructive changes the epithelial lining which
+was thrown off is replaced by new, which is formed in from three to
+four days.
+
+The fourth or quiescent stage includes the remaining twelve or
+fourteen days of the menstrual cycle, and represents the quiescent
+period prior to the initiative changes which mark the beginning of the
+next period.
+
+Average Duration of the Menstrual Flow.-- The average duration of the
+menstrual flow is five days, although the variations are considerable
+in healthy women. A flow lasting any place from two to six days is
+perfectly consistent with health; but a flow continuing less than two
+or more than six days generally indicates local or general disease.
+
+Character of the Menstrual Flow.-- For the first few hours, or perhaps
+for the first day, the flow is usually slight in quantity and light in
+color; on the second and third days the flow reaches its height, and
+is profuse and dark, but it should never be clotted; after this it
+gradually ceases. The amount of the flow varies from five to ten
+ounces. If less than five or six or more than eighteen napkins are
+pretty well saturated through, the amount may be considered abnormal.
+
+Relation of Ovulation to Menstruation.-- It has not yet been decided
+just in what relation the processes of ovulation and menstruation
+stand to each other. It is supposed that the transit of the ovum to
+the uterus occupies at least one week. It has been thought that the
+decidua of a particular menstrual period is related, not to the ovum
+discharged at that period, but to the ovum discharged at the preceding
+period.
+
+The menstrual wave, or the wave of "supplementary nutrition,"[*] upon
+which the menstrual process ultimately depends, was first established
+by Dr. Mary Putnam Jacobi in the Boylston prize essay for 1876;
+showing that menstrual life is associated with a wave of well-marked
+vital energy, which manifests itself in a monthly fluctuation of the
+tempera ture of the body, in the daily amount of the excretion of urea
+and of carbonic acid, and of the rate and tension of the pulse. The
+wave attains its maximum during the week preceding menstruation, and
+slowly falls to its minimum, which is reached the week after
+menstruation.
+
+* Dr. Goodman and Dr. Stephenson have since written on this subject,
+and the "wave" is often known as the Stephenson wave.
+
+This wave indicates a periodic variation in the bodily metabolism, and
+is probably directly influenced by the rhythmic activity of the
+menstrual center. This observation would seem to be nullified by the
+fact that the phenomena referred to have been found to occur in men as
+well as in women; and that the lower animals also seem to show the
+same periodic variations. "It is therefore evident that the phenomena
+belong not to the function of menstruation, but to a general law of
+vital energy."
+
+Definition of Menstruation.-- Menstruation may, then, be defined as
+the periodic discharge of blood from the uterus, accompanied by the
+shedding of the epithelium of the body, as well as that of the uterine
+glands near their orifices.
+
+The sanguineous discharge is due partly to the oozing of blood from
+the surfaces denuded of epithelium, and partly to active congestion.
+The discharge from the uterus is largely augmented by mucus secreted
+in increased quantity at this period from the enlarged uterine glands.
+
+The tubes take some part in the process of menstruation; their mucous
+membrane is swollen, the epithelium is shed in places, and they are
+filled with a thin bloody fiuid, containing blood-corpuscles and
+cast-off epithelium cells.
+
+The menstrual wave continues from puberty to the menopause; it is a
+nervous phenomenon. Ovulation is a progressive, non-periodic process;
+it begins before birth and continues till the ovarian tissue is
+atrophied or worn out.
+
+Premonitory Symptoms of the Flow.-- The premonitory symptoms of the
+monthly flow should not be so marked as to cause the individual any
+discomfort. The first indication of the return of the period should be
+the appearance of the flow. There is generally a feeling of abdominal
+fulness with some lassitude, and sometimes slight headache. The
+temperature is lower and the pulse is slower than at other times. This
+lowered tone of the system is an additional reason for increased care
+against exposure in wet or cold weather.
+
+Hygiene of Menstruation.-- During the menstrual periods all cold baths
+must be strictly prohibited, whether tub-baths or cold sponges. The
+reason of this is that the application of cold to the surface causes a
+driving in of the blood from the exterior of the body to the internal
+organs; and at the menstrual periods there is already a congested
+condition of the pelvic organs, and it must be remembered that
+congestion is the first stage of inflammation.
+
+Hot or warm sponge-baths may be taken throughout the period; and the
+vulva should be bathed with warm water twice a day through the entire
+period of the flow, as this not only removes the clotted blood before
+it decomposes and becomes the source of irritation, but also removes
+other irritating matters, and prevents the nervousness that is caused
+by a local irritation.
+
+It is strange how women who are scrupulously neat in all other
+respects will allow the smegma to collect in and about the vulva; as a
+matter of fact, for the purpose of cleanliness it is much more
+necessary that the external genitals should be washed twice a day with
+soap and water all through life than that the face should be washed
+that often.
+
+Another question which is still sub judice is the necessity for and
+the frequency with which vaginal douches should be taken; all
+physicians are agreed that a vaginal douche taken immediately after
+the menstrual period is beneficial, as it removes all the debris of
+the flow, which is sometimes very irritating.
+
+Exercise.-- A moderate amount of exercise should be taken every day;
+this is needed now quite as much as at any other time, and only good
+can result from it. And no harm comes of a woman going out in the rain
+or in cold weather; as has been shown, the menstrual process is going
+on for a large part of the time, and the flow is only the external
+appearance, but during the time of the flow the woman must be
+unusually careful not to get her feet wet or to sit down with damp
+clothing on. Violent exercise of all kinds is to be prohibited at this
+time, as dancing, rides on the bicycle, gymnastics, and walks of over
+three miles. The reason for this is very obvious; the uterus has now
+reached the height of its turgescence, and is heavier than at any
+other time, hence the danger that displacements or a very profuse flow
+would be caused by any kind of violent exercise.
+
+Treatment.-- If the woman has been so unfortunate as to get caught out
+in a heavy rain so that her clothes have been wet through, or if in
+the cold weather she should come into the house thoroughly chilled,
+the best thing to do is to take off her wet things as quickly as
+possible, be well rubbed down with hot, rough towels, drink a cup of
+hot tea, go to bed at once and place a hot-water bag over the abdomen.
+She should remain in bed until the next morning, to the end that the
+circulation may regain its equilibrium as quickly as possible by the
+immediate relief of the pelvic congestion. If this exposure should
+have caused the sudden cessation of the flow, a hot mustard foot-bath
+should be taken. One tablespoonful of mustard is used to a gallon of
+water as hot as can be borne; the pail should be made as full as can
+be without running over, and a blanket wrapped around the pail and
+woman, so as to cause a profuse perspiration; this should be kept up
+for ten minutes; if the water cools off, hot water may be added.
+
+  CHAPTER V.
+
+ THE ANOMALIES OF MENSTRUATION.
+
+   Menorrhagia and Metrorrhagia; Dysmenorrhea; Amenorrhea; Leuchorrhea;
+   Pruritus Vulvae.
+
+  "Defer not till to-morrow to be wise,
+   To-morrow's sun on thee may never rise."
+
+                                                          -- CONGREVE
+
+Menorrhagia and Metrorrhagia.-- By menorrhagia is meant an excessive
+or too profuse menstrual flow; by metrorrhagia, a flow of blood
+between the menstrual periods. Neither one constitutes a disease by
+itself, but is a symptom of some pathologic condition.
+
+It has already been stated that the excretory organs, by constantly
+eliminating from the system the worn-out material, keep the machine
+healthy and in good working order. Kept within natural limits, this
+elimination is the source of strength and health; beyond these limits,
+the menstrual flow becomes an actual hemorrhage that, by draining away
+the life, becomes the source of weakness and disease.
+
+No physician would dare to bleed a man or woman once a month, year in
+and year out for thirty years; but, through ignorance or folly, this
+is what many girls do for themselves.
+
+This excessive flow, aside from actual local disease, is brought about
+by excessive muscular exercise during menstruation; by the use of all
+stimulants, whether alcoholic beverages or quinin; as well as by the
+thinness of the blood.
+
+When the flow is excessive, it must be considered a pathologic
+condition, which needs the physician's attention. Rest in the
+recumbent position is the first essential; the diet must be plain and
+unstimulating, and attention must be paid to the condition of the
+blood.
+
+The general diseases which generally cause this condition are anemia,
+Bright's disease, malaria, the early stages of tuberculosis, and heart
+disease.
+
+The local causes may be reflex, as powerful emotions; or due to local
+disease of the uterus and its appendages, as the various inflammations
+and displacements of the uterus, fibroid tumors, polypi, and cancer.
+
+Dysmenorrhea is painful menstruation. The most frequent forms are due
+to uterine congestion; to mechanical causes, as a narrowing of the
+cervical canal, particularly at its internal opening, or to a
+constriction caused by the bending over of the uterus at the junction
+of the body and the neck; or to ovarian irritation.
+
+The pain varies in intensity from slight discomfort to the most
+intense uterine colic, which is experienced in the lower part of the
+abdomen. In severe cases the general health becomes undermined, the
+nervous system gives way, and hysteria and other disorders of the
+nervous system result.
+
+The congestive variety usually occurs in patients who have previously
+menstruated painlessly. The pain comes on suddenly with the flow and
+ceases when the flow stops; it is very severe and is generally
+accompanied by a diminution or a cessation of the flow. There is
+severe headache, marked diminution in the secretion of the kidneys,
+and general restlessness. The patient frequently experiences pain in
+walking, is easily fatigued, has leucorrhea and an irritable bladder.
+
+In ovarian dysmenorrhea the pain precedes the flow for several days
+and ceases when a free flow is established. The pain is of a dull
+aching character, and may be felt on one or both sides of the abdomen,
+according as one or both ovaries are involved.
+
+Amenorrhea.-- In amenorrhea the menstrual flow may not appear for some
+years after it is normally due; or the flow may cease after some
+months or years of continuance; or the flow may be abnormally scanty
+or even absent.
+
+The menstrual flow is much later in appearing in some families than in
+others, so that this may be considered as a family idiosyncrasy; and
+if the girl's health is good, it need cause no anxiety. If, on the
+contrary, the girl has severe headaches, or suffers in any way, the
+physician should be summoned at once, as the absence of menstruation
+may be indicative of some serious pathologic condition,
+
+A scanty flow is often indicative of thinness of the blood; on the
+other hand, serious anemias often lead to profuse menorrhagias or
+metrorrhagias, as has already been stated. The cause of the profound
+anemia itself may be insufficient nutrition, overwork, or lack of
+exercise.
+
+Scanty menstruation is often seen to occur in fevers, in the later
+stages of consumption, in advanced Bright's disease, in malaria, or in
+any other very serious disease. In these cases it seems to be a
+conservative process on the part of nature in the run-down state of
+the system. As consumption progresses menstruation generally ceases
+absolutely, never to return again; and in this case nothing should be
+done to try to induce a return of the flow.
+
+Great shock sometimes causes a sudden cessation of the flow; and
+sometimes a sea-voyage, followed by the change of habitat, will cause
+an obstinate form of amenorrhea.
+
+But it cannot be too well understood that, after the menstrual flow
+has been regularly established, it continues with the greatest
+regularity throughout the child-bearing period, unless the exposure to
+wet or cold has been sufficiently severe to cause great indisposition
+on the part of the woman. In this case it is possible that, if the
+exposure took place just previous to the time of the expected flow,
+one period may remain out. But except in case of serious illness,-- as
+for example, typhoid fever,-- two or more periods do not fail to
+appear except in the case of pregnancy.
+
+Leucorrhea.-- Leuchorrhea, or "whites," is a mucous or mucopurulent
+discharge from the vagina; it may be a symptom of uterine or vaginal
+disease.
+
+Immediately after the menstrual flow there is a well-marked vaginal
+secretion which is whitish in appearance; it may be transparent or of
+a milky color, and is sometimes very acrid. This secretion may also
+precede the flow, and there is nothing abnormal in this. But any
+discharge occurring between the periods sufficient to stain the
+clothing-- the so-called whites or leucorrhea-- is abnormal, and is
+caused by an inflammation of the vagina or the neighboring parts. In
+addition to the discharge there is heat and swelling of the parts,
+more or less local distress, and generally intense nervousness.
+
+If the disease is not cured, it may become chronic. The pain, heat,
+and scalding disappear, but a copious discharge continues, and in this
+stage the disease may be very obstinate and greatly reduces the
+strength. The constant drain breaks down the system, producing pallor,
+debility, pain in the back, palpitation, indigestion, and so forth.
+
+The character of the discharge in leucorrhea varies considerably, from
+a whitish or mucous secretion, to a yellowish or mucopurulent
+secretion, and is debilitating in proportion as it is profuse. It is
+to be remembered that this is not in itself a disease, but indicates a
+disease of some of the pelvic organs; and that all such inflammations
+left to themselves incline to grow worse.
+
+A severe leucorrhea is generally attended with frequent and finally
+painful micturition; pain in walking in the lower part of the abdomen,
+which may become so severe as to compel the patient to go to bed.
+
+Pruritus Vulva.-- This is an intense and persistent itching of the
+vulva, and is a symptom rather than a disease. It is not an infrequent
+result of leucorrhea, the acrid discharge of the latter leading to an
+irritation of the parts; this causes rubbing of the parts until a
+veritable inflammation is produced.
+
+Other causes of pruritus vulvae are: The local congestion, such as
+occurs at the menstrual period, or in certain cases of pelvic
+inflammations, or in early pregnancy; constipation; sedentary habits;
+congestion of the liver; incontinence of urine, and diabetes. When
+dependent on the latter, the malady is most obstinate in yielding to
+treatment. Indigestible foods or drinks, the rubbing of the clothes,
+the friction of walking, and the heat of the bed act as exciting
+causes in those predisposed to it.
+
+The essential treatment here is to at once ascertain and remove the
+cause; aids in the treatment are vaginal douches and cooling lotions.
+
+  CHAPTER VI.
+
+ THE MARRIAGE QUESTION.
+
+   Herbert Spencer's Definition of Love; What Constitutes a Suitable
+   Husband; Best Age for Marriage; Shall Cousins Marry? Contraindications to
+   Marriage; Do Reformed Profligates Make Good Husbands? the Proper Length
+   of Time for the Engagement; the Right Time of the Year to Marry; the
+   Selection of the Wedding Day.
+
+  "Well, Brutus, thou art noble; yet, I see,
+   Thy honourable mettle may be wrought
+   From that it is disposed: Therefore, 'tis meet
+   That noble minds keep ever with their likes.
+   For who so firm that cannot be seduced?"
+
+                                                  -- "Julius Caesar."
+
+Herbert Spencer's Definition of Love.-- "Love is habitually spoken of
+as though it were a simple feeling, whereas it is the most compound,
+and therefore the most powerful, of all the feelings. Added to the
+purely physical elements of it, are first to be noticed those highly
+complex impressions produced by physical beauty; around which are
+aggregated a variety of pleasurable ideas, not themselves amatory, but
+which have an organized relation to the amatory feelings. With this
+there is united the complex sentiment we term affection-- a sentiment
+which, as it can exist between those of the same sex, must be regarded
+as an independent sentiment, but one which is here greatly exalted.
+Then there is the sentiment of admiration, respect, reverence, in
+itself one of considerable power, and which in this relation becomes
+in a high degree active. There comes next the feeling called the love
+of approbation. To be preferred above all the world, and that by the
+one admired above all others, is to have the love of approbation
+gratified in a degree passing every other experience, especially as
+there is added that indirect gratification of it which results from
+the preference being witnessed by others. Further, the allied emotion
+of self-esteem comes into play. To have succeeded in gaining such
+attachment from and sway over another is a proof of power which cannot
+fail to agreeably excite amour propre. Yet again, the proprietary
+feeling has its share in the general activity. There is the pleasure
+of possession, the two belonging to each other. Once more, the
+relation allows of an extended liberty of action. Toward each other a
+strained behavior is requisite. Around each there is a suitable
+boundary that may not be crossed; an individuality on which none may
+trespass. But in this case the barriers are thrown down, and the love
+of unrestrained activity is gratified. Finally, there is an exaltation
+of sympathies, egotistic pleasures of all kinds are doubled by
+another's sympathetic participation, and the pleasures of another are
+added to the egotistic pleasures. Thus around the physical feeling
+forming the nucleus of the whole, are gathered the feelings produced
+by personal beauty that constitutes simple attachments, of
+self-esteem, of property, of love of freedom, of sympathy. These, all
+greatly exalted and severally tending to reflect their excitements on
+one another, unite to form the mental state we call love. And as each
+of them is comprehensive of multidinous states of consciousness, we
+may say that this passion fans into immense aggregate most of the
+elementary excitations of which we are capable; and that hence results
+its irresistible power."
+
+What Constitutes a Suitable Husband.-- It is desirable that the
+husband shall be a few years older than the wife. Man is later in
+coming to maturity, and also retains his sexual powers considerably
+longer than woman; so that for these functions to cease about the same
+time, the wife must be younger than the husband. A difference of from
+two to five years is best; if the parties are young, it is not
+essential that the husband should be much the wife's senior, as it is
+later in life. The husband may be ten years older, but a greater
+disparity of age than this is rarely compatible with congeniality of
+tastes and dispositions, so essential to a happy married life. The
+woman who risks her happiness with a man many years younger than
+herself violates a precept of nature.
+
+The average stature of the man is about three inches greater than that
+of the woman, and in the physiologic marriage any great deviation from
+this should be avoided.
+
+The essentials for a happy marriage may be summed up as follows: that
+the parties shall be of suitable age; that they shall be physically
+well mated and in full sympathy with each other's views of life, of
+the same social position, and of equal education.
+
+The Best Age for Marriage.-- The reproductive life begins with
+puberty, but maturity is not reached before the age of twenty-one. It
+is only then that the standard of development is reached that is most
+compatible with the successful bearing of the grave responsibilities
+of wifehood and motherhood. The too early exercise of the reproductive
+functions leads to increased suffering on the part of the mother,
+depresses her vitality, and increases her liability to disease.
+Statistics show that the mortality is very much greater where girls
+marry under twenty years of age.
+
+The offspring are apt to be small and ill developed, and die in large
+numbers in early life; only a small percentage live long and robust
+lives. In France it has been observed that where the fear of
+conscription has caused many young people to marry the offspring were
+lacking in vigor. Among the offspring of immature parents there is a
+larger proportion of idiots, cripples, criminals, scrofulous, insane,
+and tubercular than among the children of nubile parents.
+
+In our climate women are best fitted to become wives and mothers
+between the ages of twenty-four and twenty-eight years. Before this
+age neither their self-knowledge, their knowledge of the world, nor
+their experience is sufficiently mature to fit them to wisely make the
+choice of a companion for life, or to become mothers. After forty,
+most women cannot hope for children. Men had better wait until between
+the ages of twenty-seven and thirty years, before they undertake the
+responsibilities of parenthood.
+
+Shall Cousins Marry?-- They might if both families were perfectly
+healthy; but as few families are without some lurking predisposition
+to disease, it is not well, as a rule, to run the risk of developing
+this by too repeated unions.
+
+Contraindications to Marriage.-- Young women in whose family there is
+a distinct history of such hereditary diseases as cancer,
+tuberculosis, or insanity for two generations back, should not marry
+at all. Not only is this a fearful legacy to hand down to their
+children, but pregnancy and child-bearing very decidedly favor the
+development of these diseases.
+
+Syphilis in either sex is a distinct bar to marriage; first, the party
+married is sure to contract the disease, even though it may have been
+supposed to have been cured. Fortunately, the children of such
+marriages are generally still-born; still, they do sometimes live, and
+are most pitiable and sickly objects. For any one to marry under these
+conditions is a crime against society, against the State, and against
+posterity.
+
+Women who have serious forms of heart disease, tuberculosis, or
+Bright's disease would, by becoming pregnant, run a serious risk of
+losing their lives toward the close of the pregnancy or at the time of
+their confinement. In case of heart disease, the pulmonary congestion
+that accompanies pregnancy, together with the encroachment of the
+pregnant uterus on the cavity of the chest, would greatly add to the
+embarrassment of the heart's action.
+
+In normal pregnancy there is some congestion of the kidneys; where
+there is actual disease of the kidneys prior to the pregnancy, this
+congestion is apt to become so severe as to threaten the woman's life.
+These organic diseases are not to be confounded with functional
+diseases which are dependent on some other cause; as palpitation of
+the heart due to indigestion, or heart murmurs dependent on the thin
+state of the blood, or congestion of the kidneys due to exposure to
+cold;-- all of which may be cured by proper treatment.
+
+Should a woman with a fibroid tumor marry, she would run a great risk
+to her life; she should have the tumor removed, or, if this is not
+possible, she should give up all thoughts of marriage, since the
+increased irritation and congestion consequent upon the marital
+relations would tend to favor its growth. Should pregnancy ensue,
+delivery might be attended with serious complications, as very
+difficult labor, postpartum hemorrhage, or, as these tumors have but
+little vitality, and the pressure to which they are subjected during
+labor is liable to cause their death, disorganization, sloughing, and,
+as a result, puerperal septicemia.
+
+Sometimes there is such a lack of development of the genital organs as
+to prevent the woman from having children.
+
+Two persons with even a slight tendency to the same disease, either
+inherited or acquired, should not intermarry, even if they are in
+comparatively good health at the time. Their offspring would be quite
+sure to inherit their diseased tendencies.
+
+Persons whose constitutions have been somewhat injured, but who are
+not tainted with actual disease, may rear children much healthier than
+themselves, provided their own lives are wisely regulated. If they are
+growing better all the time, and are not too much broken in
+constitution, it may be safe for them to marry.
+
+Among the Jews the physician is frequently consulted before
+matrimonial alliances are contracted. This custom could not but be of
+universal benefit; many local or general diseases would be eradicated
+before marriage, and in this way much suffering and unhappiness would
+be spared; or, in other cases, the patient would be advised of the
+inadvisability of marriage.
+
+Do Reformed Profligates Make Good Husbands?-- The manner of life that
+has been led by this class of men is such as to undermine their
+health, if not to have rendered them physical wrecks. There is the
+overindulgence in alcoholic beverages, and perhaps, added to this,
+some drug habit. In addition to this, these men early in their career
+are apt to become infected with some of the venereal diseases, or
+perhaps with all of them-- gonorrhea, syphilis, and so forth; and
+these diseases have the horrible characteristics of becoming latent. A
+man who contracts this kind of a disease can never be really sure that
+he is cured. All venereal diseases are highly contagious.
+
+It is now a well-established fact that gonnorrheal infection is not
+only one of the most common causes of pelvic inflammations in women,
+but that these same inflammations are of the most virulent types,
+unless they are recognized and treated in the early stages. It is also
+a well-known fact that a large percentage of married women suffer from
+this disease. Sterility almost always results.
+
+In the case of a syphilitic parent, one or two children may be born,
+but the offspring is generally sickly and diseased. Inebriety as well
+as sexual excesses are both well recognized as distinct forms of
+disease accompanied by degeneracy of brain tissue. It is nothing less
+than criminal for such men to have children, since these children
+would at least inherit the tendency to the same diseases, if they did
+not actually have them; there is also a strong probability of such
+children being born idiots or imbeciles.
+
+It is therefore self-evident that, instead of a reformed profligate
+making a good husband, he must make a very diseased one. It has
+therefore been suggested that the parents of the prospective bride
+should demand from the intended groom a certificate of freedom from
+all venereal diseases by a physician of their own selection. Also that
+there should be legislation upon the subject, and that before a man is
+granted a license of marriage, he should have a certificate from the
+health officer of freedom from syphilis, gonorrhea, and tuberculosis.
+
+The Proper Length of Time for the Engagement.-- A period not shorter
+than three months, nor longer than one year, should elapse between the
+engagement and the marriage.
+
+There are strong physiologic reasons against long engagements: they
+keep the affections and the passions in an excited and unnatural
+condition, which after a time tends to weaken the nervous system and
+undermine the health. These evil consequences are common to both
+sexes. It is far better that the subject of marriage should not be
+entertained at all unless the circumstances are such that the union
+might with propriety be effected at once.
+
+The Right Time of the Year to Marry.-- When woman marries she enters
+upon a new life, and a very trying one. Extreme heat and extreme cold
+are both very taxing to the human economy. Midsummer and midwinter are
+therefore both objectionable, but especially the former.
+
+The Selection of the Wedding-day.-- This is by common consent left to
+the bride. She should select a time about ten or fifteen days after
+the end of one of her menstrual periods, as this is the time of
+comparative sterility, and it is most desirable that the first sexual
+relations should be fruitless.
+                          _________________
+
+  PART II.-- MARRIAGE.
+                          _________________
+
+ CHAPTER VII.
+
+ THE ETHICS OF MARRIED LIFE.
+
+   The Wedding Journey; the Ethics of Married Life; Shall Husband and Wife
+   Occupy the Same Bed? the Comsummation of Marriage; the Marital Relation;
+   Times when Marital Relations Should be Suspended.
