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diff --git a/4986-h/4986-h.htm b/4986-h/4986-h.htm new file mode 100644 index 0000000..dd1d203 --- /dev/null +++ b/4986-h/4986-h.htm @@ -0,0 +1,6673 @@ +<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" +"http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd"> +<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> +<head> +<meta http-equiv="Content-Type" content="text/html;charset=utf-8" /> +<meta http-equiv="Content-Style-Type" content="text/css" /> +<title>The Project Gutenberg eBook of The Four Epochs of Woman's Life by Anna M. Galbraith</title> + +<style type="text/css"> + +body { margin-left: 20%; + margin-right: 20%; + text-align: justify; } + +p {text-indent: 1em; + margin-top: 0.25em; + margin-bottom: 0.25em; } + +p.letter {text-indent: 0%; + margin-left: 10%; + margin-right: 10%; + margin-top: 1em; + margin-bottom: 1em; } + +p.center {text-align: center; + text-indent: 0em; + margin-top: 1em; + margin-bottom: 1em; } + +p.right {text-align: right; + margin-right: 10%; + margin-top: 1em; + margin-bottom: 1em; } + +</style> +</head> +<body> + +<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 +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. +</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 & 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"> +— 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>— "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.— 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.— 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.— 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.— 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 +Douché, 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>— "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>— 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>— 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>— 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>— 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.</p> + +<p><b>Industrial Education.</b>— 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.</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 & 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.— 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>— "OEnone."</i> +</p></blockquote> + +<p><b>Sexual Development.</b>— 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— 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>— 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>— 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>— 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>— 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>— 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>— 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— 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.</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— 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— 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>— 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>— 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>— 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>— 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>— 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>— 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>— 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>— 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>— 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>— 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>— 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">— LONGFELLOW. +</p></blockquote> + +<p><b>The Vulva.</b>— 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.</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>— 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>— 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>— 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>— 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>— 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.</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— 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>— 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>— 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>— 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">— ARMSTRONG. +</p></blockquote> + +<p><b>Ovulation.</b>— 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>— 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.—</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.—</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.—</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.—</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>— 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>— 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>— 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>— 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>— 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>— 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>— 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>— 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>— 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.—</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.—</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">— CONGREVE +</p></blockquote> + +<p><b>Menorrhagia and Metrorrhagia.</b>— 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>— 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,— as for example, typhoid +fever,— two or more periods do not fail to appear except in +the case of pregnancy.</p> + +<p><b>Leucorrhea.</b>— 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— 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.</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>— 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>— "Julius Caesar."</i> +</p></blockquote> + +<p><b>Herbert Spencer's Definition of Love.</b>— "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 <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>— 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>— 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>— 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>— 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;— 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>— 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.</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>— 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>— 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>— 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.— 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."— +DESCARTES.</p></blockquote> + +<p><b>The Wedding-journey.</b>— 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>— 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— 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.</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>— 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>— 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>— 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— 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— 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>— +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">— ARMSTRONG. +</p></blockquote> + +<p><b>Sexual Instinct in Women.</b>— 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>— 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>— 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.—</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">— PHILLIPS BROOKS. +</p></blockquote> + +<p><b>Sterility.</b>— 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— 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>— 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— 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.</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— 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>— 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>— "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!"— (Balzac).</p> + +<hr /> +<h3>PART III.— 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">— TENNYSON. +</p></blockquote> + +<p><b>Nature of Conception.</b>— 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>— 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>— 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.</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>— 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.</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.—</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.—</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>— 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>— 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>— 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>— 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>— 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.—</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.—</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.—</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— 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.—</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.—</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° +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.</p> + +<p><i>Baths.—</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° 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.</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.—</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.—</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.—</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.—</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>— 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.—</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">— ISABELLE BEECHER HOOKER. +</p></blockquote> + +<p><b>Preparations for the Confinement.</b>— 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.—</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.—</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 & 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.—</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>— 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>— 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>— 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— 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.</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>— 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.—</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."— <i>"Othello."</i></p></blockquote> + +<p><b>Management of the Lying-in.</b>— 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.—</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.—</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.—</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.—</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— 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.—</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.—</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>— 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>— 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.—</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.—</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">— LONGFELLOW. +</p></blockquote> + +<p><b>The Infant's Toilet.</b>— 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.—</i> 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.</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.—</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.—</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.—</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.—</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.—</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.—</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.—</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.—</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.— 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° 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.</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° 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.</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° 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— 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° F., remove the cotton stopper, and put on +the nipple, when it is ready for use.</p> + +<p><i>The Nursing Bottle.—</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.—</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° F. and fed directly from the sterilizing bottle.</p> + +<p><i>Fresh Air.—</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>— 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.—</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.—</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.—</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.—</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° 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>— 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.—</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.—</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>— 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>— 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.— 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>— "Locksley Hall."</i> +</p></blockquote> + +<p><b>Average Duration of Menstrual Function.</b>— 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>— 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>— 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>— 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— 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>— +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— 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.</p> + +<p><b>Pathologic Conditions of the Menopause.</b>— 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— 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.</p> + +<p><b>Hemorrhage at the Menopause a Significant Symptom of +Cancer.</b>— 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.— 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.</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.— 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.— 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.—</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— 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.</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.—</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— 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>— 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.</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— as, baths, mental and moral +hygiene, and occupation— 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— +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.</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>— "Hamlet."</i> +</p></blockquote> + +<p><b>Hygiene of the Menopause.</b>— 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>— 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>— 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>— 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— very frequently from inaction of the liver— 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>— 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>— 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>— 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>— 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>— 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>— 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">— EURIPIDES. +</p></blockquote> + +<p><b>Indigestion.</b>— 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— a three-mile walk— +should be supplemented by active gymnastic exercise.</p> + +<p>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.</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>— 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.—</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>— 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.</p> + +<p><b>Diarrhea.</b>— 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>— 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— 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.</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>— 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.</p> + +<p><i>Shower-baths.—</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.—</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° 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.</p> + +<p><i>Tub-baths.—</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° F.</p> + +<p><b>Headaches.</b>— 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>— 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>— 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.</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">— 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> +<div style='display:block;margin:1em 0;'>This file should be named 4986-h.htm or 4986-h.zip</div> +<div style='display:block;margin:1em 0;'>This and all associated files of various formats will be found in https://www.gutenberg.org/4/9/8/4986/</div> +<div style='display:block; margin:1em 0'> +Updated editions will replace the previous one—the old editions will +be renamed. +</div> + +<div style='display:block; margin:1em 0'> +Creating the works from print editions not protected by U.S. copyright +law means that no one owns a United States copyright in these works, +so the Foundation (and you!) can copy and distribute it in the United +States without permission and without paying copyright +royalties. 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