+
+  "If it is possible to perfect mankind, the means of doing so will
+  be found in the medical sciences."-- DESCARTES.
+
+The Wedding-journey.-- The wedding-journey, which was formerly the
+cause of so much discomfort to both husband and wife, has fortunately
+gone out of vogue; and in its place has come the retirement to a quiet
+country or seaside spot, away from the prying eyes of friends. Thus
+the nervous strain incident to sight-seeing and travel is avoided.
+
+The Ethics of Married Life.-- It has been said that God set men and
+women in pairs in order that they might perfect each other and
+complete each other's happiness. The secret of all true happiness in
+life lies in the spirit of altruism; one must be able to wholly forget
+herself and to find her happiness in the welfare of others.
+
+The woman who exhausts herself physically and financially on the
+preparation of her trousseau and her wedding does her husband a wrong
+by bringing him a wife who is on the verge of nervous prostration.
+
+The secret of a happy married life depends to no small extent on the
+very beginning: the relation is so entirely new, and much lies hidden
+in the character of each that was never suspected by the other.
+
+Between husband and wife there must always be mutual concessions,
+forbearance, and sympathy; a mutual helpfulness to attain all that is
+best. This, of course, implies that the life of each is an open book
+for the other to read; that there is an unreserved exchange of
+thought; and that no privilege is claimed by the one that would not
+willingly be accorded to the other.
+
+"How many men," says Balzac, "proceed with women as the monkey of
+Cassan with the violin; they have broken the heart without knowing it,
+as they have tarnished and disdained the jewel whose secret they never
+understood. Almost all men are married in ignorance of women and of
+love. They have commenced by forcing open the doors of a strange house
+and have wished to be well received in its salon. But the most
+ordinary artist knows that there exists between him and his
+instrument-- his instrument which is made of wood or ivory-- a sort of
+indefinable friendship. He knows by experience that it has taken years
+to establish this mysterious rapport between an inert material and
+himself. He could not have divined at the first stroke all its
+resources and caprices, its faults and its virtues. His instrument
+only became a soul for him and a source of melody after long study; he
+only came to understand it as two friends after the most learned
+interrogation.
+
+"So the world is full of young women who grow pale and feeble, sick
+and suffering. The ones are a prey to inflammations more or less
+severe; the others remain under the dominion of nervous attacks more
+or less violent. All these husbands have caused their own unhappiness
+and ruin. Never begin married life with a rape. To demand of a young
+girl whom one has seen forty times in fifteen days to love you because
+of the law, the king, and justice is an absurdity.
+
+"Love is the union of necessity and of sentiment. Happiness in
+marriage is the result of perfect understanding between the spirits of
+husband and wife. From this it happens that in order to be happy, a
+man is obliged to bind himself to certain rules of delicacy and honor.
+After taking advantage of the social laws which consecrate the
+necessity, it is necessary to obey the secret laws of nature, in order
+to make the sentiments flourish. If a man places his happiness on
+being loved, it is necessary that he should love sincerely; nothing
+resists a veritable passion."
+
+Shall Husband and Wife Occupy the Same Bed?-- Among civilized nations
+custom differs in this regard; in Germany, for instance, the husband
+and wife occupy separate beds in the same room; formerly in this
+country it was almost the universal custom for husband and wife to
+occupy the same bed. The current of opinion has changed in this
+respect, and it is now considered in the highest interests of both
+that they shall occupy not only separate beds, but separate rooms;
+these rooms communicating through a door which connects their
+respective dressing-rooms. This is unquestionably the best arrangement
+from the hygienic as well as from the ethical point of view. Health
+requires that one-third of the time shall be spent in sleep; the bed
+was made for sleep; and the most refreshing sleep can only be obtained
+by occupying the bed alone. If two persons occupy the same bed and one
+is restless, the sleep of the other is necessarily disturbed. Again,
+two persons occupying the same bed necessitates the same hour for
+rising and retiring, which is not always convenient or agreeable.
+Balzac writes on this subject: "To put the system of separate
+bed-rooms into practice is to attain to the highest degree of
+intellectual power and of virility. By what syllogism man arrived at
+establishing as a custom that of man and wife sleeping together, a
+practice so fatal to happiness, to health, to pleasure, and even to
+self-love, would be curious to seek out." If for financial reasons it
+is not possible to have separate bed-rooms, the German custom of
+having separate beds should be adopted.
+
+The Consummation of Marriage.-- The consummation of marriage is often
+attended with difficulty owing to the rigidity of the hymen; this, if
+present, must usually be ruptured before connection takes place. Great
+gentleness and care must be exercised by the husband if it does not
+readily yield, the use of hot vaginal injections should be kept up for
+several weeks before the trial is repeated. These usually relax the
+parts very considerably; but if coitus is still found impossible, it
+is better to consult a physician at once, when a simple operation will
+generally remove the trouble and the woman is spared much suffering.
+In no case is any violence on the part of the husband allowable, as it
+might produce irreparable injuries.
+
+There is always more or less suffering on the part of the wife at
+first, partly due to the rupture of the hymen, and partly to the
+forcible dilatation of the vagina and she should be allowed a
+sufficient time for nature to repair these injuries. By so doing, the
+constitutional disturbances and the nervous disorders which are so
+very prevalent may be prevented. Too frequent indulgence at this
+period is a prolific source of inflammatory diseases, and often
+occasions sterility and ill-health.
+
+The first nuptial relations should be fruitless, in order that any
+indisposition arising therefrom should have had time to disappear
+before the woman becomes pregnant.
+
+The Marital Relation.-- It is most important for the interest of both
+parties that there should be chastity in the marriage relation as well
+as out of it. Many young couples have had their lives ruined by
+excessive sexual indulgence. The effect is usually most severe upon
+the husband, yet the wife becomes weak, nervous, and excitable. Sexual
+excess is also the grave of domestic affection. The general rule given
+is that coitus should never take place oftener than every seven or ten
+days. When coitus is succeeded by langour, depression, or malaise, it
+has been indulged in too frequently.
+
+Among civilized people there are three widely diferent views as to the
+proper course to be pursued:
+
+First, those who maintain that sexual intercourse should not take
+place except for the propagation of the species.
+
+Second, those who believe that the act is a love relation, mutually
+demanded and enjoyed by both sexes, and serving other purposes besides
+that of procreation.
+
+Third, those who hold that sexual intercourse is a physical necessity
+for the man, but not for the woman.
+
+The first theory, "that the sexual relations should never be sustained
+save for the purpose of procreation," has many advocates. They teach
+that there are other uses for the procreative element than the
+generation of offspring, and far better uses than its waste in
+pleasures. They claim that a life of total chastity increases the
+physical and mental vigor; and there will result a procreation on the
+mental and spiritual planes, instead of on the physical ones.
+
+They also claim that to woman belongs the creative power; that she
+must choose when a new life shall be evolved; and that only by
+adhering to this law can she be protected in the highest function of
+her being-- the function of maternity.
+
+The adherents of the second theory, "that the act is a love relation,
+mutually demanded and enjoyed by both sexes, and that it serves other
+purposes besides that of procreation," claim that the female sexual
+life indicates that the healthy woman is neither indifferent nor
+passive in the generative act. It has much the same effect as in man--
+a powerful increase in her sensations, whole groups of muscles are set
+in motion, and the uterus as well as the entire nervous system are in
+an excited condition and activity. And that it is the province of the
+mother to decide when a new life should begin.
+
+The third theory, "that sexual intercourse is a physical necessity for
+the man, but not for the woman," is by far the most widely accepted.
+We will consider, first, the practical results of this last theory;
+and, second, the scientific basis on which it rests.
+
+It is generally acknowledged that this practice has done more to cause
+domestic misery, sickness, and death than that dreadful scourge of the
+human race, tuberculosis.
+
+This man, accustomed all his life to gratify his sexual passions
+promisculously, marries a virtuous young girl. In her menstrual
+periods she has had to do only with the secondary phenomena; with the
+expulsion of the ova not at all. She has had no instruction in the
+corresponding physiologic life of the man, and is astonished at the
+male sexual indications, and is led to believe in their physiologic
+necessities. The result is that she not only suffers physically, but
+feels outraged and disgraced. She is liable to the chance of maternity
+at any time; and such offspring will probably be sickly.
+
+Passion is presented to the young wife in so hideous a guise that it
+will take the utmost consideration of her husband afterward to enable
+her to completely overcome her repugnance. If she be worn and weary of
+excesses in the early days of her married life, the husband will have
+only himself to blame if he is bound all his life to an apathetic and
+irresponsive wife. Husbands place great strains upon the affections of
+their wives, and lower themselves almost past reinstatement in their
+respect and esteem.
+
+Lastly, on what scientific basis does this "physilogic necessity" for
+sexual gratification on the part of the male rest? Analogy with the
+lower animals does not bear it out. Among animals, except in rare
+instances under domestication, the female admits the male in sexual
+embrace only for procreation. Among many savage tribes this same rule
+has but few exceptions. The analogies between the male and the female
+sexual organs; between seminal emissions and menstruation; between the
+sexual life of the male and of the female, only go to accentuate the
+fact that this so-called physiologic necessity on the part of the male
+has arisen chiefly through the difference of education; so that it has
+come to be that the woman is chaste and the man is degraded; that the
+woman is too sentimental and the man too passionate. From a purely
+medical standpoint, the most eminent physicians and physiologists of
+the day all unite in advocating a chaste and continent life, simply
+for the sake of the man's own health, independently of all other
+considerations.
+
+Times when Marital Relations Should be Suspended.-- The marital
+relations should always be suspended during the menstrual period.
+During pregnancy intercourse should never, or at least very rarely, be
+indulged in. At this time the mother needs to conserve all her
+strength and energies for herself and child; and any sexual relations
+during this time increase the sufferings of the mother and impair the
+vitality of the child. It has been even suggested that much of the
+pain during parturition would be avoided by entire continence during
+pregnancy. Intercourse during the early months of pregnancy is a
+frequent cause of abortion. Women who have supposed that they have
+never been pregnant have in reality been having abortions every second
+or third month.
+
+A woman should never be subjected to coitus until three months after
+delivery. During lactation intercourse should never, or at least very
+rarely, be indulged in; as the function of lactation makes a heavy
+drain on the strength of the mother, and anything which would further
+weaken her would tend to impoverish the quality of the milk and thus
+the child would suffer.
+
+  CHAPTER VIII.
+
+ SEXUAL INSINCT IN WOMEN.
+
+   Sexual Instinct in Women; Excessive Coitus; Causes of Sexual
+   Excitability.
+
+  "Virtue, the strength and beauty of the soul,
+   Is the best gift of heaven."
+
+                                                        -- ARMSTRONG.
+
+Sexual Instinct in Women.-- After careful observation of the sexes in
+the married state, it is found that the sexual appetence is less in
+women than it is in men. Much of this difference in sexual appetence
+is doubtless due to the chastity of their lives, coupled with and
+resulting from the difference of education. The girl is taught
+repression, and the boy expression; that girls must be chaste; that
+chastity for boys is impossible.
+
+According to the intensity of the sexual instinct women have been
+divided into three classes: A larger number than is supposed have
+little or no sexual feeling. Second, those who are subject to strong
+passion; this class is larger than the first, but small as compared
+with the whole of their sex. Third, those in whom the sexual appetite
+is moderate; this class comprises the vast majority of women.
+
+And, even granting to woman more pleasure in sexual indulgence than
+usually comes to her by largest allowance, it is safe to say that in
+nine cases out of ten maternity, with its early pains and later cares,
+greatly lessens her power of enjoyment; and that for the larger part
+of her married life she is either positively distressed by the
+apparently necessary demands of her husband upon her, and irresponsive
+to them, or kept to a cheerful response by a self-abnegation and
+regard for his comfort, not to say fear of his moral aberration, which
+is a positive drain upon her health and strength.
+
+Excessive Coitus.-- Those who are most frequently found to suffer from
+venereal excesses are the newly married; especially if they have weak
+constitutions and excitable temperaments. A great deal of mischief is
+done by two persons of unequal constitutions being matched together;
+the husband may exhaust the wife or vice versa, the weaker party being
+constantly tempted to exceed their strength. In all sexual matters
+there must be a consideration for others. It is not so much from
+selfishness as from ignorance that such a mistake is made. The
+ignorance comes from a lamentable morbid delicacy which prevails on
+all sexual matters, and which prevents all open and rational
+conversation on them, even between those who have the most intimate
+knowledge of each other.
+
+When the conjugal act is repeated too often, the man will become
+gradually conscious of diminished strength, diminished nerve force,
+and diminished mental powers. Excess weakens a man's energies, and
+enervates and effeminates him. Moreover, it renders him liable to an
+infinity of diseases and a readier victim to death.
+
+Not only is the strength of the constitution lowered by the excessive
+expenditure of force and matter requisite for the perpetuation of the
+species, but this lowered standard of vitality is transmitted to
+children. There can be but little doubt that this is one of the
+reasons why so many healthy parents beget sickly children, who die
+early. They have exhausted themselves of the material from which a new
+life is created, and so it is not properly started at the beginning
+and never reaches its highest development. To the truth of this
+statement attests the mental imbecility, the pallid and attenuated
+forms, of the children who are the earlier products of marriage. The
+effect of excessive coitus in women is seen by the confirmed ill
+health of so many women after marriage and repeated child-bearing. A
+large number of these cases are dependent upon alteration and diseases
+of the genitalia; but a considerable number are unconnected with local
+disease, and in many other cases the health is never regained after
+all local phenomena have disappeared.
+
+Sexual excitement in the woman causes certain congestion of the
+genital organs; and at the time of the orgasm there is a reflex
+movement which corresponds to erection, and which consists of a
+peristaltic movement of the tubes and uterus; to the uterus also is
+ascribed an act of suction by which the spermatozoa are drawn up into
+its interior. Even when pregnancy does not follow, the too frequent
+excitation and activity of the uterus in weak constitutions causes
+illness, first of the genital organs and then of the nervous system.
+
+Local diseases caused in women by excessive coitus are: vaginal
+catarrh, acute catarrh of the vulva, acute inflammation of the lining
+membrane of the uterus as well as of the uterus itself, inflammation
+of the ovaries, and even peritonitis. It is also known to be an
+important factor in the origin of blood-tumors and of cancer of the
+uterus. Especially is coitus at a time of great physical fatigue
+liable to be provocative of uterine inflammations. Aside from ethical
+considerations, coitus during the menstrual period may be the cause of
+rupture of the impaired blood-vessels, thus causing blood-tumors.
+Excessive coitus is a well-known cause of chronic inflammation of the
+uterus; that is, a habitual congestion of the uterus is induced by
+excessive sexual intercourse. This has been frequently mentioned by
+authors as leading to enlargement of the uterus in the non-pregnant
+condition; and it is a still more potent factor in the recently
+impregnated organ, whose tissues are succulent and the vessels
+enlarged, a condition inviting congestion and enhancing the
+susceptibility to engorgement.
+
+The general manifestations of impaired health in women due to
+excessive coitus are: chronic anemia, with malnutrition; impaired and
+altered functions in all the organs, especially those of the nervous
+system. Menorrhagia is apt to be induced by overstimulation of the
+ovaries, together with exhaustion and sexual apathy.
+
+The source of so much misery is the increasing physical weakness of
+the female and the increasing nervous weakness of the male, with an
+increasing sexual excitability, two factors of tragic effect for the
+wife. Here is seen the unfortunate result of teaching two kinds of
+morals, one for men and another for women.
+
+Causes of Sexual Excitability.-- Too frequent genital irritation,
+onanism, too frequent intercourse, alcohol, too rich and too highly
+seasoned foods, lack of exercise.
+
+Treatment of Sexual Excitability.-- Avoid alcohol and precocious
+puberty. Strictest attention must be paid to the diet; everything is
+to be avoided which is difficult of digestion or which retards it. The
+following articles of diet must all be avoided: cheese, foods seasoned
+with pepper and curry, highly salted and acid foods, and all rich
+foods; and meat must be eaten only in moderate quantities.
+Constipation irritates the genitalia directly and increases the
+inflammation. The close relation of Venus and Bacchus is known not
+only in mythology. Carbonated waters are to be especially avoided,
+such as soda, seltzers, Preblauer, Geisshubler, and acid waters; also
+champagne and beer, heavy Italian, Spanish, and English wines. All
+alcoholic drinks must be forbidden.
+
+As heavy gymnastics as the strength of the individual will admit, and
+plenty of exercise out-of-doors must be taken. There must also be
+constant mental and physical employment. In women sexual excitability
+is often caused by local diseases, and passes off with their cure; if
+not, she must use her will-power, and take the various forms of cold
+baths. Sexual intercourse not oftener than once in two or three weeks,
+and avoid all intimate approaches; if this is not sufficient, she will
+have to leave her husband for a few months.
+
+  CHAPTER IX.
+
+ STERILITY.
+
+   Sterility; the Prevention of Conception and the Limitation of Offspring;
+   the Crime of Abortion; Infidelity in Women.
+
+  "Never let yourselves do evil that good may come. If you do, you
+  hinder the coming of the real, the perfect good in its due time."
+
+                                                  -- PHILLIPS BROOKS.
+
+Sterility.-- Conception is least apt to take place from the tenth day
+after one period until the third day before the next; but there is
+practically no time during a woman's sexual life when she may not be
+impregnated; in this connection it must be remembered that the
+spermatozoa stay alive in her for more than a week.
+
+During lactation women are generally sterile, especially in the first
+months which follow the accouchement, because the vital forces are
+then concentrated on the secretion of milk.
+
+The age of the wife at the time of marriage has much to do with the
+expectation of children. As the age increases over twenty-five years
+the interval between the marriage and the birth of the first child is
+lengthened. For it has been ascertained that not only are women most
+fecund between twenty and twenty-five years, but that they begin their
+career of child-bearing sooner after marriage than either their
+younger or older sisters.
+
+A wife who has had children and ceases to conceive for three years
+will probably bear no more.
+
+When marriages are fruitless, the wife is almost always blamed; but it
+is by no means the wife that is always at fault; many husbands are
+absolutely sterile. Every man is not prolific who enjoys good health
+and is vigorous. Gross states that in one case out of six the
+sterility was due to the male. Kehrer, after a series of carefully
+conducted experiments, has arrived at the conclusion that in at least
+a third of the cases of sterile marriages the husband was the party at
+fault, and that gonorrhea was the cause of the barrenness.
+
+Venereal diseases have their share of influence, and the gonorrheal
+infection is a potent cause of sterility. It is by no means proved
+that syphilis has any unfavorable influence on conception, though
+abortions due to this are frequent.
+
+Gonorrhea often prevents conception by the inflammation traveling up
+the womb, and along the Fallopian tubes to the ovaries, whose covering
+is rendered thick and dense, so that the ovum cannot escape, or if it
+does, the fimbriated end of the tube is so agglutinated that it cannot
+grasp the ovum.
+
+Alcoholism is considered a cause of sterility. It evidently does
+diminish the sexual potency in the male, and for this the female is
+often blamed.
+
+It does not follow because a woman has not given birth to a child that
+she has not conceived. The life of an infant for a long time after
+birth is a frail one, and before birth its existence is extremely
+precarious; it often perishes a few days after conception. A period
+coming on a few days late, and at the same time one which is unusually
+profuse, is the only evidence which the young wife may have of an
+abortion. Among prostitutes, the frequent delay of menstruation, then
+abundant hemorrhage, is in many cases only habitual abortion, and
+leads to changes in the generative organs which must result in
+sterility. A tendency to miscarriage may therefore be all that stands
+in the way of having a family; this can frequently be remedied.
+
+Sexual incompatibility is well known to exist; prominent examples
+being Augustus and Livia; Napoleon and Josephine. It is also a
+well-known fact that frigidity is a cause of barrenness. A short
+separation of husband and wife is often salutary in its influence upon
+fertility.
+
+It is a well-established fact that the time immediately before the
+period, but still more that immediately following the period, are the
+most favorable times for conception to take place; the remaining quiet
+in bed of the woman after the generative act is also favorable to
+conception.
+
+The most frequent causes of sterility in women are inflammation of the
+lining membrane of the uterus, or of the neck of the uterus, or of
+both. The source of this condition in women who have had children is
+most frequently due to parturition or abortion. In the newly married
+it may be due to a previously existing slight uterine catarrh in a
+displaced uterus, or it may be a manifestation of a run-down state of
+the system. In a majority of the newly married, however, the
+inflammation of the endometrium is probably due to the first efforts
+at conjugal approach. Many young women as the result of the
+preparation of the trosseau, augmented by a round of gaities at the
+time of marriage, enter the married state in a condition bordering on
+physical and nervous exhaustion; and then begin engorgements and
+inflammations which lead to future suffering and to sterility.
+Displacements and flexions of the uterus also cause sterility. Such
+displacements of the neck of the uterus may occur that, instead of
+lying in a pool of semen, as it should, it is above, in front of, or
+away from it, and this may prevent conception.
+
+Vulvar and vaginal hyperesthesia, inflammations of the vulva, undue
+shortness of the vagina, unless great care is exercised by the
+husband, will induce painful coitus, and may bring about sterility by
+favoring the formation of a copulation sac outside of the axis of the
+uterine canal, and consequently misdirection of the semen.
+
+Scrofula, probably by its effects on the general condition, leading to
+deficient development of the whole body, the genital organs included,
+may be productive of sterility.
+
+The female being less passionate than the male, the orgasm comes on
+later with her, or the male orgasm occurs so soon that she may not
+reach that stage at all. If both were simultaneous, it is reasonable
+to suppose that conception would be more likely to occur.
+
+Ovulation is doubtless more frequently performed in some women than in
+others. Some women conceive with more or less regularity every fifteen
+or eighteen months, and others at intervals of several years.
+
+The effect of repeated coition, provided that impregnation does not
+take place at once, is to engorge the uterine vessels, to alter the
+nature of the glandular secretions, to cause profound reflex
+disturbances, and thus to produce such changes in the endometrium as
+to lead to local inflammation and to general nervous exhaustion.
+Backache, leucorrhea, and irritable bladder are the first symptoms of
+this disorder; but frequently there are added to these, headache,
+indigestion, rectal tenesmus, painful and profuse menstruation. In
+many cases the disease continues in a mild catarrhal form, giving the
+woman little inconvenience besides the slight leucorrheal discharge
+which stains her clothing; but often this is indicative of such a
+change of the lining membrane of the uterus as to render it unfit for
+the fixation and development of the ovum, even should impregnation
+take place.
+
+Under normal conditions, during the intermenstrual period, a plug of
+clear viscid mucus, which is secreted by the glands of the cervical
+canal, blocks up that passage, but is washed away each month by the
+menstrual discharge. Under ordinary conditions this obstruction must
+seriously interfere with the entrance of the spermatozoa into the
+cavity of the uterus, and renders the former theory, recently revived
+by Bossi, quite tenable, that impregnation is most likely to occur
+just after the menstrual epoch.
+
+The vaginal secretion under certain pathologic conditions may become
+so acid that it induces sterility. Women who suffer m severe vaginal
+catarrh are frequently sterile, the spermatozoa being found dead in
+the vagina some hours after copulation, although an examination a
+shorter time afterward revealed them still alive. In cases where
+conception takes place in spite of a very acid condition of the
+vaginal secretion, it is probable that some of the spermatozoa enter
+the uterus before the secretion has had time to act on them, or
+possibly the spermatozoa being injected in a mass, the acid secretion
+is unable to penetrate and kill them all.
+
+The reaction of the normal vaginal mucus is always acid, that of the
+cervix alkaline; but as the result of the inflammatory condition, the
+reaction of each is often intensified, especially that of the vagina,
+which has an exceedingly sour and penetrating odor. This acid
+discharge, bathing the neck of the uterus, penetrates more or less
+into the cervical plug and causes coagulation of the alkaline mucus.
+
+The chief constituent of the semen is albumin; agents which affect
+albuminous substances influence the functional activity of the
+spermatozoa-- heat, concentrated acids, and probably concentrated
+alkalies. In normal conditions the alkalinity of the seminal fiuid
+seems to be sufficient to neutralize the acidity of the vaginal
+secretions, so that the spermatozoa may remain seventeen days or more
+(Bossi) within the vaginal canal, even during a menstrual period,
+without having their vitality destroyed.
+
+When hyperacidity of the vaginal secretion is present, it is probable
+that the fertilizing element is at once rendered inert; but should
+some of the spermatozoa succeed in reaching the interior of the
+cervical canal, the increased alkalinity of the secretion there would
+in all probability put an end to all further progress.
+
+The conditions, then, which appear to prevent fecundation are: First,
+the absence of the proper nidus for the ovum; second, the obstruction
+of the cervical canal by a mucus plug; third, increased alkalinity of
+the cervical secretion, often accompanied by the increased acidity of
+the vaginal secretion. Three conditions must, then, be determined:
+First, are there spermatozoa in the semen? Second, do they get into
+the uterocervical canal? Third, do the secretions in the canal poison
+the spermatozoa?
+
+"For those who are very anxious for offspring," wrote Marion Sims, "I
+usually order sexual intercourse on the third, fifth, and seventh days
+after the flow has ceased; and on the fifth and third days before its
+return. For the most obvious reasons this would always be before going
+to bed at night, instead of just before rising in the morning. The
+horizontal position favors the retention of semen; the erect its
+expulsion. I am satisfied that too frequent sexual indulgence is
+fraught with mischief to both parties. It weakens the semen; in other
+words, that this is not so rich in spermatozoa after too frequent
+indulgence; and when carried to the extent of a debauch, the fiuid
+ejaculated may be wholly destitute of spermatozoa. Thus it will be
+seen that it will be much better to husband the resources of both man
+and wife."
+
+The Prevention of Conception and the Limitation of Offspring.-- Some
+of the contraindications to procreation are when either parent suffers
+from a disease which is transmissible, and such diseases frequently
+manifest themselves only after marriage; when the pregnancy would
+endanger the mother's life, or even where the pregnancy is a nine
+months' torture to her; where either parent is suffering from ill
+health; or where for economical reasons no more children are desired.
+
+If there exists no condition in either parent or in their
+circumstances why they should not have children, the next
+consideration due to their children, is how the same may be procreated
+under the most favorable conditions possible; this condition can only
+be secured by making the circumtsances such that the mother shall be
+able to choose the time for their conception when both parents are in
+the best physical condition. That children should be brought into the
+world haphazard, as the result of accident, is to degrade the human
+race below that of the lower animals, where the female admits the male
+only at the time of the rut, which in the majority of cases occurs
+only once a year.
+
+Another requisite to bearing healthy children is that the pregnancies
+shall not follow each other too rapidly. Aside from the consideration
+for the health of the mother herself, she must be in good physical
+condition to bear the healthiest children she is capable of giving
+birth to; and for this there must be from two and a half to three
+years between the successive pregnancies. The results of
+overproduction on the children are frequently, that they are sickly,
+short-lived, or suffer from rickets, cerebral paralysis, idiocy, or
+imbecility.
+
+And last, but certainly not least, many women become chronic invalids,
+or are hastened to premature graves, by having children as fast as
+they possibly can.
+
+The most natural and moral way for the artificial prevention of
+conception, when on account of ill health or for economic reasons no
+more children are desired, is to abstain from sexual intercourse. But
+in the majority of cases the husband will not agree to this, and so
+the greatest number of methods have come to be used to prevent
+conception.
+
+Perhaps the most frequent method use to prevent conception is
+withdrawal before the ejaculation of semen. While this is most
+injurious to the husband-- debility, nervous prostration, and even
+paralysis are said to ensue-- the health of the wife also suffers. If,
+this interrupted sexual congress is continued for years, there develop
+gradual nervous disturbances on both sides, and a serious disease of
+the uterus makes itself felt. The generative organs become engorged
+with blood, but are not permitted to enjoy relaxation consequent upon
+the full completion of the act. This engorgement may lead to undue
+local nutrition, and diffuse growth and proliferation of the
+connective tissue may take place. Hence the uterine walls become dense
+and thickened and the nerves compressed. Of course, pain and
+tenderness and a sense of bearing down will be the result. Flexions
+and versions may be consequent upon the engorgement. The nerves become
+shattered, and the woman will be fortunate if she contracts no serious
+womb trouble.
+
+"It is strange," says John Stuart Mill, "that intemperance in drink or
+any other appetite, should be condemned so readily, but that
+incontinence in this respect should always meet not only with
+indulgence, but with praise. Little improvement can be expected in
+morality until the producing of too large families is regarded with
+the same feeling as drunkenness, or any other physical excess."
+
+Sismondi writes: "When our true duties toward those whom we give life
+are not obscured in the name of a sacred authority, no man will have
+more children than he can properly bring up. If a woman has a right to
+decide any question it is how many children she should bear. Whenever
+it becomes unwise that the family should be increased, justice and
+humanity require that the husband should impose on himself the same
+restraint which is submitted to by the unmarried."
+
+In the opinion of Dr. Edward Reich, it is very much to be wished that
+the function of conception should be placed under the domain of the
+will. But the strongest appeal has been made for the sake of morality
+itself; namely, to prevent the crime of abortion. Dr. Raciborski, of
+Paris, took the position that the prevention of offspring to a certain
+extent is not only legitimate, but it is to be recommended as a means
+of public good.
+
+Continence, self-control, and a willingness to deny himself-- that is
+what is required of the husband. But suffering women assure us that
+this will not suffice; that men refuse to restrain themselves; that it
+leads to loss of domestic happiness, to illegitimate amours; or that
+it is injurious physically and mentally; that, in short, such advice
+is useless because it is impracticable.
+
+Dr. Napheys writes: "Is it amiss to hope that science will find
+resources, simple and certain, which will enable a woman to let reason
+and sound judgment, not blind passions, control the increase of her
+family?"
+
+The Crime of Abortion.-- From the moment of conception a new life
+begins, a new individual exists; another child is added to the family.
+The mother who deliberately sets about to destroy this life by want of
+care, or by taking drugs, or by the use of instruments, commits a
+great crime, and is just as guilty as if she strangled her new-born
+infant. The crime she commits is child-murder. Women in their frenzy
+at finding themselves in this condition, and with no slightest idea of
+the sin that they are committing, are constantly guilty of committing
+abortions on themselves, or going to professional abortionists to have
+this crime of child-murder committed. This is another of the sins due
+to the ignorance of the sex in all matters pertaining to reproduction;
+and it is a fearfully prevalent one.
+
+Infidelity in Women.-- "We have now reached the last infernal circle
+of the divine comedy of marriage; we are at the depths of the inferno.
+There is something, I do not know what, terrible in the situation in
+which a married woman finds herself when an illegitimate love has
+ruined her for the duties of a wife and mother. As has been so well
+and strongly expressed by Diderot, infidelity in woman is like
+incredulity in a priest; it is the last step in human forfeitures; it
+is for her the great social crime, for it implies all the others.
+
+"Weigh the sufferings of the future, the agonies of years by the
+ecstasy of half an hour. If this conservative sentiment of the
+creature, the fear of death, does not stop her, what could be expected
+of laws? Oh, sublime infamy!"-- (Balzac).
+                          _________________
+
+  PART III.-- MATERNITY.
+                          _________________
+
+ CHAPTER X.
+
+ PREGNANCY.
+
+   Nature of Conception; Pregnancy Defined; Duration of Pregnancy; the Signs
+   of Pregnancy; Quickening; the Determination of Sex at Will; the Influence
+   of the Male Sexual Element on the Female Organism; Heredity; Hygiene of
+   Pregnancy; Causes of Miscarriage.
+
+                  "Happy he
+  With such a mother, faith in womankind
+  Beats with his bood, and trust in all things high
+  Comes easy to him, and though he trip and fall,
+  He shall not bind his soul with clay."
+
+                                                         -- TENNYSON.
+
+Nature of Conception.-- Conception, or impregnation, is the union of
+the germ and the sperm cell, the result of which is a new being. On
+coition, the semen being received into the female organs, which are at
+that time in a state of turgescence, the spermatozoa, by means of
+their own vibratile activity, find their way into the Fallopian tubes,
+and here come in contact with the ovule.
+
+The ovule is a minute cell with a transparent membrane, within which
+is the yolk containing the germinal vesicle. The spermatozoon
+penetrates into the ovule and becomes fused with it. The processes of
+development begin at once to occur. There is congestion of the uterine
+mucous membrane out of proportion to the rest of the uterus; the ovum
+finds lodging here, and becomes surrounded by a membrane which
+incloses it in a separate sac.
+
+Pregnancy Defined.-- Pregnancy begins with conception and ends with
+parturition; it provides for the nutrition and the expulsion of the
+embryo and for its nutrition for a short time after birth.
+
+The average duration of pregnancy is ten lunar months, or two hundred
+and eighty days. The date of the confinement is calculated by
+reckoning from the date of the last menstrual flow; count backward
+three months from the date of the first appearance of the last menses;
+to this add twelve months and seven days, five days being for the
+average menstrual duration and two days for the possibility of
+fecundation.
+
+Duration of Pregnancy.-- Many difficulties are experienced in
+determining the date of the expected confinement. As most pregnancies
+occur in married women, we cannot base any calculations on a single
+act of coitus. And even if there was but one, all physiologists agree
+that there is a variable period in different women, and in the same
+woman at different times, between insemination and the fertilization
+of the ovum. It is the moment of fecundation, or the union of the germ
+and sperm cells, which marks the beginning of pregnancy. The
+uncertainty becomes still greater owing to our inadequate knowledge as
+to the length of time during which the sexual elements, the ova and
+the spermatozoa, retain their vitality after liberation from their
+respective sources. While it is not certainly known, it is probable
+that the ovum is capable of impregnation any time during its sojourn
+within the oviduct and before reaching the uterus, or probably for a
+period of about one week from the time of its escape from the Graafian
+follicle. The remarkable vitality of the spermatozoa even under less
+favorable circumstances-- direct observation shows that these elements
+retain their movements for over nine days outside of the body--
+renders it almost certain that their powers of fertilization are
+maintained for a long time after they are deposited within the healthy
+female genital tract; it is believed that the spermatozoa are capable
+of fertilization after a sojourn of three or more weeks within the
+oviduct.
+
+Consideration of these facts renders apparent the impossibility of
+fixing with certainty the date of the beginning of pregnancy, since
+conception may result from the union of the ovum liberated at the
+beginning of the period with the spermatozoon introduced at the end of
+that time; or it may result from the meeting of the male elements
+already within the oviduct with an ovum discharged a day or two before
+the occurrence of the menstrual period.
+
+The Signs of Pregnancy.-- The cessation of the menstrual period is the
+sign of the greatest value in women who have been regular; but it must
+always be remembered that there may be an irregularity of menstruation
+for the first few months after marriage. The appetite is capricious;
+morning sickness or nausea in the morning on first getting up is a
+very common symptom in the early months of pregnancy; enlargement of
+the abdomen; in the first two months of pregnancy the abdomen is
+flattened and the umbilicus is depressed; after this the abdomen
+begins to enlarge. There is also an increase in the size of the
+breasts, with a deepened color of their areolae and later a watery
+secretion. The external genitals become swollen and of a bluish color.
+Feeling of the fetal movements-- that is, the movements of the small
+parts of the child in the womb-- by the mother is not always reliable,
+since gas in the intestines has sometimes been mistaken for this.
+These signs are more valuable when several exist together.
+
+The nausea and vomiting of pregnancy, the so-called morning sickness,
+consists of nausea accompanied often by vomiting or retching of a
+glairy fiuid, showing itself most frequently on rising in the morning,
+but sometimes appearing after breakfast. It is aggravated by the
+assumption of the erect position. It may begin within a few days, but
+as a rule it does not show itself until the fourth week of pregnancy;
+and it generally ceases about the fourth month, rarely persisting
+throughout the entire time. In the majority of cases it does not
+sensibly impair the health. It is a sympathetic disorder reflected
+from the uterus; it is aggravated by indigestible food, by sexual
+excitement, and by emotional disturbances; it is most marked in first
+pregnancies and in women of highly emotional natures. It is not
+infrequently due to some inflammation of the uterus or erosion about
+the external orifice, and disappears on the removal of the cause.
+
+Mammary Changes.-- During pregnancy the mammary glands are in
+immediate sympathy with the growing reproductive organs of the pelvis;
+consequently a genuine physiologic enlargement commences in these
+organs from the beginning of gestation. Their glandular structure
+becomes larger, fuller, and firmer; a sensation of weight or pricking
+is felt by the patient; the veins become more prominent. The nipples
+also become enlarged, more elongated, and somewhat erect. Surrounding
+the nipple is the areola; this becomes darker in color.
+
+In most women a drop of watery fiuid, the so-called colostrum, may be
+squeezed out from the nipple at the end of the third month of
+pregnancy.
+
+The signs of pregnancy are divided into the presumptive, the probable,
+and the positive. The presumptive signs are: menstrual suppression,
+morning sickness, irritable bladder, mental and emotional phenomena.
+The probable signs are: mammary changes, abdominal enlargement,
+changes in the neck of the womb, and certain changes which are felt on
+bimanual examination. The positive signs are: feeling the various
+parts of the fetus, active movements of the fetus, and hearing the
+fetal heart sounds.
+
+Functional disturbances of the bladder are quite often noticeable in
+the early part of the pregnancy. In the first part of the pregnancy
+the bladder is dragged upon, and later it is pressed upon by the
+enlarged uterus so that the bladder capacity is lessened and frequency
+of urination is the result. In the fourth month, when the uterus
+ascends into the abdominal cavity, these bladder symptoms subside,
+until the very close of the pregnancy, when by the descent of the now
+greatly enlarged uterus there may be even incontinence of urine.
+
+Changes in the Abdomen.-- During the first two months of the pregnancy
+there is a flattening of the abdominal surface, due to the descent of
+the uterus into the pelvic cavity, thus slightly dragging the bladder
+downward and drawing the umbilicus inward. In the latter part of the
+fourth month there is noticeable a slight abdominal enlargement, and
+the umbilicus is no longer sunken. By the end of the fourth month the
+base of the uterus has risen two inches above the symphysis, and at
+the end of the thirty-eighth week it touches the lower extremity of
+the breast-bone; the umbilicus has been for many weeks protruding;
+during the last two weeks of pregnancy the uterus again descends and
+the woman feels more comfortable.
+
+On the inspection of the abdomen of a pregnant woman there will be
+noticed a brown line which extends from the umbilicus to the pubes,
+and all over the surface the presence of striae, or long purple
+grooves, due to the distention of the abdomen; on the sides of the
+abdomen and down the thighs, red, blue, or white markings, like
+cicatrices, may be seen.
+
+Quickening.-- Quickening is the sensation experienced by the mother as
+the result of the active fetal movements of the child in the womb.
+These movements are first felt between the eighteenth and the
+twentieth week; the common rule is that quickening occurs at the
+middle of pregnancy; that is, at four and a half months. As pregnancy
+advances these active motions increase in frequency and become more
+marked. When felt or seen by the physician, as can be done in the
+sixth month, fetal movements constitute a positive sign of pregnancy.
+
+The Determination of Sex at Will.-- Although this has always been a
+question of great interest, and the subject of much experimentation,
+no rule can as yet be given by which the parents can know in advance
+of the birth of the child what the sex will be. Dr. Schenck's theory
+is that the ruling factor in determining the sex is the food partaken
+of by the mother.
+
+Furst believes that the differentiation may occur before, during, and
+a little while after the impregnation; that the chances of the
+development of one or another sex in one and the same woman may vary
+before final differentiation occurs. It is impossible to determine the
+sex of the embryo before the tenth week of fetal life. The cause of
+the differentiation, he believes, lies largely in the good or bad
+state of the health of the parents; in the first instance there being
+an excess of females, and in the latter an excess of males, relatively
+speaking. He believes that there is an excess of male children when
+conception takes place during the post-menstrual anemia. He has
+investigated one hundred and ninety-three cases carefully in regard to
+the probable date of conception after menstruation, and there is a
+notable increase of male births over female in the cases where
+conception occurred in the first five days after menstruation; that is
+to say, where the woman is not so well nourished as later.
+
+Dr. J. Griffith Davis gives as the result of her experiments in this
+direction, that when conception takes place three days before the
+menstrual period or within forty-eight hours afterward, the child will
+be a girl; when conception takes place ten days after the period, the
+child will be a boy.
+
+Although there are a greater number of the female than the male sex in
+all parts of the world where reliable statistics have been taken, in
+all civilized countries the proportion of male births is greater than
+that of females. There is a greater tendency of the male offspring to
+die earlier, and this is seen even before birth, in the proportion of
+three to two. For this reason the stronger sex as applied to men has
+been regarded by some authors as a misnomer. They are physically
+weaker in early life and succumb more readily to noxious influences.
+
+The relative age of the parents is said to be another factor in
+determining the sex of the children. Seniority on the father's side
+gives an excess of male children; equality in the age of the parents
+gives a slight preponderance of females; seniority on the mother's
+side gives an excess of females. Men, and especially scholars, who
+pass a sedentary life and who exhaust their nervous force to a great
+extent, beget more girls than boys; so, also, a very advanced age on
+the part of the man diminishes the number of male offspring.
+
+The Influence of the Male Sexual Element on the Female Organism.-- Dr.
+Alexander Harvey, of Aberdeen, has adopted the theory of fetal
+inoculation. He believes that the effect is first due to the influence
+of the male element upon the ovum, which, in consequence of the
+subsequent close attachment and freely inter-communicating
+blood-vessels between the modified embryo and the mother, inoculates
+the condition of the mother with the qualities of the male; and so, on
+the subsequent impregnation by another male, the offspring resembles
+the first male and not its real parent. He even goes further, and says
+that it is conceivable, by successive impregnations effected by him,
+that the influence may be increased, and if so the younger children
+begotten by him, rather than the elder, might be expected, ceteris
+paribus, to bear their father's image. And as regards the mother, he
+suggests the question, whether there is not something in the popular
+notion that in the course of years the wife comes to resemble the
+husband; and that not merely in respect of temper, disposition, or
+habits of thought, but in bodily appearance, which may be referable to
+this influence exerted by the husband on her constitution, through the
+medium of the fetuses in utero.
+
+  "Yet it shall be; thou shalt lower to his level day by day,
+   What is fine within thee growing coarse to sympathize with clay.
+   As the husband is the wife is; thou art mated with a clown,
+   And the grossness of his nature will have weight to drag thee
+  down.
+   He will hold thee, when his passion shall have spent its novel
+  force,
+   Something better than his dog, a little dearer than his horse."
+
+Darwin, on the other hand, considers it a most improbable hypothesis
+that the mere blood of one individual should affect the reproductive
+organs of another individual in such a manner as to affect the
+subsequent offspring. The analogy, he says, from the direct action of
+the foreign pollen on the ovaries and seed coats of the mother plant
+strongly supports the belief that the male element acts directly on
+the reproductive organs of the female, and not through the
+intervention of the crossed embryo.
+
+Dr. John Brown, in reviewing the subject, says it must be conceded
+that the male element has an influence on the female, over and above
+its fertilizing influence upon the ovum. The limit of this influence
+is at present unknown.
+
+Heredity.-- Girls are more apt to resemble their fathers in mental
+traits, disposition, and constitution; while boys take after their
+mothers. Boys procreated by intelligent mothers will be intelligent;
+while it does not always follow that the sons of intelligent fathers
+are intelligent. The poets Burns, Ben Johnson, Goethe, Walter Scott,
+Byron, and Lamartine were all born of women remarkable for vivacity
+and brilliance of language.
+
+Hygiene of Pregnancy.-- The health and perfection of the child depend
+largely upon the health and perfection of the parents at the time of
+its conception, as well as upon the condition of the mother during the
+pregnancy. Even when both parents possess a strong constitution, but
+one or both of them is suffering from a temporary exhaustion or
+malaise, the child will be born below the standard of health it ought
+to possess. Children born during the first year of married life seldom
+equal in health the children born of the same parents later; they are
+not only apt to be sickly, but the liability to premature death is
+greatly increased. For this reason it is better that the first year of
+married life should be allowed to pass without conception taking
+place. A child begotten in an intoxicated or depraved condition of a
+parent may be depraved itself in the same way, and is apt to be
+feeble-minded or idiotic.
+
+It must be borne in mind that prenatal culture of some sort begins at
+the time of conception; and that on the mental as well as on the
+physical state of the mother, the health as well as the disposition of
+the child will depend to no slight extent. The prospective mother who
+constantly gives way to her feelings does a wrong to her unborn child.
+The mother is at this time more impressionable, more nervous, and more
+irritable than is natural to her; and while her family should make a
+certain allowance for her condition, she, on her part, should not
+allow herself to give way to her morbid feelings. The prospective
+mother should not lead a life of self-indulgence, on the one hand, or,
+on the other, should not be weighed down with cares; she should
+interest herself in her usual duties, and be relieved of all anxiety
+possible.
+
+Dress.-- The clothing must be loose, and all compression about the
+waist and abdomen must be especially avoided. If the woman wears
+corsets, she must take them off at once, and substitute a Ferris or
+some similar hygienic waist. The corset prevents the proper
+development of the abdominal muscles, which play so important a role
+in the expulsion of the child from the womb, as well as in the proper
+growth and development of the fetus itself. If the woman has already
+borne children, and toward the end of the pregnancy the abdomen
+becomes pendulous, she will very materially add to her comfort by
+swearing a muslin abdominal bandage.
+
+A woolen undersuit, or undervest and drawers, with high neck and long
+sleeves, must be worn winter and summer; the grade of the wool to be
+adapted to the season of the year. The especial necessity for wearing
+wool next the skin during the pregnancy is because of the intimate
+relation between the skin and the kidneys. Any chilling of the body at
+this time is apt to lead to the congestion of the kidneys. If there is
+already any congestion of the kidneys present, or any abdominal pain,
+in addition to the undersuit an abdominal bandage should be worn.
+These bandages come woven in ribbed woolen, and fit the body snugly.
+This bandage is to be constantly worn, and, of course, changed at
+night. During the cold weather the stockings should also be of wool.
+Under no circumstances are garters allowed to be worn, as they form a
+constriction around the leg and interfere with the return of the
+venous blood to the heart, and so increase the tendency to the
+formation of the varicose veins. It is better not to use any means to
+hold the stockings up; they will be kept sufficiently well in place by
+the under-drawers. Low shoes should never be worn except in the
+hottest weather. It is of the greatest importance that the woman
+should be impressed with the necessity of the avoidance of taking
+cold, since any lung or kidney trouble is a serious complication of
+pregnancy.
+
+Diet.-- The diet is the same as that at any other time, only it is
+more necessary to guard against anything which is likely to cause
+indigestion. In other words, the diet should be plain, simple, and
+easy of digestion; nutritious and partaken of at regular intervals. In
+the latter part of pregnancy owing to the pressure of the enlarged
+uterus on the stomach, the food may have to be partaken of in smaller
+quantities and at shorter intervals. At this time also the appetite is
+abnormally large. Where it does not disagree with the patient, milk is
+the best adjuvant possible to the diet.
+
+Constipation.-- Constipation is the rule of pregnancy. This is due to
+the great pressure that the enlarged uterus makes on the bowel; and as
+important as it is at all times to keep the bowels regular, it is at
+this time more necessary than ever that the woman should have the
+bowels well evacuated every day. A retention of fecal matter in the
+body causes the reabsorption into the blood of the toxic matters, with
+the resulting headaches, dizziness, loss of appetite, and intense
+nervousness. To obviate this tendency to constipation, plenty of fruit
+and vegetables should be eaten, as well as cereals if the woman is
+taking a good deal of outdoor exercise, otherwise the latter had
+better be omitted. The woman should drink plenty of water-- at least
+three pints a day; this acts as a laxative as well as to flush out the
+kidneys. If, in spite of all these measures, constipation still
+persists, as it probably will, a seidlitz powder can be taken the
+first thing on rising in the morning; or from one teaspoonful to one
+tablespoonful of the effervescing granules of the phosphate of soda in
+a glass of water, also to be taken on rising in the morning; or
+one-half grain of the solid extract of cascara sagrada night and
+morning. The object of these is to keep the bowels open, but purgation
+must always be avoided.
+
+Bladder Symptoms.-- If there is any irritability of the bladder, any
+scalding on urination, or a very great frequency of emptying the
+bladder in the early months of pregnancy, a physician should be
+consulted at once; in the last months of pregnancy there is a desire
+to evacuate the bladder frequently, and sometimes at the last there is
+an incontinence of urine, which is due to the descent of the uterus
+and the great pressure on the bladder; this condition disappears with
+the confinement.
+
+Leucorrhea.-- If this is present to any marked degree, the vaginal
+douche should be continued throughout the pregnancy; the temperature
+of the douche should be from 110° to 112° F.; it must never be taken
+very hot or very cold. The fountain syringe should be used, and the
+bag should not be hung more than three feet above the bed, so that
+there shall not be too much force to the stream of water.
+
+Baths.-- Warm tub-baths may be taken throughout the pregnancy, but
+never oftener than twice a week, and the woman should never stay in
+the tub longer than is absolutely necessary for the bath, as otherwise
+the bath is too enervating. A daily sponge-bath of cool or cold salt
+water at a temperature of from 80° to 70° F., and in the proportion of
+a pint of rock or sea salt to a gallon of water is most invigorating,
+and counteracts many of the nervous symptoms and promotes sleep and
+good digestion. The temperature of the room in which this bath is
+taken should be 72° F. Shower-baths cause too great a shock to the
+nervous system, and they as well as foot-baths must be prohibited.
+Sitz-baths at a temperature from 110° to 90° F. may be taken just
+before retiring throughout the pregnancy. The frequency and duration
+of the bath as well as the temperature should be regulated by the
+attending physician. In cases of intense nervousness and insomnia
+these baths have an excellent sedative effect. A pregnant woman must
+never under any circumstances take ocean baths, since there is always
+great danger that the shock of the waves will cause an abortion.
+Sea-voyages should be avoided because of the severe nausea and
+vomiting, as well as the danger that the lurching of the vessel may
+cause miscarriage.
+
+The sewing-machine is a tabooed thing for the pregnant woman, because
+of the jarring of the pelvis which it produces. Sweeping of heavy
+carpets is also injurious. There must be no lifting of heavy pieces of
+furniture, and especially no lifting from the floor, as it interferes
+with the circulation in the uterus and is apt to produce miscarriage.
+
+Driving in an easy carriage over smooth roads is permissible;
+dogcarts, or any conveyance which produces much jolting, must be
+avoided; and while driving is good, the woman should not do her own
+driving, on account of the danger of the jars that would be caused by
+the sudden pulling of the horse upon the lines. Horseback-riding and
+bicycling are, of course, forbidden, as are also golf, tennis, and
+dancing.
+
+Exercise.-- Exercise in the open air should be taken every day, when
+the weather is suitable, and walking is the best form of exercise. The
+amount will be regulated to some extent by what the woman has been
+accustomed to taking, and it should always stop short of fatigue. The
+woman should live as much as possible in the open air, and she should
+attend to her ordinary duties about the house. Long railway journeys
+are always objectionable.
+
+Hemorrhoids or piles are very often troublesome toward the close of
+the pregnancy. To overcome this, the patient should lie down
+immediately after the bowel movement, and remain in the recumbent
+position for ten or fifteen minutes. In addition, care should be taken
+to secure a loose movement of the bowels. Should the piles come down,
+applications of cloths wrung out of hot water, and held well pressed
+against the bowel, should be made; the piles should then be pressed
+back until the finger feels that the mass has been pushed above the
+second constriction of the bowel, which is felt to exist at about two
+inches above the sphincter ani muscle. Should these means not suffice,
+the physician must be consulted at once.
+
+Swelling and pain of the external genitals and of the lower limbs are
+best relieved by the recumbent position. Should the veins of the legs
+be much enlarged or the feet swollen, the patient should have
+compression made by the wearing of elastic stockings. Or in some cases
+a bandage is sufficient; in this case the bandage may be made of
+muslin; it should be three inches wide, and, beginning at the toes,
+should extend up as high as the enlargement of the veins continues.
+This bandage should be freshly applied every morning before rising.
+
+Pain caused by the stretching of the skin may be relieved by the
+inunction of the skin with cottonseed or cocoanut oil. For severe pain
+in the small of the back, rubbing with soap liniment or alcohol will
+be found useful.
+
+Mental Occupation.-- Important as this always is, it is doubly so now.
+The mind should be constantly and pleasantly occupied, but no severe
+study should be indulged in. The emotional susceptibility is generally
+somewhat increased. The pregnant woman, quite excitable and irritable,
+readily responds to influences by which in the non-gravid condition
+she could not be affected. Sometimes she feels unusually well, is
+intellectually brightened and more active, and says she is positively
+happier. At other times she is despondent and morose.
+
+Physiologists admit and observation proves that maternal emotions do
+affect the development and the exterior of the fetus; likewise the
+mental organization of the fetus may be affected. All unpleasant news,
+frights, and physical shocks, also scenes of suffering and distress,
+must be avoided, as the mind is particularly impressionable at this
+time. Around the patient should be thrown a gentle and protective
+care, and she should be treated with the considerate kindness which
+her condition demands. Theatres and all places where there will be a
+large assemblage of people should be avoided, as the close air and
+general bad ventilation are apt to produce vertigo and sometimes
+attacks of fainting.
+
+Sleep.-- During pregnancy a large amount of sleep is required; there
+should be eight hours spent in sleep at night, and one hour every
+afternoon. Pregnant women should never do any night watching. There is
+unusual necessity for good ventilation during sleep at this time.
+
+The Marital Relation.-- Coitus is, as a rule, distasteful to pregnant
+women. It is for the best interest of the wife as well as for that of
+the child that all marital relation should be suspended at this time.
+Even uncivilized nations have condemned the privilege of sexual
+intercourse during pregnancy, and have visited punishment on the
+offender. If these relations are not wholly suspended, they must at
+least be at those periods which correspond to the time at which the
+woman would have been unwell had she not been pregnant. To the
+continuance of these relations throughout the pregnancy is due much of
+the suffering of the wife, not only then, but at the time of the labor
+as well; and the nourishment of the child is interfered with.
+
+Causes of Miscarriage.-- Hemorrhoids; straining at stool; excessive
+intercourse in the newly married; nursing; ocean-bathing;
+overexertion; overexcitement; a fall; any violent emotion; anger;
+sudden or excessive joy; a fright; running; dancing; horseback-riding;
+riding in a heavily built carriage over rough roads; great fatigue;
+lifting heavy weights; the abuse of purgative medicines; disease or
+displacements of the womb; and a general condition of ill health.
+
+The danger of miscarriage is greatest during the first three months of
+pregnancy. Miscarriage is a fruitful source of disease and often of
+danger to wives; it is said that thirty-seven out of every hundred
+pregnant women miscarry. Miscarriage is most apt to occur during the
+first pregnancy; and great care should be taken to prevent this, as
+the habit is easily established, and after one miscarriage has
+occurred, another is likely to follow, so that it is sometimes with
+the greatest difficulty that the woman can be made to carry the fetus
+to full term. Artificially produced abortions are not an infrequent
+cause of sterility; the young wife becomes pregnant, and has an
+abortion produced because she is not yet ready to give up all her
+pleasures; and eventually when she does become very anxious to have a
+child such an extent of uterine disease has been produced by the
+abortions that she cannot conceive.
+
+To Prevent Miscarriage.-- The life must be free from all excitement,
+and must be as quiet as possible without becoming monotonous; especial
+care must be exercised at the return of the dates for the menstrual
+periods.
+
+The symptoms of miscarriage are a show of blood, more or less profuse,
+with intense abdominal pain; on the slightest show of blood the
+patient should go to bed at once and the physician should be sent for.
+
+  CHAPTER XI.
+
+ THE CONFINEMENT.
+
+   Preparation for the Confinement; Signs of Approaching Labor; Symptoms of
+   Actual Labor; the Confinement-bed; the Process of Labor.
+
+  "To my conception one generation of educated mothers would do more
+  for the regeneration of the race than all other human agencies
+  combined; and it is an instruction of the head they need, and not
+  of the heart. The doctrine of responsibility has been ground into
+  Christian mothers above what they are able to bear."
+
+                                          -- ISABELLE BEECHER HOOKER.
+
+Preparations for the Confinement.-- The right time to engage the
+physician who is to take charge of the woman at her confinement is
+just so soon as the woman knows that she is pregnant. It used to be
+argued that, since giving birth to children was a physiologic process,
+there was no necessity for the woman to consult the physician until he
+was sent for when the labor pains began. Take the case of the woman
+who is for the first time pregnant; she is absolutely at sea; she has
+not the least idea how she ought to feel, what she ought to do or to
+leave undone; the result is that she often has a miscarriage which is
+the source of the greatest disappointment to her husband and herself,
+or she suffers very unnecessarily throughout the entire pregnancy, has
+a difficult labor, and perhaps gives birth to a sickly child.
+
+The educated physician will explain to her what symptoms are normal
+and what are pathologic, and often he will be able to entirely cure
+the latter. It is now a well-established fact that the most serious
+complications of the pregnancy, and of the labor itself are caused by
+severe congestion or disease of the kidneys. The condition of the
+kidneys can only be determined by frequent examinations of the urine;
+during the early months of pregnancy these examinations are made once
+a month, and during the last month they are made every week. The
+amount of urine passed in the normal condition is three pints a day.
+
+Nowhere, perhaps, is the constant vigilance of the physician so well
+rewarded as in the careful oversight of the pregnant woman. She goes
+through her entire pregnancy feeling well, and often the greatest
+discomfort that she suffers is due to her size; her labor and her
+lying-in are normal, and she gives birth to a healthy child.
+
+Engagement of the Nurse.-- This is generally left to the physician in
+charge of the case, since he is responsible for the safe delivery of
+the woman; but if the patient has any decided choice in the matter, it
+is acceded to unless there should be some very valid objections, and
+the physician always sends the nurse in view for that case to see the
+patient in order to ascertain if she is personally agreeable to the
+patient.
+
+Choice of Room for the Confinement and Lying-in.-- The room should be
+light, sunny, and well ventilated; it should not be too near a
+water-closet. In the city as quiet a room as possible should be
+selected, and one that is well removed from the rest of the house, so
+that if necessary perfect quiet can be maintained. The room should be
+as cheery as possible.
+
+The dress of the mother during the lying-in consists of a merino
+undervest, with high neck and long sleeves, and a nightgown, which
+shall be open all the way down the front. The gowns should be made of
+light muslin or of cambric; and there should be a sufficient number so
+that they may be changed every day.
+
+Six abdominal bandages should be provided. These are made of light
+muslin, and they should be eighteen inches wide and long enough to go
+once and a third around the patient's hips at the sixth month of
+pregnancy, or about one yard and a quarter long; they may be made
+straight or to fit the patient at the sixth month. This bandage is
+fastened down the front; it is applied directly after the labor, and
+adds greatly to the patient's comfort during the lying-in.
+
+The vulvar pads used during the lying-in are the antiseptic absorbent
+pads which can be obtained at any place where surgical dressings are
+sold; they are made of absorbent cotton, covered with cheesecloth, and
+sterilized.
+
+There must be a sufficiently generous supply of sheets so that they
+can be changed every day, and the drawsheet as often as may be
+required. Nothing is so important to a good lying-in as to have a
+clean, well-ventilated room, and plenty of fresh bed-linen.
+Cleanliness is the first requisite to antisepsis, and this is the
+secret of avoiding puerperal fever.
+
+Articles to be provided for the confinement are:
+ 1. An oblong douche-pan of agate-ware.
+ 2. An agate bed-pan.
+ 3. A bath thermometer.
+ 4. Two pieces of rubber sheeting; one, one yard square, and the other
+    two yards square.
+ 5. Two sterilized bed-pads, 30 inches square by 3 to 4 inches thick.
+ 6. Three dozen antiseptic absorbent pads.
+ 7. One pound of sterilized absorbent cotton; twelve yards of
+    cheese-cloth.
+ 8. Six abdominal bandages, eighteen inches wide, preferably made to
+    fit the figure at the sixth month of gestation.
+ 9. Two hand-scrubs.
+10. Four ounces of the tincture of green soap.
+11. Bottle of corrosive sublimate tablets.
+12. Four ounces of powdered boric acid.
+13. Half a pint of good whisky.
+14. Two ounces of aromatic spirits of ammonia.
+15. Two ounces of aqua ammonia.
+16. One pint of alcohol.
+17. Two tubes sterilized white vaselin.
+18. Plenty of large and small safety-pins.
+19. Hot-water bag.
+20. New fountain syringe, to hold four quarts; with glass nozle.
+21. One small basin for vomited matter.
+22. Two very large agate basins or wash-bowls for washing doctor's
+    hands and for antiseptic solutions.
+23. Vessel for after-birth.
+24. Three large pitchers; one for boiling water, one for cold boiled
+    water, and one for antiseptic solution.
+25. Tumbler for boric acid solution for washing baby's eyes, with fine
+    old linen sterilized.
+26. One dozen freshly laundered sheets, and two dozen towels.
+27. Stocking-drawers, muslin.
+28. Change of night-clothing warmed for the mother.
+29. A warm blanket to receive the baby.
+30. An infant bath-tub.
+31. A large piece of oil-cloth to protect the floor.*
+
+* Van Horn & Co., Park Avenue and 41st Street, New York, keep an
+obstetric outfit, containing many of the above articles, cleansed,
+sterilized, and packed in a box ready for use, so that they remain
+intact until needed. The price of this outfit is $16.50.
+
+Baby's Outfit.-- Four flannel bandages, to be made of fine, soft
+flannel, four inches wide, to go once and a third around the body. The
+edges may be pinked or whipped, but should never be hemmed; a tape is
+sewed on double, the ends passing around the body, and so the bandage
+is fastened without pinning.
+
+Six merino shirts, with high neck and long sleeves, made to button
+down the front.
+
+Cotton diaper napkins, not too large; old soft ones are preferable.
+
+Long merino stockings which can be pinned to the napkin.
+
+Flannel petticoats, not too long; these may be made on muslin bands,
+which are held up on the shoulders by means of straps. The essential
+in all the clothing is that it should be sufficiently loose.
+
+Dress-slips should not be so elaborate that they cannot be washed and
+changed with sufficient frequency; and not so long that the baby's
+feet will be hampered in their movements by them. All of baby's
+clothes but the dress should be fastened by safety-pins.
+
+Baby's basket should contain:
+ 1. One outfit of clothes.
+ 2. One tube of sterilized tape.
+ 3. A pair of blunt-pointed scissors.
+ 4. Large and small safety-pins.
+ 5. Pieces of fine old linen; old handkerchiefs are the best.
+ 6. A soft hair-brush.
+ 7. A powder box and puff, with talcum powder.
+ 8. Two tubes of sterilized white vaselin.
+ 9. Two soft towels.
+10. Castile soap.
+11. Single-bulb syringe; so-called "eye and ear syringe."
+12. A woolen shawl or wrap.
+
+If there is no nurse available before the labor sets in, and it is
+necessary for the patient to see to the sterilizing of the above
+articles, she should first scrub off all pitchers, basins, and other
+utensils, as well as the douche-pan, fountain syringe, and rubber
+sheeting, with a brush and hot soap-suds; the hand-scrubs are to be
+well washed; then each article should be pinned separately in coarse
+towels, and put to boil for half an hour in an ordinary wash-boiler.
+The articles so boiled are then dried without removing the towels, put
+away, and not opened till the time of the labor.
+
+The abdominal bandages must be laundried and pinned up in separate
+towels until they are needed. The cheese-cloth must be laundried and
+then sterilized.
+
+The vulvar pads should be pinned in an old napkin, in packages of half
+a dozen each; and one package is sterilized at a time by placing it in
+the oven until the outer covering is scorched. The linen for the
+baby's eyes and the cheese-cloth are treated in the same way; they are
+to be cut up into small pieces and sterilized as needed.
+
+Signs of Approaching Labor.-- About two weeks before labor there is a
+sinking of the womb. At the beginning of the ninth lunar month this
+was at the end of the breast-bone; it now descends to a point midway
+between this and the navel; the abdomen becomes smaller, the pressure
+on the lungs is relieved, and the woman breathes more freely. But at
+the same time that the woman is relieved of the pressure on the chest,
+she experiences increase of the troubles in the lower extremities.
+There is an increase of the bladder symptoms, with a desire for
+frequent unrination. Constipation becomes more troublesome, and there
+may be hemorrhoids; the veins of the lower extremities may become
+greatly enlarged.
+
+There is an increased fullness of the external genitals and a greatly
+augmented amount of mucous discharge. There is a feeling of anxiety
+and nervousness, with depression of spirits.
+
+During the last two weeks of pregnancy patients are apt to have
+cramp-like pains in the lower part of the abdomen. These are often
+mistaken for labor pains. True labor pains are characterized by
+starting in the back, extending around the abdomen and toward the
+pubes and down the thighs; they come at more or less regular intervals
+of half to three-quarters of an hour, and increase in intensity with a
+decrease in the intervals. A strong pain is apt to be followed by two
+weaker ones. The so-called false pains are irregular in their
+occurrence.
+
+Symptoms of Actual Labor.-- First is generally the show; this is a
+discharge of mucous tinged with blood; at the same time the true labor
+pains set in. When the patient or nurse is in any doubt as to the
+character of the pains, or when the show appears, the physician should
+be summoned at once. Other symptoms are frequent desire to empty the
+bladder and bowels, and a sensation of shivering.
+
+The Confinement-Bed.-- A single bed is much more convenient, but it is
+rarely found in a private house. The double bed is arranged as
+follows: The hair mattress is covered with a large rubber sheet, which
+is pinned with safety-pins at the corners and tucked well under the
+mattress; the rubber sheet must not be drawn too tightly for fear of
+tearing. Over this comes the sheet, and over the upper half of the
+bed, the draw-sheet; this is a sheet folded four double, which goes
+across the bed so as to come under the hips of the patient, and is
+tucked under the mattress at both sides. The object of this is so that
+it may be frequently and easily changed without disturbing the
+patient. The sheet, blanket, and spread which are to serve as a
+covering after delivery are folded back and placed on the left side of
+the bed.
+
+The lower right-hand corner of the bed-- the right side of the bed is
+that side which is toward the right hand as one stands facing the
+foot-board-- is arranged for the confinement; on this is fastened the
+smaller rubber sheet, and over this the sheet is folded, and both are
+fastened down with safety-pins. The pillow for the patient should be
+placed at the upper and inner corner of the square. After the delivery
+the patient is lifted to the upper part of the bed and the temporary
+dressing is removed. A sheet and blanket are used for a covering
+during the confinement.
+
+Before the labor begins it is well to fasten up the vest and gown, so
+that they will not be soiled, as it is important that the patient
+shall be moved as little as possible after the labor, as all movements
+tend to increase the bleeding.
+
+The floor oilcloth must be spread at the side of the bed which is made
+up for the confinement, and should extend slightly under the bed.
+
+A bureau in the room should contain the mother's and baby's clothing,
+bed-linen, towels, and any other articles which will be needed, all
+properly arranged.
+
+The clothing for the mother and baby will be placed where it will keep
+warm, and the infant bathtub will be in readiness in case of sudden
+need for it.
+
+All water used about the confinement must have been carefully
+sterilized in advance. The best way to sterilize the water is by
+boiling it in a large wash-boiler; whatever vessel is used must be
+scrupulously clean, and ought to be new. The vessel is covered over,
+and the water is allowed to boil for half an hour; it is then, still
+covered, set aside to cool. There should be three gallons each of
+sterilized hot and cold water; since in case of an emergency there
+must be plenty of water ready for use.
+
+The various articles ordered in the confinement outfit will be at hand
+ready for use. It is the duty of the nurse to have everything ready
+for the doctor before his arrival. The patient should have a full warm
+tub-bath, fresh night-clothes put on, and an enema should be at once
+given to unload the bowels, and this even though there may have been a
+bowel movement only a few hours previously. The patient should remain
+in bed until the arrival of the doctor. After an examination has
+assured the latter that all is right, she may be allowed to go around
+the room, with a wrapper thrown on over the night-gown.
+
+Conveniently near the bed should be a small table, covered with one or
+two freshly laundried towels. This table should have on it a
+wash-basin, a hand-brush, soap and hot water, an antiseptic solution,
+scissors, a ligature for the navel, and a suitable aseptic lubricant
+for the hands.
+
+The Process of Labor.-- The process of labor is divided into three
+stages. The first stage is that of dilatation; by which is meant the
+stretching of the mouth of the womb so that the child may pass
+through. At the first confinement this stage lasts about fifteen
+hours; at subsequent labors the length of this stage is much shorter,
+the average time being eight hours. The pains during this stage are
+sharp and cutting, and they are accompanied by a slight show of blood.
+The patient is fretful and nervous
+
+The second stage of labor is called that of expulsion, because in this
+stage the uterus contracts down together with the abdominal muscles to
+expel the child from the womb and the vagina into the world. The
+duration of this stage in the first confinement is about an hour and a
+half.
+
+The third stage of labor includes the time from the expulsion of the
+child till the coming away of the after-birth; the average length of
+this stage is from twenty minutes to half an hour.
+
+The average length of time for the first labor is seventeen hours; and
+for subsequent labors from eight to eleven hours.
+
+The bag of waters is the sac of membranes in which the child is
+inclosed. It contains a liquid in which the child floats; the object
+of the water is to protect the child from sudden shocks or any kind of
+injury during pregnancy. During labor this membrane with its contained
+water serves as a dilating wedge to assist in the opening of the womb,
+and it also protects the child from the direct contraction of the
+uterus upon it. When the waters break prematurely, the labor is much
+longer and more tedious; normally this should not occur before the
+mouth of the womb is fully dilated.
+
+The pains of the second stage of labor are of a bearing down
+character, and constantly increase in force and frequency; the climax
+being reached as the head passes through the vulvar orifice.
+
+A child usually lies in the womb with the head downward; the reason of
+this is that there is more room in the upper part of the uterus, and
+as the small parts of the child as it is folded upon itself take up
+the most space, they occupy this position, while the head lies just
+above the pubes. The normal position of the child is: the head is
+flexed on the chest, the legs on the thighs and the thighs on the
+abdomen, and the hands are folded across the chest. And so the child
+is usually born head first.
+
+During the stage of expulsion the head of the child is forced down
+slightly during each pain, to recede a little during the intervals
+between the pains; in this way the vagina and its external orifice are
+gradually stretched so that the head of the child may pass through
+without tearing the parts. If the head is allowed to pass through
+suddenly, or where the labors are rapid, as in the case of women who
+have given birth to several children, much mischief may be done by
+tearing the soft parts.
+
+After the birth of the head there is a short interval of rest, when
+the shoulders are born; the rest of the body easily slips out; and
+with the expulsion of the after-birth the labor is over.
+
+At the very beginning of labor the patient should be given a full warm
+tub-bath, and make an entire change of linen. She will usually prefer
+to be dressed in her night-clothing, over which during the first stage
+she may wear a loose wrapper; a sterilized napkin should be worn over
+the vulva during this stage. During the first stage, as a rule, the
+patient should not be confined to bed until the dilatation is well
+advanced; she is generally more comfortable if she is allowed to move
+around the room, and the pains are thereby advanced.
+
+The only way in which the physician can determine whether labor has
+begun is by making an internal examination; and this will enable him
+to decide as to whether it is necessary to remain or not.
+
+The nurse should always wear a wash dress in the confinement and
+lying-in room.
+
+If the labor is long, nourishment in the form of beef-tea, broths, and
+milk may be given. No stimulants should be given without the direction
+of the physician. The frequent taking of cold water is permissible.
+
+At the beginning of the labor the family and friends must be excluded
+from the room, and it must be kept as quiet and as cheerful as
+possible.
+
+Toilet of the Patient.-- The newly born child is received in a small
+blanket, is well wrapped, and laid in a warm place. The nurse then
+turns her attention to the mother; the external genitals and soiled
+parts of the body are cleansed with sterilized cheese-cloth wrung out
+of an antiseptic solution; if the body-linen has become soiled, it is
+also changed, and all blood-stained articles are removed from the bed.
+The patient is then carefully lifted up on the permanent bed, and the
+vulvar pad and the abdominal bandage are applied; after which the
+patient is allowed to rest.
+
+  CHAPTER XII.
+
+ LYING-IN.
+
+   Management of the Lying-in; Lactation; Nursing.
+
+  "'Tis is ourselves that we are thus or thus. Our bodies are our
+  gardens; to the which, our wills are gardeners."-- "Othello."
+
+Management of the Lying-in.-- Immediately after the delivery the first
+essential for the patient is absolute quiet and rest; the room must be
+kept quiet and darkened, and ordinarily the patient is allowed to fall
+into a light sleep. During the first few hours after labor the best
+position for the mother is flat on the back, with only a small pillow
+under the head. After the first twenty-four hours the patient may be
+allowed to turn on the side as she prefers. Since absolute rest is the
+first requisite for the patient, she must be left alone with the
+nurse, who must see that she does not fall into too deep a sleep. If
+the child's cries disturb the mother, it must be taken into another
+room.
+
+The lying-in room must be kept free from all odors, all soiled
+clothing must be at once removed from the room, and good ventilation
+must be insured, being careful to prevent any drafts.
+
+While the patient is asleep, and after the baby has been attended to,
+the nurse should place all blood-stained articles in cold water to
+soak. If in the city, the after-birth may be burned in the furnace or
+range; it should be well covered with coal. In the country the
+after-birth can be buried in a deep hole.
+
+During the first two or three days the vulvar dressings should be
+changed from every three to six hours, and at all times as often as
+they are soiled. Each time that the dressing is renewed the external
+genitals and their immediate surroundings are to be carefully cleansed
+with sterilized water, and finally washed with a solution of boric
+acid, in the proportion of one tablespoonful of boric acid to one
+quart of water. It is convenient to keep this solution mixed and on
+hand, as it takes some little time to prepare it; it should be kept in
+a strength double that which is desired, so that it may be diluted
+with warm water to give the desired temperature. This solution may be
+poured over the parts from a small pitcher, the douche-pan having been
+placed under the patient before the washing began. After labor the
+vulva is very sensitive, so that while the greatest care must be used
+to remove all clots of blood and the discharge, there must be no brisk
+rubbing of the parts. No blood-stained linen should be permitted to
+remain about the patient or the bed.
+
+Since the lying-in woman perspires freely, her skin ought to be
+frequently cleansed by sponging with a weak solution of alcohol in
+tepid water; this should be followed by friction with a towel until
+the skin is in a glow. Cleanliness of the bed is promoted by the use
+of a draw-sheet, which is a sheet folded to four thicknesses and
+placed beneath the patient's hips in such a way that the upper edge of
+the sheet shall come under the lower part of the pillows. Air and
+light must be freely admitted at all times in order that the room may
+be bright and cheerful. For the first few weeks the eyes of the
+new-born infant should be shielded from all strong light.
+
+Visitors.-- For the first week after the confinement the patient
+should see no visitors. Even the husband or mother should not remain
+in the room long at a time. Nothing of a disagreeable nature should be
+told to the patient; and whoever goes into the sick-room should always
+carry the most cheerful manner, as it is highly necessary that the
+patient should be kept mentally as well as physically quiet at this
+time.
+
+Diet.-- For the first twenty-four hours the diet must be restricted to
+liquids, and in most cases nothing is given until the patient has had
+a few hours' rest. The first thing that is given to the patient should
+be a cup of warm milk or tea. Milk is the best diet; this may be
+varied with beef-tea, bouillon, mutton or chicken broth; any of these
+broths may be made with rice or barley to vary the flavor, but these
+must not be given to the patient. The patient should have six ounces
+of the liquid every two hours during the day and every three hours
+during the night.
+
+On the second day bread well toasted through may be added to any of
+the liquids. On the third day stewed or baked apples should be added
+to the diet. On the fourth day, and from this on, the patient will
+have regular meals, but the diet must be a plain one. For breakfast,
+stale bread, a soft-boiled egg, fruit, and a cup of tea, not too
+strong. For dinner, which should always be given in the middle of the
+day, an oyster-stew or clam broth, a lamb chop, or a very small piece
+of beefsteak or chicken; but with these there must be no gravies or
+dressings; a potato baked in the skin; raw tomatoes, if in season;
+apple sauce or cranberry; celery; junket, plain corn-starch, lemon
+jelly, plain cup-custard. From this list the diet must be arranged so
+as to give as much variety as possible from day to day. Midway between
+breakfast and dinner, and again in the middle of the afternoon, the
+patient should have a glass of milk. The diet should be generous, but
+simple.
+
+Urination.-- The feeble condition of the bladder in the first few
+hours after delivery frequently leads to the retention of urine. Owing
+to the copious secretion of urine which is so common at this time,
+painful and injurious distention of the bladder may result. The
+patient should therefore endeavor to pass her urine in at least six
+hours after labor, whether she feels any inclination to do so or not;
+the sound of running water or warm fomentations over the bladder, warm
+water in the douche-pan, and moderate pressure applied by the hand
+over the suprapubic region, are often effective in accomplishing the
+desired result. If all these means fail, the catheter must be used as
+the last resort. During the entire lying-in the bladder should be
+emptied every six hours.
+
+Evacuation of the Bowels.-- There should be an evacuation of the
+bowels in from twenty-four to thirty-six hours after the labor. For
+this purpose a seidlitz powder may be given, or the liquid citrate of
+magnesia. If this does not suffice, an enema of warm water, to which a
+little soap or two teaspoonfuls of glycerin have been added, may be
+given. Two pints of water should be prepared; the patient will retain
+as much as she comfortably can, and as long as she can. The bowels
+should be opened daily after the first day.
+
+After-pains are caused by the same physiologic process that causes
+labor pains-- namely, by the contractions of the uterus. After the
+first confinement the after-pains are, as a rule, not severe;
+attention to the regular emptying of the bladder and bowels also
+lessens the severity of the after-pains; these pains seldom last after
+the second day.
+
+The Lochia.-- The discharges of the mother continue for about two
+weeks, and are called lochia. For the first twenty-four hours they are
+pure blood; the second and the third day they are of the character of
+bloody water; from the fourth to the sixth day they have a,
+greenish-yellow color, and from the tenth to the twelfth day they
+become pure white. Soiled napkins and dressings should never be
+allowed to remain in the patient's room.
+
+Duration of the Lying-in.-- This lasts for six weeks. During this time
+the organs of generation are returning to their normal size and
+condition. In order that the woman may be in the best condition
+possible at the end of this time, it is essential that for the first
+two weeks she should remain in bed; and so long as there is any blood
+in the discharge the woman should not be allowed to sit up. The first
+sitting up should be in bed, the patient being supported by a
+bed-rest. During the second two weeks the patient may be allowed to
+divide her time between the bed and the couch; in the latter part of
+this time she may be allowed to go around her room a very little; and
+for two weeks more she should remain on the same floor. The first
+sitting up should not last more than half an hour. Getting up and
+going around too soon after the confinement, "being too smart," is one
+of the most prolific sources of falling of the womb, and all manner of
+uterine trouble, by which the general health of the woman is greatly
+impaired.
+
+Lactation.-- If it is at all possible, every mother should nurse her
+own child; in the interests of both the mother and the child. So far
+as the mother is concerned, the process of lactation is beneficial
+because it hastens the return of the uterus to its normal size.
+Wet-nurses are known tyrants, and if the quality of the milk has
+anything to do with the disposition of the child, as is believed to be
+the case, the idea is distasteful of having a woman who belongs to the
+lower classes provide nourishment for your child; and artificial
+feeding is one unmitigated trouble.
+
+A deficiency of the quantity or the quality of the mother's milk can
+generally be remedied by the diet and attention to the health of the
+mother; if the deficiency in quantity persists, the mother's milk can
+be supplemented by artificial feeding.
+
+There may exist certain conditions of the mother in which nursing her
+own infant would be inadvisable or even impossible. Syphilis
+contracted late in the pregnancy, and tuberculosis, are
+contraindications, owing to the danger of the mother infecting the
+child. Inversion of the nipples, their excoriation, or persistent
+sensitiveness may make it impossible. In marked general debility of
+the mother from any cause whatever, it would be injurious to the
+mother and the child.
+
+After the mother and the new-born infant have had some hours of rest
+and sleep, it is advisable to apply the child to the breast, to
+receive by this first effort the small quantity of milk which is an
+especial provision to act as a natural purge and to start the bowels
+of the child into a healthy activity; this also excites the milk
+glands to secretion. The mother's milk in full supply may be expected
+in from forty to sixty hours after delivery.
+
+Nursing.-- When the mother's nipples are of the normal size and well
+formed, the healthy infant instinctively suckles at once when placed
+at the breast, but sometimes it has to be taught; by squeezing out a
+few drops of milk to wet the nipple, the child will usually take hold,
+or a little sugar and water may be put on the nipple; a little
+patience and tact are all that is necessary to insure success. But the
+infant must be taught to nurse at once before the breasts become
+engorged with milk.
+
+Under ordinary circumstances the child is to be kept at the breast for
+one year. But if within this time the menstrual period should recur
+and be profuse, or should the woman again become pregnant, the quality
+of the milk becomes poor, and necessitates the immediate weaning of
+the child; the character of the milk is also altered, and even its
+secretion may be checked. Nervous agitation may so alter the quality
+of the milk as to make it poisonous. A fretful temper, fits of anger,
+grief, and sudden terror not only lessen the quantity of the milk, but
+render it thin and unhealthful, inducing disturbances of the child's
+bowels, diarrhea, and so forth.
+
+Position of the Mother When Nursing.-- When in bed in the recumbent
+position, the mother should lie on that side from which the infant is
+going to nurse; when up, the mother should sit erect.
+
+Care of the Nipples.-- Immediately after each nursing the nipples
+should be washed off in a saturated solution of boric acid in cold
+water, and dried with a soft cloth. If they are disposed to crack,
+anoint them with cocoa-butter immediately after each cleansing. If the
+skin of the nipple is very sensitive, a nipple-shield should be used
+for the first few days; or should the nipple become sore at any time,
+the shield can be resorted to. The nipple-shield must fit tightly; the
+best ones are made of glass with a rubber tip. In the intervals of
+nursing the nipple-shield should be kept in cold water after it has
+been thoroughly cleansed by being brushed on both sides.
+
+The breasts are sometimes distended from an over-secretion of milk;
+this is relieved by saline cathartics, by abstinence from liquids, and
+by the use of a compression breast bandage. This is made of a straight
+piece of muslin, with a shallow notch cut in one edge for the neck,
+and, a deep one for each arm; the bandage is closely applied over the
+breasts, and the ends pinned in front; it is also pinned over the
+shoulders.
+
+In debilitated women the supply of milk may be insufficient; the most
+reliable evidence of this is the fact that the infant ceases to gain
+in weight.
+
+  CHAPTER XIII.
+
+ THE NEW-BORN INFANT.
+
+   The Infant's Toilet; the Crib; Feeding of Infants; Artificial Feeding;
+   the Wet-nurse; Characteristics of Healthy Infants; the Stools;
+   Constipation; Urination; Dentition.
+
+  "O thou child of many prayers,
+   Life hath quicksands; life hath snares."
+
+                                                       -- LONGFELLOW.
+
+The Infant's Toilet.-- So soon as the mother has been made
+comfortable, the toilet of the infant is attended to. This should be
+made near the register or stove; and the lap of the nurse should be
+covered with a small flannel blanket. The baby's body will be found to
+be covered over with a white, greasy, somewhat cheesy substance; some
+sort of grease is needed for its removal; rendered lard, sweet oil,
+and lanolin are the best; vaselin is less effective. All of this
+cheesy substance must be at once removed; the most difficult parts
+will be in the folds and creases. The nurse should grease the palms of
+her hands, then take the head of the child between them, and
+thoroughly grease it; particular attention must be given to the ears;
+then come the neck, shoulders, arms, chest and back, groins, external
+genital organs, and lower extremities. After the child has been
+thoroughly gone over, the grease should be rubbed off with a soft
+towel.
+
+A rectal injection of one tablespoonful of warm water is given at once
+to unload the bowels of the meconium; this generally acts before the
+baby's toilet is completed. The meconium is the first discharge from
+the infant's bowels after birth, and that which had collected in the
+intestines during the pregnancy.
+
+The Baby's Bath.-- The baby's bath-tub is filled about one-third full
+of water at a temperature of 100° F., tested by the thermometer. The
+baby is then gradually immersed in the water, with the exception of
+the head; this is supported on the left wrist of the nurse, which
+passes under the infant's neck, while her hand grasps the left
+shoulder; with the right hand the nurse quickly rubs over the child's
+head and body; the entire bath should not occupy over five minutes.
+The infant is then lifted out into the lap of the nurse, on which is
+spread a soft, warm towel, with which it is carefully dried. One of
+the important points in giving the infant its bath is to be sure that
+the groins, arm-pits, and genitals are thoroughly well dried;
+otherwise excoriation at these parts is sure to occur.
+
+After this a daily tub-bath is given in the same way; soap is rarely
+needed; when it is, castile soap should be used; its constant use is
+not necessary and would only irritate the skin. These daily baths
+strengthen the nervous system and prevent coughs and colds. The bath
+should be given during the morning, one hour after feeding, and should
+not last more than five minutes. The mother herself, just as soon as
+she is able to go around, should superintend the bath; in this way she
+is assured that if properly given, and will also recognize any
+incipient affection of the child. These daily baths should be
+continued till the child is four years old. Powder is not essential;
+but if it is desired, a plain talcum powder may be used.
+
+The Dressing of the Cord.-- After the bath the ligature which was tied
+around the cord at the birth of the child will be found slightly
+loosened; this should first be made tight, and then the cord, doubled
+back on itself, should be tied by the ends of the same ligature. A
+square of soft sterilized linen or gauze is slit up to its center; the
+cord is allowed to pass through this slit, which looks toward the
+child's right; the stump of cord is laid on the left and the ends of
+gauze are folded over this; the whole is kept in place by the
+abdominal bandage. As there is some exudation from the cord, it is
+necessary to change these dressings twice a day; as this exudation is
+of a somewhat gluey nature, it will be found that the dressings stick
+to the cord. In removing the gauze great care must be used not to make
+any traction on the cord; when the infant is placed in the bath, the
+water loosens the dressing and it falls off in the water; at other
+times it must be removed with the greatest care. There should never be
+any odor about the cord; it usually drops off about the fifth day.
+
+The process of ulceration by which the cord falls off leaves an open
+surface on the child's body which offers an avenue for septic
+infection. Great care must therefore be taken that the nurse's hands
+or anything which comes in contact with this surface should be
+perfectly clean. The dressings used must be thoroughly antiseptic.
+
+Care should be used not to fasten the abdominal bandage too tightly;
+the bath is given on an empty stomach, and allowance should be made
+for this; the binder should be loose enough to allow two or three
+fingers to easily slip under it.
+
+The Meconium.-- The First discharge that comes from the bowels is of a
+dark, greenish color, and should come away during the first
+twenty-four hours; if it does not, the baby may suffer a good deal of
+pain, and an enema of warm water must be given. As this substance is
+very difficult to be washed out of napkins, the first ones used should
+be old and afterward be burned.
+
+Cleansing.-- Every time the napkin needs to be changed, even if it is
+only wet, the baby should be washed with warm water. A napkin should
+never be used twice without washing; it chafes the child, and it is an
+unsafe as well as a filthy practice; the napkin must always be removed
+as soon as it is wet.
+
+The Infant's Toilet.-- After the application of the binder and napkin,
+comes the undervest; the fingers of the nurse are passed up through
+the sleeve to seize the infant's hand and pull it through; as soon as
+it gets a little older the child will grasp a finger laid in its palm,
+which greatly facilitates this part of the toilet. The stockings are
+next put on and pinned with safety-pins to the napkin; then comes the
+petticoat, the band of which is also loosely fastened with
+safety-pins, and with the slip the toilet is complete. All the
+clothing should be changed night and morning.
+
+The eyes and mouth should be washed out with separate pieces of gauze
+or old linen. For the mouth, a small piece of cloth wet in warm water
+is wrapped around the little finger of the right hand, going into the
+left angle of the baby's mouth and coming out at the right, going
+between the gums and cheeks as well as over the tongue. This procedure
+should be gone through with every time preceding and following the
+nursing, and in this way the milk is prevented from souring in the
+mouth, and the digestion is kept in good condition. A sore mouth in a
+baby indicates carelessness on the part of the nurse.
+
+A soft hair-brush may be used, but the scalp is too tender to permit
+the use of a comb.
+
+After the toilet has been completed, the baby is laid in its crib, on
+the right side of the body, and warmly covered. The weaker the baby,
+the more attention must be paid to the external warmth. It may be
+necessary to place a warm-water bottle in the crib, but this must
+never touch the infant.
+
+The Crib.-- The infant must have its own crib, without rockers, and it
+must on no account be put to sleep in the same bed with its mother. In
+its early life it should never be taken out of its crib except to be
+fed, to have its clothing changed, or to be bathed. There should be no
+holding on the lap, no dangling, no carrying or fussing over the
+new-born infant; and the more the baby is let alone, the better and
+healthier it will be. If baby cries, look at once to see if it needs a
+fresh napkin; if not, if any pins are sticking into it, if the
+clothing is possibly too tight; if none of these things are wrong,
+give it a sup of water and turn it over on the other side. The baby
+often becomes restless by sleeping for several hours in the same
+position. But on no account take the infant up out of its crib simply
+because it cries.
+
+Cheerfulness and good nature on the part of the infant are dependent
+on its general good health. A healthy infant should not have colic,
+but if such is the case, there is a peculiar look of distress on the
+face, which indicates that the child is in pain; what is needed is
+warmth or medication according to the severity of the case, but never
+floor walking. Begin the latter procedure, and you may hope to keep it
+up for several years.
+
+Ventilation.-- The air is sometimes vitiated for children's uses in
+various ways; their nervous susceptibilities are greater than those of
+older people. A very little odor of tobacco may cause nausea and
+discomfort to an infant in arms. The atmosphere of the room should be
+sweet and pure and unscented. All scents and perfumes affect the
+nervous system, and by constant excitation do it damage. A bouquet of
+flowers renders the air of a closed room too heavy.
+
+Feeding of Infants.-- During the day the infant should be put to the
+breast once every two hours, and once every three hours during the
+night. This interval of time between the feeding is necessary in order
+that there may be sufficient time given for digestion to take place.
+Regurgitation of milk soon after feeding is a sign that the stomach
+has been overfilled. As the infant usually falls asleep after nursing,
+it is necessary to waken it up at the time for the next nursing, as
+good digestion depends upon regularity of feeding.
+
+For the first nursing the infant may be put to the breast in from two
+to six hours after the labor if the mother is sufficiently rested;
+from ten to twenty minutes is long enough for each nursing. Before
+each nursing the nipples should be carefully washed off with a
+solution of boric acid. The first secretion of the breasts is
+laxative; that is, it acts on the bowels, and makes is unnecessary to
+give the infant anything to take for this purpose. The breasts should
+be used alternately in feeding the infant, as this allows a longer
+time for the accumulation of the milk. For the first few days the
+infant needs very little food, and the mother's milk is generally
+sufficient.
+
+The infant should be given a teaspoonful of cool water to drink two or
+three times a day, as the milk does not quench the thirst. The water
+should be sterilized by boiling, and be kept in an air-tight flask.
+
+At the end of the third month the intervals of nursing for the daytime
+should be three hours, and the last nursing at night should be at
+eleven o'clock, and the first nursing in the morning at five o'clock;
+thus allowing the mother an interval of six hours of unbroken sleep.
+
+The best evidence of the proper nutrition of the child is a
+progressive gain in weight. The child should be weighed every week. A
+loss of a few ounces usually takes place during the first few days
+after birth, so that the child does well if at the end of the first
+week it weighs as much as it did at birth. After the first week the
+weekly gain should not fall below five ounces.
+
+The Wet-nurse.-- When the mother for any reason whatever is not able
+to nurse her child, the best substitute is a wet-nurse. Before she is
+employed the wet-nurse should always be carefully examined by a
+physician to insure her freedom from disease. The best age is between
+twenty and thirty years, and the age of the child of the nurse should
+be at least within a month of that of the child to be nursed. The best
+sign of the good health of the nurse and of the condition of her milk
+is furnished by the health of her own child. The breasts should be
+well formed and the nipple of good shape. It is well, if possible, to
+get a woman who has borne several children, as she will understand the
+care of the child better. No woman who is not perfectly healthy is fit
+to be a wet-nurse; and even after she has been engaged her health and
+her habits must be watched over.
+
+Artificia1 Feeding.-- The first requisite in artificial feeding is
+that the milk shall be made to correspond as nearly as possible to
+that of the mother. For this purpose the following formula, prepared
+by Rotch, of modified cow's milk is considered the best:
+
+                       Milk            2 ounces
+                       Cream           3 ounces
+                       Water           10 drams
+                       Milk-sugar   6 3/4 drams
+                       Lime-water       1 ounce
+
+To make one pint of the mixture for use in the twenty-four hours, take
+the milk and cream as soon as it comes in the morning, and mix as
+above directed.
+
+No less important than the correct proportions of the ingredients, is
+freedom from disease germs and bacteria of putrefaction. Complete
+sterilization is possible by prolonged boiling; but experience has
+proved that under prolonged exposure to a temperature near the
+boiling-point certain changes take place in the albuminoids of the
+milk which greatly impair its digestibility. Full sterilization of
+milk for infant feeding has therefore practically been abandoned. It
+has been found that milk heated to 167° F. for twenty minutes, and
+promptly chilled by placing on ice, remains practically sterile for
+twenty-four hours, and it is spared the injurious changes which take
+place at a higher temperature. This process is known as
+Pasteurization. The Arnold steam sterilizer affords a convenient
+method of sterilizing; if used with the cover removed, the steam
+chamber being open, the temperature of the steam chamber does not
+exceed 170° F.
+
+It is claimed that in the Arnold steam sterilizer, with the use of a
+suitable gas stove, the water begins to boil at the end of two minutes
+after the gas is lighted. A four-ounce bottle of milk at an initial
+temperature of 70° F. in the open steam chamber attains a temperature
+of 170° in just one hour. An exposure of about one hour and twenty
+minutes in the steam chamber is therefore necessary for the
+Pasteurization.
+
+The rules for sterilizing are as follows:
+
+First, clean the bottles thoroughly; then place them in cold water,
+which is allowed to come to boil and boiled for ten minutes.
+
+Second, fill each with the milk you wish to use; put in the rubber
+cork without the glass plug; this leaves a small opening in the rubber
+cork; set the bottle in the basket, then in the boiler.
+
+Third, set in the refrigerator until needed for use.
+
+Fourth, when wanted for use, place a bottle of the milk so prepared in
+the tin mug which accompanies the sterilizer; fill the mug with hot
+water to the height of the milk in the bottle, heat the milk to the
+temperature of 99° F., remove the rubber cork and put on the nipple,
+when it is ready for use.
+
+Fifth, cleanse the bottle immediately after using; throw away any milk
+that has not been used.
+
+Sixth, if the steaming process is preferred, place the basket without
+the bottles in the boiler, fill the water up to, but not above, the
+bottom of the basket, place the bottles in the basket, and proceed as
+before.
+
+It is important that the milk should be sterilized or Pasteurized as
+soon as it is served in the morning. Each bottle must be thoroughly
+washed as soon as it is emptied. Milk sterilized in this way will keep
+for days without spoiling, as it is hermetically sealed and all the
+unhealthy germs have been removed.
+
+The most exact method for the artificial feeding of infants, and that
+which most nearly approaches the mother's milk, is that used by the
+"Walker-Gordon Laboratory," branches of which are to be found in many
+of the large cities.
+
+Not only is the greatest care taken that the milk used shall be pure
+and sterilized ready for use, but these laboratories are equipped by
+special machinery which separates the important elements of the milk--
+namely, the fat, the milk-sugar, and the proteids. So that the
+physician can modify the proportions of these various ingredients of
+the milk to meet the necessity of the age and requirements of the
+infant.
+
+When the milk contains too little sugar, the infant does not gain as
+rapidly in weight as it would otherwise do. Too much sugar in the milk
+is indicated by colic, thin, green, or acid stools, or eructations of
+gas from the stomach.
+
+An excess of fat in the milk is indicated by vomiting; too little fat
+causes constipation with dry hard stools. Proteids in excess are a
+prolific cause of colic and also of diarrhea.
+
+Prescription blanks are furnished the physician, who fills out the
+percentages of fat, milk-sugar, proteids, and alkalinity, to suit the
+age, weight, and general condition of the child. He orders also the
+amount to be given at each feeding, and the number of feedings to be
+given in the twenty-four hours. Each bottle contains just the amount
+to be given at one feeding. All that the mother needs to do is to
+place the bottle in a receptacle containing warm water, until the milk
+has attained a temperature of 99° F., remove the cotton stopper, and
+put on the nipple, when it is ready for use.
+
+The Nursing Bottle.-- This should be of clear glass, with a rounded
+bottom, and of such a shape as is easy to clean; so that no particles
+will cling around a corner which cannot be reached. The graduated
+bottle is the most convenient, as it enables the quantities of each of
+the materials used in the preparation of the feeding to be mixed in
+the bottle, doing away with the trouble of measuring before putting
+into the bottle.
+
+Rubber Nipples.-- Two nipples should be kept for alternate use, and no
+nipple should be used longer than two weeks. A soft rubber of conical
+shape is best, with an opening at the top which is not too large, so
+that the milk will not flow through, as it is desirable that the child
+should obtain the milk by suction. So soon as the feeding is over, the
+nipple should be removed from the bottle, and brushed on both sides
+with a stiff brush. It should then be put in cold water, where it is
+kept until it is again wanted.
+
+The baby should be fed slowly, from ten to twenty minutes being taken
+for each feeding. Sucking from an empty bottle or with a nipple in the
+mouth should never be permitted, as in this way the baby draws air
+into its stomach, which will result in colic. Each flask should
+contain only enough for one feeding.
+
+In lieu of the regular sterilizing apparatus, milk may be similarly
+prepared by placing the milk in an ordinary glass fruit-jar with a
+screw lid. This is placed in a colander over a pot of boiling water;
+the milk should be allowed to boil in the open jar for two minutes;
+the jar-lid is then screwed on, and it should steam for twenty minutes
+longer.
+
+The capacity of the infant stomach at birth is about one ounce, which
+is the average quantity of food that should be taken at one meal. The
+average rate of increase in the amount of food is one and a half drams
+a week for the first six months; subsequently somewhat less. The
+intervals of feeding should be two hours at birth, and increased to
+three hours at the end of the third month. The food should be given at
+a temperature of 99° F. and fed directly from the sterilizing bottle.
+
+Fresh Air.-- In warm weather the baby is taken out-of-doors in from
+three to four weeks after birth; in cold weather not before two to
+three months. In the latter case it is prepared for the change by
+being first dressed as for the street, with wrap and cap; the windows
+of the room are then opened, and the infant is carried about here. In
+the winter months when the baby is first taken out, it is better to
+carry it in the arms, as it will be kept warmer in this way, and if it
+does become chilled it will be more quickly noticed.
+
+Characteristics of the Healthy Infant.-- The average weight of an
+infant at birth is about seven pounds, and its length is about twenty
+inches; the extremes are four pounds or a little less up to eleven
+pounds. The head and trunk of the child are developed out of
+proportion to the limbs.
+
+The skin of the new-born infant varies from pinkish to red; about the
+fourth day the color becomes somewhat yellowish; this tinge should
+disappear about the end of the second week, and at the same time the
+skin begins to peel off.This process lasts about two weeks longer,
+when the baby's skin takes on its normal color.
+
+The shape of the head varies greatly, much being due to the amount of
+pressure during labor; but this disappears in a few days. As a rule,
+the large bones of the head are felt to be separated by membranous
+ridges called sutures; there is one on the median line on the top of
+the head, and at either end of the suture is a large open space,
+called a fontanel. The largest one is at the front of the head, and is
+called the anterior fontanel; it is about large enough to be covered
+by the tips of two fingers, and is of a lozenge shape; this opening
+does not close till the child is about eighteen months old. In a
+healthy baby this fontanel should be on a level with the bones of the
+head; a slight pulsation may be noticed in it, due to the pulsations
+of the vessels of the brain. There is a much smaller three-cornered
+fontanel at the back of the suture, and one behind either ear; these
+soon close up with bone.
+
+A new-born baby cannot probably do any more than distinguish light
+from darkness. Up to the sixth week there is an inability at
+coordination of the ocular muscles; after this time the eyes begin to
+move in an orderly manner, and they will follow a bright object moved
+slowly in front of them. At about the end of the second month rapid
+movements are perceived, as is evinced by the child's closing its eyes
+quickly on an object suddenly approaching it. At three months the
+child begins to recognize colors; the first recognized are yellow,
+red, pure white, gray, and black. But the faculty of distinguishing
+between colors is not perfected till the third year. The mother is
+recognized about the third month. Hearing and a sense of smell develop
+rapidly after birth; loud noises in its vicinity will cause a child to
+start during the first day after birth. By the time the child has
+reached three months of age it shows signs of having a mind of its
+own, and is capable of exercising thought. It grasps for objects, and
+indicates its likes and dislikes. At from eight to ten months it can
+utter several syllables, and at the age of one year should be able to
+say mama and papa; at two years it should be able to frame short
+sentences.
+
+Weight of the Baby.-- By the end of the sixth month the child's weight
+should be double what it was at birth; that is, about fourteen pounds;
+at the end of the twelfth month be three times as much as at birth, or
+about twenty pounds.
+
+Muscular Action.-- Muscular action in the new-born infant is entirely
+involuntary, there being no voluntary acts until about the end of the
+third month. Sucking and licking are largely instinctive. The
+movements of the arms and legs are impulsive acts, and occur during
+sleep, just as they did in the intra-uterine life. The act of raising
+the head, which is attempted about the fourth month in healthy
+children, is volitional, requiring not so much added strength of
+muscle as power of coordination. As volition develops the power of
+coordination gradually increases, and the child learns to perform
+voluntary or purposeful acts. Voluntary grasping is done after the
+fourth month. As the child learns to balance its head, it attempts to
+sit up. This act is not successfully accomplished until about the
+fortieth week; the child sits firmly alone when ten or eleven months
+old. Before this time it is necessary to support the head and spine of
+the child with the hand. By the third or fourth month the infant
+should be able to grasp things. The child begins to creep about the
+ninth month. The clothing should be so arranged as to allow entire
+freedom of motion.
+
+It should be able to stand up by a chair by the tenth month, and be
+able to walk alone at the end of the first year. It is important that
+parents should know this, since not knowing what a normal baby ought
+to be able to do, cases of birth palsy, or even an attack of paralysis
+due to teething, are not infrequently overlooked, not only by the
+mother, but even by the doctor, who attributes the inability of the
+child to do what other children can do at this age simply to weakness,
+which the child will outgrow; and thus the time passes in which the
+most could be done to cure the child and to prevent the subsequent
+deformity.
+
+A baby should not be forced to stand or walk; a very stout baby, on
+account of its weight, will stand up and walk much later than a slight
+one, the two being equally healthy. Or if a baby has been sick, it
+will feel no inclination to stand up. Naturally, a child creeps before
+it walks, and this develops the muscles of the lower limbs, so that
+they will support the weight of the child in standing. By prematurely
+forcing a child to stand up and walk, there is danger of causing
+bow-legs, as the bones of the legs are still weak; the child should be
+discouraged from standing up too much rather than encouraged to stand
+up more.
+
+Sleep.-- A large proportion of the time of early infancy is spent in
+sleep; for the first few weeks the infant only wakens up to be fed.
+During sleep the eyelids should be tightly closed; a partial opening
+of the lids, showing the whites of the eyes, is an indication of ill
+health. Up to the age of six, children require twelve hours of sleep
+at night, besides an hour or more in the middle of the day; the child
+should be permitted to sleep as long in the morning as it will.
+
+Respiration.-- The healthy infant breathes on an average forty-four
+times a minute; the only time the respirations can be satisfactorily
+counted is during sleep. When the child is awake, the respirations are
+hurried by slight movements of the body, crying, and so forth. The
+average pulse of a newborn baby is one hundred and forty; this is
+hurried by the same causes that hastens respirations; the pulse is
+most easily counted at the anterior fontanel. The average temperature
+of the infant is 99° F. When the tip of the nose and the extremities
+are cold, it indicates a lowered vitality.
+
+The nature of the child's cry indicates, variously, hunger, temper, or
+pain; the mother will soon learn to distinguish these varieties. If
+the child cries because it is hungry, the cry ceases so soon as it is
+fed. But a child is never to be fed simply because it cries; it must
+be fed on the hour by the clock. If this rule is not strictly adhered
+to, it will suffer all the forms of indigestion and colic that babies
+are heir to. If it cries because of colic, there is a drawn look on
+the face, and at the same time the legs are sharply flexed on the
+thighs and the thighs on the abdomen. If the cries are due to earache,
+the head will be rolled about from one side to the other. In either
+case nothing will stop the cries until the pain is relieved. A baby
+does not shed tears until the third month.
+
+The Stools.-- The stools of a very young baby fed on breast-milk
+should be of a yellow or orange color. There should be three or four
+evacuations daily; they should contain no curds. Stools of bottle-fed
+babies are lighter in color and more offensive.
+
+Constipation.-- Constipation is not uncommon in infancy; it may be
+overcome by the use of a soap suppository, or by an injection of warm
+soap-suds into the bowel, or by an injection of oil and water, or by
+gentle friction over the bowel, following the course of the large
+intestine.
+
+To make the soap suppository, take a piece of castile soap about an
+inch long, give it the shape of a cone not any larger than the end of
+the little finger, and make it perfectly smooth. This is inserted to
+about half of its length into the rectum and held there until it
+causes the bowels to move.
+
+The bowel injection is best given by means of the single-bulb syringe,
+known as the eye and ear syringe; the bulb holds about two
+tablespoonfuls of liquid. This may be warm cotton-seed oil, sweet oil,
+or glycerin one teaspoonful to warm water two tablespoonfuls. The
+nozle should be small, smooth, and well oiled. It should be very
+carefully introduced into the bowel, being directed a little to the
+left side, and the bulb gently squeezed to force the contents into the
+bowel. The injection is more effective if it is retained for a little
+while; this is accomplished by making slight pressure on the anus with
+a towel.
+
+Rubbing the abdomen for about ten minutes in the direction of the
+large bowel is sometimes very effective in overcoming constipation;
+begin in the right groin and rub up as far as the border of the ribs,
+then across to the left, then down on the left side.
+
+Vomiting.-- Vomiting means often only that the stomach has been
+overfilled, and may be relieved by withholding all food for a few
+hours.
+
+Urination.-- The frequency of urination in a newborn baby will vary
+greatly with the weather and other conditions; in cool weather it is
+not unusual for the napkin to need changing almost every hour. Healthy
+urine should not stain the napkin. The new-born infant secretes very
+little urine until it begins to take nourishment freely. The bladder
+is usually emptied during birth, and very often the bowels also, so
+that if the child seems well and there is no malformation of the
+parts, the family may be assured that the apparent retention of urine
+is only temporary.
+
+The use of hot fomentations over the kidneys and bladder will often
+hasten the evacuation of urine if it has been unduly delayed. If the
+secretion seems highly concentrated, a drop of sweet spirits of niter
+in a teaspoonful of water may be given every two hours.
+
+Teething.-- The first tooth generally appears about the end of the
+fourth month; in delicate children they come later. As a rule, the
+lower front teeth come first, coming in pairs, one tooth coming on
+each side of the mouth; followed in about a month by the corresponding
+teeth in the upper jaw. Preceding their appearance the gums become
+swollen, hot, and painful, and the saliva forms in excess and runs
+from the mouth. The child is irritable, flushed and restless; and
+there usually occurs some disturbance of the bowels, commonly
+diarrhea. This all indicates a nervous derangement, and calls for a
+judicious diet and general careful oversight. The symptoms subside
+when the teeth are through. During teething the child manifests a
+desire to bite on something, and a soft rubber ring will give it great
+comfort.
+
+The first set of teeth are twenty in number, and are usually cut in
+groups, starting about the fourth month and continuing until between
+the twentieth and thirtieth month, when the first dentition should be
+complete. As a rule there is an interval of rest between the eruption
+of the various groups. During dentition children are generally more
+peevish and fretful than usual, but there should be no general
+constitutional disturbance. During dentition it is of especial
+importance to keep the bowels well opened; it is better to have them
+too loose than costive; constipation at this time greatly increases
+the tendency to convulsions.
+
+Bottle-fed babies are apt to cut their teeth later than those nursed
+at the breast. The lack of appearance of any teeth before the end of
+the first year indicates that the nutrition of the child is below par,
+or, in other words, that the child has rickets. The permanent teeth
+begin to appear about the sixth or seventh year.
+                          _________________
+
+  PART IV.-- THE MENOPAUSE.
+                          _________________
+
+ CHAPTER XIV.
+
+ THE MENOPAUSE.
+
+   Average Duration of the Menstrual Function; Duration of Menopause; the
+   Menopause; General Phenomena of the Menopause; Prominent Symptoms of
+   Menopause; Pathologic Conditions of the Menopause; Hemorrhage at the
+   Menopause a Significant Symptom of Cancer; Causes of Suffering at
+   Menopause.
+
+  "Yet I doubt not through the ages one increasing purpose runs,
+   And the thoughts of men are widened with the process of the suns.
+   Knowledge comes, but wisdom lingers, and I linger on the shore,
+   And the individual withers, and the world is more and more.
+   Knowledge comes, but wisdom lingers, and he bears a laden breast,
+   Full of sad experience, moving toward the stillness of his rest."
+
+                                                  -- "Locksley Hall."
+
+Average Duration of Menstrual Function.-- The average duration of the
+menstrual function is from thirty to thirty-two years. Raciborski
+estimated the duration of menstrual life at about thirty-one years and
+nine months. According to him, the mean age of puberty at Paris was
+fourteen years and seven months; therefore, the average age of the
+menopause was forty-six and one-half years. Tilt gives the average age
+of the cessation of menstruation in 1082 cases as forty-five years and
+nine months. The average age is between forty-five and fifty years. It
+has been shown by Krieger, Kisch, and others, that the earlier the
+menses appear, the later they cease, and vice versa. However, when the
+first period is unusually early or late, the menopause comes very
+early. Also that the sexual function is usually abolished earlier in
+the laboring classes, who are compelled to work hard and who have many
+cares, than in the well-to-do and rich.
+
+Race does unquestionably influence the duration, but given a sound
+healthy race, which is not too much enervated with civilization, and
+the menstrual process will, equally with the total physical vigor and
+the vitality, be increased. At the present day there is an increased
+sexual vitality, which shows itself in the fact that the duration of
+menstrual life has been increased three to four years during the past
+generation. The inference can be fairly deduced that vigorous vitality
+causes prolongation of the menstrual process and the actual age.
+
+Duration of Menopause.-- By the menopause or climacteric is understood
+the whole period from the beginning irregularities in the time of
+appearance of the menstrual flow until its actual cessation. The
+average duration of the menopause is from two and a half to three
+years.
+
+The Menopause.-- The menopause is a physiologic and conservative
+process. It occurs at a time of life when all the tissues are most
+stable and the nutrition of the body is at its best. Other physiologic
+changes which occur at the same time are decrease in the size of the
+spleen and lymphatic glands, the muscular coats of the intestine
+atrophy, and lessened peristalsis ensues; hence the increased tendency
+to constipation. These are not the degenerations of age, but the
+blood-supplying, blood-making, and blood-elaborating organs of the
+body have completed the growth of the organism, done their work, and
+are striking a balance with the needs of the economy.
+
+The object of each metamorphic or developmental epoch is a critical
+readjustment of the organism, in order to insure the greatest possible
+amount of health for each subsequent period of life. In the vast
+majority of cases this object is quietly effected, but sometimes the
+constitution only rallies after having been severely shaken for a
+varying period.
+
+General Phenomena of the Menopause.-- Borner states that while many
+women pass this period without noting any change in their former
+condition, and are conscious of the occurrence of the change of life
+only by reason of the absence of the menstrual flow, others suffer for
+years with a host of troubles.
+
+One of the most essential changes is that of the woman s psychic
+condition-- from slight vagaries, loss of interest in the daily
+affairs of life, to melancholia and insanity.
+
+"Two factors are generally taken into account: first, the sudden
+cessation of the menses; second, the reflections of the patient caused
+by her condition, meditations on the loss of youth and sexual power,
+and anxiety in view of the dangers of the climacteric. It cannot be
+denied that there is some truth in the supposed sad thoughts about the
+beginning of old age, and the depression caused by them can scarcely
+be considered abnormal" (Borner).
+
+Napier believes that it is extremely rare for the cessation to occur
+without some physical discomfort or some disturbance of the nervous
+system, but adds that: "Some women, however, cease menstruating with
+very slight inconvenience." As a rule, the woman misses one, two, or
+more periods, then a menstruation of almost normal quantity and
+duration; and this is again repeated at gradually longer intervals,
+and with a diminished flow, until actual cessation occurs.
+
+The periods cease owing to the degeneration and disappearance of the
+glandular tissues of the uterus, and secondarily to similar changes in
+the ovaries and other glands. This is followed by an atrophy of all
+the structures of the genitalia.
+
+An increase in the size of the uterus, from increase in the amount of
+blood, is frequently noticed at the beginning of the menopause; later
+it becomes smaller in all its dimensions. The wall becomes thinner;
+the cervix becomes shorter and thinner, sometimes hard, sometimes
+flabby as a membrane. But the distinguishing feature of the menopastic
+uterus is atrophy of its lining membrane.
+
+The changes in the uterus and Fallopian tubes are earlier than those
+in the ovaries, so that ovulation, though lessened in activity, may
+persist for a considerable time after menstruation has ceased. Ovarian
+atrophy has been referred to senile rather than menopastic changes.
+
+Atrophy of the ovaries occurs very gradually. Peuch found that in one
+case the ovaries were of normal size three years after the
+establishment of the menopause. Kiwisch describes the structural
+change in this gland as consisting, on the one hand, of an increase of
+the connective-tissue stroma; and, on the other hand, the Graafian
+vesicles themselves undergo retrograde change. In consequence of these
+microscopic changes, which take place very slowly, the entire organ
+becomes harder and smaller.
+
+Napier believes that the ovaries secrete specialized substances which
+aid in determining menstruation; and that in a less degree the
+utricular glands and the glands of the Fallopian tubes share in this
+action. He considers that this is probably secondary to the chain of
+peripheral irritation from the uterine glands, but that this secretion
+is none the less an essential feature of the menstrual process.
+
+In support of this view he calls attention to the pigmentation of the
+skin which occurs during pregnancy and chlorosis, showing that the
+absence of the catamenia results in the retention in the blood of some
+substance which would normally be excreted at this time.
+
+Other atrophic changes in the genitalia are shriveling of the vulva,
+with prolapse of the vagina or uterus from relaxation of the ligaments
+and loss of the natural support afforded by the changed perineal body.
+
+Uterine catarrh occurs almost invariably, and only ceases in advanced
+years. Displacements of all kinds are frequent, but on account of the
+now greatly diminished weight of the uterus, these are insignificant.
+
+The vagina is at first almost always hyperemic, but this disappears as
+the vessels successively atrophy. The vagina gradually becomes
+narrower and shorter. The mucous membrane loses its rugae and presents
+a pale, grayish, blanched hue.
+
+The researches of Byron Robinson, made by the dissection of a number
+of old women, show that after the menopause not only is there an
+atrophy of the genital organs, but that the hypogastric plexus of the
+great sympathetic nervous system also shrinks away. "It becomes
+smaller and firmer, and no doubt some strands disappear. On this fact
+must he based the pathologic symptoms accompanying the cessation of
+the menstrual function."
+
+The importance of the genital organs is shown by the vast nerve-supply
+sent to them. When this great nerve-tract becomes atrophic, so that it
+can no longer transmit the higher physiologic orders, all parts of the
+sympathetic system must be unbalanced, until a new line, the next line
+of least resistance is established. And Robinson believes that this is
+the explanation of the many pathologic manifestations of every viscus
+at the menopause; that is, "the irritation which arises by trying to
+pass more nervous impulses over plexuses than normal gives origin to
+what is unfortunately known as functional disease. It is just as
+organic as any disease, only we are unable to detect it."
+
+Chemical changes in the blood and tissues are constant vital
+phenomena; increased oxidation causes increased activity of the
+circulation, increase of temperature, increase of urea and carbonic
+acid in the economy from retrograde changes, and, finally, during
+menstrual life the flow of blood from the uterus carried off the
+effete materials from the highly charged system.
+
+The elimination of albuminoids, as shown by the altered condition of
+the blood after menstruation, is greater than can be accounted for by
+the blood discharged. When the menopause is attained suddenly, the
+retention of such albuminoid substances must act toxically. Hence the
+resulting clinical fact that sudden cessation of the menses is, in the
+majority of cases, attended with pronounced symptoms of discomfort,
+and it is in these cases that untoward results are most likely.
+
+James Oliver believes that the catamenial flow eliminates from the
+body substances whose presence in the blood would exert a deleterious
+influence on the animal economy.
+
+The Prominent Symptoms of the Menopause.-- Christopher Martin holds
+that the symptoms of the change of life are produced largely by a
+condition of instability and increased excitability of certain other
+cerebrospinal centers directly brought about by failure of the
+menstrual center, and adds: "It is probable that the ovaries, like the
+liver and thyroid gland, modify the blood circulating through them,
+and add to the blood some peculiar product of their metabolism. It may
+be that some of the climacteric symptoms are due to the loss of this
+substance from the system."
+
+Arthur Johnstone's theory of the symptoms of the menopause is that the
+lining membrane of the uterus atrophies and becomes old cicatricial
+tissue, and sinks into quiet decay. The nervous system begins to
+readjust itself; but no longer having free outlet through the soft,
+lymphoid tissues of the uterus, the wave pressure meets with
+resistance and a choppy sea results. Vertigos, bilious attacks, and so
+forth are nothing more than reflex waves. The weakest organ of the
+individual is the one that generally suffers. And that the kidneys,
+which all along have borne the brunt of life, should now show positive
+signs of disease is natural.
+
+The etiology and pathology of the menopause lie in the sympathetic
+nervous system. And it is by the breaking up of the harmony of
+previous processes that nervous disturbances are produced.
+
+After the cessation of the flow, over 8% of women suffer from
+"flashes"; this symptom is caused by irritation of the heart and
+vasomotor centers. The blood-vessels of the head and neck seem to be
+most affected, yet the skin of the whole body shares in the
+disturbance. Besides the vasomotor and heat center being disturbed,
+the sweat center is irritated. The flushes and flashes are followed by
+various degrees of sweating, which varies from a slight moisture to
+great drops.
+
+Nervous irritability is a prominent symptom in 8% of women at the time
+of the menopause. Most of the pain arises around the stomach; that is,
+the solar plexus. Digestive disturbances are very common at this time;
+they may be in the shape of fermentation, diarrhea, or constipation,
+accompanied by congestion of the liver.
+
+Tilt holds the very plausible view that the too strong reaction of the
+sexual organs on the central ganglia of the sympathetic nervous system
+is their principal cause of disease. Puberty, menstruation, pregnancy,
+lactation, or the menopause almost always entail some derangement of
+this system which is sometimes sufficiently severe to lead to insanity
+and suicide. Debility underlies all affections of the sympathetic
+nervous system, in the same way as nervous irritability underlies all
+cerebral diseases. Sometimes there is an overpowering sense of
+exhaustion pervading the whole system.
+
+Forms of climacteric insanity are delirium, mania, hypochondriasis,
+melancholia, irresponsible impulses, and the perversion of moral
+instincts.
+
+"If the reproductive apparatus does not act on the brain by the
+instrumentality of the circulating organs of the blood, it must do so
+by means of the nerves. The genital apparatus is richly endowed with
+nerves from the sympathetic system, and I have shown how frequently
+evident signs of disturbance in these centers coincided or alternated
+with headaches, nervousness, hysteria, and epilepsy. What wonder,
+then, if the same powerful influence of the sexual organs, through the
+instrumentality of the sympathetic system, should at times produce a
+permanent derangement of the mental and moral faculties. I am thus led
+to look on the sympathetic nervous center as a source of vital power
+producing reflex morbid phenomena, in accordance with variable
+cerebral predisposition" (Tilt).
+
+Another very frequent symptom of the menopause is distress in the
+region of the heart, with palpitation and shortness of breath. It may
+be caused by the condition of the blood, whether it be impoverished--
+anemia-- or too rich in red globules; by reflex irritation of the
+pneumogastric or sympathetic nerves; by overexertion; or by
+alcoholism. It may also be due to general debility; the woman resists
+fatigue less easily, and she experiences a general malaise. To the
+palpitations are rapidly added faintness and shortness of breath. The
+sleep is troubled with distress in the region of the heart. It is said
+that women in whom the menopause occurs early are more liable to
+tachycardia than those who menstruate later in life; and that it
+occurs with especial frequency when the menopause has been prematurely
+induced by surgical operation or by disease. It is believed that this
+functional heart trouble is caused by the increased connective-tissue
+fibers of the sexual organs acting in some unknown way on the terminal
+fibers of the sympathetic; and it is not infrequently due to the
+formation of scar tissue at the seat of a cervical laceration, and has
+often been promptly and permanently relieved by removing the
+cicatricial tissue and suturing the wound. The cause acts by producing
+a transitory paralysis of the inhibitory fibers of the pneumogastric
+nerve.
+
+Pathologic Conditions of the Menopause.-- Perhaps the most alarming
+symptom of the menopause is hemorrhage. It may be due to general or
+local causes. Among the general causes are diseases of the heart,
+lungs, spleen, and kidneys. Local causes of hemorrhage are:
+inflammation of the lining membrane of the uterus, chronic pelvic
+inflammations, faulty uterine positions, erosions and ulcerations of
+the mouth of the uterus, fibroid tumors, and cancer. All competent
+observers agree that cancer in women is much commoner from forty to
+fifty years than at any other age.
+
+Hemorrhages occupy the foremost place among the pathologic phenomena
+of the genital tract during the menopause. Hemorrhage has been
+attributed in many instances to the senile rigidity and friability of
+the uterine vessels, which are not in a condition to offer sufficient
+resistance to the blood-pressure which is brought to bear on their
+walls; there is also softening and relaxation of the uterine tissue.
+Additional causes are found in the circulatory disturbances in the
+pelvic organs, whereby the outflow of blood from the pelvic vessels is
+hindered a chronic congestion in the uterine vessels is produced. It
+has also been attributed to early and profuse menstruation, frequent
+and difficult labors, frequent abortions, and excess in drinking.
+
+The third and last variety includes those cases which may be referred
+to some disease of the pelvic organs themselves. Anatomic changes may
+lead up to pathologic conditions. A chief feature characteristic of
+uterine disease is malnutrition from atrophy-- a sudden curtailing of
+the blood-supply from the degeneration of the genital-nerve apparatus
+and consequent impaired vitality of tissue from defective nourishment.
+The anatomic changes in the glands and substance of the uterus also
+favor the irritation, and the development of new growths, which may be
+malignant or benign-- as cancers, fibroid growths, and so forth.
+
+Hemorrhage at the Menopause a Significant Symptom of Cancer.-- Not
+only should any excessive and prolonged bleeding at the time of the
+menopause be a source of great anxiety to the woman, but even the
+irregular appearance of a slight show of blood just sufficient to keep
+the clothing stained, or a slight bleeding following coition; since
+all of these are symptoms of very great gravity, and demand an
+immediate local examination and appropriate treatment.
+
+The widespread belief among the laity that hemorrhage at the time of
+the menopause is a normal condition, and that if left alone it will
+stop in the course of a few years, is most erroneous and fatal. On
+this altar of ignorance thousands of women sacrifice their lives every
+year. The case-book of any gynecologist will testify to the truth of
+this statement. The following three cases will serve to illustrate
+different types of hemorrhage in cancer patients, in no one of which
+did the patient even suspect that she was suffering from anything more
+serious than the "vagaries of the menopause."
+
+Case I.-- Woman aged seventy years; came on account of incontinence of
+urine, which had been troublesome for two years. The menopause
+occurred at fifty. She stated that three or four years previous to her
+visit, she had had a return of the flow of blood, perhaps twice in the
+first year, and that during the past year there had been a flow every
+month-- about the same that there used to be. This she took to be a
+return of the menstrual period. She said, further, that there was a
+constant bleeding-- enough to necessitate the wearing of a napkin--
+and an occasional severe hemorrhage; that she could not take long
+walks or drives because of the excessive flow which followed.
+
+The case was one of cancer of the uterus which had spread to all the
+pelvic viscera; and in addition to this, the patient's general
+condition was such that any operation was out of the question. Yet the
+patient had never thought of the possibility of any uterine trouble
+sufficiently serious to make a local examination necessary. It was
+only the loss of control over the bladder that drove her to seek a
+physician's advice.
+
+Case II.-- Woman aged fifty-three years came to consult me because of
+pain, hemorrhage, and loss of weight. There had never been any
+cessation of the menstrual period. She said that she began to have
+irregular hemorrhages three years previously, and that they were
+constantly becoming more frequent and more alarming, and that, in
+addition to this, there was a constant discharge of blood, which
+necessitated her wearing a napkin all the time. She also stated that
+for the preceding six months the pain had been so severe that she had
+not had one solid night's sleep, and that in that time she had lost
+forty pounds in weight.
+
+This patient was in the very last stages of cancer of the uterus, and
+all that could be done for her was to make her comfortable. She had
+given birth to one child which caused a deep tear of the neck of the
+womb; and it is probable that this neglected tear was the primary
+cause of the cancer, which began in the neck of the womb.
+
+Case III.-- Woman aged forty-five years; married, but had never had
+any children. She said that the periods were normal as to duration and
+amount, but that for the past two years they had two days ahead of
+time, and that for the past four months she had been having just
+enough irregular bleeding between the periods to keep her clothing
+stained.
+
+On examination a diagnosis of cancer of the uterus was made. The
+pathological examination proved this to be a most malignant type of
+cancer of the neck of the womb. The entire uterus and appendages were
+at once removed. And although the patient made an excellent recovery
+from the operation, she succumbed to the disease one year after the
+operation was performed.
+
+These cases have been cited at length because they are all typical and
+because of the variety of symptoms and the great difference of age.
+Only in one of the cases was there any very severe pain, and it was
+really the pain, which had become unendurable, which caused the
+patient to seek relief.
+
+It is the concensus of opinion of the medical profession that cancer
+of the uterus is one of the common causes of death among women; that
+the cancer rate of mortality has increased during the last four
+decades; that it is most common near the time of the menopause; and
+that there is a direct causal relation between cancer of the neck of
+the womb and the traumatisms which occur during childbirth.
+
+The symptoms of cancer of the uterus are hemorrhage, a more or less
+offensive discharge, and pain. The quantity of blood may vary from a
+slight amount which occasionally stains the clothing to a profuse
+hemorrhage. In the married, bleeding following coition is always a
+suggestive symptom. During the menopause any irregular or profuse
+bleeding should excite suspicion. After the cessation of the menopause
+any bleeding whatsoever, whether slight or profuse, should always be
+regarded as a danger signal which demands an immediate and thorough
+local examination. The same is true of any offensive vaginal
+discharge. Pain is frequently so late a symptom that to wait for its
+appearance means that the favorable time to perform an operation has
+passed by. Emaciation is also a symptom of advanced disease.
+
+Cancer is chiefly a disease of the climacteric; when there is a
+diminished power on the part of the tissues to resist adverse
+influence. It affects the debilitated and overworked, but it is also
+found in the well nourished and in the comparatively young.
+
+Cancer always begins as a local disease, and when it occurs in the
+uterus, it is easily accessible and eradicable in its earliest stages;
+that is, if the disease is discovered in its incipiency, an operation
+will remove all the diseased tissue. If, on the contrary, the disease
+is left to nature, the growth spreads out into the surrounding viscera
+like the roots of a tree in the earth, and the cancer may be literally
+said to eat into the tissues which it invades. At the same time the
+germs of the disease begin to be carried all through the body, and the
+entire constitution is affected.
+
+Prophylaxis, or the Prevention of Cancer.-- All pelvic inflammations
+should be promptly treated, and not allowed to become chronic.
+Leucorrhea is a symptom of inflammation, the true cause of which can
+be determined only by local examination. Women who have given birth to
+children-- and this is more especially necessary as they near the age
+of forty years-- should be carefully examined for tears of the neck of
+the womb. If these tears are extensive they should be repaired, as it
+is certain that malignant growths frequently do follow local injuries
+and traumatisms.
+
+Any irregular or profuse bleeding demands an immediate investigation
+by means of a local examination.
+
+A stormy, irregular, or delayed menopause should excite in the woman a
+suspicion of some abnormal condition.
+
+The importance of women being carefully watched by gynecologists at
+this period of their lives cannot be too emphatically stated, for upon
+the early recognition of cancer depends the only hope of radical cure
+of the disease. It is estimated that at the present time not less than
+95 per cent. of all cases of cancer of the uterus come under the
+observation of the profession at a stage of the disease when all
+prospect of permanent relief is out of the question.
+
+It is a deplorable state of affairs that women, not knowing what a
+normal climacteric is, attribute all hemorrhages, no matter how
+severe, to the change of life. Therefore, regarding the hemorrhage as
+a necessary evil, they fail to consult a specialist until the
+favorable time for eradicating the disease by means of an operation
+has passed. And whatever knowledge science may bring in the future as
+to the cure of cancer, at present it is a fact universally agreed upon
+that early operation, while the cancer is still local, is the only
+radical cure for the disease.
+
+Pruritus Vulvae. Perhaps one of the most annoying and obstinate
+symptoms of the menopause is pruritus vulvae. This is sometimes caused
+by sugar in the urine; there is a congestion of the liver which
+results in sugar being thrown into the system and this is eliminated
+by the kidneys. It is quite possible that this is due to the altered
+circulatory conditions of the menopause.
+
+Kidney Disease.-- The last pathologic condition which we will mention
+is kidney disease. Le Gendre believes that the menopause exerts a
+deleterious effect on the kidneys, whether this be a congestion,
+followed by a diminution in the quantity of urine, or a sort of
+auto-intoxication due to the retention of a poison in the system that
+has been prevented from leaving by the ordinary path.
+
+Armstrong says that in almost all cases at the time of the menopause
+the amount of urine passed is below normal, the specific gravity is
+increased, and that the urine contains urates and almost always uric
+acid in excess. Further, that the functions of digestion and
+assimilation and the various metabolic changes are so largely under
+the control of the nerve-centers that nothing seems more likely than
+that so great a disturbance of that system as takes place at the
+menopause should cause secondary derangements of these most important
+functions. That being so, the blood becomes loaded with waste
+products, and the usual symptoms follow-- gout and so forth.
+
+It has been a grave question in the mind of the medical profession
+whether the dangers that certainly do attend the menopause are natural
+or acquired; that is, could these dangers be averted by any
+precautions or hygienic measures on the part of women, or are these
+dangers a necessary accompaniment of this period of life?
+
+Tilt has reached the conclusion that: "The best way to avoid the
+dangers of this critical time is to meet its approach with a healthy
+constitution. A marked want of strength prevents the regular
+succession of the vital phenomena by which all critical periods are
+carried on. And as the change of life is marked by debility, when this
+is grafted on constitutional weakness, loss of power will be of long
+duration. All complaints remain chronic because there is not stamina
+enough to carry them through their stages."
+
+Causes of Suffering at Menopause.-- Dusourd, whose practice lay in an
+agricultural district in the south of France, as well as Tilt,
+believes that peasant women suffer little at this time. Their health
+is generally good when the menopause comes on and they are little
+liable to nervous disorders. The poor of large towns suffer much at
+this epoch-- the necessity of working hard, the anxieties of poverty
+and their unhygienic surroundings. But by a fortunate compensation the
+necessity for working hard prevents or cures the nervous affections
+which so often assail the rich at this period.
+
+Tilt's cases showed that women who suffered much at the menopause had
+previously suffered at puberty and at the menstrual periods. And among
+thirty-nine cases where there was no suffering at the menopause, there
+was the same immunity from suffering at puberty and at the menstrual
+epochs.
+
+Tilt's statistics were, or course, taken from English women. In
+forty-four cases of my own, all women past the menopause, the average
+age of the first menstruation was fourteen years and four months; and
+the average age of the actual cessation of the menstrual flow was
+forty-eight years and five and two-thirds months. Subtracting from
+this the average age of the first menstruation, we have as the mean
+age of menstrual life thirty-four years one and two-thirds months;
+that is, the average duration of the menstrual function was from two
+to four years longer than that usually given.
+
+A further investigation in order to ascertain any possible relation
+between the age of marriage and the number of pregnancies and the
+sufferings of the menopause elicited the following statistics. The
+average age of marriage was twenty-five years and ten months. Of the
+four women who were married after thirty-eight years, all were
+sterile; among the remaining there was an average of slightly above
+three children each. Forty per cent. of all these cases had one or
+more miscarriages. Nine had habitually suffered from severe
+dysmenorrhea, eleven had slight dysmenorrhea, and twenty-two had never
+felt the slightest inconvenience.
+
+In a list of fifty-two cases, eight were added to the list already
+given, all of whom had passed the menopause. Five were perfectly
+healthy and had never suffered the slightest inconvenience. Of these,
+one was single and only one had one miscarriage. Ten had suffered at
+the time of the menopause from slight malaise, but not sufficiently to
+call in a medical attendant. Thirty-seven were more or less seriously
+ill; thirty of these needed local as well as constitutional treatment,
+and seven constitutional treatment only.
+
+The prominent symptoms of the climacteric were as follows: Marked
+debility, 24; intense nervousness, 31; nervous prostration, 9;
+melancholia, 10; headache, 14; neuralgia, 6; hysteria, 7; irritable
+heart, 11; tachycardia, 8; insomnia, 19; indigestion, 32;
+constipation, 28; diarrhea, 3; leucorrhea, 38; rheumatism, 21; gout,
+1; Bright's disease, 12; hemorrhage, 6; alcoholism, 2; corpulency, 2.
+
+As a result of the study of these cases, the most striking feature was
+the relation of miscarriages to the sufferings and ill health at the
+time of the menopause. Of the nineteen women who had miscarriages,
+only one did not suffer in some way at the time of the menopause. Four
+suffered only slightly, and fourteen suffered extremely, not only
+during the menopause, but in the post-climacteric period as well. And
+the next most striking feature was that the prominent symptoms of the
+menopause are preeminently reflex or the functional diseases of the
+nervous system.
+
+Tilt believes that single women suffer less than other women at the
+time of the menopause. He further writes: "As at puberty, from the
+ignorance in which it is still thought right to leave young women, so
+at the change of life, women often suffer from ignorance of what may
+occur, or from exaggerated notions of the perils which await them. It
+would be well if they were made to understand that if in tolerable
+health, provided that they will conform to judicious rules, they have
+only blessings to expect from the change of life. Most unfortunately,
+the individual not cognizant of the invisible changes going on in the
+economy does not adapt the mode of life to the new conditions of the
+organism, and the weakened and lessened amount of the digestive fluids
+is unable to master the large quantities of food. The absorbents
+refuse to take more than is needed to repair the tissues. The
+atrophying muscles of the digestive tube, unable to hurry on the mixed
+products of indigestion; fermentation; and micro-organisms inciting
+fermentations and elaborating toxic alkaloids, poison and disorder the
+functions of life. Man's outdoor life enables him to escape many of
+these evils.
+
+"Woman's enervating mode of life, the continued introspection, coupled
+with the peculiar changes in the nutrition of the body at this time,
+render the nervous system peculiarly impressionable and liable to the
+manifold forms of diseases. 'The woman is told that she must be calm
+and patient, and in time the tomb-builder will alleviate all her
+sufferings.' This critical period may be dangerous to those who are
+always ailing, for habitiual sufferers at the menstrual periods, and
+for those affected with uterine diseases. If, on the first indication
+of the change of life, women who are in fair health carefully followed
+a regimen and pursued a line of life in harmony with the physiologic
+processes on which this change depends, disease would be prevented.
+But as the change concerns a natural function, it is left to nature;
+no additional precautions are taken, and advice is sought only when
+the mischief is done."
+
+It is not wise to marry during this period. On the first appearance of
+the irregularities of the menopause the amount of food and stimulants
+to which women have been accustomed should be curtailed rather than
+augmented. The system requires supporting by medicine and regimen--
+as, baths, mental and moral hygiene, and occupation-- rather than
+stimulating by spirits.
+
+We have seen that, in accordance with the plethric theory, which
+prevailed until 1835, and with the nerve theory, which is based on the
+latest anatomic and physiologic researches, menstruation is a
+physiologic process to get rid of effete material, and is therefore an
+excretion.
+
+At the end of perhaps thirty years, by a conservative process of
+nature, the child-bearing period ceases and the organism is readjusted
+to the end that the woman's vitality may all be conserved for her own
+individual life.
+
+Each metamorphic or developmental period of life-- dentition, puberty,
+and the menopause-- throws a special strain on the nervous system, and
+the recent studies of the sympathetic nervous system at the time of
+the menopause show that very extensive anatomic changes occur at this
+time. That being the case, the woman must lead such a life as will
+insure her having on hand a large reserve force necessary to meet
+these heavy demands. Tilt's observations show that women who have
+experienced no suffering at puberty or, at the menstrual periods do
+not suffer at the menopause. It is therefore evident that the time to
+begin this preparation is in childhood.
+
+That single women suffer less than married women would suggest that
+excessive coitus and the occurrence of abortions, frequent
+child-bearing, and lesions as the result of pregnancies, many of which
+lesions could have been prevented or cured by the timely aid of the
+physician, are the combined sources of much of the suffering at the
+time of the menopause.
+
+That the most frequent and serious disturbances are those of the
+nervous system, and that from their mode of life and habits of
+introspection the rich suffer more from these ailments than the poor,
+must cause serious consideration of the physiologic necessity for a
+definite occupation for the daughters as well as for the sons of the
+rich.
+
+The frequency with which Bright's disease is found at the time of the
+menopause is dependent not so much on the local physiologic changes
+which are taking place as on the time of life. Loomis says that it was
+not until life-insurance examinations became so common that the
+frequency with which kidney disease existed in persons who believed
+themselves well was even imagined. And as a result of his observations
+in these cases, and of a large number of autopsies conducted at the
+Bellevue, he stated that it was his belief that 90% of men and women
+over forty years of age suffer from some form of Bright's disease.
+That being the case, it would seem that after this period of life at
+least as much attention should be directed to the kidneys as to the
+teeth, and that a semi-annual examination of the urine should be made.
+
+Although the menopause is a physiologic occurrence, yet, owing to the
+many pathologic changes which are liable to take place at this time,
+the woman should be as carefully watched during the menopause by the
+gynecologist as the pregnant woman now is by the obstetrician. If the
+same care were taken, in the majority of cases, the dangers attending
+the menopause would be avoided, and the woman would be prepared to
+enjoy a healthy and useful post-climacteric period of life.
+
+  CHAPTER XV.
+
+ HYGIENE OF THE MENOPAUSE.
+
+   Diet; Constipation; Stimulants; the Kidneys; the Skin; Turkish Baths;
+   Massage; Exercise; Profuse Menstruation; Hemorrhage; Mental Therapeutics.
+
+  "'Tis the breathing time of day."
+
+                                                         -- "Hamlet."
+
+Hygiene of the Menopause.-- The changes which occur in all the organs
+of the body at the time of the menopause are retrograde, and therefore
+just the opposite of those which occur at the time of puberty. This
+fact should be borne in mind in the matter of alimentation. All that
+is now needed is to make the repair equal to the waste.
+
+Diet.-- Unless the woman is taking a great deal of active exercise, it
+is better to diminish the amount of meat eaten, and to increase the
+vegetable food and take more fluids. Unless the effect of the meat
+eaten is counterbalanced by active outdoor exercise, it produces an
+excess of waste matter, which accumulates and causes biliousness, and
+sometimes rheumatism and gout. A vegetable diet is less taxing to the
+excretory organs than an animal diet.
+
+Indigestion is at this time of life apt to appear in the form of
+fermentation, which may assume the gastric or intestinal type. The
+chief causes of the formation of gases are the lessened peristaltic
+action of the intestines, the increased tendency to congestion of the
+liver and to obstinate constipation.
+
+All dishes rich in sugar, as cake, candy, preserves, and jelly, should
+be indulged in with moderation; or where there is a tendency to
+fermentative indigestion, they should be wholly avoided.
+
+All dishes known to be difficult of digestion, as hot breads, pastry,
+cheese, fried dishes, and rich salads, should be cut off the menu,
+since these readily overtax an already weakened digestive system.
+
+If there is a hereditary tendency to rheumatism or gout, the disease
+is most apt to take on an active form at this time. In either case the
+manifestation of the disease indicates an excess of uric acid in the
+system, and a diet becomes a necessity. Pickles, all highly spiced
+articles of food, and vinegar must be omitted from the bill of fare.
+The vinegar may be replaced in salad-dressings by lemon juice.
+Tomatoes, rhubarb, strawberries and grapefruit are contra-indicated;
+also all articles of food rich in sugar.
+
+In chronic cases animal food cannot, as a rule, be excluded from the
+dietary, but must be limited in quantity. Fish, eggs, and fowl may be
+eaten, also a moderate amount of lean meat in the form of beef, lamb,
+and mutton. Milk may be indulged in freely. The diet should consist
+principally of easily digested fresh green vegetables. The amount of
+tea and coffee should be limited. All malt liquors, sweet wines, and
+champagne must be absolutely prohibited.
+
+Constipation.-- A daily free evacuation of the bowels is essential to
+good health. Where constipation exists, and the woman is full-blooded,
+with a tendency to a rush of blood to the head, saline laxatives are
+indicated. But if the woman is constipated and anemic, cascara sagrada
+is a better laxative; while cod-liver oil acts as a laxative and at
+the same time improves the quality of the blood.
+
+Stimulants.-- Women resort to alcoholic stimulants as an analgesic to
+relieve pain, whether physical or mental; as a narcotic to produce
+sleep; and as a spur to a failing appetite or bodily powers.
+
+The majority of women patients say that they first used alcohol in the
+shape of whisky, brandy or gin to relieve pain at the time of the
+menstrual period. The pain that is caused at this time by a chilling
+of the body would be as effectually relieved by drinking a cup of hot
+tea; while if the pain is intense and constant, recurring every month,
+it is doubtless caused by some local inflammation, and the use of
+alcohol only veils the real trouble, and the woman loses valuable time
+by not consulting a physician at once.
+
+As to the use of alcohol to blunt the nervous sensibility due to
+mental suffering, it is the testimony of the entire medical profession
+that this is the greatest cause of inebriety or drunkenness among
+women of all classes of society.
+
+Sleeplessness generally arises from some well-defined physical cause--
+very frequently from inaction of the liver-- and the proper remedial
+agents should be used to remove the cause.
+
+While at first the use of alcoholic beverages increases the appetite,
+as the amount taken is increased, distaste for food is created, the
+system languishes under an insufficient food-supply, and the original
+aim of increasing the appetite is defeated.
+
+As to taking stimulants to do more work than one could otherwise
+accomplish, it is by means of stimulants that woman can accomplish her
+physiological ruin more quickly than is possible in any other way. And
+the early symptoms of chronic alcoholism show themselves in the form
+of neuralgia, insomnia, palpitation of the heart, and muscular
+tremors.
+
+The Kidneys.-- On account of the prevalence of some form of Bright's
+disease after forty years of life, the kidneys should be carefully
+watched at this time. And in order to keep them in good condition they
+must be well flushed with water every day. Three pints of urine should
+be excreted daily, and three pints of water as such must be taken into
+the system daily. The urine should be examined by the physician every
+six months. In this way kidney disease is often discovered in its
+incipiency, which otherwise might run into a serious form of Bright's
+disease.
+
+The Skin.-- It must be remembered that the skin is one of the
+excretory organs of the body, and the pores should be kept well open
+by the various forms of baths.
+
+The Turkish bath or some modification of it will often be found to be
+particularly useful. Massage with alcohol after the bath lessens the
+tendency to take cold. For a woman who is anemic or run down, it is
+well to follow the Turkish with the Roman bath, which is an inunction
+with almond oil or cocoa-butter. A much more thorough massage is given
+with the Roman bath than with the "alcohol rub." It is often necessary
+to modify the Turkish bath by omitting the steam-room and shortening
+the time spent in the hot dry air. In ordinary cases the time spent in
+the hot dry-room should be only that necessary for producing a free
+perspiration. This time varies in different individuals from ten to
+twenty minutes. No woman should go to a Turkish bath without first
+consulting her physician, since if the woman has a weak heart, the
+bath may be the source of positive danger. Comparatively few women are
+strong enough to take the cold plunge.
+
+Massage.-- Massage, well given by a skilful masseuse twice a week,
+will greatly tone up the nervous and circulatory systems. Women who
+are very stout and who have sluggish livers with obstinate
+constipation will find massage particularly beneficial.
+
+Exercise.-- Daily exercise in the open air is absolutely essential to
+every woman's good health. The minimum amount of outdoor exercise
+compatible with health is an hour's walk, at the rate of three miles
+an hour. If the woman has never taken any exercise, she must begin
+with a very short walk and stop on the first sign of fatigue.
+Gradually increase the distance and the speed until the three miles is
+reached.
+
+Profuse Menstruation.-- If the menstrual flow is unusually profuse or
+lasts beyond the regular time, the woman should stay quietly in bed
+until the flow ceases. All exercise increases the flow.
+
+The flow now becomes less in quantity, and the periods more infrequent
+than formerly. Hemorrhage must always be regarded as a danger-signal
+the significance of which can scarcely be overestimated. To
+immediately consult a specialist on the appearance of any
+irregularities of the flow would, in the opinion of the most eminent
+gynecologists of the day, be the means of saving thousands of women's
+lives every year.
+
+Mental Therapeutics.-- It is particularly necessary at this time of
+life that the mind should be pleasantly occupied. Her children have
+passed the age when they need her constant supervision, and the mother
+must take some relaxation from her home cares, in the form of social
+diversions, amusements, outdoor life, and change of scene. Any mental
+occupation that will take the woman out of herself is the best
+possible safeguard against a state of introspection which conjures up
+a host of evil fantasies, and which is the first step in the downward
+road to a fixed and permanent melancholia.
+
+  "Hang sorrow, care will kill a cat;
+  And therefore let 's be merry."
+
+  CHAPTER XVI.
+
+ HINTS FOR HOME TREATMENT
+
+   Indigestion; Constipation; Diarrhea; Enemas; Vaginal Douche; Baths;
+   Headache; Fainting; Hemorrhage.
+
+  "Woman is woman's natural ally."
+
+                                                        -- EURIPIDES.
+
+Indigestion.-- The chief causes of indigestion are: eating rapidly,
+eating at irregular hours, eating indigestible foods, constipation,
+and lack of exercise. No one who values her good health will allow
+herself to be hurried through a meal, nor will she allow the
+perplexities of life to be thrust upon her at the table for solution.
+The first requisite for the digestion of foods is that they should be
+well masticated, so that the digestive fluids may act on the finely
+divided particles to the greatest possible advantage. And while
+digestion is going on all mental labor should be held in abeyance, in
+order to avoid drawing the blood away from the stomach to the brain.
+Furthermore, it is a well-known fact that digestion is best performed
+when the meals are served at regular hours.
+
+Constipation leads to the formation of gases in the intestines, to
+fermentation, and to the absorption of toxic materials by the blood.
+
+Through lack of exercise, the appetite fails, the liver becomes
+torpid, and the muscular and nervous systems lose their tone.
+
+The exercise which the housekeeper gets in going around her house is
+not sufficient. Daily exercise in the open air is essential to health;
+as this is to supplement the indoor exercise, the amount taken will
+vary in proportion to the former. For teachers or those who have a
+sedentary occupation an hour's active exercise in the open air-- a
+three-mile walk-- should be supplemented by active gymnastic exercise.
+
+For people in good health, a mixed diet-- that is to say, a diet
+consisting of meat, vegetables, and fruit-- is the best. If the
+individual is not well, then the diet must be adapted to meet the
+needs of that particular case.
+
+Hot breads, all articles of food fried in fats, salads, and pastry are
+difficult to digest. Tea is very constipating, and when taken in
+excessive quantities renders the individual nervous. An excess of
+coffee leads to congestion of the liver.
+
+Where indigestion exists, the simplest and most sensible remedies are
+to regulate the diet, and avoid eating between meals. By drinking a
+glass of water as hot as it can be sipped one hour before each meal,
+the mucus is washed out of the stomach, the stomach is empty on coming
+to the table, and in the best possible condition for the gastric juice
+to act on the food-stuffs.
+
+Constipation.-- Constipation is the rule with the average American
+woman; the causes are their corsets, the tight bands of their
+clothing, lack of exercise, and the fact that they drink too little
+water and too much tea. The most rational means to overcome it is to
+drink more water; at least three pints a day should be taken, in
+addition to soups, tea and coffee, and so forth; the water must be
+taken into the system as such. Then attention must be given to the
+diet; plenty of fruit should be eaten, vegetables, and coarse bread.
+
+Regularity in this, as in all other habits of life, is most essential,
+and the individual should go to the toilet at the same hour every day,
+even if there is no inclination to have a bowel movement, and thus the
+habit will be established; the most convenient time is directly after
+breakfast.
+
+Medical Treatment.-- But if all these means have failed, medicines
+must be resorted to. Cold water is a better laxative than hot; to a
+glassful of cold water add from one teaspoonful to one tablespoonful
+of the effervescing granules of the phosphate of soda, and take this
+the first thing on rising in the morning. This preparation of soda is
+particularly useful because it acts slightly on the liver. Other
+laxatives are: a seidlitz powder dissolved in a glass of cold water on
+rising; a wineglass or more of Hunyadi Janos, also taken on rising.
+Any of these may be taken with safety by pregnant women. For children
+the simplest laxative is one teaspoonful of Husband's milk of
+magnesia, to be taken in one glass of water on rising.
+
+Enemas.-- Perhaps one of the most common methods used by the laity for
+the relief of constipation is the rectal injection, or enema. Enemas
+habitually given to unload the bowels are productive of much harm by
+overdistending the rectum, so that in time the rectum fails to react
+to the normal stimulus-- namely, the presence of the feces-- as it
+otherwise would. But by some means or other the bowels must be well
+moved once every twenty-four hours. And it is much better to use an
+enema than to go to bed without a bowel movement. If the woman is
+going around, so that she can give the enema to herself, the most
+effective way to take it is in the knee-chest position or an
+approximation to this. Either a fountain or bulb syringe may be used
+for this purpose; a quart of water at a temperature of 110° F. should
+be prepared by making it into a suds with castile soap, or one
+tablespoonful of glycerin may be added to one pint of water. The nozle
+to be used is the smallest one that comes with the syringe, the
+so-called infant's nozle; this is quite large enough, and its
+insertion is not nearly so painful as the larger ones; the nozle must
+be well greased with vaselin. When everything is ready, the patient
+gets down on her knees with the shoulders near the floor, having first
+loosened all of her bands and taken off her corsets; the nozle is
+introduced as far as it will go into the rectum, and if a bulb syringe
+is used the water must be very gradually squeezed into the rectum,
+otherwise it will not retain so much; or if the fountain syringe is
+used, it must not be hung too high. So soon as the patient feels that
+she has taken all that she can retain, she should lie down on the left
+side, and retain the water as long as possible, as it is thus rendered
+more effective. An enema so taken will be very much more effective
+than one taken in the ordinary manner of sitting on the toilet. In the
+method just described more water can be used and it will be longer
+retained; it can be felt to go up along the course of the large bowel,
+and it will often be found very effective when the ordinary enema
+fails. This enema will often be found to be a very valuable aid in
+curing an obstinate chronic diarrhea, which is kept up by particles of
+feces remaining in the folds of the large intestine. If the patient is
+confined to bed, she should lie on the left side, with a heavy towel
+folded under her to prevent the bed from becoming wet; when the nurse
+withdraws the nozle she should make pressure on the anus with the
+towel, to help the patient to retain the water as long as possible.
+But should the patient have gone so long without a bowel movement that
+all these means fail, it will be necessary to precede the water enema
+with one of oil; or still more effective is the following combination:
+take one teaspoonful of the spirits of turpentine, the yolk of one
+egg, and two tablespoonfuls of olive oil, and beat well together, and
+add to these one pint of water at a temperature of 110° F.
+Constipation, however, of so obstinate a character as this demands a
+physician's attention.
+
+Diarrhea.-- A diarrhea may be acute or chronic; the treatment is
+essentially different. For an acute attack accompanied by frequent
+stools and severe abdominal pain the first thing to do is to go to
+bed. If there is nausea, drink a glass of water as hot as can be
+taken, at once; for the diet, a glass of scalded milk, not boiled but
+just allowed to come to the boiling-point, every two hours; and
+nothing else should be taken until the diarrhea is well in check. If
+the pain is severe, a spice plaster over the abdomen will be found to
+be very comforting. It is made as follows: take of powdered allspice,
+cinnamon, cloves, and ginger each two tablespoonfuls, and two
+teaspoonfuls of cayenne pepper; mix well together in a bowl; then
+quilt in a piece of flannel large enough to cover the abdomen; when
+ready for use, dip in hot whisky and apply as hot as the patient can
+bear; cover over with a large napkin, as the plaster produces a deep
+stain which does not wash out; keep on as long as necessary. If the
+rest in bed and the milk diet kept up for twenty-four hours do not
+suffice to cure the diarrhea, it is not wise to take any risks, but
+send for your doctor at once. Or if there should be any blood in the
+stools, do not wait for anything, but send for the doctor without
+delay.
+
+For a chronic diarrhea an enema given in the knee-chest position, as
+already described, will often be found a most efficient remedy. In
+diarrheas the use of fruits and vegetables should be avoided; the best
+diet after the milk is bread well toasted through, toast-water,
+soft-boiled eggs, beefsteak, oyster stew, and clam broth.
+
+Vaginal Douche.-- To be of service except for mere cleansing purposes
+the douche must be taken in the horizontal position, either on a couch
+or, if it is not cold, on the floor. Of course, this position
+necessitates the use of a douche-pan. The douche-pan is best of
+agate-ware, oblong in shape, and with a broad strip which comes under
+the nates. On lying down to take the douche the nates must come down
+well over the pan and the clothing must be pushed well up to prevent
+the water from seeping up the back. To make the woman more comfortable
+there should be a pillow under the head, and she must have a shawl or
+some light woolen material to throw over her while taking the douche
+to prevent chilling; thus doing more harm than good.
+
+There are two forms of syringes on the market: the bag or fountain
+syringe, which is hung up sufficiently high-- about three feet above
+the patient-- to cause the water to flow; and the bulb syringe, in
+which the bulb has to be constantly squeezed by the hand, which is
+tiresome to many women, but this is a much more convenient form to
+have in traveling. During pregnancy the fountain syringe only should
+be used, and it should be hung as low as will enable the water to
+flow. For a woman who has never taken douches it is well to begin with
+a temperature of 110° F., gradually increasing the temperature to 118°
+or 120°; this is as high as the woman should attempt to go, for a
+higher temperature would burn her, leaving the vulva so sensitive that
+she would only be able to take cool douches for a long time after
+this; a bath thermometer should be used in all cases to test the
+temperature, so that the woman knows exactly what she is doing.
+
+In cases of inflammation of the uterus or its adnexa four quarts of
+water should be used, and the douche should be taken in the horizontal
+position. The water thus acts as a hot poultice about the uterus, and
+the woman will find on rising that some water flows out from the
+vagina. Ordinarily plain hot water is all that is necessary to use,
+but where the discharge is acrid and scalding, the plain hot-water
+douche should be followed by a warm douche containing one teaspoonful
+of borax to a pint of water. The best time for taking a douche is at
+night just before retiring; there is also less danger of taking cold
+when the douche is taken at this time.
+
+The scalding sensations at the vulva may be due to the acidity of the
+urine, in which case it will be increased just after urination; or it
+may be due to an acrid discharge from the vagina. A little observation
+on the part of the patient will enable her to distinguish which is the
+real cause. If there is any trouble with the urine, it should be
+carefully examined at once, as some congestion or inflammation of the
+kidneys is not infrequently present, which if attended to might be
+cured, and which if allowed to run on unattended to, may develop into
+a serious form of Bright's disease.
+
+The genitals should be washed with soap and water night and morning.
+Women who do not suffer from leuchorrhea need not take a vaginal
+douche more than once a week; after the menstrual flow the vaginal
+injection is advised to remove the detritus of the flow.
+
+Baths.-- The most ordinary forms of baths used may be classified under
+sponge-, shower-, sitz-, and tub-baths. The sponge-bath as ordinarily
+taken is of service for cleansing purposes, and if the water be cold
+it tones up the system to some extent, and is so a preventive against
+taking cold. The effect of this bath will be found to be vastly more
+beneficial if salt is added to the bath in the proportion of a pint of
+salt to a gallon of water; either sea-salt may be used or the ordinary
+coarse salt. It is most advantageously taken sitting in a bath or
+hat-tub, so that the entire surface of the body will be wet at the
+same time, and the water can be allowed to run down the back and over
+the chest. It is well to begin these baths at a temperature of 80° F.
+and to gradually decrease this until the bath is taken at 70°, which
+is about the temperature of running water, and the bath should be kept
+up at this. For most people the best time to take the bath is just
+before retiring; this bath is not only very strengthening, but also is
+excellent in cases of insomnia and nervousness.
+
+Shower-baths.-- These may be taken after a hot bath, or taken alone
+after violent muscular exercise. The body should be quickly scrubbed
+off and the shower should be warm at the beginning and gradually
+allowed to become cold, stooping over so as to get the full force of
+the shower on the spine and over the region of the stomach and heart.
+They will be found to be most refreshing after great muscular fatigue,
+and, when taken after the hot tub-bath, greatly lessen the
+susceptibility of the individual to taking cold.
+
+Sitz-baths.-- These are given for their local effect in cases of
+inflammation; whether this inflammation be of the kidneys, bladder, or
+of the uterus and its adnexa. A sitz-tub is necessary to properly take
+this form of bath. The water should be used as hot as is comfortable
+to the patient, from 105° to 110° F., hot water being added as the
+first cools off; a pint of salt should be added to the gallon of
+water, and the patient should remain in this from five to eight
+minutes. A blanket should be wrapped about the patient so that she
+will be thrown into a perspiration; it is almost needless to say that
+the only time for taking this bath is just before retiring, and that
+this bath does make the woman more susceptible to taking cold, so that
+it is necessary to wear an abdominal woolen bandage day and night.
+
+Tub-baths.-- The tub-bath ought not, as a rule, be taken more than
+twice a week, unless the cold plunge is used, which may be taken every
+day. If the tub-bath is taken hot, the woman should remain in it not
+much longer than is necessary to scrub off with a flesh-brush; this
+bath should be followed either with a cold shower-bath, or the water
+in the tub be gradually allowed to cool off until it is down to 70° F.
+
+Headaches.-- Headaches, aside from those of acute illness, may be
+roughly divided into three classes: first, those which are due to
+indigestion; second, neuralgic headaches; and, third, those due to
+pelvic inflammations. The headaches due to indigestion are usually
+located over the eyes and all over the forehead; they are more or less
+constant and are accompanied by other symptoms of indigestion, and
+very often by constipation. The feces are allowed to remain in the
+bowels overlong, the toxic matters are taken up by the blood, and
+headaches and vertigo result.
+
+Neuralgic headaches are of an entirely different character; the pains
+are here of a lancinating character, and are not confined to any one
+region of the head. As a rule, they are accompanied by neuralgic pains
+in other parts of the body. Neuralgia generally means a rundown state
+of the system from overwork, worry, or malaria, and tonics and
+cod-deliver oil are indicated.
+
+A constant dull pain on the top of the head or in the back of the neck
+generally indicates some uterine inflammation, and can only be cured
+by removing the cause. In any case it is very evident that taking the
+various "headache powders" with which the market is flooded will never
+cure the woman of her headaches; and many of these powders are very
+dangerous, especially where the heart is weak, as most of them are
+heart-depressants.
+
+Fainting.-- Fainting may be due to a weak heart, to heart disease, or
+to sudden shock, as on receiving a bad piece of news; during pregnancy
+the close air of a room may cause a woman to faint. The first thing to
+be done is to lay the woman down on the floor or bed with nothing
+under her head; loosen all her clothes about the neck and waist, and
+throw the windows open so that she will get plenty of fresh air. If
+she is able to drink, give her one teaspoonful of aromatic spirits of
+ammonia in four tablespoonfuls of cold water. If the feet are cold,
+place hot-water bottles to them to improve the circulation. And if at
+the end of fifteen minutes she does not show signs of decided
+improvement, give her two tablespoonfuls of whisky in an equal
+quantity of hot water. In the meantime the physician will have been
+summoned. These attacks of fainting often occur in a crowded
+ball-room, and are due to tight lacing and the poor ventilation of the
+room.
+
+Hemorrhage.-- A profuse hemorrhage is the most alarming as well as the
+most dangerous thing which can befall a woman, and the very nearest
+doctor should be summoned until the family physician can be gotten
+there. The woman should be made to lie down wherever she may happen to
+be, her clothes loosened, the windows thrown open, so that she will
+not only have plenty of fresh air, but that the air shall be cool. If
+the blood is coming from the mouth, give her pieces of ice to hold in
+it; if she coughs up the blood, it would be well to put a bag of
+ice-cold water or cloths wrung out of ice-water on the chest. If the
+woman is suffering from a uterine hemorrhage, have her take at once a
+hot vaginal douche, from 118° to 120° F., and have the foot of the bed
+raised. The head should always be kept low.
+
+Women hold their health in their own hands to a far greater extent
+than they have ever dreamed of; and if the majority of women suffer,
+it is very often their own fault, either because they have disregarded
+nearly every law of health, or have allowed trivial ailments to go on
+until they were almost incurable.
+                               _______
+
+  "The broad mountain-top, with its sunlight and free air, is
+  possible to all of us, if we choose to struggle on and reach it."
+
+                                                  -- Phillips Brooks.
+                          _________________
+
+  GLOSSARY.
+                          _________________
+
+Abortion. The expulsion of the fetus before the end of the third lunar
+month.
+Afferent Nerves. Those nerves which convey the impressions to the
+nerve-centers.
+After-pains. The pains which follow labor and which are caused by the
+contractions of the uterus.
+Amenorrhea. Absence of the menstrual flow.
+Anemia. The so-called thinness of the blood, due to a deficiency of
+red blood-corpuscles.
+Antisepsis. The use of chemical substances which have the power of
+destroying germs.
+Anus. The external circular outlet of the rectum or distal part of the
+large intestine.
+Appendages, Uterine. The Fallopian tubes, the ligaments of the uterus,
+and the ovaries.
+Atrophy. A progressive diminution in the bulk of an organ or tissue.
+Automatic. Involuntary, mechanical.
+
+Bulbi Vestibuli. A plexus of veins on each side of the vestibule.
+
+Capillaries. The terminal and very finest branches of the
+blood-vessels.
+Catamenial Flow. See Menstruation.
+Cellular Tissue. A loose, transparent tissue which surrounds the
+muscles and organs of the body.
+Cerebrum. The upper and larger portion of the brain.
+Chlorosis. Anemia of young women about the time of puberty.
+Climacteric. See Menopause.
+Clitoris. A small, elongated, erectile organ situated at the upper
+part of the vulva.
+Cohabitation. See Coitus.
+Coition. See Coitus.
+Coitus. Syn., coition, copulation, cohabitation, sexual congress,
+sexual intercourse. The carnal union of the sexes.
+Colostrum. A thin albuminous fluid which appears in the breasts at the
+fourth month of pregnancy.
+Conception, or impregnation, is the union of the germ and sperm cell
+which results in a new being.
+Confinement. Childbed, the expulsion of the child from the womb.
+Congestion. The abnormal accumulation of blood in a part.
+Constipation. Costiveness; a state in which there is not a free daily
+evacuation of the bowels, or where the evacuations are hard or
+expelled with difficulty.
+Continence. Abstinence from or moderation in sexual indulgence.
+Copulation. See Coitus.
+Cord, Umbilical. The cord which connects the fetus with the mother.
+Through the blood-vessels contained in this cord the child receives
+nourishment.
+Corpuscle. A very small particle.
+
+Decidua. A membranous sac formed in the uterus during gestation, and
+thrown off after parturition.
+Defecation. The act by which the contents of the bowel are expelled
+from the body.
+Dehiscence. The splitting open of an organ.
+Dentition. The cutting of the teeth.
+Dysmenorrhea. Painful and difficult menstruation.
+Dystocia. A difficult labor.
+
+Embryo. The name applied to the very earliest stages of the child in
+utero; that is, up to about the time of quickening.
+Endometrium. The lining membrane of the uterus.
+Epithelium. A layer of minute cells which forms the covering of many
+membranes.
+Erection. The state of a part which, having been soft, becomes rigid
+and elevated by the accumulation of blood within its tissues.
+
+Fallopian Tubes. Two very small tubes extending from the upper angles
+of the uterus to the ovaries and serving to convey the ova from the
+ovaries to the uterus.
+Feces. Stools; the normal discharge from the bowels.
+Fetus. The child in utero from the time of quickening to that of
+birth.
+Fomentations. The application of cloths which have previously been
+dipped in hot water.
+Function. An action of an organ which could be performed only by that
+organ, and which is necessary to the well-being of the individual.
+
+Generative Organs. Syn., genital, reproductive, sexual; those organs
+in the male and female by means of which a new being is created.
+Genital. See Generative.
+Gestation. See pregnancy.
+Gonorrhea. A highly contagious venereal disease, characterized by an
+inflammatory discharge of mucus from the urethra and prepuce in the
+male, and from the urethra and the vagina in the female.
+Graafian Follicles. Minute ovarian vesicles which contain the ova.
+
+Hemorrhoids. Piles or tumors at or within the anus, and consisting of
+enlarged veins.
+Hymen. The semilunar fold situated at the outer orifice of the vagina
+in the virgin.
+Hypertrophy. The increased activity of a part which leads to an
+increase in its bulk.
+Hypochondriasis. Morbid feelings concerning the health and simulating
+disease.
+
+Impregnation. See Conception.
+Infectious. See Contagious.
+
+Katabolic Nerves are those nerves which stimulate the breaking down of
+tissue.
+
+Labia Majora. Two thick folds of skin which extend backward from the
+mons veneris.
+Labia Minora. Nymphae; two very delicate folds of skin which are
+inside of and protected by the labia majora.
+Labor. See Parturition.
+Lactation. The secretion of milk; nursing, suckling the child.
+Lactiferous Ducts. The milk ducts.
+Leucorrhea. Whites; a whitish or yellowish discharge from the vagina.
+Lochia. A discharge which follows labor and which lasts for about two
+weeks.
+Lying-in. The period which follows childbed.
+Lymphatics. The vessels in which the lymph is carried.
+
+Mammae. The mammary glands; the breasts.
+Marital Relations. See Coitus.
+Massage. A systematic kneading of the muscles.
+Meatus Urinarius. The external orifice of the urethra.
+Meconium. The first discharge from the infant's bowel after birth, and
+which had collected in the intestines during the pregnancy.
+Medulla. The base of the brain at its junction with the spinal cord.
+Menopause. Climacteric, change of life, the time of the natural
+cessation of the monthly sickness.
+Menorrhagia. An excessive menstrual flow.
+Menstruation. Menstrual period, menstrual flow, menses, monthly
+sickness, the monthly discharge of blood from the uterus, which, with
+certain exceptions, recurs monthly from about the age of thirteen to
+forty-six years.
+Metabolism. Transformation changes.
+Metamorphoses. Changes of shape or structure.
+Metrorrhagia. A flow of blood between the menstrual periods.
+Micturition. The act of passing water.
+Miscarriage. The expulsion of the fetus between the twelfth and
+twenty-eighth weeks.
+Molecular. Belonging to the molecules, or the minutest portion of
+anything.
+Mons Veneris. The uppermost part of the vulva, which is a fatty
+cushion covered with hair.
+
+Nerve-center. A nerve station from which orders are transmitted and
+where orders are received.
+Nubile. Puberty, that period of life in which young people of both
+sexes are capable of procreating children.
+Nymphae. See Labia minora.
+
+Ovaries. Two small ovoid bodies, one on each side of the uterus, in
+which the ova are formed.
+Oviduct. See Fallopian tobe.
+Ovulation. The formation of the ova in the ovary, and the discharge of
+the same.
+Ovule. See Ovum.
+Ovum. Germ cell, a small, round vesicle situated in the ovaries, and
+which, when fecundated, constitutes the rudiments of the embryo.
+
+Parturition. Labor, delivery, child-birth, the expulsion of the child
+from the womb.
+Pathologic. Relating to the diseased condition of tie body.
+Pelvis. The bony cavity situated at the lower end of the spinal column
+and supported by the thighs.
+Periodicity. The recurrence of physiologic phenomena at regular
+intervals.
+Periphery. The circumference of an organ.
+Peristaltic Action. An alternate contraction, making small, and
+enlargement of the bowel; it is by this means that foods, etc., are
+forced along its passage.
+Peritoneum. A serous membrane which lines the abdominal cavity, and
+wholly or in part envelopes the organs contained in it; it also partly
+covers the organs contained in the pelvic cavity.
+Phenomena. Remarkable appearances.
+Physical. Pertaining to the body.
+Placenta. After-birth, a soft, spongy, vascular body adherent to the
+uterus, and which is connected with the embryo through the umbilical
+cord.
+Plethora. A condition marked by a superabundance of blood.
+Postpartum Hemorrhage. Hemorrhage following labor.
+Pregnant. Enceinte, gravid; the state of a woman who is with child.
+Premature Labor. The expulsion of the fetus between the end of the
+twenty-eighth week and the time that labor ought to have occurred.
+Propagation. The spreading or extension of a thing.
+Pruritus Vulva. An intense itching of the privates, or vulva.
+Psychic. Pertaining or belonging to the mind.
+Puberty. Sexual maturity; nubility; that period of life in which young
+people of both sexes are capable of procreating children.
+Pubes or Pubis. The lowest and middle part of the pelvis in its
+anterior surface.
+Puerperium. The lying-in after child-birth.
+
+Quickening. The sensation experienced by the mother as the result of
+active fetal movements in the womb.
+
+Rectum. The lower extremity of the large intestine.
+Reflex. The reflection of an impulse from a nerve-center which has
+been received from elsewhere by that center.
+Reproduction. See Generative.
+Respiration. Breathing.
+Rugs. Wrinkles.
+Rut. The copulation of animals.
+
+Septicemia, Puerperal. Childbed fever.
+Sexual. That which relates to sex. See Generative.
+Smegma. A cheesy substance which may collect about the vulva.
+Spermatozoa. The essential male fertilizing elements.
+Sympathetic Nervous System. Presides over involuntary acts; as
+digestion, breathing, etc.
+Syphilis. A venereal disease which is highly contagious by coition,
+contact with the lips, etc.
+
+Tachycardia. Distress in the region of the heart, with palpitation and
+shortness of breath.
+
+Umbilicus. Navel.
+Urea. The most important of the solid constituents of the urine.
+Ureters. The ducts leading from the kidneys to the bladder.
+Urethra. The excretory duct from the bladder for the escape of the
+urine.
+Urination. The act of passing water.
+Uterosacral Ligaments. Ligaments which pass from the uterus to the
+sacrum, and assist in holding the uterus in position.
+Uterus. Womb; the hollow, pear-shaped pelvic organ which is destined
+to retain the child from the moment of its conception until the time
+of its expulsion at birth.
+Utricular Glands. Glands of the uterus.
+
+Vagina. The canal which connects the female internal and external
+organs of generation.
+Vascular. Pertaining to the blood-vessels.
+Vasomotor Nervous System. Comprises the brain, spinal cord, and the
+nerves given off from the cord: this system presides over voluntary
+acts, that is, those acts which are under the control of the will.
+Vestibule. A smooth cavity that exists in the female between the
+perineum and the nymphae.
+Viscera. The contents of the large cavities of the body.
+Vulva. The external genitals, private parts, the female external
+organs of generation.
+Vulvitis. Inflammation of the vulva.
+
+
+
+
+*** END OF THE PROJECT GUTENBERG EBOOK, THE FOUR EPOCHS OF WOMAN'S LIFE ***
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